HealthCare Voice

Are These The Good Old Days?

Our lives are changing at such a rapid pace that it is hard to comprehend what is actually taking place.  We are being swept along by an avalanche of innovation, information, and connectivity that, together, are shaking some of society’s long-standing norms.

Everything is faster, bigger, more connected.

Gone is the simple way of life that many retiring Baby Boomers fondly remember, a time in which we lived our lives sheltered from the avalanche of information, the good and the bad, the true and the fiction.  In this era, the flow of information depended on radio, the arrival of the afternoon or morning newspapers or the start of the nightly network news. 

Today the news is free flowing from the Internet – sometimes reliable, sometimes not.  It can be hard to tell the difference.

Connectivity has become a lifestyle essential.  Almost everyone has a cell phone.  Many have smartphones to check their email, surf the web, or to remotely watch television.  Texting has become the preferred method of communication among people under the age of 30.  Some would rather send a terse text message than to talk on the telephone. 

When not texting, this new younger generation is busy growing up much faster than their Baby Boomer parents, participating in risky behavior, from underage drinking to recreational drug use, or engaging in sexual relations at an earlier age than their parents. 

The wealthy are wealthier, the poor are poorer, and our country is more heavily in debt.  Our politicians are more divided than ever, pursuing rhetorical assaults that are frequently more self-serving and reckless than helpful.

Some executives have pushed the envelope of what is right and wrong in business to make more and more money, amounts that were hard to imagine less than 20 years ago, regardless of the impact their questionable acts might have on the company or their most valuable asset, the employees.

The pace of change, with all of its good and bad implications, has invaded our leisure time.  In sports, our favorite athletes are bigger and faster.  Their sheer size, their strength, and speed, has produced new physical hazards that equipment makers cannot accommodate.  The number of head and spinal injuries is up sharply in pro football, prompting the NFL to insert new rules to protect the players.  In professional basketball, the players are taller and bigger.  When compared to our bygone heroes like Guard Bob Cousy (Boston:  6’1”), Center Bill Russell (Boston: 6’9”), Guard Calvin Murphy (Houston: 5’9”) or Center Moses Malone (Houston: 6’10”), today’s stars seem like giants. At the current pace, the National Basketball Association will need to raise the basket from 10 to 12 feet and lengthen the court. 

Some of this change is just a natural evolution.  We can’t do anything about it, nor should we try.  The question is whether these forces of nature and the values of society can be separated to avoid a gigantic explosion because, at the speed of our current times, we are overheated?

Or, are these the “good old days” about which our kids will tell stories to their grandchildren? 

© 2011 John Gregory Self

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Career Management In Complicated Times

In a rapidly changing global economic environment with high long-term unemployment likely, regardless of who controls the levers of power in Washington, the value of career planning is in the spotlight. 

There are basically two schools of thought:

 1.  It is a waste of time.  No one can predict the future -- new technologies, business realignments and the resulting job losses, or opportunities that will emerge amidst the chaos.

 2. It is invaluable.  Career planning requires a sense of focus and discipline that is essential to navigate the opportunities and multiple pitfalls in the New Normal economy.

I vote for option number two.  I am not engaged in career coaching or outplacement businesses so I have nothing to gain from advocating for the value that is inherent in the career planning process.  In fact, I cannot imagine entering the workforce today without a plan for my professional life.

I freely admit that there are thousands upon thousands of stories of people who have enjoyed a rewarding, interesting, varied and prosperous career following what I call the opportunistic pathway; moving from job to job without knowing what new professional adventure next week, next month or next year will bring. But that was then and this is a competitive, unpredictable now.

As a matter of disclosure, I must that admit that I qualify for membership in the  “I Had No Plan Or Clue” class.  I began my career before I graduated from college, working for a daily newspaper.  From there, my career took me to Lubbock and Houston where I worked as an editor and writer.  I left the news business for public relations at Houston’s Hermann Hospital.  From there I became the first director of Life Flight, to the national marketing manager of the helicopter company, to acquisitions for an investor-owned hospital management company, back to Hermann to lead the start-up of a multi-hospital affiliated program, to a senior executive post responsible for business development for the hospital management company, to forming my own consulting firm, back to the town where I grew up to run home infusion pharmacy, correctional health businesses (not all at once), EMS, and then to be the general manager of an international nurse recruitment agency before leaving to form a recruiting firm and, finally, to forming my current executive search firm, JohnGSelf Associates, Inc.  And I did it all without a plan, an approach that I would not think about recommending in today.

My experiences – and my amazing luck – led me to the realization that career planning is no different than strategic planning for a business in which you are constantly adjusting strategy and tactics to address changing market threats and opportunities.

Career planning provides a framework for discipline and focus that will allow an individual to maximize their professional potential.

Is it a waste of time?  Not a chance. 

There are thousands upon thousands of people who trusted that everything would work out, professionally speaking.  It did not.

Not to sound glib, but luck is not a good career management strategy. 

© 2011 John Gregory Self

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How Important Is Your Human Resource Leader?

"If businesses managed their money as carelessly as they manage their people, most would be bankrupt."

That is the opening sentence in Bill Conaty's and Ram Charan's book The Talent Masters:  Why Smart Leaders Put People Before Numbers. If that does not make you uncomfortable as a healthcare CEO, then you must be in the above average category in terms of hiring, training and retaining the best talent.

Mr. Conaty, who was Jack Welch's Senior Vice President of Human Resources at GE, and Ram Charan, a top business advisor/author/speaker, have written one of the best, if not the best, books on talent management.  They argue that the best companies are those which excell in identifying and developing raw talent.

As healthcare providers enter a period of financial uncertainty and turmoil, the quality of an organization's talent will be the single most critical determinant of an their success; not their location, the stylishness of their big box facilities or their existing reputations.  Those will seem so insignificant when the fight for survival turns deadly serious. Less you think that all the big healthcare provider success stories of today will be around in five to 10 years, think about the hundreds of former market leaders in retail, services, computers, consumer products or even banking that are now but a distant memory, an "oh yeah, whatever happened to those guys?" They didn't find or keep the best people.

It always comes down to that fuzzy, soft concept of talent management. Organizations that fail to build their talent management around an exemplary CEO/Chief Human Resource Officer partnership, are running down a risky path.

The hospital Chief Financial Officer is the trustee of the financial resources. "The human resource function will only be as strong as the CEO wants it to be. If the CEO does not have high expectations for HR, then it will be second tier," even reporting to the COO or some other vice president, Charan and Conaty write.

"Why wouldn't the CEO want an HR function that is as important an managing the financial resources?  HR is, after all, the trustee of an organization's human capital."

Being a talent manager -- becoming a talent master -- is now an essential leadership comptency. 

© 2011 John Gregory Self

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Rethink Is Possible AND Necessary

There is a troubling strain of conventional wisdom that suggests that nurse-doctor relationships are dysfunctional, and that is one big reason for our unacceptable problems of quality of care.

Karen Bartholomew, RN, an international speaker and healthcare culture expert and Dr. Joseph Bujak, a speaker and consultant on physician relationships, clinical quality and patient safety, writing in Hospital Impact, claim “that the two most important people responsible for our patients’ care frequently never talk to each other, and when they do the interchange is often dysfunctional.

“No wonder 22 patients die an hour from avoidable harm.”

What makes this article more disturbing is their assertion that changes in medical practice over the past 20 years leave “physicians and nurses lamenting that it was ‘better’ in the old days.”

The authors point to structural changes in both the practice of medicine and hospital operations as reasons for this unacceptable breakdown in communication.

Physicians – “Physicians have progressively become more sub specialized, diffusing responsibility and challenging the ability to integrate care.  Coverage groups expanded, reducing the number of days on-call so that the primary attending physician is often unreachable.”  The authors point to physician rounding – sometimes before the patient is even awake – and the demands for improved productivity mean that there is little or no time for the physicians to locate the primary nurse.  “Sadly, physicians often don’t even know the names of the nurses who care for their patients.  How easy it is to be disrespectful of someone who remains anonymous – especially over the telephone.”

Nurses – The structural changes in hospital operations have also adversely impacted nursing.  “Twelve hour shifts make the continuity of care more difficult.  Only 40 percent of the nurse’s work is actually nursing – they are performing clerical duties, locating missing medications, trying to find equipment or on the telephone on hold.”  In a typical patient care cycle, the authors point out that “one nurse admits (the patient), another gives care, and yet another discharges in 48 hours – another example of why failed communication is the number one cause of medical error.”

But all is not lost.  Ms. Bartholomew and Dr. Bujak argue that structural changes can also make things better, a rethink of the physician-nurse relationship: 

1. The expansion of hospital intensivists and hospitalist physicians is reducing the number of doctors who are involved in complex cases
2. Team rounding is becoming more prevalent
3. Physician availability for an entire shift improves the frequency of nurse-physician communication
4. Situation-Background-Assessment-Recommendation/Request (SBAR) is “improving the nurses’ understanding, supporting their professionalism, and helping them prevent the entrapment of physicians when a lack of necessary information precludes good communication
5. Personalization of the nurse-physician relationship is essential.  Physicians should know the names of the nurses they deal with, and nurses should insist on identifying themselves before each encounter
6. Brief weekly – at least monthly -- education opportunities for nurses provided by a physician
7. Charge Nurse presentation of a case scenario at weekly physician rounds – an unheard of practice at most institutions, the authors say
8. Executives must lead what will amount to a cultural transformation at most hospitals “by insisting on daily communication, physicians knowing nurse names, creating joint education and celebratory venues and bedside rounding and actually living the values of the organization by zero tolerance of disruptive behavior -- same rules for all roles”

It has taken a long time for healthcare quality to slip to these disturbing levels in quality and safety, and our turnaround will not be “on a dime.”

The bigger question will be whether hospitals can sustain the focus that will be required to make these kinds of changes in an era of unprecedented cuts in funding that will prompt more focus on costs and productivity.

These valuable eight points are more of inside the box solutions. 

I wonder how we will manage the nurse-physician relationship outside the box – when we are forced to redesign how we deliver care because can we cannot sustain what we are doing now.

A healthcare system “rethink” is not only possible, it is necessary.

© 2011 John Gregory Self

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Integrity, Consistency and Walking the Talk

Integrity is a much admired and sought after characteristic in leadership.  When you ask board members or employees about the ideal characteristics for a new leader, integrity is almost always number one on the list, rarely lower than number three.  So since it so critical, what is it?  What does it really mean when a CEO or other leader is said to have great integrity?

Yes, it means telling the truth.  It also means doing the right thing, even when no one is looking.  It means giving credit to others when they deserve the recognition.  It means being authentic.  It means living your personal and professional life in balance, honoring your commitments.

It also means being consistent.  And for some leaders, that is where the rubber skids off the road.

Here is a classic example for healthcare: hospital leaders love to say that their employees are their most important asset.   These kinds of statements are a verbal tip-of-the-hat, an acknowledgement that it takes hundreds or thousands of employees to make a hospital operate.  The real question is whether a hospital can be successful without great employees?  As we grapple with the storms of change generated by impending reductions in reimbursement from deficit reduction programs, the answer is a resounding “no”!

Hospitals talk about the value and importance of their employees.  Rarely is a hospital annual report produced without that perfunctory claim.  More to the point is the question of how many CEOs walk the talk?  How many leaders tell their employees that they are truly the heart and soul of the organization and then back it up, day in and day out, with words and deeds to reinforce that claim?  How many CEOs make daily rounds, engaging their employees in meaningful ways?  How many come in overnight to bring coffee or cold drinks and snacks to the nurses and other support personnel who are there for the patients?  Not once or twice in their tenure, but on a regular basis?  How many leaders visit patients on a regular basis, to say hello and to ask how well the organization is doing to help them get better? 

As a CEO, or any leader for that matter, when you make grand statements statements regardiong your vision and values, then you must personally follow through.  That is called being consistent.  Employees pay attention to it because they know it reflects a leader’s integrity.    

© 2011 John Gregory Self

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Career Management: Married With Children

If you are female and married and aspire to have a big career and a big family, the odds that you will be successful are working against you.  Two children are OK, but when you have three, everyone assumes "you are home with the kids, right?"

That from Laura Vanderkam, a New York City author (168 hours: You Have More
Time Than You Think) who reported that when she mentions to people in social circles that "my prominent lump is baby number three, (people) either don't ask me about my job (while asking everyone else about theirs), or they say, 'kiss of death' for a career or that it will 'derail' your professional prospects."

Aside from Ms. Vanderkam's current state of pregnancy, she was motivated to focus on this issue in her BNET blog this week after reviewing an Australian study issued in July that reported that a mere 21 percent of the mothers under the age of 30 with three children worked outside the home.  Lord knows, with three children, working inside the home is no walk in the park; the demands of being a full-time COO of the home is an incredibly tough job. Older women with three or more children were a greater part of the workforce -- 55 percent versus 68 percent of that group who had only two kids, according to the survey.

As I speak at college campuses on career management, I am frequently asked by women graduate students about choices -- career and life -- and the prevailing mood in the marketplace about the so-called life balance issue. Will they derail their career path to the CEO spot, or one of the other C-suite posts if they take time out for a family?

In healthcare, the career versus having children question may become a more challenging for issue (choice) for women as hospitals and other providers face profound reductions in reimbursement over the next 10 years. Hospital leaders say they can see a day where they will have to do more with less, which could translate into longer hours at the office and an expanding workload for the after-hours time at home. That said, there are more than a few examples of successful women leaders who have managed to balance the rigors of two full-time jobs (their career and motherhood) while achieving impressive results in business.

Today, this is not an either or choice for women.  It does, however, require incredible discipline, enormous focus and physical and mental stamina, but there are some outstanding women executives who are able to do both, and do it well.

While it may get tougher for women executives to achieve the comfortable work-life compromise, there will always be opportunity for competent executives, regardless of their gender and number of children, the Australian study notwithstanding.

Many studies on this subject tend to reflect conventional wisdom and that is seldom right.

© 2011 John Gregory Self

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Bad Firing, Good Firing and the Company Brand

Why would you fire your chief executive officer over the telephone?  Why would anyone want to work for a company that would treat its CEO so shabbily?  Why would you do business with that company?

The sudden dismissal of Yahoo CEO Carol Bartz, reportedly an outspoken, combative, occasionally arrogant and sometimes profane executive, prompted me to think about how companies fire people, and the fact that how companies execute the termination can define an organization's corporate image and recruiting brand.

To be fair to the Yahoo board, Ms. Bartz was reportedly failing to meet performance expectations established by the Directors. There are many on Wall Street who argue that her termination was justified.  Others say that her style made it inevitable. That said, the issue should be not the "why" but the "how."  

There are reasons, justifications -- excuses -- as to why the board acted the way it did. Central among them was that Ms. Bartz was traveling and the board did not want word of their decision to leak before they had spoken to their CEO.  Others speculate that she may have had a clause in her employment contract that required immediate notification of termination. Fine, those are important issues to consider. But here is another:  if the intent was to rid the company of a leader who was failing in order to protect the interests of the brand and its shareholders, why would the board execute their plan of termination in a way that would cast a darker cloud over the already troubled company? 

That Ms. Bartz fired off an email broadside to her employees explaining that she had been fired over the telephone should not have been a surprise to the board or its advisors.  Nor should the resulting damage to  the organization's image.

Boards frequently hire CEOs with fanfare for what they hope will be strong operating results, favorable press, and a strengthening of the corporate brand.  They are almost always disappointed, frustrated, even angry when their best layed plans fall short.  But there is no excuse for the board to make a bad situation worse with a poorly executed plan.

How an organization terminates employees says a lot about the real heart and soul of the company. Taking the high ground may not make the person or persons who have made the decision and who are notifying the employee feel less frustrated, but how they perform this important role will shape the image of the company.

Yahoo is not the lone offender in American business. Thousands of times each day, someone is fired for a myriad of reasons, from poor performance to unethical or inappropriate conduct. There may be reasons to immediately remove the employee from the workplace.  There may be ample justification to have security personnel available.  Even when companies try to terminate someone in the right way, things can go wrong. Fortunately these incidents are the exception.

But companies who do not take the high road, protecting the dignity of the outgoing employee including complimenting the employee for their accomplishments and wishing them well while keeping security out of the room and the prying eyes of their colleagues at bay, are being short-sighted.  

Miss-hires, at whatever level, are a costly mistake, but to make the matter worse by ending the employment relationship badly simply multiplies the problem.

© 2011 John Gregory Self

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Leadership Check-Up

The leadership team that you have today may not be the team that can help you move to the next level of performance, a new peak that may mean the difference between success or selling to a competitor.

The road ahead for healthcare providers is fraught with unprecedented challenges.  Today, more than any other time in the last 30 years, CEOs realize that waiting too long to fine tune their leadership resources could lead to serious consequences.

There is an emerging trend  -- CEOs are giving their organizations a “leadership checkup” using their internal organization development team or an outside consultant.

This is a dicey proposition, especially if you have a stable team that, up to now, has consistently produced good results.  You do not want to embark on a assessment strategy that will put valued members of the team "in play" – sampling the job market in an over abundance of caution because the leadership assessment could cost them their job security.   

To succeed – that is to say to produce a realistic assessment that provides insight while valuing the contributions of the team – you must begin by selecting the right consultant, one who offers a balanced set of skills, from diplomacy and compassion to operational insight and a keen understanding of the challenges ahead.  But more importantly, you must have a consultant that, in the privacy of the CEO’s office, will tell them what they need to hear, not what they want to hear, free of financial motives.

Most consultants come to the table with a set of built-in weaknesses – most of which are built around the desire to secure additional add-on consulting or a future engagement.  Not everyone in the market is concerned with doing the right thing, particularly if their performance and financial incentives favor the art of winning add-on business.

Subject matter expertise is also important.  Healthcare is a complex and unique industry.  Legendary management guru Peter Drucker posited that hospitals are among the most complex of human organizations every created.  Leadership experts or coaches that lack a depth of knowledge of healthcare delivery and the impact that budget deficit reductions will have on healthcare providers are not ideally suited for this work. 

The game is changing for executive recruiters as well.  The traditional transactional model of “order placement” will not work.  CEOs need more than an “order taker.”  They need a leadership consultant who understands the issues, and who is as obsessed with the results as their Client.

The solution for CEOs is to look for executive recruiters who understand that their 50-year-old business model has changed and that it is not just about the fee.

In the end, we will all change.

 

© 2011 John Gregory Self

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All Is Well

Poosted  from Tyler, Texas

On the day we are born, scientists tell us, we begin to die.

Death at an early age is a tragedy.  The death of a baby with an irreparable defect is heart wrenching.  A teenager who dies in an accident is shocking, filling us with a consuming grief of wonderful memories and sadness for a future that will never be.

We all react to death in a different way, personally and professionally.  The healthcare industry is unique among all others because we are there at the start of life and, frequently, we are there at the end.  We tend to see this as the inevitable, albeit very expensive, part of the natural order.  That does not spare us the grief and sadness when a friend dies, but it is such an ever-present element of our profession. 

For teenagers, the death of a friend evokes a raw outpouring of sadness and confusing disbelief, but at the same time there is a certain detachment that restores balance; death is an anomaly.  They are reassured by the belief that something this tragic could never happen to them.  As we move into the last 10 to 20 years of life, death takes on a new meaning.  It is now more than the obscure concept of existential inevitability.  It is a real part of our lives and we understand that death can come at any time. 

In the last quarter of our own life, the death of a friend, especially one so full of life, is startling, but we do not waste time asking how something so sudden, so shocking could happen because we know.  

When the person who dies is a successful and beloved physician -- and a friend -- the news may feel surreal but the understanding that comes with our own advancing age typically mitigates the disbelief and shock.  We know there are only two choices: retreat into grief or double down on the joy of life.  Death is inevitable, but what we do with our remaining days in this life is not.

In Henry Scott Holland's 1910 sermon on death at St. Paul's Cathedral as King Edward VII lay in state, he wrote:

"Life means all that it ever meant.  It is the same that it ever was.  There is absolutely unbroken continuity. Why should I be out of mind because I am out of sight?

"I am waiting for you, for an interval, somewhere very near, just around the corner.

"All is well."

Happy Trails my friend.

© 2011 John Gregory Self

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It Is Good To Be Nice

Hiring “nice” is a great idea, especially when you combine that with a healthy dose of passion.

That is the approach Andy Lansing takes.  A recovering lawyer, Mr. Lansing is President and Chief Executive Officer of Chicago-based Levy Restaurants, a food service company with a diverse portfolio of operations that includes award-winning restaurants such as James Beard-winning Spiaggia and Bistro 110 in Chicago, Fulton’s Crab House, Portobello and Wolfgang Puck Grand Café at Walt Disney World Resort, renowned sports and entertainment venues like Lambeau Field in Green Bay, STAPLES Center in Los Angeles, and American Airlines Arena in Miami, and events including the Super Bowl, World Series, Kentucky Derby, NHL and NBA All-Star Games and the Grammy Awards.

If healthcare is one of the most complex businesses in the world, then leading a company of restaurants and food service operations all across the country can be more than just a challenge, especially in tough economic times.  Mr. Lansing says give him people who are nice and passionate and he can teach them everything they need to know, and everyone can have fun doing it.

In healthcare we take ourselves very seriously.  It is deeply baked in our industry’s DNA – we do very serious work, from brain surgery to delivering babies or suturing a child’s cut.  We hire people with the appropriate credentials, technical expertise, and experience.

Our choices for leadership reflect that industry DNA.  Sometimes we hire more for credentials and supposed track record with almost no emphasis on the candidate’s personality or leadership style.  Then we are shocked when there is a CEO meltdown and an expensive severance agreement. 

Mr. Lansing argues that there are two kinds of leaders – those with positional power and those with personal power.  He describes positional power this way: “I have power over you because I am your boss. I am important. I am the CEO. You should fear me because of who I am.”

Personal power, Mr. Lansing explains, “is what is inside you.  It is how you treat people and how you lead.” 

Mr. Lansing’s leadership philosophy is a model that some hospital CEOs should take to heart.  Employees will always work harder, go the extra mile and care more about what they are doing for the capable CEO who knows how to treat people.

Over the next several years, healthcare will face unprecedented challenges – from reimbursement to more scrutiny on quality of care and patient safety.  CEOs will need every advantage they can muster to thrive in this type of turbulent environment. 

The “screamers,” the “barkers” and the abusive, tough-guy senior leaders who think their way is the best way should sit in the time out chair and learn some important lessons from a very smart CEO who is passionate about his company and who is also a nice person.

Source:  New York Times, “A Deal-Breaker Question for Job Interviews," Sunday, Aug. 28, 2011

© 2011 John Gregory Self

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4 Questions Physician Candidates Should Ask Recruiters

There are four critical questions I believe that physicians should ask before submitting to the wooing calls of a recruiter.

I need to disclose that I began my search career recruiting physicians. Secondly, while I no longer recruit physicians strictly for clinical practice, I am involved in recruiting physicians for C-Suite and executive leadership positions. 

The American College of Physician Executives' LINKEDIN site is currently featuring an interesting discussion on this very subject.  I made some comments there but I wanted to bring them across to my blog for your review and comment.  If you are a LINKEDIN member I urge to visit this page.

Physicians can quickly and effectively "qualify" the recruiter and the opportunity by asking these questions. 

1.  Is the recruiter working on an exclusive, retained basis or with a non-exclusive contingency contract?  

Be wary of the non-exclusive agreements. Success in the latter case comes by submitting as many "qualified" candidates as possible, as quickly as possible. In this scenario, it is primarily a metrics game -- if a recruiter submits more candidates before their competitor, they will have a better percentage of closing the deal.  With this approach the physician's interest typically becomes secondary. It is about the commission and recruiters working in this environment, and in a few of the big "mill" retained firms, are pressured to close deals. 

 2.  What type of placement guarantee is the recruiter offering the client?

As a candidate, this is one of the most important questions you can ask.  Why?  No placement guarantee, or anything less than a 1-2 year guarantee, means they do not have much skin in the game, except their reputation.  Research suggests that most physicians stay at least a year so equal or less time is not much of a guarantee. Physicians should care because the more risk the recruiter has, the more concerned he or she will be in ensuring the "fit" is right and that the physician candidates have a complete and accurate understanding of the opportunity. In other words, alignment of interests.

3.  Are you getting full disclosure?  

Every organization, from Mayo and the Cleveland Clinic to a multi-specialty clinic in rural Alabama, has issues that they would rather physicians not know about before they sign. I refer to this as the "good, the bad and the ugly." One clinic did not like to disclose their turnover rate -- it seems their attractive comp plan was attractive on paper, not in practice. The recruiter, who had a 6-month placement guarantee -- which is to say no guarantee -- was practicing the search equivalent of "don't ask, don't tell." In one year, 6 physicians left the practice. Their turnover was 50% at 24 months, according to the CEO of the neighboring hospital who quit providing income guarantees until the parnters in the practice agreed to full disclosure of their good, bad and ugly issues. 

4.  Is the recruiter going to send you written information disclosing all the essential elements of the practice -- salary, benefits, and the good, the bad and the ugly?

If they can't or won't, run, do not walk, away. 

Some recruiters will argue this is an unrealistic model. I would argue that is exactly why this segment of the recruiting industry "enjoys" so much criticism.

Physicians, who were once at the top of the healthcare food chain in terms of earnings and importance when I began my career in the mid-1970s, should not be treated less appropriately in the recruiting process than other healthcare executives. But that is exactly what is happening in far too many cases day in and day out.

© 2011 John Gregory Self

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Annual Performance Reviews: The End of an Entitlement

Employees cherish a gross sense of entitlement in the form of their annual performance review and the almost certain yearly raise.  In many organizations, this “right” extends to  the very job itself, regardless of performance or economic conditions.

 The irony in the odd conceptual evolution of annual  performance reviews and obligatory raises, is that we are not talking about a unionized workforce. 

 In good economic times, this sense of entitlement in the workforce grows.  In bad times, it is the source of enormous friction and decline in employee morale, both of which create a distraction from the organization’s mission.

In many U.S. Hospitals, the system has been in place so long that employees cannot imagine any other alternative.  As long as hospitals are doing well -- defined as having ample days of cash on hand -- there is no sense of urgency to change.  In this misaligned employer-employee relationship, the business principle that cash covers a multitude of sins could not be more accurate. 

As healthcare providers we know, or should know, that we are on the verge of a tsunami of change that will, sooner than later, force an overhaul in our business model, a variation of which we have used since the arrival of Medicare in the mid-1960s, with a course correction in the mid-1980s with the implementation of DRGs.  Congress and regulators have tweaked the model so many times that we now operate business systems that are so complex that our patient bills are almost indecipherable.

The Patient Protection and Affordable Care Act, which in theory is designed to reduce healthcare spending, may or may not be fully implemented.  In the end, that will be up to the 12 wise men on the Supreme Court, but that is not the big game changer that will blow up the current system of how we deliver care and how much we are paid.  The bomb is the inevitable sharp and ongoing reductions in Medicare and Medicaid payments that will be necessary to control the annual deficit and long-term debt which are, previous Congressional cuts in spending notwithstanding, still very much out of control.

So the day of entitlements as evidenced by so many current dysfunctional performance review and annual merit pay programs, will require a shift in the traditional top-down, command-and-control relationship  that we “enjoy” with our employees today. 

When the next round of federal reimbursement reductions, that will be steady in their frequency and painful in their impact, begin, it will be too late to recover if you are not prepared. 

The smartest guys in the room, those CEOs who understand that this inevitable storm is building on the horizon, are already beginning to think about what the next generation of health system will look like, how it will be organized, and what all of this will mean to their employees, increasing numbers of whom will be physicians. 

On Friday I will outline an essential first-stage employee strategy.  Until then, I would like to hear what you think.  How do you see the deficit/debt crisis affecting our existing business model and what would you do to prepare for a challenging future?

© 2011 John Gregory Self

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The Gospel of Service and Excellence

With all the pressures on a CEO, it is tempting to think that a consulting package can solve problems that essentially begin and end with people. Employees and physicians look to the boss.  If he or she is not walking the talk, it hits the informal employee news wire, spreads through the organization -- that the latest service initiative is nothing more than the latest customer initiative -- and the program fails.  The best approach I have seen is what I call the Gospel of Service and Excellence.  

Every day, the CEO talks about it and lives it. 

That is why verbal communications skills and leadership presence are shooting to the top of our chart of CEO critical competencies.  If you cannot personally communicate the value and importance of change, you cannot lead change.

On Sunday I am speaking to the national meeting of radiology/imaging professionals at the massive Gaylord convention center near DFW International Airport.  My focus will be on Employee Empowerment: A Strategic Imperative. I have spent a lot of time talking to hospital CEOs and other leaders who are on the cutting edge -- not necessarily in the spotlight -- for improving quality care and and building an environment of safety for the patients.  

Here is what I have learned:

1. Excellence in service and top patient satisfaction scores must go hand in hand but currently that is not necessarily the case even with some of the perennial industry leaders.

2. Landing on the Top 100 or the Top 50 lists is great PR but how are your HCAHPS scores? It is importnt to focus on processes and techniques in improving patient care and safety, but in your zeal to improve, do not forget the patient and their family.   

3. The unsung heroes, those CEOs who understand that improving quality and safety is much more important than securing a top ranking by some national magazine or consulting service, are more often than not those who use the Gospel of Service and Excellence technique.  Not a day goes by that they are not walking the halls, visiting with employees, physicians and patients, preaching the importance of adhering to best practices.  Yes, they invest in technology to measure and track performance.  Yes, they draw on outside expertise from time to time to get a fresh set of eyes for performance improvement opportunities.  But the CEO does the heavy lifting of driving the change, not a coach or team of consultants. He is walking the talk and asking for input at all levels.

© 2011 John Gregory Self

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Customer Satisfaction Programs: There Is No Silver Bullet

Success of a brand-name customer service/satisfaction initiative is not based on which pricey program a healthcare organization buys, but the commitment, the passion and the skills of the Chief Executive Officer.

Healthcare organizations looking for the magic silver bullet, should understand that it does not exist.  

Quint Studer was a very successful President of Baptist Hospital in Pensacola, Florida, not because of some template or costly consulting package.  No, he succeeded because of his commitment, his drive and deep understanding of common sense leadership principles. There is nothing magical about his very popular approach, or of those promoted by his able competitors.  They provide a solid framework for cultural transformation.  But without a strong CEO, no army of cosultants can produce an environement that fosters clinical excellence, patient safety and exceptional patient satisfaction scores.  

There is no substitute -- none whatsoever -- for a dynamic leader who can craft and communicate their vision, and who can successfully build a strong leadership TEAM that, day in and day out, delivers exceptional results.  

If you need to believe that there is a silver bullet, then there it is -- hard work and personal involvement by the CEO.

© 2011 John Gregory Self

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Going Out On A Limb...Not Really

In one of the silliest of debates in the world of healthcare, challenging economic times and the inevitable cuts in reimbursement from healthcare reform and deficit reduction have fueled a renewal of the endless haggling over who is better: not-for-profit or investor-owned hospitals?

Let's cut to the chase:  the winner is/will be those hospitals that achieve superior results in terms of quality, safety and patient satisfaction.  Who cares about the ownership structure?

I have worked in the healthcare industry for more than 30 years.   When I first went to work for Hermann Hospital in Houston as a young PR director and the first director of Life Flight in early 1976, there were actually more investor-owned hospitals in the market than the staid non-profit behemoths of tertiary care.  While the big tertiary care facilities that took care of the sickest patients were tax-exempt, the hard-charging investor-owned community facilities reshaped the market dynamics in terms of competition, the speed with which business decisions were made, and their ground-breaking efficiency.

Today, the pros and cons of which ownership model is superior are once again being debated.  The truth is that both ownership structures are fraught with weaknesses that healthcare reform and the ongoing deficit/debt reduction efforts will challenge.  

Who will win?  To borrow a line from the late Molly Ivins, a newspaper columnist who covered Texas politics for decades, "I am going to go out on a limb and tell you that I haven't a clue."  That said, I do know what will be the deciding factor.  Quality people.  Organizations that recruit and retain the best talent and who understand the consequences of the "new normal" and the lower rates of reimbursement, will end up on top.  If you do not hire and retain the best people, it is impossible to compete in a hyper-challenging financial/business model transformation.

Eventually, when the financial squeeze reaches painful levels, ownership structure will certainly come into play.  I think I know how it will play out, but that is a conversation for a different day. There are so many policy/reimbursement issues about which hospital CEOs have so little control   For now, if you are a hospital CEO, pay attention to the most important variable you can control:  the quality of people you hire and the rate of retention. That is one of the most important things you will do as THE leader.

© 2011 John Gregory Self

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OK, Here's the Deal

Several months ago, I announced that I was going to shift from writing a blog exclusive to healthcare to more general interest issues. I promised that I would get back to you when my plans came together. All I can say is that best made plans are subject to change. So, here's the deal.

I am going to continue with HealthCare Voice. The focus will remain on healthcare leadership, strategy, career management, talent acquisition, retention, team development, etc.  My brand advisors and some of my valued readers encouraged me not to stray from my original intent. So, I changed my mind.  

HealthCare Voice will continue to appear at least twice a week.  In the near future it will be moved to my website, JohnGSelf.Com which is being expanded by my capable marketing team at Brandnu Marketing, a DFW firm that specializes in helping organizations enhance their brands and grow their businesses.  HealthCare Voice will feature a new design but will offer the same subscription and push distributition capabilities (which means RSS or email alerts). I will get back with you before the site is changed so that you can renew your subscription or RSS feed based on the new URL.

Plans for a general interest blog in support of my public speaking business are in full swing. This blog will focus on a variety of subjects about which I have a strong interest. More on this later.

© 2011 John Gregory Self

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Organizations Do Not Care About People...

Organizations do not care about people, only people care about people.

_{That was the theme of a recent Seth Godin blog.  It is the people, plain and simple.} 

_{For the record, Mr. Godin is a marketing innovator who pioneered “permission marketing.”  His daily blog is the 15th most popular in the Blogosphere world.}

Next month I am speaking to a national meeting of the association of imaging management which has decided to hold its annual conference on the sizzling skillet that is North Texas in August.  My seminar theme is how empowering employees is a strategic imperative in our “new normal” economy where unemployment remains excessively high and consumers are tapped out.  I am going to make the case that empowering people is more than a strategic necessity, it is a moral imperative.

I speak and write frequently about the importance of people in business and how they – our employees -- should be our most valuable asset, just as we advertise in our annual reports and recruitment brochures.  Of course today, for the most part, that is simply not true.  Today, far too many CEOs are unwilling, or unable, to walk their talk, a fact that is not lost on their employees.  From hospitals to airlines, carmakers to manufacturing and retails businesses still view their employees as not their most important asset, but their biggest expense. The consequences of that approach are all bad, and accepting the inevitable adverse impact this mindset inflicts on our customers/patients, is immoral.

As I travel around the country, I see signs posted in the hallways and employee work areas that are designed to boost morale and reinforce the corporate culture, as if clever, pretty signs will achieve the desired effect.  “Our People Are Our Most Important Asset,” is in the top 10 of popular postings.  But the sad truth is that if companies have to resort to hanging signs to remind their employees, they are truly in trouble.  What they are really telling their employees is: 

“Our people are our most important slogan.”

 

© 2011 John Gregory Self

EXECUTIVE RECRUITMENT: Can You Afford Average?

It is a recurring question -- how can I be sure that I am hiring the right executive and that once they join will they stay?

In all honesty, when dealing with people, there are no absolutes.  But with the right search consultant -- internal or with a firm -- and a gold-plated recruiting/candidate screening process, you can substantially mitigate the risks. However, let the buyer beware:  if your executive search firm uses terms like “job order”, “hiring authority” or “fill rate”, more than likely they are a placement agency or staffing company trying to move up the financial ladder.  

The real secret to success in executive search is to select a partner or search consultant who possesses some important skills.  First and foremost, success in executive search is not tied to the number of years of experience.  That is helpful, but if the consultant lacks a particular set of skills necessary for success, years of experience will ensure only that you are buying experienced mediocrity.  Nor is the size of the firm of any consequence unless your organization is a multinational operator and geographic reach is important.  No, the secret lies in the search consultant who will be doing the majority of the work.  Does this person possess a deep understanding of the culture of the organization -- the values, the rules governing interpersonal relationships, and how decisions are made?  Do they require complete transparency regarding performance expectations, details regarding the hurdles that must be overcome to achieve success, and identification of the always dangerous sacred cows?  The consultant must insist that the client lose their natural desire to put their best foot forward while obscuring important problems or challenges that will become the organizational equivalent of an IED - improvised explosive device -- with career-limiting consequences.

Is the consultant who will do most of the work on your search, save perhaps the candidate's final interview with the engagement partner, present for the all important site work, or are they closeted away in the Firm’s office working on other projects?  (That is the most common model in the search industry.)

If your consultant does not force you to deal with the tough issues, do not be surprised if the outcome is only average.  Executive search is like dating and marriage -- decisions are made after four or five dates.   If the search does not force the client to deal with always-present nasty little details in advance of the marriage, there is a good possibility that it will not be a long and productive relationship and the divorce will be messy and costly.  

The truth is that far too many executive recruiters practice what I call “don’t ask, don’t tell”  recruiting. The partner signs the engagement, a consultant who may, or may not have been present for the site work, prepares a superficial job description and if the candidate doesn’t ask about the culture or potential problems that could affect their success, the search firm does not tell.  Oh, the big firms deny that is the case, but I have interviewed far too many candidates who say otherwise.

How confident is the search firm in their ability to find a candidate who will deliver value to the organization?  To test a search firm's true mettle, ask the partner in charge if they will guarantee their work for an extended period of time and listen for the reasons they do not.  Most firms offer a 12-month placement guarantee.  That is average.  There are one or two firms competing in the healthcare provider segment who will offer an extended placement guarantee, but they are the exception.

So the answer to the question is, in the end, really this:  Given the cost of an executive search -- professional fees plus an overhead assessment and travel costs:  Can you afford average?

© 2011 John Gregory Self

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Quality and Safety: The Secret Ingredient for Success

I have had the pleasure of working with some great health system and hospital clients that have achieved national recognition for achieving meaningful and sustainable improvements in quality of care and patient safety.  These are not manufactured results for some national magazine survey or billboard campaign.  Their quality scorecards, based on national standards, are impressive.

Do you know what characteristic is evident in each of these star organizations?  A CEO with a laser-like focus who is passionate about quality and safety, a leader who is willing to stake his/her personal and professional reputation on achieving and sustaining excellence on these two deliverables, and every employee in the organization knows it.

A colleague, someone I personally admire and respect, works for a health system that is struggling with quality. The employees know it.  They all talk about it – outside of earshot of the patients, of course. He is seeking another job, determined never again to work for a CEO who does not put quality and safety ahead of all else, including his social calendar or vacation schedule. 

All this talking in my friend's current organization has led to some amazing excuses and, sadly, inaction.  The leadership team just can’t seem to overcome their inertia on this critical subject.  Intellectually they want to do something but they cannot seem to see a clear pathway.  Their excuses run the gamut – take your pick from the usual suspects: poor leadership by the CEO; doctors who have grown complacent or more focused on financial returns than their patients; overworked nurses; the nasty, socially reprehensible financial costs associated with frivolous malpractice claims.

 We all know that there are causes for poor quality -- it is not always simply the physician or a nurse -- but many organizations adopt what I call “non-blame solutions.”  They spend a great deal of money on quality improvement in search of an easy answer where none exists instead of focusing on creating a culture of quality care that is real, and holds people accountable for improving the situation. 

All of this rationalization aside, I have come to believe that hospitals that suffer from continuing poor quality of care and patient safety do so because they choose to.  They could do something about the problem but they don’t.  What a damning statement, but the truth is that if you strip away all the excuses, the leaders and the physicians just cannot make the hard choices, ruffle feathers.  They say they do, because that is what people say who recognize that certain behaviors or outcomes or bad but lack the will or ability to drive change.

Sometimes it is just easier to do nothing or, worse, go through the motions – including meetings upon meetings, the engagement of consultants, the development of process improvement plans, and the investment in elaborate programs for collecting and plotting data.  The painful truth is that if the leadership team lacks the passion to fix the problem, if they are unwilling to stake their personal and career reputations on solving the situation, then most of what they say, the efforts they make, and the money they spend on equality improvement, is just the equivalent rearranging the deck chairs on the Titanic.

© 2011 John Gregory Self

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A New Type of CMO

Healthcare reform is extending beyond the Washington beltway.

You can see it in how health systems, hospitals and other providers are shifting their marketing strategies from the traditional wholesale approach -- physicians are the primary customer -- to retail marketing in which hospitals appeal directly to patients on the basis of quality, safety, technology, scope of services and access.  

As physicians shift their employment and business orientation from physician-owned practices to employment by hospitals and insurance companies -- yes, payors are beginning to acquire practices as well -- hospitals are turning their attention directly to the patients.

In the process, CEOs are creating yet another CMO position for their senior leadership team: Chief Marketing Officer. In the earliest days, marketing Vice Presidents or Directors were seen, more often than not, primarily as strategy, advertising and/or "sales" people.  

Providers now are quickly adjusting their perspective, acquiring sophisticated marketing information systems to aggregate and analyze a mountain of data hospitals have been collecting for years but never used in a meaningful way.

HealthLeaders.Com has published an excellent article, Image Makeover that is worthy of review. 

Read More.

© 2011 John Gregory Self

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Customer 2.0

The nation's hospitals, which have consistently lagged behind other industries in terms of management technology and service, will soon face a new demand for MIS innovation just as they are implementing new platforms, systems, and programs to deal with electronic health records and the concept of meaningful use.

It is called Customer 2.0.

It seems like only yesterday that some hospitals ventured timidly into the 20th century with call centers to assist clients navigate their way through a myriad of questions concerning unpaid balances, paying bills, scheduling and registration.  Now we learn that other industries are looking at innovative ways to meet consumer demands that want them to incorporate new media into the customer service mix.

This will not be a change that occurs overnight.  Thank goodness, since healthcare management information systems, which are today better than ever, are still far behind retail and manufacturing.  But this is a change that will come, and once the critical mass trigger is hit in other industries, it will sweep into healthcare.

Here is a post from Christopher Elliott writing in BNET, the excellent interactive business site from CBS:

"Brett Shockley, a senior vice president at Avaya, told a recent technology conference that businesses are just coming to terms with a new kind of consumer – he called it Customer 2.0 – and defined it like this:

They’re born with a keyboard. They’re born with an attitude.

Now that they’re graduating from college, they’ve got a disposable income and there’s about 80 million of them.

We’ve got to pay attention to all the different ways that they want to communicate. We’ve got totake all of this into consideration in our companies."

READ MORE.

If you are not a regular reader of BNET, I want to encourage to check in on this site from time to time.  They have some excellent articles. 

Now add to the mix that we will have less money for the whistles and bells – aka new technology – and the fact that we are change resistant, voila, you have yet another interesting confluence of competing interests that will make the CEO’s job – already one of the most difficult on earth – even more challenging.

 Have a great weekend.  I am staying indoors, if at all possible.  It is forecast to be 100+ again in Dallas.

 © 2011 John Gregory Self

 

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What's In A Name?

What’s in a name?

A lot, it would seem, especially if you can find the humor in the law of unintended consequences in the child naming arena. And sometimes the last name is an indicator of the career choice of its owner.

When parents pick names for their children, they typically rely on family tradition, personal preferences, or what is currently popular. They do not think ahead to the implication of the awkward possibilities that a marriage or career choice might produce.

When I was growing up in East Texas, I had a friend. His last name was Fernley. He was cool. A lot of girls agreed, including the daughter of a local OB-GYN. Her name was Finley. Luckily, the romance ended in high school and we were spared  dealing with Finley Fernley.

In an earlier married life, I had a sister-in-law whose first name – her only name – was Morgan. She fell in love, got engaged and then, fortunately, the romance faded.  The good news is that the world was spared a woman whose name would have been Morgan Morgan.

In my days of reporting for The Houston Post, I frequently worked with a photojournalist – a photographer – whose last name was Click. He liked to hang out in a bar on Buffalo Speedway. Dave Press was a foreman in the press room of one of my former newspaper employers.

When I left the news business, I joined Hermann Hospital in Houston as their public relations director, and I met an aspiring Colon and Rectal surgeon whose last name was, no kidding, Dr. Butts. Fortunately his first name was not Seymour. 

BNET Blogger Steve Tobak wrote last week about a Wall Street Journal article that discussed aptonyms – when your name reflects your profession, like my teaching hospital acquaintance, Dr. Butts.

Mr. Tobak thoughtfully assembled a list from the WSJ as well as “reliable examples” from the comment section. Kudos to Mr. Tobak for bringing these wonderful examples to our attention:

• Personal injury attorney:  Patricia Boguslawski of Teanack, NJ. Her name is apparently pronounced Bogus–law-ski. Really
• Urologist:  Rick Chopp of Austin
• Doctors Toothman and Brush – two dentists from a location unknown
• Will Wynn – a former mayor of Austin
• Dr. Chu – an orthodontist
• Dr. Butcher – yes, a dental surgeon
• Dr. Jacqueline Hott – a sex therapist
• A urologist who did vasectomies – Dr. Harold Stop
• Laureen Light – a psychologist
• Soo Yoo – an attorney

Finally, apparently the founder of the University Of Rhode Island Graduate School Of Oceanography was Charles Fish. And then there was a family Realtors in West Virginia with the surname of Greathouse, Mr. Tobak wrote.

He asks us not to forget about the financial advisor whose name was actually Rich Widows.

I am John G. Self of Dallas and Tyler, Texas.  Clearly my name has nothing to do with recruiting or any of my earlier career pursuits.  I have been accused of being "self"-centered, but I will just ignore that for now.  My father was a very successful retail baker in Tyler. By ancestry we are Dutch by way of Arkansas. An earlier spelling of the family name, changed prior to my father's arrival in this world, was Selph.  No humor there, thank goodness. My grandfather, also a baker and later in life a city judge in Terrell, Texas, did ride his bicycle through Indian territory -- now known as Oklahoma -- when his family decided to forego the wilds of Arkansas for Texas. 

No, I do not have children with the names of “Him” or “Her” but my name does come up frequently in Sunday morning sermons.

 

© 2011 John Gregory Self

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Five Reasons Hospital CEOs Get Fired

From Anchorage Alaska

Hospital CEOs have their hands full.  They face a boiling cauldron of operational, financial and competitive challenges – any of which could prove career limiting.  Surprisingly, however, many CEOs fail not because they lacked knowledge or expertise in running a hospital or dealing with the myriad of threats.  Rather the fastest-track to a severance agreement, or unceremoniously escorted from the building, can be found in five major failings.

 The overarching principles on this subject are two-fold:  First, CEOs and senior executives should know themselves. The second “first” rule is that CEOs should do no harm to the employees they lead or the customers they serve.  CEOs who keep their eyes on these balls will typically do well, all other things equal – knowledge, talent, and expertise.

So why do CEOs get fired?  More often than not it is style, or lack of political sensitivity, that will be a CEO’s undoing.  In more than 30 years in healthcare leadership – 17 years in executive recruiting – I have seen senior executives run aground many times over because they lacked the sensitivity to read, understand and adjust to the shifting political and marketplace sands that exist in virtually every health system or hospital, from the governing board and medical staff to the hourly employees who do the really important work.

Here are the five sure-fire issues that will get a CEO fired.

1. Micromanage your team - Micromanagers are like amateurs masquerading as "in-the-know" leaders. Let's be honest, if you have to get that involved in the operations of the enterprise, you are not hiring the right people.  When you micromanage, you destroy morale, and disrupt service.  You show me a hospital CEO or COO who is a micromanager and I will show you an organization that is, or will, suffer quality and  patient safety problems, and, eventually, poor financial performance.
2.  Be a Bully - There is no place in leadership for bullies/abusive leaders.  If you have to use anger, intimidation, or abuse to achieve targeted results, or if you enjoy calling out subordinates and humiliating them in front of their peers, you might want to reconsider changing careers. Your employees -- and your customers --  will be delighted you have left. In short, if you think that approach to management is smart leadership, you do not belong in healthcare.  Management and employee turnover is dangerous for your patients and it is very expensive.  The only way a CEO with this particular mortal sin can hold on to their job is if they work for an incredibly toxic board or a ridiculously misguided corporate entity that equates this type of boorish behavior with “tough” leadership.  There is no accounting for stupidity that manifest itself in this type of misguided and misinformed corporate or governing board oversight.
3. Ignore Your Customers – That is perhaps one of the biggest – and most common – sins in healthcare today.  Take care of your customers. They will take care of you (and your career).  Steve Jobs and Apple blew past Microsoft in terms of market cap, not because they treated their customers with dismissive indifference, but because they were passionately focused on offering an extraordinary customer experience – exceptional quality and best-in-industry service.  Day in and day out, Apple employees focus on their customers – meeting their needs with enthusiasm that is fueled by a belief that they are working for an outstanding company “that gets it.”  Fighting with your customers (read: physicians) – even though they may also be your competitors at some point in the day – is a bad idea.  It demonstrates, without equivocation, that you do not get it.  As a savvy politician once said, never fight with a man who buys printer’s ink by the barrel.  Taking a my-way-or-the-highway posture with the people who admit patients and generate revenue or the board members who evaluate your performance is a really bad idea.  As CEO, you are supposed to be on top of the emerging trends.  If your physicians are concerned with their revenue, be a partner, not an adversary. That point is not rocket science but you would be surprised how many CEO terminations can be traced to an arrogant belief that you can fight with your customers and still be a winner.
4. Excel in self-importance – CEOs, you should (read: must) check your ego at the front door.  It is not about you.  It IS about the people you serve.  In a crummy economy, the smart leaders are the ones who walk the floors and talk to their employees – on all shifts, all the time – looking for ways to improve quality and service, how they can make a meaningful difference in the lives of those who, day in and day out, actually do the work.  CEOs should regularly visit their physicians – all of them – on their turf.  Listen, learn.  This is not for show.  The employees and the physicians know when they are being taken seriously and they appreciate the effort.  So many CEOs fail to build this reservoir of goodwill that will be essential to survive the inevitable crisis that will occur during a standard tenure of five to seven years.  CEOs have all sorts of excuses why they can’t do this (I have heard most of them), but when the board makes the decisions to terminate, remember your lame excuses and then decide if you like the feeling of getting the boot.
5. Be a Phantom CEO -- You cannot lead from behind closed doors and a cadre of assistants who shield you from your customers and those who actually do the work that generates the revenue.   Stop trying.  In plain terms, do not build walls or a honking big silo of reinforced concrete around yourself.  CEOs should not let their fears or insecurities make them a prisoner of the executive suite, venturing out only for the weekly manager’s meeting or occasional hospital-wide event.  A CEO once told me, “I just do not feel comfortable interacting with the employees without others being with me.”  Insecurity is the stuff that walls and silos are made of.  Get a coach and get over it. Or get an outplacement adviser.  You will need one

Bonus Reason:  Avoid Accountability. Blame others for your failings.  Your       subordinates will really love you for that one.  Do the opposite.  Be accountable.         No one likes a leader who is full of excuses, who dodges accountability.  Revel in       being responsible for the success of the organization. Take joy in the challenge.         Talk about it constantly and hold others accountable.  That is a powerful       message.  No one likes a dodger who is better at excuses than results

© 2011 John Gregory Self

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Can You Spell Bad Service? MICROSOFT

A year ago, as I worked to launch my new executive search firm, I experienced problems loading a customer/candidate database. I needed help in a hurry so I turned to the software company.  What a disaster in customer service.  It was if their motto was We make a lot of money selling software.  Don't bug us.  Visit our web site.

Welcome to Microsoft customer support.

If you are not a technical wizard, the Microsoft web page is as opaque as the complex Collateralized Debt Obligation instruments from the real estate debacle that were so complicated that the bankers who sold them didn't understand. Forget trying to find the right article, among hundreds, that will explain the issue and tell you how to fix it, assuming they were written in easy-to-understand English.   

They make it difficult to find their contact information and more difficult still to find a telephone number to technical support for the specific product.  When you finally get through the telephone decision decision tree, assuming you are not cut off, you are then connected -- using a system that is only marginally better than two orange juice cans and string -- to a technical support guru who is obviously not in the USA.  You struggle to hear. Understanding the representative is another struggle.  A pronounced accent and a bad connection is one definition of technical support hell.

Now compare that with Apple.  Today I had a question; I used their super fast Safari browser, easily found the technical support contact information, entered my product model number and filled in a quick form to explain the problem.  They gave me choices:

1. Immediate call.  They would call me.  The waiting time listed on the web was less than one minute.

2. I could schedule a call

3. I could use their knowledge base -- for the technically sophisticated among us

I chose the immediate call. Within seconds of entering my number, my telephone was ringing.  Apple was calling.  I also received a case number and explanation on my email. The technical support representative was friendly, eager to help and communication was not a problem... I will not ramble on.  Apple owners get it.  They know that this company is committed to making high quality products that surprise and wow their customers, and they back that up with what many think is best-in-industry customer service. No competition.  

Microsoft service is a long standing bad joke.  And given the mediocrity of some of their software, you would think they would take customer service a little more seriously. But what the heck, they are making a lot of money.  Too bad Apple just passed them in terms of market capitalization.

So now we come to hospitals.  We are not even in the same universe when it comes to customer service.  

A friend visited her physician who works in an integrated health system. They took x-rays, performed lab work and gave her two major injections to counter an infection.  She is a Medicare beneficiary.  Several weeks later, she received a bill, which she paid.  Then she received another much larger invoice, which was for her lab work.  Immediate payment was requested.  It seemed high, so my friend called Medicare to determine how much they had paid.

Guess what? Medicare had not been billed. Medicare's representative advised her to wait to pay that amount until the clinic filed a claim and Medicare determined how much they would pay.  The suggestion was clear -- that if my friend paid the clinic the full amount now, she might have to wait for months before receiving a refund. So she called the clinic billing office and dealt with someone whose name should have been: Ms. I Am Clueless. They discussed the situation but it was unclear to my friend if she made any progress, if anything was resolved, based on her conversation with the customer service representative. Hence the clueless moniker.

This week my friend received yet another bill for a different amount for the same test, but the amount -- $43 with another $4 tacked on as a late fee because the amount had not been paid in 30 days. She called the clinic back and talked to another customer service representative, Ms. Dismissive Indifference, who said she could not see why they had added a late fee since the payment due was not late.   In the end, however, my friend paid the principal amount and the late fee. She was told that it was just easier to do so.  I an era of tightening reimbursement, I guess that is just one small way to boost revenue. 

The big bill apparently is still rattling around in payment hell waiting for a settlement. 

This story, unfortunately, is fairly common. Not all hospitals and large clinics operate this way.  There are some great operators who get it right every day.  But many do not.

I work in healthcare and I am beginning to hate even thinking about going to my doctor. He is part of a big clinic whose centralized business office is run, I have come to believe, by some obscure, inept arm of the government.  Who needs the aggravation?  It is like dealing with Microsoft.  

The problem for most hospital CEOs is that they only hear about these incredible stories only if someone complains, which my friend will not do.  So absent an aggressive pro-actve customer service program that can identify problems before they alienate clients, nothing much changes.  Far too many are like Microsoft's leadership.  If they are profitable, the seem to say, don't sweat the small stuff.  I guess that means service, too.

Healthcare providers need to stop and take a page from Apple's playbook. They understand customer service and they love to exceed their customers' expectations.

 © 2010 John Gregory Self                        

Health Systems, Hospitals Got It Right

Because I am not shy about criticizing or challenging my industry – healthcare – when we fail to live up to our mission of quality/safer patient care and support for the communities we serve, I owe it to my colleagues to voice my support when I believe they get it right.  They have in one very important area.

Executive compensation continues to be a hot subject both in the U.S. and Europe.  Not a week goes by without a news report, analysis or essay on the subject. While the current lightning rod is the large investment banks, there are far too many public corporations that are guilty of bad practices in how they pay their executives and how they explain it publicly.  

The central issues giving life to this continuing flow of coverage on the subject are the size of the base salaries and/or bonuses, the relationship between the pay for some easily understood performance metric, and the rights of shareholders – or the lack thereof – when the “owners” of the company are not happy with size or justification for the genrous awards.

Executive compensation issues and the financial community’s sense of entitlement, continues to irk regulators, millions of small business owners and “average Joes” everywhere.  The large banks single handedly drove this country to the verge of a global credit market contagion.  However, the continuing problems and lack of transparency in executive compensation are not confined to the banks.  There are hundreds of examples of corporations throughout the U.S. and Europe that treat shareholders as troublemakers of the worst sort if they deign to believe they are entitled to any rights  to have a meaningful say on this issue.

In healthcare delivery, we have kept our wits about us on executive compensation when other industrial and service sectors lost their way. We are not perfect, but our industry does remarkably well, all things considered. 

While there are health system and hospital CEOs who earn high six and low seven-figure incomes – and they are the exception – there are few examples where the size of compensation of a hospital CEO is inconsistent with the scope of responsibility and the complexity of the challenges these executives face.  In fact, there are examples aplenty of hospital CEOs of difficult-to-manage public and mid-sized community hospitals who are underpaid for the work they do and the results they produce. 

I am not going to discuss the payor or pharmaceutical segments because I lack the expertise.  My search firm does not work in those areas, but I believe there are certainly examples of these bad  compensation practices in the health insurance, technology, and pharmaceutical segments.

Health system and hospital boards, for the most part, are responsive to their communities and tend to be prudent in evaluating the CEO and how they pay him or her for the results they produce.  No, community boards are not as transparent as they should be in some markets, but even in the worst of cases, they are infinitely more responsive than the boards of far too many major public corporations who have created more rules and hurdles to block true shareholder input into how the company is run.  It is a maddening situation for many mom and pop investors, and increasing numbers of institutional investors, who are tiring of the corporate arrogance and greed.

Hopefully, as community healthcare organizations deal with the immense challenges that are part and parcel of our “new normal” economy, persistent high unemployment and anemic growth rates, their boards will become more transparent, not less, and more communicative, not less, regarding the size and scope of their community benefit which is how they justify their tax-exempt status.

Big corporations may have a legal requirement to be more forthcoming, but community healthcare providers have a moral and ethical duty.  And there is a big difference. 

 

© 2011 John Gregory Self

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