A consulting colleague of mine told me of a story of how he fired the client! Not that the work was not rewarding, but that the culture was so disfunctional - at the top - that it had permeated the lower levels. Got me thinking about all the leadership traits that we ignore when someone is "getting results" - and the legacy that they leave behind.
Lots of leaders have arrived in organizations needing turnaround and after a year of planning, identifying the leaders that will stay and those that will go, they start mumbling about how the culture needs to change. And then they repeat the mantra that cultures take years to change...
so what is a leader to do!
If it looks like a bully, it is a bully - get rid of them. If it looks like an obstructionist, it is an obstructionist - let them obstruct someone else. Don't expect the frontline to treat patients with respect when they are not treated similarly. Make some visible changes and be as transparent as possible (confidentiality is important I know) that the culture is about vision, goals, measured performance, innovation etc and does not have room for brute force or road blocks at the top. Be clear about who is taking their place.
So in the short term:
1. Visible style changes
2. Repeat and focus on what is most important to change (rapid implementation, budget, service) - pick one
3. Measure, measure, measure -everyone to that standard
4. Evaluate and celebrate the change - With what counts - promotions, salary, bonuses, days off...etc. Incentivize the change.
I know one disgruntled employee of a fortune 50 company who was taken over in a "merger". He was a lucky one who kept his job, but felt betrayed by the merger. He grumbled a bit, but did his job well. When the year end bonuses came out for performance and they were twice the size of the previous company; his grumbling went into the closet. When it happened again, the grumbling stopped.
The moral- they won't love you for change but they will go along if you practice what you preach and you reward those who go for the ride. Let them know why they should follow you.
Friday, October 23, 2009
Monday, October 19, 2009
Is Population based planning in your best interest?
The Washington Post article this morning on the CBO's estimates on the various reform bills had me thinking about the lack of population based health planning used by hospitals. See http://www.washingtonpost.com/wp-dyn/content/article/2009/10/18/AR2009101802541.html?wprss=rss_politics .
Why do I think hospitals should care other than to sound intelligent in the healthcare debate? Because without that counterbalance to your strategy, you are following the lemmings off the cliff. Its like the recent housing market, subprime lending and all the other wonderful ideas. How many of us have started the 'center for this and that' because it was a great money maker. What happens when that money maker is no longer the economic driver, the primary care practice is.
Okay okay, you do environmental assessments as part of your strategy. Why is that not enough? Because if the paradigm shifts, and the model really does change, where are you? Do you know the cost per capita in your community (without looking it up). (I bet you know your bottomline and your numbers of deliveries without looking them up). Do you know fertility rates and cancer rates by race, age sex and zip? Do you know beds per 1000 in the community, bed days per thousand residents, back surgeries per thousand residents? Cardiologists per capita, PCCs per capita. The insurers do, the government does and if you are in an overbedded or competitive market watch out when reform begins to roll out if you don't know.
Do you know the performance of your medical staff on diabetic protocols and other protocols for chronic disease patients? IF your doctors are not compliant and know it, do you think new diabetics will chose them?
Food for thought on a Monday morning.
Why do I think hospitals should care other than to sound intelligent in the healthcare debate? Because without that counterbalance to your strategy, you are following the lemmings off the cliff. Its like the recent housing market, subprime lending and all the other wonderful ideas. How many of us have started the 'center for this and that' because it was a great money maker. What happens when that money maker is no longer the economic driver, the primary care practice is.
Okay okay, you do environmental assessments as part of your strategy. Why is that not enough? Because if the paradigm shifts, and the model really does change, where are you? Do you know the cost per capita in your community (without looking it up). (I bet you know your bottomline and your numbers of deliveries without looking them up). Do you know fertility rates and cancer rates by race, age sex and zip? Do you know beds per 1000 in the community, bed days per thousand residents, back surgeries per thousand residents? Cardiologists per capita, PCCs per capita. The insurers do, the government does and if you are in an overbedded or competitive market watch out when reform begins to roll out if you don't know.
Do you know the performance of your medical staff on diabetic protocols and other protocols for chronic disease patients? IF your doctors are not compliant and know it, do you think new diabetics will chose them?
Food for thought on a Monday morning.
Tuesday, October 13, 2009
If you didn't hear it you know it anyway!
NPRs story on doctor practices in Vermont and Maine. Surprised that practices differ and there is no objective data to support it. The only data was what is paid for and the outcomes...Yup you guessed it, more did not make the population healthy. More back surgeries, worse outcomes.
I think we all know it. But what does it mean for us going forward.
1. Payment incentives need to radically change
2. Outcome data needs to be shared with patients -not comparing providers but what does this mean for the patient in terms of quality of life, length of life, disabilities, etc vs other treatments
3. Healthcare needs to be system based not hospital driven. There is no system now with few exceptions. Where there is utilization is lower with no negative health outcomes.
I think we all know it. But what does it mean for us going forward.
1. Payment incentives need to radically change
2. Outcome data needs to be shared with patients -not comparing providers but what does this mean for the patient in terms of quality of life, length of life, disabilities, etc vs other treatments
3. Healthcare needs to be system based not hospital driven. There is no system now with few exceptions. Where there is utilization is lower with no negative health outcomes.
Are you surprised?
Insurers don't like any provisions that lessen the individual mandate? Wouldn't we all like mandates for individuals and corporations to buy our products. And if we don't they will raise their rates? So that is how capitalism works? I thought it was the opposite. If they don't buy your product you lower your rates! I am being drawn back in my thinking about how the market doesn't work in healthcare (HBR article a few months back) - there is no upside incentive to materially cutting back on the cost of services. It is the most expensive services that are used more to make up the slack in revenue and then the insurers pass it on with their slice.
Mmmm....350+ lobbyist descending on Washington. One per elected official. Wonder who wins this debate!
So where does that leave the public option. The Dems seem to have backed themselves into a corner with a good financial score on the no-public option option....where do they go from here....Clinton all over again?
Mmmm....350+ lobbyist descending on Washington. One per elected official. Wonder who wins this debate!
So where does that leave the public option. The Dems seem to have backed themselves into a corner with a good financial score on the no-public option option....where do they go from here....Clinton all over again?
Thursday, October 1, 2009
Real income growth to pay for health care
Health Affairs this month is all about cost...
" 53.6 percent of real income growth over the period would go to health care. Moreover, even with the more favorable assumption, the nation would still face important challenges paying for care".
Just think of that over half of every new dollar earned by Americans will go to their healthcare. How long do you think they will put up with it? If you aren't the lowest cost provider in your service area now, you are going to have some explaining to do. And what if they start to tax those dollars.
Technologies and systems that reduce per capita expense is what leadership needs to be about. Do you even know per capita expense in your community? Does your board?
" 53.6 percent of real income growth over the period would go to health care. Moreover, even with the more favorable assumption, the nation would still face important challenges paying for care".
Just think of that over half of every new dollar earned by Americans will go to their healthcare. How long do you think they will put up with it? If you aren't the lowest cost provider in your service area now, you are going to have some explaining to do. And what if they start to tax those dollars.
Technologies and systems that reduce per capita expense is what leadership needs to be about. Do you even know per capita expense in your community? Does your board?
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