Wednesday, February 25, 2009

A rainbow in the clouds

In prior blog posts and in multiple communications recently transmitted throughout CHRISTUS, we have indicated that we have begun our second decade amidst an almost perfect storm, which is being experienced as a widespread economic crisis both in the U.S. and throughout the world.

It is also true that like with many storms, there is a rainbow appearing amidst the clouds.

What are the positives that we might gain from looking at these challenging times as possible opportunities that will occur only once or twice in one’s professional lifetime?

The economic crisis is so widespread and so large that it touches the lives of almost everyone who is a part of the CHRISTUS family, whether they are a physician, Associate or volunteer. Based on what they are seeing as responses to this crisis from other industries, i.e., layoffs, benefit reductions and other expense controls, they have created a readiness in their own minds to not only expect but accept similar changes that might occur while on the CHRISTUS Journey to Excellence.

In reality, there is an openness to change which could not readily be created at times when all parts of the industry are going well and moving in positive directions. Resistance to change is the major barrier for preventing good companies from becoming great, and therefore it only seems appropriate that although we never enjoy the circumstances, taking advantage of this openness to change which has resulted during these stormy times may create a competitive advantage for CHRISTUS Health.

Secondly, although health care has been significantly affected during this recession/depression as it has in the past, it has not been as severely affected as most other industries. Because of the significant number of layoffs occurring and because health care is relatively recession-proof in the long term, we are seeing a significant increase in the applications to nursing schools and to colleges and universities that provide degrees in health care administration. This would seem to indicate that after several years, we will have an influx of graduates to quickly fill the many vacancies that are currently present in the health care industry.

And finally, as we discovered from our Futures Task Force II learning journeys, to remain competitive and sustainable for the long-term, CHRISTUS must evolve to become the highest clinical and service quality provider with the lowest cost structure. The actions which we must undertake to accomplish this necessary transformation could never occur to a significant degree when cash is flowing and profits are large. For such changes to be hardwired into an organization, the organization itself must be facing challenges which heretofore have never been experienced.

Although we would all be much happier if the storm was less severe and perhaps was much shorter in duration, we must also ask ourselves if indeed this storm is providing us with strategic opportunities and transitional momentum which could not occur if the weather was calm and the sun was bright.

Wednesday, February 18, 2009

What must leadership do/change in challenging times?

I recently spoke with the CHRISTUS Muguerza Academy class of 2008 about what leadership must do or change in challenging times. Although they were meeting in Monterrey, Mexico, I joined them via video conference to conserve resources and continue our commitment to good stewardship.

I began by encouraging this Academy class to continue seeking out opportunities to learn and grow and embrace a commitment to continuous, lifelong learning. Health care is always changing—new diseases are discovered, some existing diseases are cured and technology is constantly developing. Leadership always requires a strong foundation and ensuring that you are prepared for the times unfolding before you.

Today, we know that the entire word is traveling through trying times. We are experiencing an economic crisis, continued volatility of the stock market and worldwide investments and even weather disasters like the hurricanes that affected CHRISTUS facilities last year. Many people believed that health care was a “recession-proof” market, but we all know now that this is not necessarily the case.

These times have proven to us that, indeed, the world is “flat.” Because the U.S. is so linked to the economics of other countries (for example, through trade in China and service centers in India), our country’s market volatility quickly spread to the world. CHRISTUS Health provides international services, recognizing that because of this global outlook, our international services continue to become ever more important.

This also means that trying times call for even greater and more focused leaders. They must see challenging times as providing new opportunities for change and improvement. Great leaders take difficult times to address opportunities which they haven’t been able to address before.

It is true that significant change comes in hard times, and even personal character is really built this way, as well. I believe that I am who I am more because of the hardships I have endured than the successes I have achieved. It seems that, many times, we learn more from hardships than successes.

So although these times are challenging, leaders have great opportunities, as well. I believe that in times of change, great leaders must do the following:

1. Accept change as the new reality. Great leaders do not resist change, but find ways to harness and create it. As a physician in the Emergency Department, one of the most invigorating experiences for me was seeing a patient with multiple injuries and complications. Some people may have given up, but I said, “Let’s save this person.” I think I probably performed better than I would have on an elective surgery like a gallbladder procedure because I was focused and knew that the patient’s outcome rested solely in our hands.

2. Find ways to maintain an optimistic outlook. Leaders must be able to motivate people to follow them, and therefore must be worth following. Be sure to talk about the positives and always look positive and optimistic. You will certainly need to spend time quietly behind closed doors, but when you are in front of people, you must see the glass as half full. Many times I treated patients and told them that I was going to save their lives. If the patient died, they did so in spite of what my team did, not for our lack of effort or because we gave up.

3. Review and recommit to your mission, vision and values. You cannot forgo or walk away from these or the Journey to Excellence. You must pause and recommit.

4. Clearly define the challenges. Many times, we face multiple challenges at once, and becoming overwhelmed by them renders us ineffective. Facing the unknown is terrible. Facing known challenges is difficult, but they are easier to address. When treating a trauma patient, if we know their injuries, we can address them one-by -one and ensure we treat the most drastic problems first.

5. Be more focused on detailed action plans. One of the things we did in this troubled economy was refinance our bonds to the lowest interest rates possible. This year, we were required to meet face-to-face with our investors, just like for-profits. They asked many questions. “Which of your regions are not doing well? What are you doing to turn them around? Where will these regions be in three months? Where will you grow? Where will you shrink? When the region turns around, how profitable will it be?” As a leader of CHRISTUS, I had to know the answers to those questions and be very familiar with our financial situation.

6. Be extremely clear in success metrics. Our balanced score card reports things like our patient satisfaction in the Emergency Department, our days in cash, etc. We need to know these measurements because it’s important to know where we are, where we have been and where we are going. Leaders who are not great have a lot of hope that things will get better. Unfortunately, though, hope is not enough. Improvement requires measurement so actions with clearly-defined results can be put into place.

7. Elevate your commitment to team efforts. Big challenges require big teams, and these teams must be stronger than in good times. When I was a practicing surgeon, I could remove a diseased gallbladder with only an anesthetist and a scrub nurse. However, if I was operating on a serious trauma case, I could remove a spleen and ruptured liver, but we would also need a hematologist to monitor blood clots and a cardiologist to repair a ruptured valve. The team must constantly ask, “Are we doing the right things?” They must also praise people when things go well and learn to ask, “How can I help you make things better?” In the end, the question is not how I did, but how we did.

8. Celebrate the incremental victories. Celebrating small steps gives you the energy to conquer the next steps. Significant challenges will not be solved overnight, but will require short-and long-term solutions. We must celebrate the short-term victories to have enough energy to reach the top of the mountain in our long-term quest.

9. Review and refocus your strategies. Strategies for good times may not be the same as strategies for challenging times; in fact, we may need to cancel, delay, or change some of our existing plans. We know that construction on many hospitals in the U.S. has halted, and openings of new hospitals have been delayed by other systems. We know that elective procedures such as hip and knee replacements and bariatric and plastic surgery will see a lower demand in challenging times, and we may need to alter our strategies accordingly. Also, if we were planning on building a hospital or a clinic, we might decide to build it smaller or in a different location. It is possible to delay some investments, but we must know why this choice is being made. Most importantly, don’t get hung up on last year’s plans, especially if this year’s environment is significantly different.

10. Communicate constantly. In challenging times, it is even more important to “tell our story.” During times like these, people become distracted by all the challenges, so we must tell our story over and over and over again. Truth calms, but rumors are destructive. If we do not repeat the truths over again and fill the communication bucket, it will get filled with rumors. Keep the rumor mill to a minimum by filling those communication channels with truth.

In challenging times, it is easier to say it isn’t worth it because it is harder to motivate people. However, the rewards of leadership are never greater than when we can look back at the end and say we have been successful in taking CHRISTUS through challenging times, and it has emerged better than before.

Wednesday, February 11, 2009

The Importance of Communication

I recently participated in an interview about health care reform (especially wellness, prevention and national health insurance) with SCIENCE AND SOCIETY, an Internet radio program that covers environmental conservation, medical breakthroughs and health care reform, computer science and space exploration. SCIENCE AND SOCIETY was one of the first Internet radio programs on the Web and one of the first to introduce podcasts to Internet users.

For those of you who aren’t familiar with them, podcasts are downloadable audio files that many organizations and public figures circulate on the Internet to communicate their messages to a wider audience. These files can even be stored on iPods and other mobile audio devices.

In the interview, I was given the chance to address topics ranging from CHRISTUS’ experience with coordinated community care and staffing community clinics, the importance of medical homes, what must be done to make health care affordable for Americans, the shortage of primary care providers and use of physician extenders and CHRISTUS’ 10th anniversary. (You can listen to the interview here.)

I’m still learning about all the new communication vehicles available these days, but I have always recognized the importance of communicating regularly and effectively. Uncertain times make regular communication even more of a necessity, and CHRISTUS’ commitment to transparency compels us to tell our story through as many avenues as possible.

Obviously face-to-face contact remains important, which is one of the reasons I committed to visiting all of CHRISTUS’ regions before our 10th anniversary on Feb. 1. But even during my visit to our CHRISTUS Muguerza region in Mexico, we used video conferencing technology to transmit my messages to Associates in rural regions that we could not reach in our limited amount of time there. We will continue to use these types of technologies—which all our facilities have access to—to conduct virtual meetings in these tough economic times and to keep the lines of communication as open as possible as we move forward.

Wednesday, February 4, 2009

Celebrating CHRISTUS Health's 10th Anniversary

Then Jesus asked, “What is the kingdom of God like? What shall I compare it to?” It is like a mustard seed, which a person took and planted in their garden. It grew, became a tree, and the birds of the air perched in its branches.” ~Luke 13: 18-19

Sunday, Feb. 1, 2009, marked the 10th anniversary of the founding of CHRISTUS Health, which we have come to know as CHRISTUS Day. As we recall the formation of our health system 10 years ago when the Sisters of Charity of the Incarnate Word of San Antonio and the Sisters of Charity of the Incarnate Word of Houston joined their health care ministries, it is important to not only reflect and honor our past history, but to celebrate our many accomplishments and to recognize our Associates for bringing CHRISTUS through the past decade.

The theme of our 10th anniversary commemoration, “Celebrate The Journey. Transform Our Future.” is being graphically depicted by a tree to symbolize CHRISTUS Health’s strong roots from a seed planted by the sisters and all of their partners in ministry throughout the years. Our 10 years of growth have produced many branches, a multitude of leaves and plentiful fruit.

Associates, physicians, volunteers and board members in all CHRISTUS regions, including the Dallas system office and Houston and San Antonio system support centers, were invited to participate in local CHRISTUS Day prayer services, marked by the sharing of scriptures, reflection and a closing invitation for each Associate to write his or her name on the front of a vinyl leaf, along with a personal gift which they offer for the continued growth of the ministry of CHRISTUS Health. The attendees are then invited to affix their leaf to a banner bearing the likeness of a tree.

So as we filled our CHRISTUS “Trees” with leaves, we were able to witness a visible sign of God’s blessing on our ministry.

In this challenging economic time and when all of us, both our regional and corporate services operations, are working diligently to reduce expenses and operate as efficiently as possible, we were ever mindful of the need to be as frugal and prudent as possible when planning this CHRISTUS Day.

Following is a summary of the system Communications/Marketing and Mission/ Spiritual Care departments’ plans to bring creativity and inspiration to local celebrations in each region as well as a sense of enthusiasm, excitement and recommitment on the part of our Associates, physicians, volunteers and boards to upholding the CHRISTUS Mission and Core Values:

• Simple yet meaningful programs that could be used – if the regions desired – for local prayer services;
• The creation of a five-minute DVD/Video using largely existing footage of Associates and internal voice-over talent. This was provided in DVD format for use at meetings and special events, but was also made available via a Web link for internal use;
• The design of simple materials to augment local celebrations (banners, balloons); posters and tabletop display inserts were also offered as optional items;
• The design of some external tools such as ads that can be used also in internal newsletters – that were, again optional, for the region; and
• Other electronic promotions that were designed and implemented by the system Communications/Marketing department including a special newsletter edition and an online version of the video on the intranet site. In addition, a special e-mail from me will be distributed to all Associates later this week.

Ten years ago, both communities of the Sisters of Charity of the Incarnate Word realized that ministering together is better than ministering on parallel paths. By coming together, they planted the seed which became CHRISTUS Health. Just a decade later, the tree has grown from the tenth largest Catholic health care system in the U.S. to the sixth largest. The system has also flourished internationally with the strong CHRISTUS Muguerza branch in Mexico.

We who gathered to mark this tenth anniversary paused to reflect on this growth which has resulted from the seeds planted by the sisters, originally, and by each of us as we have traveled together for this last 10 years.

Needless to say, our journey is not over; in fact, in many ways, we have only started. As long as there are people who lack access to adequate health care services, our faith-based ministry has a role. And, as the psalmist, we can be confident as we face the future: “Planted in the house of the Lord, we shall flourish in the courts of our God.”

Answering the Call for Our Second Decade

While we are celebrating our 10th birthday, we should reflect upon our rich heritage that spans more than 140 years of continuous response to our founding call: “Our Lord Jesus Chris suffering in the persons of a multitude of sick and infirm of every kind, seeks relief at your hands.”

Together, we have journeyed through 10 years of challenges and changes, while creating significant and measurable progress. During these 10 years, CHRISTUS Health has grown:
• From 23,000 to 30,000 full, part-time and per diem Associates;
• From 5,500 to 9,000 physicians on medical staffs throughout our system;
• From 1,000 to 1,5000 volunteers;
• From CHRISTUS services or affiliated services in Texas, Louisiana, Arkansas, Oklahoma and Utah, expanding into Iowa, Missouri, Georgia, and New Mexico in the U.S.; and Chihuahua, Coahuila, Nuevo Leon, Puebla, San Luis Potosi, and Tamaulipas in Mexico.
• To include almost 350 medical facilities and services, encompassing hospitals, clinics and outpatient centers, long-term care facilities and other health care ministries throughout the U.S. and in Mexico.

Although we have grown and accomplished much, we will still continue to face challenges and be required to make more changes in the future. As we embark upon our second decade as the CHRISTUS Family, we also must again reaffirm our commitment to answer Bishop Claude DuBuis’ call seeking help for those who were suffering.

Each CHRISTUS Day, we go back to this heritage as to a fountain from which we draw strength and inspiration. As guardians of our heritage, let us celebrate and pass along the rich legacy which has been entrusted to each of us! Let us pray to have the strength and persistence to do this sacred work in an excellent way and finally, may we have the enthusiasm and the commitment to continue to accelerate our Journey to Excellence so the trust that each family has who turns the life of their loved ones over to us is truly deserved.