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.

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