Being an advocate in health care is critically important in order to impact the three most vocal voices of change with regard to health care policy and positioning. These three voices are: government, business and patients and their families. If these groups are to effectively improve both quality and service in the health care sector, we must ensure that they have clear and accurate information to redesign the health care delivery system appropriately.
Reaching a consensus on this issue, however, is getting increasingly difficult, because there is no common voice in health care today. It would be wonderful if one person or a small group of people could stand before our federal and state lawmakers and say, “This is what patients want and this is the reason why,” or “This is what physicians want and this is the reason why.” However, getting this consensus is almost impossible today. Younger physicians think differently than older physicians. Highly-paid specialists are thinking very differently than lower-paid primary care providers. And women physicians, understandably, as a group, often think differently than their male counterparts. Because of this difference, we have seen a declining membership of physicians in the American Medical Association (AMA), which in part is caused by the fact that some physicians believe an association cannot represent the myriad voices that are being expressed. This issue also permeates the common voice for the continuum of health care.
It would be ideal if hospitals, physicians and nurses could stand as a strong, cohesive component of the delivery system and say in unison, “This is what we are thinking, and this is what we want to happen.” However, as health care has gotten increasingly complex, as capital needs have risen with the introduction of more and more technology and as federal funding has decreased (only exaggerated more recently by the extreme amount of expenditure required by the Iraq war), the polarity between these groups has been increased. Obviously, this is because if the federal government is to give more money to physicians, they must take it away from hospitals, and vice-versa. Hence, when we come to the table to advocate for increased funding, the solution is often one that enhances polarity and therefore further decreases our chances of finding a common voice.
For example, before CMS instituted its current reimbursement system based on DRGs, we were cost reimbursed, so hospitals earned money by keeping patients in the hospital longer as the result of a daily fee, and physicians made more money because they were paid a daily visitation fee. In the current DRG system, however, hospitals are rewarded for getting patients out of the hospital quicker, and physicians have lost a revenue stream. Therefore, giving one group more money necessitates taking it away from another group and has heightened this polarity.
This challenge also permeates the clinical arena, and is obvious particularly in such areas as end-of-life issues and the treatment of people with life-threatening or potentially terminal diseases. Although most people when not directly involved with a serious illness would indicate that quality of life is much more important than quantity of life, when they are in the midst of a personal experience with a terminal illness that involves themselves or their families, they often develop the reverse position and many times opt for treatments and procedures which are expensive and in fact useless.
Getting consensus around treatment protocols and care management--although improving--is still challenging.
So in the end, while consensus is challenging in many arenas and advocacy remains very important, advocating for the appropriate care for the poor will be essential when the redesign of health care becomes a reality. Hopefully this will occur with the election of a new president, but regardless, we all must realize that coming to the table with a strong consensus from all of the three voices will probably be impossible.
So what’s my answer?
It goes back to a very simple position that I believe I have expressed in the past: we must choose people to represent and participate in redesigning the health care delivery system who are analytical, open to listening, can interpret and understand the data, can have their minds changed by persuasive discussions and will always keep what is best for the patients and their families as their ultimate priority.
At this point, we cannot depend on a consensus regarding health care reform to be our guide. If we wait to hear the common voice regarding health care change before we create the direction for tomorrow, I am fearful that we will have waited too long.
Wednesday, December 5, 2007
Tuesday, November 27, 2007
Physician Leadership – A Necessity for the Future
Many people throughout my career have asked me if all health care leaders should eventually be physicians who have moved into administrative roles. My answer to this question has always been, and will likely continue to be, “No.” That doesn’t mean, however, that I don’t believe an increasing number of health care leaders should be physicians or other clinicians. The key, however, is not in their clinical background, but whether they have actually developed the core competencies to become capable leaders.
It is clear that the additional knowledge that clinicians--including physicians--bring to the leadership table because of their health care experiences at the bedside or in the exam room is extremely valuable, particularly in determining what creates the best care management outcomes. However, if this knowledge is not combined with the core competencies of leadership, many of which have been discussed in prior blog posts, this knowledge is often worthless. In fact, with clinical expertise often comes an arrogance which is a barrier to good leadership.
Hence, it is my belief that physicians and clinicians make great leaders if they can develop the necessary competencies, and that more of them who have these competencies are needed.
To be a physician leader, one must be extremely comfortable with the “grey areas” that exist in administration because every decision in health care is not black or white, and the pros and cons must be evaluated in each case to make sure the correct administrative decision is being made. However, physicians have this capability, for we are constantly faced with identifying a list of differential diagnoses for each patient so that we have alternatives to consider if our primary diagnosis proves to be incorrect.
In addition, physicians must be extremely comfortable with change, although for many this is a struggle. However, I believe that most physicians, like myself, have had to learn to utilize new technologies over the years. For example, the open subcostal surgical procedure I did for gallbladder extraction in the past is totally unacceptable today, and if surgeons who trained in my generation could not adapt to this new technology and laproscopic procedure, they actually cannot be practicing in 2007.
And finally, physician leaders must be extremely comfortable with making difficult and tough decisions, particularly if they are in the “grey area” mentioned above. However, once again, I would propose that physicians in their clinical practices are making tough decisions on a quite regular basis.
So, in summary, I do believe that physicians make excellent leaders if they can develop those additional competencies as mentioned, and constantly reflect on the similarities between clinical decision-making and leadership decision-making. It is clear to me that more physician leaders will be sought in the future, because all organizations are putting more emphasis on improving quality of care. Outstanding physicians are well-prepared and best positioned to bring the knowledge of how to accomplish excellent quality to the table.
Second, all organizations like CHRISTUS must eventually go on a journey to excellence similar to the one we have been undertaking for the last eight-and-a-half years. Physician leaders understand the need for a balanced scorecard, which is learned by balancing the patient’s quality of life with his or her quantity of life. Our balanced score card requires us to focus on the simultaneous improvement of four areas: clinical quality, service delivery, business literacy and community value.
Third, excellence must be seen as a necessity, not as a luxury. I believe that physicians understand this, and for the most part, understand each day that they have an awesome responsibility to care for patients’ lives and therefore truly understand what I mean when I say that we have been called to do sacred work.
Fourth, a positive alignment between physicians, hospitals and health systems is key today to overcome the negativity which has been caused by increasing governmental regulations and the polarity of reimbursement between physicians and hospitals. Physicians will listen to many people, but will most intently hear what other physicians are saying, and therefore, physician leaders become critical in this physician alignment process.
Based on the knowledge and understanding garnered from many years as a physician leader, I would reiterate and stress that although non-physicians are key and critical as part of leadership teams, the future of health care will be enhanced if physician leaders can not only increased in number, but can be integrated with present leadership teams to maximize their effectiveness in reaching all the goals which are central to a journey to excellence.
It is clear that the additional knowledge that clinicians--including physicians--bring to the leadership table because of their health care experiences at the bedside or in the exam room is extremely valuable, particularly in determining what creates the best care management outcomes. However, if this knowledge is not combined with the core competencies of leadership, many of which have been discussed in prior blog posts, this knowledge is often worthless. In fact, with clinical expertise often comes an arrogance which is a barrier to good leadership.
Hence, it is my belief that physicians and clinicians make great leaders if they can develop the necessary competencies, and that more of them who have these competencies are needed.
To be a physician leader, one must be extremely comfortable with the “grey areas” that exist in administration because every decision in health care is not black or white, and the pros and cons must be evaluated in each case to make sure the correct administrative decision is being made. However, physicians have this capability, for we are constantly faced with identifying a list of differential diagnoses for each patient so that we have alternatives to consider if our primary diagnosis proves to be incorrect.
In addition, physicians must be extremely comfortable with change, although for many this is a struggle. However, I believe that most physicians, like myself, have had to learn to utilize new technologies over the years. For example, the open subcostal surgical procedure I did for gallbladder extraction in the past is totally unacceptable today, and if surgeons who trained in my generation could not adapt to this new technology and laproscopic procedure, they actually cannot be practicing in 2007.
And finally, physician leaders must be extremely comfortable with making difficult and tough decisions, particularly if they are in the “grey area” mentioned above. However, once again, I would propose that physicians in their clinical practices are making tough decisions on a quite regular basis.
So, in summary, I do believe that physicians make excellent leaders if they can develop those additional competencies as mentioned, and constantly reflect on the similarities between clinical decision-making and leadership decision-making. It is clear to me that more physician leaders will be sought in the future, because all organizations are putting more emphasis on improving quality of care. Outstanding physicians are well-prepared and best positioned to bring the knowledge of how to accomplish excellent quality to the table.
Second, all organizations like CHRISTUS must eventually go on a journey to excellence similar to the one we have been undertaking for the last eight-and-a-half years. Physician leaders understand the need for a balanced scorecard, which is learned by balancing the patient’s quality of life with his or her quantity of life. Our balanced score card requires us to focus on the simultaneous improvement of four areas: clinical quality, service delivery, business literacy and community value.
Third, excellence must be seen as a necessity, not as a luxury. I believe that physicians understand this, and for the most part, understand each day that they have an awesome responsibility to care for patients’ lives and therefore truly understand what I mean when I say that we have been called to do sacred work.
Fourth, a positive alignment between physicians, hospitals and health systems is key today to overcome the negativity which has been caused by increasing governmental regulations and the polarity of reimbursement between physicians and hospitals. Physicians will listen to many people, but will most intently hear what other physicians are saying, and therefore, physician leaders become critical in this physician alignment process.
Based on the knowledge and understanding garnered from many years as a physician leader, I would reiterate and stress that although non-physicians are key and critical as part of leadership teams, the future of health care will be enhanced if physician leaders can not only increased in number, but can be integrated with present leadership teams to maximize their effectiveness in reaching all the goals which are central to a journey to excellence.
Tuesday, November 20, 2007
Giving Thanks
As we approach Thanksgiving, I am sure we are all most thankful for our families and friends, the loved ones who support us each day as we continue on life’s journey. However, for those of us in health care, I am sure that a close second on the list would be our thanks for being called into health care and the ability to serve those in need. However, as in any profession, our work has its share of clouds and sunshine—there are successes and failures, and there are opportunities and challenges. Those of us who work in health care, physicians, nurses, and all the support teams including the people who park our cars, cook our food and keep our patients’ records, we must demonstrate a continuous positive outlook and be resilient when challenges loom ahead.
How do we create this optimistic outlook and the ability to climb the highest mountains and run the most difficult marathons? First and foremost, we must celebrate our incremental victories.
As I have observed the health care industry for over the last 40 years, I have come to believe that health care improvement is never linear, but rather is incremental, with the slowest improvement seen in the earliest part of the initiative. Consequently, frustration can occur when we pause and evaluate just how little progress has been made over an extended period of time. But knowing that a tip-point will be reached when improvement will be accelerated gives one the ability to pause when each incremental improvement is made--however small--to celebrate what I have called the “incremental victory.” It is in this celebration, whether it be a mere thank-you note, an ice cream social, or a pizza party, that our Associates and physicians will find the energy to journey to the next success point on the improvement schedule.
Secondly, our resilience must come from reminding ourselves each day that we are doing sacred work. Our work is not necessarily sacred in the sense of religion, but sacred in the sense that every day, people turn their lives over to us. Knowing that people have put their most precious gift into our hands—the life of their child, mother, etc.— means to me that they must trust us explicitly. This knowledge should energize us and create in us a total commitment to our ministry and to ensuring that every miracle moment that we create for our patients and residents is of the highest quality possible.
Third, we should be creating for our Associates and our physicians the very best place in which to work. This means that we should be providing to the best of our ability, the latest equipment and knowledge to help them carry out their work as effectively and as efficiently as possible. But even more important, we must be hiring and retaining the right Associates and physicians—those who have a strong commitment to our mission, vision and values and who prioritize teamwork over individual performance.
Yes, this Thanksgiving is a time when we can express sincere thanks for being called into the health care profession. We are doing sacred work, we can create incremental victories and we can be a strong member of a team that ensures that the trust which our patients and their families place in us each day is well-deserved. And hopefully, they, too, will be giving thanks that when they needed help, they discovered CHRISTUS and its people.
How do we create this optimistic outlook and the ability to climb the highest mountains and run the most difficult marathons? First and foremost, we must celebrate our incremental victories.
As I have observed the health care industry for over the last 40 years, I have come to believe that health care improvement is never linear, but rather is incremental, with the slowest improvement seen in the earliest part of the initiative. Consequently, frustration can occur when we pause and evaluate just how little progress has been made over an extended period of time. But knowing that a tip-point will be reached when improvement will be accelerated gives one the ability to pause when each incremental improvement is made--however small--to celebrate what I have called the “incremental victory.” It is in this celebration, whether it be a mere thank-you note, an ice cream social, or a pizza party, that our Associates and physicians will find the energy to journey to the next success point on the improvement schedule.
Secondly, our resilience must come from reminding ourselves each day that we are doing sacred work. Our work is not necessarily sacred in the sense of religion, but sacred in the sense that every day, people turn their lives over to us. Knowing that people have put their most precious gift into our hands—the life of their child, mother, etc.— means to me that they must trust us explicitly. This knowledge should energize us and create in us a total commitment to our ministry and to ensuring that every miracle moment that we create for our patients and residents is of the highest quality possible.
Third, we should be creating for our Associates and our physicians the very best place in which to work. This means that we should be providing to the best of our ability, the latest equipment and knowledge to help them carry out their work as effectively and as efficiently as possible. But even more important, we must be hiring and retaining the right Associates and physicians—those who have a strong commitment to our mission, vision and values and who prioritize teamwork over individual performance.
Yes, this Thanksgiving is a time when we can express sincere thanks for being called into the health care profession. We are doing sacred work, we can create incremental victories and we can be a strong member of a team that ensures that the trust which our patients and their families place in us each day is well-deserved. And hopefully, they, too, will be giving thanks that when they needed help, they discovered CHRISTUS and its people.
Wednesday, November 14, 2007
The Role of Partnerships in Health Care Systems
Last week, CHRISTUS Health announced that we have signed a non-binding letter of intent to form a partnership with St. Vincent Regional Medical Center, the largest provider of health care in Santa Fe, N.M. It is our hope that as a result of due diligence, which is presently being performed, that the partnership agreement and the transition to CHRISTUS leadership and management can occur on or before Feb. 1, 2008. For the readers of this blog, this report should probably elicit the following questions: 1.Why would St. Vincent regional medical center want or need a partner? 2.Why would CHRISTUS Health want to enter a new market? 3.Are partnerships rather than total ownership a viable option for expanding health care in the future?
In addressing these questions, let us begin by briefly reviewing an article published in Trustee magazine in September of 2007 entitled, “Standing Alone: Assessing a Hospital’s Long-Term Viability”. This article begins with the statement, “The trend of the past decade is clear: Hospital-health system affiliations are up, and the number of independent community hospitals is down. In 2005, 55 percent of hospitals were part of health systems, up from 46 percent just five years earlier.”
This article continues to indicate that stand-alone hospitals may be challenged because of economic changes occurring in their markets, stronger competitors competing in their markets and, therefore, the challenge of generating sufficient operational margins to support their capital needs. In prior blog posts, we discussed that from our future planning, we learned that declining reimbursement and the need for new, non-invasive technology would be the drivers of the health care of the future. Both of these trends require a new approach to obtaining capital funds. It is this knowledge and understanding that drove the St. Vincent Regional Medical Center board and its leadership to contemplate the need for a partner at a time when they are the sole community provider and are fiscally sound. Their timing is critical, for many stand-alone hospitals wait far too long to review a potentially innovative and new strategic direction, and consequently are often facing significant cash-flow challenges approaching bankruptcy levels. In this wounded state, it is much more difficult to find a viable partner or a workable strategy. Such was the case reported recently with a hospital in New Jersey that has been unsuccessful in obtaining a partner after a two-year search, and have reported that their doors will be closed before the holiday season.
So specifically, St. Vincent Regional Medical Center decided that they needed a partner to ensure that access to appropriate capital would be available in the future, but they also agreed that being part of a larger system would give them exposure to best leadership and management practices and also best practices in regards to quality, service and community health delivery.
By utilizing that criteria, St. Vincent did a national search and determined that CHRISTUS Health was its best partner opportunity. Because the management expertise in CHRISTUS was also deemed as a positive contribution to the partnership, St. Vincent has agreed to sign a management contract with CHRISTUS so that their leadership team will in fact become CHRISTUS Associates and fall under CHRISTUS management.
Once the partnership agreement is signed, I will highlight more specifically our other partnership characteristics in a future blog post to give you a better understanding of one workable model for a partnership in American health care. We will also discuss at that time other partnerships which CHRISTUS has undertaken and do a contrast and comparison of those models along with the full ownership model, which is how we predominately operate throughout our system.
With regard to what’s in it for CHRISTUS, in our strategic planning process over the last 8-and-a-half-years, we have determined that to be an excellent organization, we need to be growing and expanding our ministry through a number of models, not solely through acquisitions. Therefore, we formed a partnership with Baptist St. Anthony’s Health System in Amarillo, Texas in 1998. We followed this with the Mexico partnership with the Muguerza health system in 2000, and hence began a formal partnership journey within our system. To eliminate the need to examine each partnership independently, we developed guidelines for such partnerships as a result of our decision to expand our portfolio to become one-third acute care, one-third non-acute care and one-third international.
For our acute care ventures in the U.S., we have indicated that we will only partner with organizations having the following characteristics:
1. Similar mission, vision and values;
2. Located in organically growing communities (i.e., new populations are entering the community);
3. Surrounded by geographical areas which are in need of expanded health care;
4. Located outside of our present markets, many of which are in the hurricane belt and
5. Markets which have stronger business literacy so that we might have more resources to care for the growing uninsured.
With these criteria in mind, we answered the invitation to begin discussions with St. Vincent, which as indicated, ended in CHRISTUS being chosen as their preferred partner.
With regard to the final question, partnership vs. ownership, regardless of the financial viability of any organization in health care, capital requests and appetites always exceed capital capabilities. Therefore, partnerships permit an organization to expand its ministry--particularly if it provides high-quality care--to new areas while not being required to provide all of the capital itself. So growth with less capital is possible. Hence, introducing partnerships into your expansion portfolio seems appropriate, provided that at the end of the day, your partners look as much like you as possible.
In addressing these questions, let us begin by briefly reviewing an article published in Trustee magazine in September of 2007 entitled, “Standing Alone: Assessing a Hospital’s Long-Term Viability”. This article begins with the statement, “The trend of the past decade is clear: Hospital-health system affiliations are up, and the number of independent community hospitals is down. In 2005, 55 percent of hospitals were part of health systems, up from 46 percent just five years earlier.”
This article continues to indicate that stand-alone hospitals may be challenged because of economic changes occurring in their markets, stronger competitors competing in their markets and, therefore, the challenge of generating sufficient operational margins to support their capital needs. In prior blog posts, we discussed that from our future planning, we learned that declining reimbursement and the need for new, non-invasive technology would be the drivers of the health care of the future. Both of these trends require a new approach to obtaining capital funds. It is this knowledge and understanding that drove the St. Vincent Regional Medical Center board and its leadership to contemplate the need for a partner at a time when they are the sole community provider and are fiscally sound. Their timing is critical, for many stand-alone hospitals wait far too long to review a potentially innovative and new strategic direction, and consequently are often facing significant cash-flow challenges approaching bankruptcy levels. In this wounded state, it is much more difficult to find a viable partner or a workable strategy. Such was the case reported recently with a hospital in New Jersey that has been unsuccessful in obtaining a partner after a two-year search, and have reported that their doors will be closed before the holiday season.
So specifically, St. Vincent Regional Medical Center decided that they needed a partner to ensure that access to appropriate capital would be available in the future, but they also agreed that being part of a larger system would give them exposure to best leadership and management practices and also best practices in regards to quality, service and community health delivery.
By utilizing that criteria, St. Vincent did a national search and determined that CHRISTUS Health was its best partner opportunity. Because the management expertise in CHRISTUS was also deemed as a positive contribution to the partnership, St. Vincent has agreed to sign a management contract with CHRISTUS so that their leadership team will in fact become CHRISTUS Associates and fall under CHRISTUS management.
Once the partnership agreement is signed, I will highlight more specifically our other partnership characteristics in a future blog post to give you a better understanding of one workable model for a partnership in American health care. We will also discuss at that time other partnerships which CHRISTUS has undertaken and do a contrast and comparison of those models along with the full ownership model, which is how we predominately operate throughout our system.
With regard to what’s in it for CHRISTUS, in our strategic planning process over the last 8-and-a-half-years, we have determined that to be an excellent organization, we need to be growing and expanding our ministry through a number of models, not solely through acquisitions. Therefore, we formed a partnership with Baptist St. Anthony’s Health System in Amarillo, Texas in 1998. We followed this with the Mexico partnership with the Muguerza health system in 2000, and hence began a formal partnership journey within our system. To eliminate the need to examine each partnership independently, we developed guidelines for such partnerships as a result of our decision to expand our portfolio to become one-third acute care, one-third non-acute care and one-third international.
For our acute care ventures in the U.S., we have indicated that we will only partner with organizations having the following characteristics:
1. Similar mission, vision and values;
2. Located in organically growing communities (i.e., new populations are entering the community);
3. Surrounded by geographical areas which are in need of expanded health care;
4. Located outside of our present markets, many of which are in the hurricane belt and
5. Markets which have stronger business literacy so that we might have more resources to care for the growing uninsured.
With these criteria in mind, we answered the invitation to begin discussions with St. Vincent, which as indicated, ended in CHRISTUS being chosen as their preferred partner.
With regard to the final question, partnership vs. ownership, regardless of the financial viability of any organization in health care, capital requests and appetites always exceed capital capabilities. Therefore, partnerships permit an organization to expand its ministry--particularly if it provides high-quality care--to new areas while not being required to provide all of the capital itself. So growth with less capital is possible. Hence, introducing partnerships into your expansion portfolio seems appropriate, provided that at the end of the day, your partners look as much like you as possible.
Wednesday, November 7, 2007
Transformational Leadership: Changing Ahead of the Curve
The average life span of Fortune 500 Companies is 40 to 50 years because many do not embrace transformational change ahead of the curve. Organizations that will stand the test of time will require innovative leaders who are able to change ahead of this curve.
This is most important in the health care industry, as more affordable health care will not come from an injection of more funding, but rather from innovations that aim to make more and more areas of care cheaper, simpler and more accessible to our patients.
This will require not only innovation, but resilience as well. Resilience is the ability to bounce back from difficult or challenging experiences, manage pressure and adapt quickly to change while continuing to produce excellent results. Luckily, this trait can be learned and improved over time. I believe the four characteristics of resilient leaders are the abilities to:
1. Accept reality
2. Find meaning in difficult situations
3. Make plans for a better future and
4. Improvise quickly to solve problems
As we prepare to change ahead of the curve, we can no longer benchmark ourselves against our historical progress or our peers, but instead must know our new competitors like technology vendors and retail providers such as CVS, WalMart, etc. We must become increasingly skilled at predicting the toxic side effects of change, and become more comfortable with the controversy change can cause if we are truly to take our appropriate place in the future we are predicting to provide the highest quality care in the most convenient ways possible.
To become truly transformational leaders, we must embrace five key mindsets.
Mindset #1 is maintaining the right balance between market–making and disciplined execution. This is not an either/or, but a both/and mindframe, and will require flawless execution balanced with our future thinking (3 year planning, 10 year plans, our Futures Task Force). To develop this mindset, a leader must avoid false tradeoffs and commit to a dual focus on the present and the future.
Mindset #2 is obsessively identifying and multiplying talent. We must always be on the lookout for new talent and support our leadership training so we continue being a talent multiplier. To develop this mindset, a leader must invest a disproportionate amount of time in recruiting and developing people.
Mindset #3 is the commitment to continuing to use a selective scorecard to measure business performance with rising benchmark scores. We must continue to support total transparency, including our quality data, financial information and community benefit numbers. To develop this mindset, a leader must rely on simple, memorable ways of measuring success and use every occasion to share those success stories across the organization.
Mindset #4 includes continuing to recognize technology as a strategic asset. Our clinical performance, business strategy and IT strategies must converge, and we must carefully and thoughtfully evaluate our adoption of new technologies in a timely manner. To develop this mindset, a leader must invest in technologies that will demonstrably lead to better business performance.
Mindset #5 is an emphasis on continuous renewal and “must haves.” Leaders must be continuously alert for our own competitive softness and vulnerability, always be on the lookout for new market opportunities, demonstrate fierce pride in their organization’s history and articulate its relevance to a rapidly changing future. Storytelling is important to lift spirits, raise expectations and talk about the pain that accompanies change. A leader must put in motion the powerful mindset of continuous renewal so it becomes the self-sustaining engine for innovation and better ideas. To develop this mindset, a leader must ensure that everyone in the organization understands what to preserve in their current way of doing business and what to do away with.
Our greatest challenge as CHRISTUS leaders is that we must get 30,000 full- and part-time Associates and 6,000 physicians, in multiple countries from multiple cultures, to think in similar terms about the purpose of our ministry and what they individually must do to accomplish that purpose and be aligned. We must all share the same mindsets. We must believe nothing is impossible.
This is most important in the health care industry, as more affordable health care will not come from an injection of more funding, but rather from innovations that aim to make more and more areas of care cheaper, simpler and more accessible to our patients.
This will require not only innovation, but resilience as well. Resilience is the ability to bounce back from difficult or challenging experiences, manage pressure and adapt quickly to change while continuing to produce excellent results. Luckily, this trait can be learned and improved over time. I believe the four characteristics of resilient leaders are the abilities to:
1. Accept reality
2. Find meaning in difficult situations
3. Make plans for a better future and
4. Improvise quickly to solve problems
As we prepare to change ahead of the curve, we can no longer benchmark ourselves against our historical progress or our peers, but instead must know our new competitors like technology vendors and retail providers such as CVS, WalMart, etc. We must become increasingly skilled at predicting the toxic side effects of change, and become more comfortable with the controversy change can cause if we are truly to take our appropriate place in the future we are predicting to provide the highest quality care in the most convenient ways possible.
To become truly transformational leaders, we must embrace five key mindsets.
Mindset #1 is maintaining the right balance between market–making and disciplined execution. This is not an either/or, but a both/and mindframe, and will require flawless execution balanced with our future thinking (3 year planning, 10 year plans, our Futures Task Force). To develop this mindset, a leader must avoid false tradeoffs and commit to a dual focus on the present and the future.
Mindset #2 is obsessively identifying and multiplying talent. We must always be on the lookout for new talent and support our leadership training so we continue being a talent multiplier. To develop this mindset, a leader must invest a disproportionate amount of time in recruiting and developing people.
Mindset #3 is the commitment to continuing to use a selective scorecard to measure business performance with rising benchmark scores. We must continue to support total transparency, including our quality data, financial information and community benefit numbers. To develop this mindset, a leader must rely on simple, memorable ways of measuring success and use every occasion to share those success stories across the organization.
Mindset #4 includes continuing to recognize technology as a strategic asset. Our clinical performance, business strategy and IT strategies must converge, and we must carefully and thoughtfully evaluate our adoption of new technologies in a timely manner. To develop this mindset, a leader must invest in technologies that will demonstrably lead to better business performance.
Mindset #5 is an emphasis on continuous renewal and “must haves.” Leaders must be continuously alert for our own competitive softness and vulnerability, always be on the lookout for new market opportunities, demonstrate fierce pride in their organization’s history and articulate its relevance to a rapidly changing future. Storytelling is important to lift spirits, raise expectations and talk about the pain that accompanies change. A leader must put in motion the powerful mindset of continuous renewal so it becomes the self-sustaining engine for innovation and better ideas. To develop this mindset, a leader must ensure that everyone in the organization understands what to preserve in their current way of doing business and what to do away with.
Our greatest challenge as CHRISTUS leaders is that we must get 30,000 full- and part-time Associates and 6,000 physicians, in multiple countries from multiple cultures, to think in similar terms about the purpose of our ministry and what they individually must do to accomplish that purpose and be aligned. We must all share the same mindsets. We must believe nothing is impossible.
Wednesday, October 31, 2007
Passion and vision
As I travel around the CHRISTUS system, and often when I present to other organizations, two questions that I often receive are: 1) how do you become a visionary, and 2) how do you create passion in an organization?
Although the answers to these questions must be filled with artful thinking rather than scientific approaches, they have been asked so frequently that I recently forced myself to reflect on a more meaningful articulation of the answers to give a better understanding of how you incorporate vision and passion into your professional competencies and therefore into the organization which you lead.
Let’s begin with vision. I think many people believe that visionaries are in some ways sprinkled with angel dust so that the future actually becomes real in their dreams. However, for me, vision must come from people who are embedded in the realities of today, having a clear understanding of how today works, so that their predictions for the future are made with this reality in mind (which hopefully will lend credibility to these predictions).
Footed in this clear understanding of today, a visionary then takes the time to look back and ask the question, “What changed from the past, what caused these changes, and hence, what are the results of these changes that made the present look like it is today?”
This knowledge, then, is helpful in determining the similar causal events that will change today to create a predictable future. An example of “visionary thinking” is my belief that numerous diseases will be cured in the next 10 years, and some new diseases will be introduced. I say this because I have watched tuberculosis, polio and nine types of childhood leukemia--which were prevalent 25 years ago--be cured. The causes for these miraculous events were the focus on understanding the infrastructure of medications and how they worked at the cellular level. This knowledge has been magnified at least a million-fold in these 25 years, which guarantees for me that we will more rapidly eradicate present diseases in the future. I am predicting that more childhood leukemias and adult cancers will be cured, and that Alzheimer’s and Parkinson’s disease may in fact be so well controlled that they can be managed much more easily at home or in outpatient settings.
And yes, there will be some new diseases identified. Why do I believe this? When I look back on my 40 years of travel, I can recall that AIDS was not a recognized as a disease for the first 32 years, and Fifth disease, a viral self-limiting disease in children, was never listed in the pediatric text book which was my bible in med school for child care. Today, however, we are all familiar with the prevalence of AIDS, and studies show that 40 to 60 percent of adults worldwide have laboratory evidence of a past infection of Fifth disease.
So what diseases might be identified in the future? I would definitely expect some in the area of infectious disease, and perhaps several new types of cancer that will appear in the very elderly, as we are seeing people living 100 years or more who will have at least 30 years more exposure to environmental contaminants than previous generations.
In addition to understanding the reality of today and the ability to look back and use the past as a barometer of the future, true visionaries who are creating believable and worthwhile visions also are constantly monitoring environmental, social, political and technological trends based on current data. There are an array of articles and organizations that can provide this information, and a true visionary devotes sufficient time to incorporate the learnings from these trends into their predictive processes.
And at the end of the day, I would also have to admit that if you are comfortable as a visionary, you will take some educated guesses and, occasionally, make a prediction which is less sound (but still possible), with the intent of socking your audience so their ears will always be attentive.
Although we have many futurists and visionaries speaking on the national circuit today, my concern is that many of them are not working in health care or have not worked in health care, and hence their predictions of the future are not based on their clear understanding of today and their ability to look back and use their past experience as a strong predictor of the future. The absence of these two competencies gives me less confidence in the visions that they are seeing.
With regard to passion, I consider it the ability to believe in the vision you have created and sign people up to follow you toward this vision. For me, passionate people who are able to create passion in others are—first and foremost—fully knowledgeable regarding the content of the subject they are delivering. They are able to “connect the dots” between everything they have done in the past, are presently doing and planning to do in the future. They are able to provide believable rationale for what they are doing, and they are able to create soundness in their vision by driving it via the pieces that I outlined above.
Clearly the second competency of creating passion is a passionate style of delivery. And although this will vary from person to person and is best done by delivering charismatic, engaging and rapidly-moving speeches on stage, there are many people who are passionate but are uncomfortable with this type of delivery. The common characteristic of a passionate style is delivering your thoughts in such a way that people truly believe that you mean it and somehow feel the passion exuding from every pore in your body. Consistency of presentation, whether it be the hand-waving type or with quiet style, is a key ingredient, because the one thing that causes people to question passion is inconsistency in leadership performance.
And this leads to the final ingredient: people will only believe that you are passionate if you are credible, which in today’s world means that you “walk the talk”: do what you say you are going to do, do it in the timeline to which you have committed and hold yourself accountable to the goals you have set.
If you are to be a visionary and passionate leader, you must work at developing these competencies, devote the time necessary to studying and dreaming about the future, and people must see a halo of vision and passion over your head when they see you coming.
Although the answers to these questions must be filled with artful thinking rather than scientific approaches, they have been asked so frequently that I recently forced myself to reflect on a more meaningful articulation of the answers to give a better understanding of how you incorporate vision and passion into your professional competencies and therefore into the organization which you lead.
Let’s begin with vision. I think many people believe that visionaries are in some ways sprinkled with angel dust so that the future actually becomes real in their dreams. However, for me, vision must come from people who are embedded in the realities of today, having a clear understanding of how today works, so that their predictions for the future are made with this reality in mind (which hopefully will lend credibility to these predictions).
Footed in this clear understanding of today, a visionary then takes the time to look back and ask the question, “What changed from the past, what caused these changes, and hence, what are the results of these changes that made the present look like it is today?”
This knowledge, then, is helpful in determining the similar causal events that will change today to create a predictable future. An example of “visionary thinking” is my belief that numerous diseases will be cured in the next 10 years, and some new diseases will be introduced. I say this because I have watched tuberculosis, polio and nine types of childhood leukemia--which were prevalent 25 years ago--be cured. The causes for these miraculous events were the focus on understanding the infrastructure of medications and how they worked at the cellular level. This knowledge has been magnified at least a million-fold in these 25 years, which guarantees for me that we will more rapidly eradicate present diseases in the future. I am predicting that more childhood leukemias and adult cancers will be cured, and that Alzheimer’s and Parkinson’s disease may in fact be so well controlled that they can be managed much more easily at home or in outpatient settings.
And yes, there will be some new diseases identified. Why do I believe this? When I look back on my 40 years of travel, I can recall that AIDS was not a recognized as a disease for the first 32 years, and Fifth disease, a viral self-limiting disease in children, was never listed in the pediatric text book which was my bible in med school for child care. Today, however, we are all familiar with the prevalence of AIDS, and studies show that 40 to 60 percent of adults worldwide have laboratory evidence of a past infection of Fifth disease.
So what diseases might be identified in the future? I would definitely expect some in the area of infectious disease, and perhaps several new types of cancer that will appear in the very elderly, as we are seeing people living 100 years or more who will have at least 30 years more exposure to environmental contaminants than previous generations.
In addition to understanding the reality of today and the ability to look back and use the past as a barometer of the future, true visionaries who are creating believable and worthwhile visions also are constantly monitoring environmental, social, political and technological trends based on current data. There are an array of articles and organizations that can provide this information, and a true visionary devotes sufficient time to incorporate the learnings from these trends into their predictive processes.
And at the end of the day, I would also have to admit that if you are comfortable as a visionary, you will take some educated guesses and, occasionally, make a prediction which is less sound (but still possible), with the intent of socking your audience so their ears will always be attentive.
Although we have many futurists and visionaries speaking on the national circuit today, my concern is that many of them are not working in health care or have not worked in health care, and hence their predictions of the future are not based on their clear understanding of today and their ability to look back and use their past experience as a strong predictor of the future. The absence of these two competencies gives me less confidence in the visions that they are seeing.
With regard to passion, I consider it the ability to believe in the vision you have created and sign people up to follow you toward this vision. For me, passionate people who are able to create passion in others are—first and foremost—fully knowledgeable regarding the content of the subject they are delivering. They are able to “connect the dots” between everything they have done in the past, are presently doing and planning to do in the future. They are able to provide believable rationale for what they are doing, and they are able to create soundness in their vision by driving it via the pieces that I outlined above.
Clearly the second competency of creating passion is a passionate style of delivery. And although this will vary from person to person and is best done by delivering charismatic, engaging and rapidly-moving speeches on stage, there are many people who are passionate but are uncomfortable with this type of delivery. The common characteristic of a passionate style is delivering your thoughts in such a way that people truly believe that you mean it and somehow feel the passion exuding from every pore in your body. Consistency of presentation, whether it be the hand-waving type or with quiet style, is a key ingredient, because the one thing that causes people to question passion is inconsistency in leadership performance.
And this leads to the final ingredient: people will only believe that you are passionate if you are credible, which in today’s world means that you “walk the talk”: do what you say you are going to do, do it in the timeline to which you have committed and hold yourself accountable to the goals you have set.
If you are to be a visionary and passionate leader, you must work at developing these competencies, devote the time necessary to studying and dreaming about the future, and people must see a halo of vision and passion over your head when they see you coming.
Wednesday, October 24, 2007
Effective Teaming
Although I talked at great length about teaming in my last post, I would like to share some additional thoughts about the qualities of strong teams which I shared with the CHRISTUS Senior Leadership Team as we sat in Chicago waiting to accept our leadership award last week.
It has always been clear to me that teams are grown, rather than born. Consequently, I particularly wish to share with you what I believe has helped to fertilize the growth of our team over the last nine years.
First and foremost, teams must become comfortable with making individual sacrifices for the good of the whole. As we formed CHRISTUS Health and determined that our new location would be in Dallas rather than in Houston or San Antonio (where the two current corporate offices were housed), numerous team members had to make the sacrifice of moving to new geographical areas. For some, the timing was not right because of children’s ages or because they were fully integrated into the communities where they presently lived. In addition, the simultaneous movement of spouses always presents a challenge. But when the decision was made that certain senior team members needed to be in the Dallas office, they voluntarily made the moves and overcame the challenges. In addition, new office space needed to be developed, and because it wasn’t ready immediately when we transitioned to Dallas, we needed to sacrifice and meet in a hotel or other location for an interim period of time. Developing a strong team with a large number of moving parts at the beginning is not always ideal, but yet this was a building block for our strong team’s functioning as we continued our Journey to Excellence.
Secondly, strong teams have to tolerate high anxieties. The original team members were designated as “interim” since they did not know if the new CEO (that is me) would want to continue to support them, nor did they know whether they would want to work for him or her. However, they continued to be very loyal, focused and hard-working as we formed together an outline of what we would need to accomplish in CHRISTUS’ first 60 days. I would like to point out that every member of that original team is still part of the team nine years later.
Third, strong teams need to develop trust—a trust for each other’s judgment, knowledge and commitment to do what we say we are going to do. This trust develops over time and is only enhanced through the years by a team that is strong. Clearly, this may be the hardest competency to develop because we are people with all the characteristics of imperfect human beings. Everything we have done has not turned out perfectly, but our trust in each other is enhanced by debriefing on and learning as much from our failures as our successes.
Next, excellent teams manage transitions well. We have had two COO transitions in the first eight years of our journey, during which I served as the COO for a nine month period in 2000 and a two-and-a-half year period from 2004 to 2006. In August of 2006 we recruited another member of our Senior Leadership Team who fulfills the COO responsibilities. He has transitioned onto our team quickly, becoming a full-fledged member and fully accepted into the organization.
Also, excellent teams are innovative. Once again, our team has demonstrated this in many ways. Some examples of this include our movement into Mexico and our transition of our portfolio to one-third acute, one-third non-acute and one-third international.
Excellent teams must also take risks, and our team’s list of risks would be quite extensive. It would include our willingness to enter international markets as well as our acquisition of the Stehlin Foundation for Cancer Research. Although we were loosely connected with this center before we acquired it (they were located on one of our campuses), we recently became full owners of it, and have, therefore, entered the drug development field. We are taking this risk not because we think it might bring a great financial reward, but because we believe that the Stehlin Foundation has a great possibility of introducing several life-saving drugs for severe cancers that people all over the world now endure. It is important to note that CHRISTUS also took a risk and spent over $20 million in developing the artificial rib for children born with a hemi-thorax in the late 80’s and early 90’s. This apparatus is now FDA-approved and has been touted recently as one of the 20 most significant advances made in the orthopedics in the last 75 years. This serves as just one example of a risk supported by a strong vision which resulted in a life-saving legacy for many people.
Excellent teams also need to know how to “garage sale,” to go through their assets and determine what no longer makes sense for the good of the ministry. Our team has taken this task to heart, and through our eight-and-a-half years, has exited markets and programs, leaving in their places much more innovative ways to provide new and better services in those communities.
Strong teams also plan and manage growth. They are willing to adopt new “children” and assimilate them into their family. We have many new locations and new partnerships which have strengthened the CHRISTUS family through geographical distribution, service expansion and diversity of people.
Resiliency is the next trait that is critical to strong teams. Resilient people remain optimistic during difficult and challenging times, and although they may temporarily find themselves in a valley or on a detour on the journey, they never lose sight of the destination regardless of how high the summit might be. Our Journey to Excellence, although it has be steadily progressing, has had leveling off points where we have gotten stuck in some of our improvement plans, but as a team we have never given up nor lost sight of the end point.
And finally, excellent teams like ours are committed to continuous, life-long learning. We are constantly sharing articles, reviewing journals, pouring over environmental assessments and networking with others to determine the latest trends, technology, etc. As a result, we are developing an innovation institute which will bring together—in a virtual way—all the programs and people necessary to build the future health of care on our successes, one that will serve a greater number of people in a larger number of places, giving them the right care at the right time in the right place.
A strong team is essential for any organization to reach excellent goals, and I hope my last few posts will give you better insight as to what those competencies are required for those teams and how they might be developed.
It has always been clear to me that teams are grown, rather than born. Consequently, I particularly wish to share with you what I believe has helped to fertilize the growth of our team over the last nine years.
First and foremost, teams must become comfortable with making individual sacrifices for the good of the whole. As we formed CHRISTUS Health and determined that our new location would be in Dallas rather than in Houston or San Antonio (where the two current corporate offices were housed), numerous team members had to make the sacrifice of moving to new geographical areas. For some, the timing was not right because of children’s ages or because they were fully integrated into the communities where they presently lived. In addition, the simultaneous movement of spouses always presents a challenge. But when the decision was made that certain senior team members needed to be in the Dallas office, they voluntarily made the moves and overcame the challenges. In addition, new office space needed to be developed, and because it wasn’t ready immediately when we transitioned to Dallas, we needed to sacrifice and meet in a hotel or other location for an interim period of time. Developing a strong team with a large number of moving parts at the beginning is not always ideal, but yet this was a building block for our strong team’s functioning as we continued our Journey to Excellence.
Secondly, strong teams have to tolerate high anxieties. The original team members were designated as “interim” since they did not know if the new CEO (that is me) would want to continue to support them, nor did they know whether they would want to work for him or her. However, they continued to be very loyal, focused and hard-working as we formed together an outline of what we would need to accomplish in CHRISTUS’ first 60 days. I would like to point out that every member of that original team is still part of the team nine years later.
Third, strong teams need to develop trust—a trust for each other’s judgment, knowledge and commitment to do what we say we are going to do. This trust develops over time and is only enhanced through the years by a team that is strong. Clearly, this may be the hardest competency to develop because we are people with all the characteristics of imperfect human beings. Everything we have done has not turned out perfectly, but our trust in each other is enhanced by debriefing on and learning as much from our failures as our successes.
Next, excellent teams manage transitions well. We have had two COO transitions in the first eight years of our journey, during which I served as the COO for a nine month period in 2000 and a two-and-a-half year period from 2004 to 2006. In August of 2006 we recruited another member of our Senior Leadership Team who fulfills the COO responsibilities. He has transitioned onto our team quickly, becoming a full-fledged member and fully accepted into the organization.
Also, excellent teams are innovative. Once again, our team has demonstrated this in many ways. Some examples of this include our movement into Mexico and our transition of our portfolio to one-third acute, one-third non-acute and one-third international.
Excellent teams must also take risks, and our team’s list of risks would be quite extensive. It would include our willingness to enter international markets as well as our acquisition of the Stehlin Foundation for Cancer Research. Although we were loosely connected with this center before we acquired it (they were located on one of our campuses), we recently became full owners of it, and have, therefore, entered the drug development field. We are taking this risk not because we think it might bring a great financial reward, but because we believe that the Stehlin Foundation has a great possibility of introducing several life-saving drugs for severe cancers that people all over the world now endure. It is important to note that CHRISTUS also took a risk and spent over $20 million in developing the artificial rib for children born with a hemi-thorax in the late 80’s and early 90’s. This apparatus is now FDA-approved and has been touted recently as one of the 20 most significant advances made in the orthopedics in the last 75 years. This serves as just one example of a risk supported by a strong vision which resulted in a life-saving legacy for many people.
Excellent teams also need to know how to “garage sale,” to go through their assets and determine what no longer makes sense for the good of the ministry. Our team has taken this task to heart, and through our eight-and-a-half years, has exited markets and programs, leaving in their places much more innovative ways to provide new and better services in those communities.
Strong teams also plan and manage growth. They are willing to adopt new “children” and assimilate them into their family. We have many new locations and new partnerships which have strengthened the CHRISTUS family through geographical distribution, service expansion and diversity of people.
Resiliency is the next trait that is critical to strong teams. Resilient people remain optimistic during difficult and challenging times, and although they may temporarily find themselves in a valley or on a detour on the journey, they never lose sight of the destination regardless of how high the summit might be. Our Journey to Excellence, although it has be steadily progressing, has had leveling off points where we have gotten stuck in some of our improvement plans, but as a team we have never given up nor lost sight of the end point.
And finally, excellent teams like ours are committed to continuous, life-long learning. We are constantly sharing articles, reviewing journals, pouring over environmental assessments and networking with others to determine the latest trends, technology, etc. As a result, we are developing an innovation institute which will bring together—in a virtual way—all the programs and people necessary to build the future health of care on our successes, one that will serve a greater number of people in a larger number of places, giving them the right care at the right time in the right place.
A strong team is essential for any organization to reach excellent goals, and I hope my last few posts will give you better insight as to what those competencies are required for those teams and how they might be developed.
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