As we discussed last week, we believe the development of our brand, which is centered around our Journey to Excellence and our commitment to transparency, has propelled the significant growth we’ve had in the system over our decade of existence as CHRISTUS Health.
This growth, of course, has occurred mainly in the two traditional ways that growth happens. Using the analogy of a family, this includes having our own babies (building hospitals, clinics and programs from the ground up), and going into an orphanage and adopting an adolescent (taking on a facility either through management, partnership or ownership which has been in existence for at least 20 years).
The first category, building our own, would recently include CHRISTUS Santa Rosa Westover Hills in San Antonio; CHRISTUS Muguerza Hospital Reynosa in Reynosa, Mexico; CHRISTUS Muguerza Sur in Monterrey, Mexico; the outpatient center at CHRISTUS Hospital - St. Elizabeth in Beaumont, Texas and the new inpatient/outpatient tower at CHRISTUS St. Frances Cabrini in Alexandria, La. Adopting an adolescent has recently played itself out in the acquisition of CHRISTUS Santa Rosa - New Braunfels in New Braunfels, Texas; our management contracts in five communities across the U.S.; our partnership with CHRISTUS St. Vincent Medical Center in Santa Fe, NM and our entire CHRISTUS Muguerza operation.
Although both of these methodologies for growth are extremely positive and beneficial, they likewise have their own set of challenges. When adopting a 16-year-old, you at least know what the last 16 years has created, compared to having a newborn when the next 16 years are extremely unknown. However, with the newborn, you have the advantage of molding the next 16 years, which is like creating new cement, while with the adolescents, you must chip away at the old cement if you wish to put in its place a new behavior.
More specifically, you can compare these two models in four different aspects: First, the amount of orientation you need regarding the system that they are joining. If you are building a new program or facility, this orientation can be slower and can evolve as the structure is being built. However, if you are merging or taking over the management of an older organization, the orientation must be more intense and in real-time.
Second, these models differ in the relationship building skills they require. When you are building something from the ground up, you are usually doing so in proximity to a present region which has a well-established administrative structure. Therefore, the leadership of the new structure can quickly be integrated into the already-established team. If you are acquiring an organization, however, you are dealing with an entire group of people who are not familiar with your history. Therefore, you will need to spend much more time while the partnership is being negotiated to develop strong interpersonal relationships with this team.
Third, building a shared culture is a much different process in each of these models. When building a new program or structure close to an existing regional structure, the culture can be grown as the program/structure is being built, and can be modeled by the team that is already in place. When a long-standing facility or program is being merged into CHRISTUS, the culture must be created within that smaller organization, which is a much more challenging task. This is aided by bringing that leadership team into the CHRISTUS leadership development programs. This process is even further enhanced if CHRISTUS Associates and leaders are willing to move into this older organization and assume leadership there when it is merged into CHRISTUS Health.
And the fourth aspect would be focus of time and energy. Although at first it might seem that it would take less time to acquire a facility or program than build one, it has been our experience that both methods require equal amounts of time and energy. Building a new structure requires focused facility planning, new hiring, ordering supplies and intense tactical planning to make sure that everything and everyone are in the right place for the day of opening. This somewhat compares to the amount of energy that it takes to do the 2 o’clock feeding until a baby reaches approximately one year of age. With the well-established facility, an equal amount of effort is utilized by transitional team meetings and creating extensive plans relating to salary and benefit changes, policy and procedure differences, branding with signage and logos and articulating the CHRISTUS-like processes that are mandated by being part of a larger family.
In essence, growth is an essential part of a vibrant organization, and occurs either by building your own or acquiring and merging with others. CHRISTUS has elected to take both pathways as opportunities became available. It is important to recognize that each of these are beneficial but have a set of challenges which, if understood and addressed appropriately, will create success in either case.
Wednesday, September 24, 2008
Wednesday, September 17, 2008
The Importance of a Strong Brand
As I have previously mentioned, we are in the process of making regional visits both in the U.S. and in Mexico to all of our campuses, facilities and programs to review our progress on our 10-year Journey to Excellence as we approach or 10th anniversary in Feb. of 2009.
During these regional trips, we are reviewing the following in detail:
1. What we have carried through from the prior two organizations that came together to form CHRISTUS Health;
2. What were some intentional strategies which were implemented immediately when CHRISTUS came together in 1999;
3. Where we are on all of our metrics embedded in our Journey to Excellence;
4. The importance of Futures Task Force I during this first 10-year journey and
5. What will the next 10 years potentially look like for CHRISTUS Health?
In this blog post, I would like to discuss the first two issues. I have reviewed where we are on our journey thus far already, and will certainly provide an update on that subject closer to our 10th anniversary in February of next year. We have also reviewed our Futures Task Force I process, and will be sharing with you in more detail what Futures Task Force II recommends in the February 2009 timeframe also.
Because the two organizations that came together to form CHRISTUS were over 133 years old when CHRISTUS was formed, we needed to make sure we reviewed their history and carried forth into those elements which were an important part of their culture. As a result of this review, the mission of these two organizations remains the mission of CHRISTUS Health: to extend the healing ministry of Jesus Christ.
However, as I have recently observed the Associates, patients and residents in a variety of settings in the U.S. and Mexico, it is clear to me that this mission is more vibrant and robust than it was when we began in 1999. We are a much more diverse organization with regard to our ethnicity, gender, age, religion and even talent. Our ecumenical profile has indeed expanded in all these aspects, and it is clear that Jesus would support embracing all people and therefore the direction we have taken. Also, the equality of all people and every individual is embedded in the incarnational spirituality of our founding congregations and their two health systems; consequently, this also supports the ever-expanding profile of the CHRISTUS family as well as the people we serve.
The values of the two prior organizations were also extremely strong, so they were carried forth into CHRISTUS Health with only minor revisions. We added excellence to our core values as well, because as we are taking care of people and their lives, excellence is a necessity and not a luxury. Therefore, excellence must be expressed consistently and constantly in our values, whether verbally or in writing. And more importantly, they must be seen as living behaviors in our activities every day.
Of course, both prior organizations had visions, but when combined, these were not deep enough for CHRISTUS Health. Consequently, by working with our system governing board and leadership team in we created and adopted our present vision statement that indicates we will provide exemplary processes, programs and people in local, regional, national and international communities so that all may experience God’s healing presence.
As I pause and look at these three important foundational elements of CHRISTUS Health, it is my belief that they will continue to be our mission, vision and values long into the future.
So as CHRISTUS Health came together in 1999, undergirded by these 3 profound documents, forming our firm foundation, the Senior Team intentionally did two important things.
First, they committed immediately to the importance of having the CHRISTUS name on all buildings and programs both present and future, and indicated that this would represent our brand. Subsequently, this brand has been developed and is characterized by two important characteristics: our Journey to Excellence, and transparency. Our continuous and nonwavering commitment to having metrics in our four directions to excellence and our willingness to have those available on our website as well as to our internal audience so we can be honest about where we are and committed to action plans to get us where we want to be are the heart and soul of CHRISTUS Health. In fact, as we knew it would be our brand that would cause other people to ask whether or not they could become part of the CHRISTUS organization. It is this brand that has given us the ability to acquire what is now CHRISTUS Santa Rosa - New Braunfels hospital, become partners with St. Vincent Regional Medical Center in New Mexico and expand from two hospitals to seven in Mexico.
It is our brand which causes the state and federal governments to call us periodically to ask us what we think about an issue upon which they are deliberating. It is our brand that is behind the waiting list for people who want to work in various CHRISTUS regions and programs. It is our brand that has caused us to be named in some locations as one of the best places to work. It is the commitment to our brand that has caused us to face the challenges of the last 10 years, to implement the changes that were required to address these challenges and to make the progress that we have made in all four directions to excellence during this 10-year journey.
And it is our brand that has caused hospitals looking for buyers or partners to select us over other bidders that would have paid more and promised more from the for-profit segment of health care.
We are one of the few large international systems that utilizes a system name which is visible on buildings, stationary, vehicles and advertisements and represents the consistencies that are present in all CHRISTUS facilities and programs whether in a rural community a large city, academic program, or school-based clinic. This branding was done intentionally, and we believe has been an essential factor in the building of our culture of excellence and our opportunity for expansion internationally.
However, we also recognized in 1999 that the miracle moments which would improve the health of our patients, residents and their families would not occur in the Dallas system headquarters or within the system logo or brand. Rather, these moments would be created by the members of the CHRISTUS family who are serving in our regions and facilities, and that is why our branding strategy includes the region as well as the local facility or program, i.e., CHRISTUS Santa Rosa Children’s Hospital, CHRISTUS Spohn Health System, CHRISTUS Muguerza High Specialty Hospital.
It is the balance between the system consistencies and the local customization to meet the community needs in our regions and programs that guarantees success for the many, varied communities we serve both in the U.S. and Mexico. It’s the appreciation of the need for this balance that truly has made us successful during this first decade of our journey.
Balancing the consistency throughout all of our regions with the local strategies and tactics has given us the ability to grow from 22,000 Associates to almost 30,000, to grow our net revenue from $3.3 billion to $4.7 billion, to grow our physician family from 6,200 to 6,800, to grow our foundation philanthropy programs from $12 million to almost $30 million and to grow our volunteer numbers from 900 to 1,800.
This growth in and of itself is not important. That is, being big just to be big should never be a goal. But to be able to serve a larger number of people so that the mission, vision and values that we carried forth could be extended to others is. That we are continuing to improve the health and well-being of a greater population is the appropriate outcome.
Growth is important if it is done right, for a non-growing organization often lacks the energy, enthusiasm, optimism and innovation that is required to be filled with a culture of excellence. CHRISTUS Health intentionally carried forth the important items from the past and immediately put forth key strategies which appear to have created the ideal recipe for a successful CHRISTUS Health in its first decade, and hopefully has created the building blocks for strength to go forward into the future.
During these regional trips, we are reviewing the following in detail:
1. What we have carried through from the prior two organizations that came together to form CHRISTUS Health;
2. What were some intentional strategies which were implemented immediately when CHRISTUS came together in 1999;
3. Where we are on all of our metrics embedded in our Journey to Excellence;
4. The importance of Futures Task Force I during this first 10-year journey and
5. What will the next 10 years potentially look like for CHRISTUS Health?
In this blog post, I would like to discuss the first two issues. I have reviewed where we are on our journey thus far already, and will certainly provide an update on that subject closer to our 10th anniversary in February of next year. We have also reviewed our Futures Task Force I process, and will be sharing with you in more detail what Futures Task Force II recommends in the February 2009 timeframe also.
Because the two organizations that came together to form CHRISTUS were over 133 years old when CHRISTUS was formed, we needed to make sure we reviewed their history and carried forth into those elements which were an important part of their culture. As a result of this review, the mission of these two organizations remains the mission of CHRISTUS Health: to extend the healing ministry of Jesus Christ.
However, as I have recently observed the Associates, patients and residents in a variety of settings in the U.S. and Mexico, it is clear to me that this mission is more vibrant and robust than it was when we began in 1999. We are a much more diverse organization with regard to our ethnicity, gender, age, religion and even talent. Our ecumenical profile has indeed expanded in all these aspects, and it is clear that Jesus would support embracing all people and therefore the direction we have taken. Also, the equality of all people and every individual is embedded in the incarnational spirituality of our founding congregations and their two health systems; consequently, this also supports the ever-expanding profile of the CHRISTUS family as well as the people we serve.
The values of the two prior organizations were also extremely strong, so they were carried forth into CHRISTUS Health with only minor revisions. We added excellence to our core values as well, because as we are taking care of people and their lives, excellence is a necessity and not a luxury. Therefore, excellence must be expressed consistently and constantly in our values, whether verbally or in writing. And more importantly, they must be seen as living behaviors in our activities every day.
Of course, both prior organizations had visions, but when combined, these were not deep enough for CHRISTUS Health. Consequently, by working with our system governing board and leadership team in we created and adopted our present vision statement that indicates we will provide exemplary processes, programs and people in local, regional, national and international communities so that all may experience God’s healing presence.
As I pause and look at these three important foundational elements of CHRISTUS Health, it is my belief that they will continue to be our mission, vision and values long into the future.
So as CHRISTUS Health came together in 1999, undergirded by these 3 profound documents, forming our firm foundation, the Senior Team intentionally did two important things.
First, they committed immediately to the importance of having the CHRISTUS name on all buildings and programs both present and future, and indicated that this would represent our brand. Subsequently, this brand has been developed and is characterized by two important characteristics: our Journey to Excellence, and transparency. Our continuous and nonwavering commitment to having metrics in our four directions to excellence and our willingness to have those available on our website as well as to our internal audience so we can be honest about where we are and committed to action plans to get us where we want to be are the heart and soul of CHRISTUS Health. In fact, as we knew it would be our brand that would cause other people to ask whether or not they could become part of the CHRISTUS organization. It is this brand that has given us the ability to acquire what is now CHRISTUS Santa Rosa - New Braunfels hospital, become partners with St. Vincent Regional Medical Center in New Mexico and expand from two hospitals to seven in Mexico.
It is our brand which causes the state and federal governments to call us periodically to ask us what we think about an issue upon which they are deliberating. It is our brand that is behind the waiting list for people who want to work in various CHRISTUS regions and programs. It is our brand that has caused us to be named in some locations as one of the best places to work. It is the commitment to our brand that has caused us to face the challenges of the last 10 years, to implement the changes that were required to address these challenges and to make the progress that we have made in all four directions to excellence during this 10-year journey.
And it is our brand that has caused hospitals looking for buyers or partners to select us over other bidders that would have paid more and promised more from the for-profit segment of health care.
We are one of the few large international systems that utilizes a system name which is visible on buildings, stationary, vehicles and advertisements and represents the consistencies that are present in all CHRISTUS facilities and programs whether in a rural community a large city, academic program, or school-based clinic. This branding was done intentionally, and we believe has been an essential factor in the building of our culture of excellence and our opportunity for expansion internationally.
However, we also recognized in 1999 that the miracle moments which would improve the health of our patients, residents and their families would not occur in the Dallas system headquarters or within the system logo or brand. Rather, these moments would be created by the members of the CHRISTUS family who are serving in our regions and facilities, and that is why our branding strategy includes the region as well as the local facility or program, i.e., CHRISTUS Santa Rosa Children’s Hospital, CHRISTUS Spohn Health System, CHRISTUS Muguerza High Specialty Hospital.
It is the balance between the system consistencies and the local customization to meet the community needs in our regions and programs that guarantees success for the many, varied communities we serve both in the U.S. and Mexico. It’s the appreciation of the need for this balance that truly has made us successful during this first decade of our journey.
Balancing the consistency throughout all of our regions with the local strategies and tactics has given us the ability to grow from 22,000 Associates to almost 30,000, to grow our net revenue from $3.3 billion to $4.7 billion, to grow our physician family from 6,200 to 6,800, to grow our foundation philanthropy programs from $12 million to almost $30 million and to grow our volunteer numbers from 900 to 1,800.
This growth in and of itself is not important. That is, being big just to be big should never be a goal. But to be able to serve a larger number of people so that the mission, vision and values that we carried forth could be extended to others is. That we are continuing to improve the health and well-being of a greater population is the appropriate outcome.
Growth is important if it is done right, for a non-growing organization often lacks the energy, enthusiasm, optimism and innovation that is required to be filled with a culture of excellence. CHRISTUS Health intentionally carried forth the important items from the past and immediately put forth key strategies which appear to have created the ideal recipe for a successful CHRISTUS Health in its first decade, and hopefully has created the building blocks for strength to go forward into the future.
Wednesday, September 10, 2008
Lessons Learned from Hurricane Rita
In the aftermath of Hurricanes Katrina and Rita, CHRISTUS Health leaders were asked to debrief and share learnings of how we could be better prepared to address hurricanes or other natural disasters going forward.
We witnessed many wonderful examples of our Associates simply doing whatever it took to extend the healing ministry of Jesus Christ during the hurricanes and afterward. These incredible efforts involved overcoming challenges of nature, bureaucracy and some of our own processes. Therefore, while our memories were still fresh, we took time to look at what we did right and what we could improve upon. The debriefing work also helped us approach our government advocates regarding storm relief efforts and future planning.
To organize their thoughts, leaders were asked to reflect on 11 areas:
1. General hospital operations and community preparedness
2. Evacuation issues, including staff evacuation
3. Before, during and after storm patient care and transfer, and patient tracking
4. HR and staffing issues, including Associate housing
5. Communication: CHRISTUS internal; CHRISTUS entity and governmental; intergovernmental; public safety
6. National Disaster Medical System (NDMS) and Federal Emergency Management Agency (FEMA) issues
7. Logistics, Materials, Supply and Transportation
8. Financial and Claims: tracking expenses; reimbursement; funding for storm costs; documenting and valuing insurance claims
9. Regulatory issues, including waivers
10. Decision making: authority, leadership at CHRISTUS, local, state and federal levels
11. Public health issues
A hurricane debriefing report was compiled from over 30 sources and comments in an effort to identify commonalities. Based on this report, an extensive planning document that detailed important duties relative to emergency preparedness and the local/regional responsibilities and system responsibilities in response was prepared, and has been very helpful in our ongoing preparations.
We were also able to identify areas that would probably be issues during and after major storms in the future. These included many activities which must be coordinated through other entities (such as state and federal agencies), like transporting patients, power concerns (including securing generators as well as fuel) and transporting necessary supplies to our affected facilities following a storm. In addition, we know that staffing may be a concern, as many of our Associates were ready and willing to come back to work, but unable to return to the area because of blocked or damaged roads. In addition, if the affected area is without power, we must find a way to provide housing, food, etc. to Associates who stay or return immediately following a storm.
In addition, our Risk Management department has also devoted much time to the study of our response to Rita. As a result, we have gathered many resources and materials that have been on hand during the following hurricane seasons and have implemented disaster preparedness training as well as an alert system.
Obviously, in any disaster or large-scale emergency, much of our planning will be rendered ineffective, no matter how well thought-out it may have been. However, it is ultimately the resourcefulness and commitment of our CHRISTUS leaders and Associates that allow us to continue our mission of extending the healing ministry of Jesus Christ even under the most difficult circumstances.
We witnessed many wonderful examples of our Associates simply doing whatever it took to extend the healing ministry of Jesus Christ during the hurricanes and afterward. These incredible efforts involved overcoming challenges of nature, bureaucracy and some of our own processes. Therefore, while our memories were still fresh, we took time to look at what we did right and what we could improve upon. The debriefing work also helped us approach our government advocates regarding storm relief efforts and future planning.
To organize their thoughts, leaders were asked to reflect on 11 areas:
1. General hospital operations and community preparedness
2. Evacuation issues, including staff evacuation
3. Before, during and after storm patient care and transfer, and patient tracking
4. HR and staffing issues, including Associate housing
5. Communication: CHRISTUS internal; CHRISTUS entity and governmental; intergovernmental; public safety
6. National Disaster Medical System (NDMS) and Federal Emergency Management Agency (FEMA) issues
7. Logistics, Materials, Supply and Transportation
8. Financial and Claims: tracking expenses; reimbursement; funding for storm costs; documenting and valuing insurance claims
9. Regulatory issues, including waivers
10. Decision making: authority, leadership at CHRISTUS, local, state and federal levels
11. Public health issues
A hurricane debriefing report was compiled from over 30 sources and comments in an effort to identify commonalities. Based on this report, an extensive planning document that detailed important duties relative to emergency preparedness and the local/regional responsibilities and system responsibilities in response was prepared, and has been very helpful in our ongoing preparations.
We were also able to identify areas that would probably be issues during and after major storms in the future. These included many activities which must be coordinated through other entities (such as state and federal agencies), like transporting patients, power concerns (including securing generators as well as fuel) and transporting necessary supplies to our affected facilities following a storm. In addition, we know that staffing may be a concern, as many of our Associates were ready and willing to come back to work, but unable to return to the area because of blocked or damaged roads. In addition, if the affected area is without power, we must find a way to provide housing, food, etc. to Associates who stay or return immediately following a storm.
In addition, our Risk Management department has also devoted much time to the study of our response to Rita. As a result, we have gathered many resources and materials that have been on hand during the following hurricane seasons and have implemented disaster preparedness training as well as an alert system.
Obviously, in any disaster or large-scale emergency, much of our planning will be rendered ineffective, no matter how well thought-out it may have been. However, it is ultimately the resourcefulness and commitment of our CHRISTUS leaders and Associates that allow us to continue our mission of extending the healing ministry of Jesus Christ even under the most difficult circumstances.
Wednesday, September 3, 2008
Hurricane Gustav: Another Valley
I have recently mentioned CHRISTUS’ experiences at the top of the mountain and the bottom of the valley in a period of two-and-a-half months. On one hand, we successfully separated conjoined twins at CHRISTUS Santa Rosa Children’s Hospital, while on the other we experienced a heparin incident in our NICU at CHRISTUS Spohn South. We talked about the importance of an organization on a Journey to Excellence being able to successfully experience and address those issues in the valley, and through those learnings, gain the knowledge and expertise to move toward the top of the mountain once again.
We predicted that other valleys would present themselves to CHRISTUS Health as we continued our Journey to Excellence for the next 10 years of our history. Indeed, such was the case five days ago when Hurricane Gustav directly aimed itself to several of our hospitals in the Gulf Coast region.
Just as we experienced in Hurricane Rita several years ago, we had to evacuate four of our hospitals in the direct line of the storm: CHRISTUS Hospital - St. Elizabeth in Beaumont, Texas; CHRISTUS Hospital - St. Mary in Port Arthur, Texas; CHRISTUS Jasper Memorial Hospital in Jasper, Texas and CHRISTUS St. Patrick Hospital in Lake Charles, La. In addition, we had to determine the potential consequences of the after-effects of the storm on our hospitals in close proximity, including CHRISTUS St. Frances Cabrini Hospital in Alexandria, La.
Because we are an organization that debriefs after our valley experiences, we learned a great deal from the challenges which Rita presented. Therefore, this time we were much better prepared both at the system and regional level, because our Risk management department has since made efforts to improve our disaster preparedness throughout the U.S.
Consequently, all of our regions, including Mexico and our newest region in New Mexico, participated in system-wide conference calls and made themselves available to take evacuees from the affected regions and to also provide supplies and staff as requested.
The affected regions were able to evacuate their patients smoothly and in an orderly fashion, so when the storm reached its peak, we had few or no patients in the four campuses that were in the line of the storm. However, all of these four campuses agreed to keep their Emergency Departments open and operational so that they could continue to serve their communities.
What leadership skills are necessary and were demonstrated to help us successfully walk through this most recent valley? I believe that there are seven critical skills to highlight.
First, organizational skills. All hurricanes and most other crises in valleys naturally create chaos and disarray. Our leaders demonstrated the ability to minimize this chaos and create plans, next steps and to-do lists which resulted in hour-by-hour plans that accomplished the goals which had been outlined several days before the hurricane hit.
Second, analytical skills. It is clear that every problem or issue during such crises cannot be identified in advance, and our leaders demonstrated their ability to quickly analyze the problem, create a rapid solution and implement it promptly.
Third, team building. Because crises such as hurricanes play out over a prolonged period of time of (often four to six days), one small group of people cannot provide the leadership which is required to come through a crisis successfully. Therefore, the breadth and depth as well as strength of team is vital during this period of time, so that several sub-teams can be assigned to work and then rest, rotating with other teams that will do this in reverse. Great team-building during Gustav was demonstrated throughout the CHRISTUS system, both in the U.S. and internationally.
Fourth, innovation. Unfortunately, during crises, some routine solutions do not address the issue successfully, and therefore the ability of the leadership team to innovatively think of new and potential solutions rapidly is essential. There were many examples of innovation during our recent crisis, including cross-staffing and opening up a daycare center with the faculty from our school-based health centers as two examples.
Fifth, flexibility. Traditional roles and responsibilities often do not suffice and create success during a crisis; therefore, all members of the leadership team must be flexible to do whatever is necessary to address the urgent challenges they face. Clearly, during a crisis in a valley, the responsibility at the end of each of our job descriptions, “other duties as assigned” should probably become the lead responsibility during this period of time.
Sixth, optimism. Walking through valleys like living through hurricane Gustav is a devastating experience under the best circumstances. Often, whatever can go wrong does go wrong, and occasionally even the best thought-out plans to address the issues are not successful. However, if leadership becomes discouraged, they will then become ineffective, and all the best-laid plans will quickly deteriorate, adding to the general chaos mentioned above. Consequently, a leader must make sure at all times--particularly when seen publicly or making public announcements--that optimism is visible or embraced in the words used in both verbal and written communications. This is of course helped by rotating schedules so that excessive exhaustion is avoided, and is also aided by celebrating the incremental victories as these crises unfold. That is, making sure the successes are communicated as widely as the challenges. We have discussed celebrating incremental victories in the past as necessary to re-energize leadership to move to the top of the mountain, and this is never more important than when one is in the valley.
Seventh, resilience. After several days of in being in the midst of a crisis, the team will often find themselves “hitting a wall,” much like a runner experiences in the 21st mile of a marathon. Unfortunately, crises are often not over when the wall is in sight, and therefore leadership must find the resiliency they need to continue the journey with the strength and energy that is required. Resilience was seen continuously during our recent experience, as our system and regional leadership teams were fully present and enthusiastically participated in our regular conference calls.
As we have discussed in the past, leadership skills and competencies are essential if an organization is to reach excellence and sustain themselves at the top of the mountain. But in reality, these skills are even more important as one’s organization is experiencing a walk through the valley.
We predicted that other valleys would present themselves to CHRISTUS Health as we continued our Journey to Excellence for the next 10 years of our history. Indeed, such was the case five days ago when Hurricane Gustav directly aimed itself to several of our hospitals in the Gulf Coast region.
Just as we experienced in Hurricane Rita several years ago, we had to evacuate four of our hospitals in the direct line of the storm: CHRISTUS Hospital - St. Elizabeth in Beaumont, Texas; CHRISTUS Hospital - St. Mary in Port Arthur, Texas; CHRISTUS Jasper Memorial Hospital in Jasper, Texas and CHRISTUS St. Patrick Hospital in Lake Charles, La. In addition, we had to determine the potential consequences of the after-effects of the storm on our hospitals in close proximity, including CHRISTUS St. Frances Cabrini Hospital in Alexandria, La.
Because we are an organization that debriefs after our valley experiences, we learned a great deal from the challenges which Rita presented. Therefore, this time we were much better prepared both at the system and regional level, because our Risk management department has since made efforts to improve our disaster preparedness throughout the U.S.
Consequently, all of our regions, including Mexico and our newest region in New Mexico, participated in system-wide conference calls and made themselves available to take evacuees from the affected regions and to also provide supplies and staff as requested.
The affected regions were able to evacuate their patients smoothly and in an orderly fashion, so when the storm reached its peak, we had few or no patients in the four campuses that were in the line of the storm. However, all of these four campuses agreed to keep their Emergency Departments open and operational so that they could continue to serve their communities.
What leadership skills are necessary and were demonstrated to help us successfully walk through this most recent valley? I believe that there are seven critical skills to highlight.
First, organizational skills. All hurricanes and most other crises in valleys naturally create chaos and disarray. Our leaders demonstrated the ability to minimize this chaos and create plans, next steps and to-do lists which resulted in hour-by-hour plans that accomplished the goals which had been outlined several days before the hurricane hit.
Second, analytical skills. It is clear that every problem or issue during such crises cannot be identified in advance, and our leaders demonstrated their ability to quickly analyze the problem, create a rapid solution and implement it promptly.
Third, team building. Because crises such as hurricanes play out over a prolonged period of time of (often four to six days), one small group of people cannot provide the leadership which is required to come through a crisis successfully. Therefore, the breadth and depth as well as strength of team is vital during this period of time, so that several sub-teams can be assigned to work and then rest, rotating with other teams that will do this in reverse. Great team-building during Gustav was demonstrated throughout the CHRISTUS system, both in the U.S. and internationally.
Fourth, innovation. Unfortunately, during crises, some routine solutions do not address the issue successfully, and therefore the ability of the leadership team to innovatively think of new and potential solutions rapidly is essential. There were many examples of innovation during our recent crisis, including cross-staffing and opening up a daycare center with the faculty from our school-based health centers as two examples.
Fifth, flexibility. Traditional roles and responsibilities often do not suffice and create success during a crisis; therefore, all members of the leadership team must be flexible to do whatever is necessary to address the urgent challenges they face. Clearly, during a crisis in a valley, the responsibility at the end of each of our job descriptions, “other duties as assigned” should probably become the lead responsibility during this period of time.
Sixth, optimism. Walking through valleys like living through hurricane Gustav is a devastating experience under the best circumstances. Often, whatever can go wrong does go wrong, and occasionally even the best thought-out plans to address the issues are not successful. However, if leadership becomes discouraged, they will then become ineffective, and all the best-laid plans will quickly deteriorate, adding to the general chaos mentioned above. Consequently, a leader must make sure at all times--particularly when seen publicly or making public announcements--that optimism is visible or embraced in the words used in both verbal and written communications. This is of course helped by rotating schedules so that excessive exhaustion is avoided, and is also aided by celebrating the incremental victories as these crises unfold. That is, making sure the successes are communicated as widely as the challenges. We have discussed celebrating incremental victories in the past as necessary to re-energize leadership to move to the top of the mountain, and this is never more important than when one is in the valley.
Seventh, resilience. After several days of in being in the midst of a crisis, the team will often find themselves “hitting a wall,” much like a runner experiences in the 21st mile of a marathon. Unfortunately, crises are often not over when the wall is in sight, and therefore leadership must find the resiliency they need to continue the journey with the strength and energy that is required. Resilience was seen continuously during our recent experience, as our system and regional leadership teams were fully present and enthusiastically participated in our regular conference calls.
As we have discussed in the past, leadership skills and competencies are essential if an organization is to reach excellence and sustain themselves at the top of the mountain. But in reality, these skills are even more important as one’s organization is experiencing a walk through the valley.
Wednesday, August 27, 2008
The Mountains and Valleys of Leadership
In a recent blog post, I discussed the implications of the mountain and valley that CHRISTUS Health experienced recently with regard to the separation of conjoined twins at CHRISTUS Santa Rosa Children’s Hospital and the heparin incident in our NICU at CHRISTUS Spohn South. In that post, I talked about the leadership requirements necessary to travel over mountains and into valleys.
The importance of this discussion was indeed re-emphasized to me on my visit to our Texarkana region recently. At our Touchstone awards in 2006, we presented a Leadership award to the Texarkana team because they had reached all their excellence goals for several years and had demonstrated that they knew how to sustain excellence in all four of our directions on our Journey to Excellence. (This was the first and only time we have presented this award to a team of regional leaders.) The Senior Leadership Team at CHRISTUS talked about them frequently, indicating that by improving clinical quality and service delivery while maintaining a strong emphasis on community value, they had proven that they could create business literacy throughout their region. We even said they had “cracked the code,” and we published several papers based on their performance.
However, as they moved through FY07, they had some major challenges, particularly with their business literacy, and therefore lost focus on their clinical and service measurements, causing their metrics to decrease. This obviously caused us to pause and ask the question, “Did they really deserve the Leadership award in 2006?” Did we think they had some of the right qualities for being an outstanding leadership team, but in fact were they missing some of the more important ingredients which we failed to notice?
These questions deserved and have received much reflection, because we as the Senior Leadership Team, the coaches and mentors of these regional leaders and many of the future leaders of CHRISTUS Health, must make sure that we are teaching the right leadership competencies to be successful not only today, but long into the future.
When I visited this region recently and specifically spoke about their successes in FY08, it was clear to us all that we had made the right decision in giving them the first and only Leadership award, because as a result of their outcome metrics in 2008, they are now once again the best region of the 13 in CHRISTUS with regard to our directions to excellence. They have demonstrated that an excellent team is able to reach the mountaintop, but can, if faced with a perfect storm, find themselves in a valley. When they find themselves in this valley, they can quickly reenergize themselves, develop and implement corrective action plans and move forward out of the valley to the mountaintop once again.
This team has demonstrated the resilience, the optimism, the strong integrated teamwork and the intense focus that is required to journey from the valley to the mountaintop once again. These are necessary in addition to the traditional competencies of financial knowledge, conflict management, strategic planning and others which are essential to be designated as an excellent team. These are the qualities that must be learned by all present and future leaders in health care both in the U.S. and internationally. These are the qualities that must be taught in our Masters of Health Care Administration programs and must be role modeled and be re-emphasized throughout CHRISTUS, including through our mentoring programs. These qualities need to be identified in the applicants for our management excellence and leadership academy trainees as we prepare the future leaders to succeed us in this future health system.
In summary, we were right. The Texarkana team had those qualities and deserved the Leadership award. And more importantly, they never lost those qualities when they found themselves in the valley.
The importance of this discussion was indeed re-emphasized to me on my visit to our Texarkana region recently. At our Touchstone awards in 2006, we presented a Leadership award to the Texarkana team because they had reached all their excellence goals for several years and had demonstrated that they knew how to sustain excellence in all four of our directions on our Journey to Excellence. (This was the first and only time we have presented this award to a team of regional leaders.) The Senior Leadership Team at CHRISTUS talked about them frequently, indicating that by improving clinical quality and service delivery while maintaining a strong emphasis on community value, they had proven that they could create business literacy throughout their region. We even said they had “cracked the code,” and we published several papers based on their performance.
However, as they moved through FY07, they had some major challenges, particularly with their business literacy, and therefore lost focus on their clinical and service measurements, causing their metrics to decrease. This obviously caused us to pause and ask the question, “Did they really deserve the Leadership award in 2006?” Did we think they had some of the right qualities for being an outstanding leadership team, but in fact were they missing some of the more important ingredients which we failed to notice?
These questions deserved and have received much reflection, because we as the Senior Leadership Team, the coaches and mentors of these regional leaders and many of the future leaders of CHRISTUS Health, must make sure that we are teaching the right leadership competencies to be successful not only today, but long into the future.
When I visited this region recently and specifically spoke about their successes in FY08, it was clear to us all that we had made the right decision in giving them the first and only Leadership award, because as a result of their outcome metrics in 2008, they are now once again the best region of the 13 in CHRISTUS with regard to our directions to excellence. They have demonstrated that an excellent team is able to reach the mountaintop, but can, if faced with a perfect storm, find themselves in a valley. When they find themselves in this valley, they can quickly reenergize themselves, develop and implement corrective action plans and move forward out of the valley to the mountaintop once again.
This team has demonstrated the resilience, the optimism, the strong integrated teamwork and the intense focus that is required to journey from the valley to the mountaintop once again. These are necessary in addition to the traditional competencies of financial knowledge, conflict management, strategic planning and others which are essential to be designated as an excellent team. These are the qualities that must be learned by all present and future leaders in health care both in the U.S. and internationally. These are the qualities that must be taught in our Masters of Health Care Administration programs and must be role modeled and be re-emphasized throughout CHRISTUS, including through our mentoring programs. These qualities need to be identified in the applicants for our management excellence and leadership academy trainees as we prepare the future leaders to succeed us in this future health system.
In summary, we were right. The Texarkana team had those qualities and deserved the Leadership award. And more importantly, they never lost those qualities when they found themselves in the valley.
Wednesday, August 20, 2008
The Value of Relationships
Having completed visits to six of the CHRISTUS Health regions as part of our plan to spend time in every region, site and business unit both in the U.S. and internationally as we move toward our 10th anniversary, I have been reflecting on the value of relationships in creating a culture of excellence in an organization.
In these last 10 years, before each trip to a facility or program the senior team has asked the question, “Are we doing the right thing by taking the time of the local leaders to facilitate our visits?”
We questioned whether they had more important things to do than planning an agenda for our visit, which obviously involves the time and efforts of members of their teams. And as much as we would hope they would not make special preparations, we always know that they will be made, and we will be fed well during our visits. Obviously, this is not only a time but an expense issue as well. So is it really worthwhile?
During these visits--as we have done in the past--we instruct the local teams to utilize our time as effectively as possible, making sure they know we are available as early as 6 a.m. and want to fill our day completely until 9 or 10 at night. We ask them to make sure that as we come to give our updates, they create forums for us to reach as many Associates, board members (both governance and foundation), physicians (including medical leadership) and volunteers as possible. For our visits over the last two months, they have done just that. In our most recent regional visit, I had the opportunity to interact with over 2,500 Associates, 12 governance board members, 20 foundation board members, 30 members of their medical staff and over 200 volunteers. I was amazed at the attendance at the various forums, the attentiveness during my presentations, the thoughtfulness of the questions posed during the dialogues and the constant comments by many of how beneficial these interactions were.
These comments included:
* “I can’t believe you spent the time to come and visit us.”
* “I cannot believe that you know our journey so well that you can speak to it without looking at notes.”
* “We are truly appreciative of having a better knowledge of what the entire CHRISTUS system is doing.”
* “It is great to understand how we as a department, business unit or clinical service fit into the regional strategies and how that strategy then fits into CHRISTUS Health system strategy.”
* “We are so proud of being part of the CHRISTUS family because we now know better what other family members are doing, particularly as you shared the stories of Santa Rosa and Spohn as being at the top of the mountain and in the valley in the last several weeks as well as the work occurring in the CHRISTUS Stehlin Foundation in Houston.”
* “We are pleased to see your passion and enthusiasm, which gives us the energy and the focus we need to continue the Journey to Excellence in our specific areas.”
In the past, if you asked many CEOs in health care what their major role in their organization was, they would tell you it was to be the external face of the health care system. That would mean that they thought most of their time should be spent in Washington, at the state government, attending national and state association meetings and addressing local groups such as Rotary and Lions clubs regarding the status of the health care system they were leading.
Although these external activities are still important today, with the challenges we are facing in health care, it is my belief that much more attention must be placed on creating the internal face of the leadership team for all the Associates, physicians and volunteers who are part of the CHRISTUS family. It is clear to me that the Journey to Excellence is only attained if the people believe and work in a culture of excellence. And it is more clear to me than ever after six of these regional meetings that the culture of excellence can only be created, energized and sustained if the CEO and the leadership team are there to speak to it and to demonstrate by behavior that it is a way of life in CHRISTUS Health and not a mission, vision and value statement framed on a wall or embedded in a series of policies in a book that is rarely read by anyone.
We all know at CHRISTUS that these trips take an enormous amount of time and effort on the part of the leadership team, the communications team who plans the agenda and the local leadership team who carries out the implementation. But at the end of each trip, the value of these efforts are reinforced and remind us that although we might believe that our greatest asset in health care and particularly in CHRISTUS Health may be the $4.7 billion we have on our balance sheet which represents the amount of buildings and technologies that we own and operate, in reality our greatest asset is our people. And people are motivated by people who have developed relationships with them and who demonstrate by the way they walk and talk that they are committed to excellence. This can only be transmitted by face-to-face forums through these regional visits, and must be seen as one of the most important things we do. So often we attempt to resolve crises in health care quickly and efficiently and fail because we have not established the appropriate culture or relationships prior to the occurrence of the crisis.
The challenges in health care are great and the changes we must make to address these challenges are even greater, but at the end of the day, if we expect to make the progress necessary to provide excellence for every person who comes through our doors, we must believe that relationships and the culture of excellence that comes from them is the essential ingredient to be sure that our people create an excellent environment in both clinical and quality services so that the care that is rendered is worthy of the CHRISTUS brand.
In these last 10 years, before each trip to a facility or program the senior team has asked the question, “Are we doing the right thing by taking the time of the local leaders to facilitate our visits?”
We questioned whether they had more important things to do than planning an agenda for our visit, which obviously involves the time and efforts of members of their teams. And as much as we would hope they would not make special preparations, we always know that they will be made, and we will be fed well during our visits. Obviously, this is not only a time but an expense issue as well. So is it really worthwhile?
During these visits--as we have done in the past--we instruct the local teams to utilize our time as effectively as possible, making sure they know we are available as early as 6 a.m. and want to fill our day completely until 9 or 10 at night. We ask them to make sure that as we come to give our updates, they create forums for us to reach as many Associates, board members (both governance and foundation), physicians (including medical leadership) and volunteers as possible. For our visits over the last two months, they have done just that. In our most recent regional visit, I had the opportunity to interact with over 2,500 Associates, 12 governance board members, 20 foundation board members, 30 members of their medical staff and over 200 volunteers. I was amazed at the attendance at the various forums, the attentiveness during my presentations, the thoughtfulness of the questions posed during the dialogues and the constant comments by many of how beneficial these interactions were.
These comments included:
* “I can’t believe you spent the time to come and visit us.”
* “I cannot believe that you know our journey so well that you can speak to it without looking at notes.”
* “We are truly appreciative of having a better knowledge of what the entire CHRISTUS system is doing.”
* “It is great to understand how we as a department, business unit or clinical service fit into the regional strategies and how that strategy then fits into CHRISTUS Health system strategy.”
* “We are so proud of being part of the CHRISTUS family because we now know better what other family members are doing, particularly as you shared the stories of Santa Rosa and Spohn as being at the top of the mountain and in the valley in the last several weeks as well as the work occurring in the CHRISTUS Stehlin Foundation in Houston.”
* “We are pleased to see your passion and enthusiasm, which gives us the energy and the focus we need to continue the Journey to Excellence in our specific areas.”
In the past, if you asked many CEOs in health care what their major role in their organization was, they would tell you it was to be the external face of the health care system. That would mean that they thought most of their time should be spent in Washington, at the state government, attending national and state association meetings and addressing local groups such as Rotary and Lions clubs regarding the status of the health care system they were leading.
Although these external activities are still important today, with the challenges we are facing in health care, it is my belief that much more attention must be placed on creating the internal face of the leadership team for all the Associates, physicians and volunteers who are part of the CHRISTUS family. It is clear to me that the Journey to Excellence is only attained if the people believe and work in a culture of excellence. And it is more clear to me than ever after six of these regional meetings that the culture of excellence can only be created, energized and sustained if the CEO and the leadership team are there to speak to it and to demonstrate by behavior that it is a way of life in CHRISTUS Health and not a mission, vision and value statement framed on a wall or embedded in a series of policies in a book that is rarely read by anyone.
We all know at CHRISTUS that these trips take an enormous amount of time and effort on the part of the leadership team, the communications team who plans the agenda and the local leadership team who carries out the implementation. But at the end of each trip, the value of these efforts are reinforced and remind us that although we might believe that our greatest asset in health care and particularly in CHRISTUS Health may be the $4.7 billion we have on our balance sheet which represents the amount of buildings and technologies that we own and operate, in reality our greatest asset is our people. And people are motivated by people who have developed relationships with them and who demonstrate by the way they walk and talk that they are committed to excellence. This can only be transmitted by face-to-face forums through these regional visits, and must be seen as one of the most important things we do. So often we attempt to resolve crises in health care quickly and efficiently and fail because we have not established the appropriate culture or relationships prior to the occurrence of the crisis.
The challenges in health care are great and the changes we must make to address these challenges are even greater, but at the end of the day, if we expect to make the progress necessary to provide excellence for every person who comes through our doors, we must believe that relationships and the culture of excellence that comes from them is the essential ingredient to be sure that our people create an excellent environment in both clinical and quality services so that the care that is rendered is worthy of the CHRISTUS brand.
Wednesday, August 13, 2008
Competition and Collaboration
I’m sure that many of you have read the recent article published by the American Hospital Association in which they predict that 1,200 of the 5,200 hospitals in America will most likely go bankrupt in 2009. One would expect our first response to that news to be elation, in that some of these hospitals may be in our markets and this would eliminate our competition and make our Journey to Excellence easier.
However, this first impression may not, in reality, be the ultimate effect of these closures. In CHRISTUS Health, we are living out this experience in real-time as hospitals in two of our regions in the U.S. have announced bankruptcy, and one of the two is being auctioned off in the next several weeks.
Obviously, during this period of time, the institutions are rapidly downsizing their census, and many of their patients are being seen in our facilities. But because both of these hospitals are in two of our most challenged regions where the number of uninsured or underinsured is extremely high, the shift of patients to our facilities is not paralleling a significant rise in collectible revenue, but is increasing our expenses significantly. Consequently, these closures are ultimately having a negative effect on our bottom line. It seems that this scenario will be the most likely one playing out in all of the markets where these bankruptcies may occur, given that bankruptcies are most likely to take place in challenging markets that have a higher-than-average number of uninsured and therefore a large bad debt.
If, then, our response is not elation and we expect negative results, what should our response be? First and foremost, in good times and bad, we should always work to develop open communication with our competitor to make sure we are meeting the needs of the community in the best possible way. In fact, if collaborative planning was always a high priority for health care delivery systems, perhaps the appropriate services could be separated into each of the facilities in a community, preventing unnecessary duplication and causing each hospital to be much more profitable or at least to absorb fewer losses. Unfortunately, most economists and governmental officials in the U.S. seem to believe that a competitive model that works in other industries will successfully work in health care, which is truly a service industry open 24 hours a day, 365 days a year, where all those who seek treatment must be served (at least for emergencies).
Unfortunately, because of the highly regulated nature of health care, the fact that the majority of our payments are provided by the cumbersome governmental entities of Medicare and Medicaid and the polarity between physicians/providers and hospitals/health systems, theories from Economics 101 have never and will never work. In fact, the competitive nature that has resulted between different providers in the same community all over the country has caused an extreme duplication of services and technology, which ultimately do not create profitable product lines and may even result in the overuse of treatments and procedures.
Although we offered to collaborate with the hospitals in the two regions I mentioned above, our offers to have those conversations were never accepted, and the resulting outcomes are evident. Therefore, we are now faced with the closure of these hospitals, and must determine the best way to quickly absorb an increased number of patients and hopefully develop efficiencies and effective processes to do this in a way that will minimize our losses and eventually produce business stability along with these increasing volumes.
But because this cannot be done in a proactive way over a defined period of time, but rather has to be done in reaction to a crisis, bankruptcy or foreclosure, often the initial solutions create short-term challenges which require significant effort to turn into positive values in the long-term.
The reality is that what might seem like a joyous occasion initially actually becomes a significant issue and often a burden when the realities of the situation are fully understood. So as we stand here in this moment in time, it would be best to reflect upon the best ways to prevent these foreclosures and bankruptcies from occurring, rather than being forced to stand idly by while the additional nearly 1,200 closings occur.
However, this first impression may not, in reality, be the ultimate effect of these closures. In CHRISTUS Health, we are living out this experience in real-time as hospitals in two of our regions in the U.S. have announced bankruptcy, and one of the two is being auctioned off in the next several weeks.
Obviously, during this period of time, the institutions are rapidly downsizing their census, and many of their patients are being seen in our facilities. But because both of these hospitals are in two of our most challenged regions where the number of uninsured or underinsured is extremely high, the shift of patients to our facilities is not paralleling a significant rise in collectible revenue, but is increasing our expenses significantly. Consequently, these closures are ultimately having a negative effect on our bottom line. It seems that this scenario will be the most likely one playing out in all of the markets where these bankruptcies may occur, given that bankruptcies are most likely to take place in challenging markets that have a higher-than-average number of uninsured and therefore a large bad debt.
If, then, our response is not elation and we expect negative results, what should our response be? First and foremost, in good times and bad, we should always work to develop open communication with our competitor to make sure we are meeting the needs of the community in the best possible way. In fact, if collaborative planning was always a high priority for health care delivery systems, perhaps the appropriate services could be separated into each of the facilities in a community, preventing unnecessary duplication and causing each hospital to be much more profitable or at least to absorb fewer losses. Unfortunately, most economists and governmental officials in the U.S. seem to believe that a competitive model that works in other industries will successfully work in health care, which is truly a service industry open 24 hours a day, 365 days a year, where all those who seek treatment must be served (at least for emergencies).
Unfortunately, because of the highly regulated nature of health care, the fact that the majority of our payments are provided by the cumbersome governmental entities of Medicare and Medicaid and the polarity between physicians/providers and hospitals/health systems, theories from Economics 101 have never and will never work. In fact, the competitive nature that has resulted between different providers in the same community all over the country has caused an extreme duplication of services and technology, which ultimately do not create profitable product lines and may even result in the overuse of treatments and procedures.
Although we offered to collaborate with the hospitals in the two regions I mentioned above, our offers to have those conversations were never accepted, and the resulting outcomes are evident. Therefore, we are now faced with the closure of these hospitals, and must determine the best way to quickly absorb an increased number of patients and hopefully develop efficiencies and effective processes to do this in a way that will minimize our losses and eventually produce business stability along with these increasing volumes.
But because this cannot be done in a proactive way over a defined period of time, but rather has to be done in reaction to a crisis, bankruptcy or foreclosure, often the initial solutions create short-term challenges which require significant effort to turn into positive values in the long-term.
The reality is that what might seem like a joyous occasion initially actually becomes a significant issue and often a burden when the realities of the situation are fully understood. So as we stand here in this moment in time, it would be best to reflect upon the best ways to prevent these foreclosures and bankruptcies from occurring, rather than being forced to stand idly by while the additional nearly 1,200 closings occur.
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