The historical model of private health coverage in the U.S. has been to obtain it through your employer. This model doesn’t work anymore. We need a system of care that reflects current culture. The social contract of employment has changed, so health care access needs revision too.

We’re not lifetime employees anymore.

My parents were part of a generation that spent their entire careers with one employer. Company-sponsored health coverage worked well because there was so little movement. Many employers even granted continued coverage in retirement. It is long past time to acknowledge how much this social contract has unraveled. People entering the workforce have a much greater probability of multiple employers while living in many different geographies. Only governmental employees now seem to build long tenures of service.

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The human body is the most brilliant machine ever created and the quintessential work of art. The headline above is not referring to your creativity and accomplishments in your clothing optional private abode; it is taking literary license from 19th century Danish author, Hans Christian Andersen.

Reflect on the fairy tale, The Emperor’s New Clothes. The Emperor (leader) was a vain man, concerned more with appearances, accolades, and maintaining his current position than the harsh realities that others faced. His subjects were afraid to express their honest opinions to him, fearing they might be deemed unfit for their position or even stupid. The climax of this tale occurs when he is fooled by some weavers into wearing a “spectacular new suit” that, in fact, doesn’t exist at all. The Emperor is allowed to parade through the town naked. Finally, a mere child blurts out in honesty that the Emperor is wearing nothing at all.

Leaders at all levels of an organization run the risk of being caught naked at work, but this risk increases as one ascends the ranks. People see pleasing their boss as important, essential to keeping their jobs. Most leaders would proclaim they are wise enough to detect blatant deception, but it is often more subtle than that. Very often what happens is filtering; direct reports present the info that makes them look good and their boss is expecting. This filtering of information is equivalent to a slight degree of course variation which becomes obvious 100 miles or more into the journey.

What would Mr. Andersen say to leaders today?

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The best healthcare boards are dedicated to the success of the organizations and communities they serve, have a sincere hunger to stay up-to-date and informed about industry standards and stay curious about emerging trends. Board members have to be well educated on the issues, well prepared for generative discussions, and be mindful of the interests and concerns of stakeholders. Being a contemporary healthcare board member demands a great deal and, in turn, can provide a rewarding experience.

Boards play a critical role in the long-term success of organizations. In addition to the expected fiduciary responsibilities, healthcare boards are tasked with promoting and embodying the mission and vision of the institution and advocating for its well being while setting aside self-interest. Advocacy includes ongoing education of politicians and civic leaders, fundraising and networking with potential donors, and telling the organization’s “story.” It is imperative that the board builds relationships in the community in order to expand services to meet community needs and partner with other aligned organizations.

The highest functioning boards share similar traits: absolute fiduciary responsibility inclusive of finances, safety, quality and the employee and patient experiences; development, implementation and monitoring of a long-term strategic plan; and establishing leadership goals and monitoring performance compared to the goals. Additionally, most not-for-profit boards are self-perpetuating so a key responsibility for today’s board is selection of new board members. Now more than ever, an important criterion for board member selection should be diversity. In this case, diversity should be considered in the broadest sense.

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Politicians, businessmen, and even housewives ask the questions: “Why is healthcare so complicated? Why can’t it be simpler?”

They even demand: “I need care, tell me the price, and don’t make me wait so long.”

Amazon knows me as a member of Prime and maintains my information securely in the cloud. Amazon knows where I live with my saved data/information and then delivers to my house in three days or even less. They know me. “Why do I have to keep filling out the same paperwork at my hospital every time I arrive? It is my regular appointment with my same doctor and the same office and hospital. Why don’t they know me by now?”

Apple has all those apps I can just download from the app store for service, education, entertainment or every day conveniences.

“If physicians and hospitals are so sophisticated with all their expensive equipment, why can’t I just get an app to simply make an appointment, review my bill and pay utilizing PayPal?”

“I’ll tell you what causes a real headache, trying to pay a bill after a stay at my hospital.”

Finally, “Why can’t I just download my healthcare information and take it with me wherever I go?”

Industry-wide, we providers are internally focused on creating results; too often myopic in our approach. Ongoing comparisons within the healthcare industry are continuous and judicial yet we restrict our world toward outmaneuvering only the local competitors; however, our patients are judging us by the expectations created outside of healthcare through their engagement in the broader world of technology and business.

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In recent weeks Democratic candidates seeking the party’s nomination have given their preferences about how to reform U.S. health care. My experience in over 30 years of community hospital leadership led me to agree with the comments of John Delaney that Medicare-For-All would be a financial disaster for the vast majority of American hospitals. Very few U.S. hospitals have costs at or below Medicare payments.

Yet I don’t agree with Congressman Delaney’s statement that we shouldn’t touch the private health coverage market that covers 100 million Americans because those people will want to keep their coverage. I think there are a great number of Americans in the private coverage spectrum who have been saddled with enormous up-front deductibles and large co-payments and ever-narrowing health provider options who are ready to talk.

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Long term success in life is rarely achieved by perpetual crisis management and the ability to work around the clock to meet a deadline…not that great leaders and successful individuals don’t have that ability and need to deploy it from time to time! One of the keys to sustained success is balance. Balance should not be viewed as a goal that is attained; rather a dynamic state in need of frequent adjustment…like a see-saw.

Plenty has been written about time management and work life balance, each method with its own merits. If you have taken some of this published advice and it has brought you success, don’t change a thing. If you continue to struggle, I urge you to read on.

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In this episode on helping digital startups sell their solutions, I want to focus on the issue of implementation. It is certainly important to have a wiz bang digital solution. Equally important is how to implement the solution and manage the changes it causes. All startups should understand the concerns the hospital C-suite has around the implementation process. Specifically, the startup must be prepared to answer the following:

1. Is the company going to take responsibility for all the administrative hurdles including the IT security approval? Customers want assurance that the company is going to answer all inquiries and assist with completing documentation. Additionally, customers will want the company to track the progress of all approvals and follow up as necessary.
2. Does the company have previous experience with change management? Although the hospital may have a performance improvement team skilled in change management, it is important for the company to have people who also understand this complex process in order to work collaboratively.

Read the full list.

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In my last blog post I discussed the challenges digital health startups face when trying to sell to hospitals and health systems. In this post I suggest some ways to overcome the hurdles and succeed in building a client base.

Startups need to be realistic about where they are in their product life cycle. As I mentioned previously, hospitals are risk adverse with tight budgets. These organizations want proof that your solution is actually going to have the impact you claim. Early on it is beneficial to look at smaller organizations for “proof of concept.” Ambulatory settings, such as ambulatory surgery center or multi-specialty clinics are often good places to alpha and beta test a new solution. These organizations are often nimbler, and as a result, more receptive to innovation. Smaller healthcare settings may present easier access to administrators and clinicians who can help get your solution implemented. Additionally, the information security requirements may be easier to address in smaller settings.

As a startup in healthcare you must understand the economics of the US healthcare system.

There are two key questions you need to answer as you build your business model.

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The pathway to success for digital health startups is challenging. Hospitals are often looked at as the point of entry for digital startups. Trying to work with large hospitals can pose challenges for early stage start-ups for several reasons:

1) Hospitals often are a part of larger systems. As a result, there are multiple layers to the approval process with multiple decision makers prolonging the sales cycle. In my experience as COO of an academic medical center the time from initial interest to contract can exceed two years. Furthermore, complex deployment processes add to the timeline for pilot implementation.

2) Hospitals and health systems have narrow margins. Most hospitals have margins of 2-4%. The Congressional Budget Office has forecasted that up to 50% of hospitals may face negative margins by 2025. There is competition within the budget for both new and replacement capital. Furthermore, there is reluctance to add ongoing new expenses to capital budgets. Read the complete list here.

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This is Part 3B of this three-part series.

Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights.

Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?

Some Questions for Cross-Benefit

Organizational leaders are inclined to plan and motivated to implement. How can leaders apply the individual-based MI change process, especially its relentless focus on the “why,” to better empower others to engage in large-scale challenges?

Organizational leaders and MI counselors are tempted to pursue short-term results over long-term empowerment and are challenged to sustain progress. How can they employ the iterative, escalating scaling process and longer-term, biologic view of SEED-SCALE to advance in a manner that harnesses the human energy of self-direction and local ownership? Read Full Article.

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Good operations is good strategy. Operational excellence. Blocking and tackling. Within health systems, the ongoing importance of good operations should be highlighted as a foundational element of every strategic plan. Good operations is a “no lose” strategy that positions a health system for success regardless of the many external forces providing new challenges. Value-based contracting, risk-sharing and Medicare break even strategies are all dependent on the fundamentals of sound operations. Operational Excellence requires strong and improving performance across a broad spectrum of metrics related to safety and quality, customer service and cost efficiency.

Safety and quality. Our consumers have historically assumed that a healthcare system – especially one with brand recognition – provides a safe environment and good clinical quality. They have had little information to guide decisions related to safety and quality. Health systems must compare performance against top quartile performers and make the changes necessary to achieve this level of achievement consistently. And make the information available to the public in a discernible manner that is meaningful to consumers and motivating to caregivers. Safety and quality must be embedded within any strategic plan.

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Focusing on joy, especially in work, is gaining momentum. It has my attention! It is clear to me that the mindset and habits are exactly what great leaders have and do and what developing leaders should concentrate on.

It is very tempting for any leader, especially those in healthcare, to focus on what’s wrong, what needs to be fixed. It’s time to view the situation through a different lens…we need to focus on the meaning and purpose of our work. This is a distinct advantage for those of us in healthcare, our mission is making peoples lives better. Joy is not in things, it is in US. IHI describes pride in workmanship as a fundamental right; having the connection to meaning and purpose promotes such pride and is the basis of joy.

Take the Joy Quiz.

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This is Part 3A of this three-part series.

Read part 2.

This Part 3A briefly reviews four change methods and Part 3B will compare them

“I have no idea how to change anyone. But I carry around a long list of people in case I ever figure out how.” - Anonymous

Eliminate four billion dollars of waste from a large healthcare system next year. Increase the CMS TPS (Total Performance Score) for a hospital from the national average of 38.1 to 60 in two years. Reduce maternal, child and infant mortality in Nigeria by 50% in three years. These are large-scale improvement goals – at healthcare system, hospital and population health levels, respectively.

Improvement at the community, organization and individual levels are all connected: improvement requires change and all change is personal. An organization is a group of people with a common purpose; and a community is a group of people with the potential for acting together (Taylor). While communities and organizations are made up of individuals, how they evolve and change is not merely an additive process of how each individual changes. Societies and organizations are complex adapting systems and their advancement matures through their disciplined movement.

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“Stand alone” hospital presidents provide a great deal to admire.

I was the lead in a recent strategic retreat and the CEO was incredibly impressive as I watched her interact with her board, her physician leadership and her administrative team. Once again it rekindled my awareness of how small hospital CEOs have to do it all. They are the engaged in the community, lead in the facility, influence the physicians, head Human Resources, know all the staff by name and can even be involved in the revenue cycle, IT and compliance departments. There is very little this CEO isn’t aware of from governmental changes to the one physician or nurse who leaves unexpectedly. There is no cushion. There is no room for error. It is a pure survivability issue. They must know everything and be involved in everything. As they look around them, there are few, if any, people to delegate to within the organization. They have the community depending on them as one of the key employers if not the largest of their city. System CEOs on the other hand have delegation capabilities and can look to corporate for support and capital. While a smaller hospital CEO bears the brunt of this responsibility.

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All leaders will openly admit that they could not do their job without their team. However, as humans, I’d bet that most of them, in a moment of frustration, have thought “it would be easier if I just did it myself.” Why? Because influencing people is a gradual process, not simply a decision with immediate results.

Accepting the reality that no matter how brilliant or hard-working you are, you will always need your team which means you need to learn how to influence them.

Master the following attributes and you will be well on your way.

10 Leadership Traits that Drive the Ability to Influence Teams

Grateful Attitude - As a leader you are always on stage and therefore need to possess and portray a grateful attitude. Start your day with a ritual that grounds you; whether this is prayer, meditation, exercises, reflecting on loved ones, etc. When your day gets tough, reflect on, or re-enact your gratitude ritual.

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This is Part 2 of a three-part series
Read Part 1.

“Help! I need somebody! Help! Not just anybody. Help!” – The Beatles

When a cry for help begs a response, how do we assure that productive help, not just good intention, actually happens?

When faced with failure, what does a responder do? As an expert/advisor, you have a choice: correct the specific failure or strengthen the system (Taylor, Just and Lasting Change). To make this decision, it is critical to discern: is this an event-induced “disaster” – Ebola, Tsunami, Hurricane – or is it a chronic, systematic, or lifestyle-induced failure? In medicine, the difference is how a physician treats a patient with emergency trauma vs a patient with a chronic disease. The global relief vs development challenge has a healthcare leadership parallel: rescue or strengthen.

Why does it matter?

Diagnosis before treatment. This sounds simple, but when immediate relief is needed, the help reflex to correct or fix seems obvious. Yet, the best intended responses vary greatly in their effectiveness. Because often what helps in relief now, hinders development later – having the opposite of the intended effect. When dysfunction occurs, the temptation to intervene with mandated action may be warranted, but it can also compromise an organization’s culture or a community’s ability to evolve. This is a core dynamic of social change if local energies are to be harnessed. Read Full Article.

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The healthcare environment continues to undergo rapid and profound change with mergers, acquisitions and new business models forever changing the landscape of how we lead and deliver healthcare for the next millennium. In my previous article, I discussed the concepts of leading your team through complex problem solving. Today the focus is on you, the leader, how you successfully navigate yourself through new relationships, complex reporting structures and multi-entity healthcare business models.

As leaders in this new matrix and/or multi entity models, we are challenged to rethink our leadership style and model into a much more collaborative and creative approach to be successful. New relationships, business or otherwise require us to lead together, build upon individual and team strengths and become much more resilient to change. In my experience, I’ve had the opportunity to both model and observe what I call best practices when leading in a highly complex and matrix environment:

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There are likely more articles, books, blogs and seminars pertaining to Leadership than any other subject. In addition to our formal education and training as a leader, we have learned leadership traits from mentors, bosses, and other leaders over the years; we’ve learned what aspects of leadership we admire, and consider motivating and successful, AND...WHAT ASPECTS WE DON’T.

As a leader, leadership is not about you. Leadership is about those you serve and support, those you impact around you. I’ve learned over my career that command and control may yield short term gains in performance, and in emergent situations may be needed. However, if the goal is to create and sustain a high performing, forward thinking and dynamic organization and one that attracts the best talent, managing through fear and intimidation will not cut it. Relationships, trust, loyalty and truly caring about people, will build a resilient, loyal, high performing organization. Read Full Article.

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Part 1 of a three-part series

“We cannot solve our problems with the same level of thinking that created them.” ― Albert Einstein

In the U.S., some refer to healthcare system change as an oxymoron. It is complicated. It is hard. And while progress has been made, we have a long way to go.

But if such change in healthcare is challenging in the richest nation, then imagine it in low resource countries. In many sub-Saharan African countries, healthcare must compete with investment in other more impactful determinants of health such as education, food security, and sanitation that, if present, are weakly established. Layer in different governments, languages/dialects, and cultures; include frontier rural locations, tribal influences and religious differences and the challenge to improve health and healthcare in countries such as Tanzania, Madagascar, and Nigeria can feel truly overwhelming.

Historically, the traditional approach to both change in U.S. healthcare and global development has been to identify needs and direct resources, typically money, at the perceived needs. This pattern has resulted in little success and in many cases, regression, harm and/or increased costs. In global development, despite over a trillion dollars channeled to low resource countries in the past two decades, little progress – and often regress – has resulted (Taylor, Empowerment On An Unstable Planet). In U.S. healthcare, it has created and perpetuated a medical industrial system that is three times as expensive as other countries for almost median outcomes. The lesson? Funds are zero sum limited; human energy is not. And the only real empowerment is self-empowerment.

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It happens. The organization is off plan…by a lot; and it is not the first time. More than a modest correction or a “wait until next month.” Many factors were likely involved, but the relentless dynamics of the market have overwhelmed a longstanding management team. It is akin to a cyclist who has slipped back from the peloton due to chronic cadence deficit – and now the gap is widening.

When a leadership change is made while the organization is on plan, it is often political. When an organization is off plan, and a leadership change is NOT made, it is often political (or paralysis). But when performance is off plan and the board and/or corporate office makes a CEO change, what are the key considerations?

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