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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“The obstacle is the path” is a Zen proverb that tells us that obstacles are the key to success.

Sometimes the only way out is through. The key to overcoming adversity is at times simple perseverance. Winston Churchill said, “If you’re going through hell, keep going.” Churchill was surrounded by people who, early in World War II, wanted him to give in to Hitler. He would not surrender. If he had, the world would be a very different place today.

Adversity gives us strength. Great athletes must challenge their bodies to develop the strength, skill and agility needed to excel. My mother is fond of quoting Ralph Waldo Emerson who said, “That which we persist in doing becomes easier, not that the nature of the task has changed, but our ability to do has increased.” The Russians are the masters of extended times in space. These cosmonauts were able to spend many months in the apparent weightlessness of space free of the constraints of gravity, but when they landed on the steppes of Kazakhstan, they had to be carried away on stretchers. They had lost so much bone and muscle mass that they could no longer stand.

In entrepreneurship, we are taught that the key to innovation is the “pain”. The pain is the problem that your innovation solves. If there is no pain, no problem, then there is no need for your innovation. Many entrepreneurs developed innovations that made them very successful when they found that the marketplace did not offer a solution to their own problem. They knew that others would value their solution if available so they offered a product or service to solve the same problem for others. Read Full Article.

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Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.

Despite asserting to my Dad, in my youth, the growing impact of technology, e.g., pilotless planes, long-range capabilities, etc., he remained convicted of the mantra “the ultimate weapon is the man on the ground.”* My Dad and his colleagues, some of whom made it past D-Day, are heroes. I have since learned that there were others “on the ground” back in the U.S. who heroically enabled these heroes. During the planning for the largest invasion in modern history, a significant challenge was figuring out how to get our troops from ‘ship-to-shore.’ The U.S. federal government knew how make large ships to get our troops across the English Channel, but they could not get our troops to the shore. Enter Andrew Jackson Higgins, who was described by Dwight D. Eisenhower in 1964 as “the man who won the war for us.” (Read Full Article)

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Oregon's Eagle Creek fire along the Columbia River

Monday we reflected on the September 11, 2001 attack on the United States. It was a pivotal moment in the country’s history and Americans continue to recognize its importance in our lives on its anniversary each year.

Currently the United States is experiencing another significant chapter with wide ranging weather conditions that affect a large portion of the population. We have had two hurricanes since August 25, and Jose, a third storm following them could feasibly land in the Virginia area; there are dozens of forest fires in over ten western states; and as of Sunday night, 260 earthquakes have been registered in Idaho since September second.

The Wiederhold network extends nationwide, either as current or past clients or simply those we know as friends and colleagues. We continue to think of everyone in harm’s way and hope for the safety of them, their friends and families.

In its 2016 global CEO survey, Price Waterhouse Coopers reported that fifty-five percent of CEOs think that a lack of trust is a threat to their organization’s growth.

Stephen M. R. Covey, in his book: “The Speed of Trust,” asserts, "The ability to establish, extend, and restore trust with all stakeholders – customers, business partners, investors and coworkers – is the key leadership competency of the new, global economy."

Paul Zak, in the January/February 2017 issue of Harvard Business Review and the feature article: “The Neuroscience of Trust,” states that employees in high trust organizations are more productive, have more energy at work, collaborate with colleagues and stay with their employers longer than in low trust cultures. Regardless of industry, your job as a leader is to create a culture of trust.

In our work with clients, we coach them around the following five behaviors which are scientifically proven to promote trust:

1. Model transparency and vulnerability: While it may seem ironic, there is great power in admitting when we’ve made mistakes. In healthcare, we strive to create just accountability cultures. The most powerful and impactful leaders are those who stand up in front of their organizations and tell stories about their mistakes and the critical learning from those mistakes.
2. Leverage inquiry AND advocacy: Judith Glaser, in her book: “Conversational Intelligence,” describes three levels of conversation. All are necessary in certain circumstances, yet we tend to overuse the first two: telling, and trying to convert others to our perspective (levels I and II), and we underuse the last: transformational discussions (level III) with a mutual sharing of perspectives and an attitude of curiosity. This sharing stimulates our pre-frontal cortex which allows for our most creative thinking. “Imposing our perspective: telling behavior” can trigger another’s primitive brain (amygdala) and can result in fight, flight, or freeze reactions. Through coaching, one of my clients re-defined the 80/20 rule where it now means that she talks only twenty percent of the time and listens eighty percent of the time. The impact on her engaging with others, her talent selection success, and her ability to make strategic decisions has been powerful.
3. Identify and honor your values: What do you stand for? As I coached a physician client, she discovered that her words and actions were not honoring what she said she held as most important. She was torn between caregiving needs for her aging mother and her work demands. Through coaching, she transformed her thinking from reactionary: worrying what others might think, to purpose-driven: honoring private time AND work responsibilities.
4. Make it easy for others to provide you constructive feedback: the higher you go in organizations, the fewer people there are who feel comfortable providing you constructive feedback. My clients expect that I will offer observations of their behaviors and/or thinking that is interfering with their leadership effectiveness. One simple question you can ask on a routine basis is: “What can I do differently that would support my being a more impactful leader?” And then do it.
5. Deliver on promises and do NOT promise anything you cannot deliver: Sometimes as leaders we believe we must respond immediately to a request. In doing so, we risk promising something that we later determine is less of a priority or can’t be done. Trust means following through with commitments.

While not always easy, leaders who are committed to creating a culture of trust will continue to be disciplined around these 5 behaviors- especially in hard situations. As employees become more emotionally engaged with leadership, productivity and retention will naturally increase.

Joy W. Goldman RN, MS, PCC, PDC
Executive Director, Leadership Coaching
Wiederhold & Associates

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If you have worked in healthcare for more than a few years, you have probably seen at least one crisis develop in your facility. Although every incident can become a crisis, there are some that happen that can have lasting effects for the facility and everyone it touches. Crises can be from a natural disaster, human error, regulatory non-compliance, to equipment failure. All have the consequences of affecting human lives to negatively impacting the institution both financially and its reputation. What is common to all of these situations are how you and your team react to them. I have found common steps to ensure that you can react quickly, efficiently, and minimize the negative effects.

• Policies and Procedures – All too often, leadership recognizes that a crisis can happen, but few believe it can happen to them. Because of this denial, many leaders may read the administrative policies and procedures when they first come on board, and never review or update them at least annually. It is extremely important to know your crisis plans and review them annually. The time to become familiar with you plan is not in the middle of a crisis.
• Drill, drill, drill – The old saying, practice makes perfect is critical in the middle of a crisis. Practicing not only a disaster drill such as a fire or bomb threat, but also when JCAHO or the State comes in for an unannounced visit will go a long way to putting calm in the chaos. When everyone knows their role in the plan, everything goes much smoother. In addition, outsiders, such as inspectors or even the public, will gain a sense of calm and confidence in your team if everyone reacts according to the plan.
• Be the leader – If you are the one responsible for leading the institution, everyone will be looking to you for clues on how to react. If you seem rattled or unsure, your staff will also be rattled and unsure. If you present confidence and surety, the actions of your team will also demonstrate the same. If you are familiar with the plan and follow it, the crisis will play out more favorably than if you are unsure of your and your team’s role.
• Trust your team – They are there for a reason and should be experts in their roles. If you have practiced drills and ensured competence during a time of crisis, your team needs the space to do their job. Let them. It will go a long way to resolving the issue and building trust for the future.
• Communicate openly and honestly – There is a time and place to communicate what is going on in the facility, but when you do, and I recommend the leader of the facility being the spokesperson, being as open and transparent as possible can help stop rumors and defuse a potential media frenzy. The same message must be transmitted through all channels whether that is media, memos, or social media. Different messages will create confusion and distrust.
• Update often – If the crisis is one day, one week, or ongoing, keep everyone updated. A lack of communication will be filled with rumor and innuendo.
• Finally, debrief – When the crisis has passed, perform a thorough analysis of what happened and institute corrective measures.

You will experience a crisis in your institution. How you prepare and act during the crisis will define you as much as your success or failures as a leader.

In 2013, I will celebrate 20 years of being an entrepreneur. In 1993 when we started our focus was on the recruiting side, but over the years our business has become strictly focused on transition. It was initially only external transition, but now involves internal transition as well as executive coaching. A very wise person once said to me, “since you know so much about why people separate or fail in their careers/jobs, why don't you take that information and also use it to help people stay gainfully employed?” We listened and that's when we started the executive coaching part of the program.

In those years, as I worked with executives and senior managers it became apparent to me why in most cases people separate from their organizations. And when I say separation, I am focusing on individuals that have been on some level asked to leave or left through mutual agreement. Those reasons have little to do with performance and understanding the task at hand or having the technical skills to execute their jobs, but around what I would label “soft skills”. Soft skills would include things such as communication, listening, emotional intelligence, messaging, relationship building, and conflict resolution. In most cases as we tracked back their last 60 to 90 days of employment, it became apparent that, first, this was no surprise and second, it had more to do with key relationships and politics.

My job is all about talking with people and the majority of them, despite rising high in the organization, are very much focused on task. I by no means, am saying that that is not important, but it is only half the equation. The other half is the soft skills. And then the next question becomes: why do we not pay attention? Here are some of my observations over the years; this is by no means a comprehensive list:

• Do not see it as important
• Are not comfortable with the soft skills
• They are difficult to measure
• They are the first thing to be neglected in a stressful situation

My point is this: life is about balance and one must strike a balance between achievement and mastering the soft skills. If people would do that, they would be in much greater control of their own destiny career-wise. It's time to start paying attention or continue to repeat the past.

Let's call this a sequel to my blog on Adhering to the Process. As most of you are aware I just returned from Denver and a successful completion of my second half marathon. I have attached a few pictures from that event in the charity section of the website. The gentleman that ran with me is Rick Newsome who works with Kaiser in Denver and is a friend. Why was it successful and how does it relate to my favorite subject of transition? First, in my mind the term transition has expanded, it now includes both external and internal transition and both the gainfully employed and gainfully unemployed.

Now back to why my run was successful. First, I made a commitment I kept. Just like anyone going through transition, I stayed the course. Second, I stayed focused on incremental gain. I bettered my last time by approximately 4 to 5 minutes.

I had obstacles that came my way, but I did not quit or blame others. I dealt with and overcame them. Over the last month I developed runner's knee. This made running painful and impacted the frequency of my training, diminishing it considerably. I made the necessary adjustments, but my commitment to the end result never changed. No transition, on any level will ever go exactly to plan and one will have to make adjustments to ensure success rather than blame others for failure. I took responsibility for the injury and moved on. I did not look for excuses. The last two miles were grueling because I had not trained as much as I wanted to because of the injury. I felt like quitting and I know many others have felt the same way under similar situations. In the end I stuck it out and finished the race. What kept me going was that I remembered that feeling, that wonderful feeling, when you accomplish something challenging. On the other side of that, I didn't want to deal with waiting another year to finish the event. That's too long to suffer and deal with that shortfall. We all have these kinds of experiences in transition. We need to stay focused on that wonderful feeling we get when we reach that next opportunity and push on through the pain. Remembering the feeling can keep us going. I also remember someone saying to me, and I'm not sure who to give credit to, but it went like this: when you’re closest to a failure, you are also closest to success. I do believe that.

As I write this, I'm on a plane back to Atlanta from Denver. I'm tired and I'm in a little pain, but I feel good about staying the course. No, I did not injure myself permanently and I am not asking you to do that. There will be those times when staying the course will be impossible because the reward sought does not come close to the potential downside. At those times, one may have to save it for another day. But then I remember another little saying that I adhere to. You don't become a good sailor by sailing calm seas. So remember that wonderful feeling of success and, whenever possible, stay the course.

Transition provides a great opportunity for many changes and I am talking about good changes. A great opportunity to find some balance, and one area to enhance, is exercise. We owe it to ourselves and the ones who love us to get involved. I have personally benefited from exercise without a coach, but would without hesitation recommend the use of one. Before doing so I would ask that you do your due diligence and check references and make sure, if you are a bit more mature, to get one who has experience working with your age group. I found the younger coaches are little bit too zealous with people middle-aged and above.

My job is, as is many of yours and also for those in transition, extremely stressful. The benefits below, I have personally experienced. They have come with consistency balanced with intensity.

• A much better attitude
• Increased confidence
• Higher energy
• Better health
• Sharper focus
• Better self-image
• A greater ability to work through the dips/valleys that we all experience.

Of course we all know the positive outcomes when we produce endorphins through exercise. And, of course, for the older group like myself, a much more youthful look and feel.

We, as a company, have seen the benefit of a consistent exercise program with many of our clients. We are so committed to this component of transition that I have often thought of making it part of our program. Perhaps through hiring an experienced coach to have a one-on-one discussion with each of our clients to help them develop an appropriate program for their transition. We are still giving this serious consideration. Another observation since I started this business in 1988, is that I have seen a real change in the image of C-level individuals. That image today is much more health oriented and image oriented. Right or wrong, it has started to play a great role in candidate selection.

Exercise, like everything else, requires balance. Too little and the benefits are limited too much and lead to possible injury. I also believe it must be a combination of cardio and weight lifting. As we get older, it is a known fact that we lose muscle mass which impacts our metabolism rate which can help us control our weight. Also please do not forget, if there are medical issues, see a doctor before you begin any regular exercise program.

I am not naïve enough to suggest that every process is perfect, but I am convinced that well-thought-out ones, when followed, produce outstanding results on a consistent basis. My question and challenge to you today is why do we ignore them and attempt to circumvent them only to ensure our own failure? I see this so much in career transition where I am focused. In my mind, I see three possible reasons. First one: I have not used this process before so I'm not convinced completely that really works. Second one: I am impatient and I want the results yesterday. Third one: I know everything and I can ignore or change this process and be more successful. Now keeping this in mind let me relate it to a real situation I'm currently involved in.

I am currently in Denver, Colorado, actually about 50 miles southwest of Denver Colorado at about 9000 feet. I am here training for a half marathon on May 19th in Denver. I have some wonderful friends that allow me to stay with them during this two-week period. This is my second year. Let me share with you what I experienced the first year. First, I accepted the fact that I'm not an expert in this area and I needed to seek out experts. Why did I need to seek out experts? I did because most of my running takes place in Houston and in Atlanta. The cities are at approximately 34 feet above sea level and 900 feet above sea level respectively. As you all know, Denver is the mile high city that puts it at approximately 5280 feet. This fact alone created much concern and apprehension on my part. So after talking with many experts I developed a process that would help me adjust and perform at this level respectably. I had never executed this process but I knew I had to stick to it. I had to be patient and have faith in it. Believe me, that was a challenge on many days. When I say many days I felt like I was coughing up a lung, most you would understand that. I didn't feel the process was working for me, but I said I'm going to stick with it because people who knew better said it would work. And in the end, when I ran the event, it was one of the best runs of my life. As I mentioned, I am now back in Colorado and using the same exact process. The major difference this year is that I know the process works. Last year, I had to do it on faith and by accepting my experts’ expertise. Having experienced the process with success also added to my confidence.

What is my point? We cannot be experts in everything, accept that, and find an expert to help you build the process. Now once you are done with the experts, create the process. Then comes the tough part. Adhere to the process without circumventing it or changing it and no matter how impatient you become or concerned over your progress, stick with it. Stay focused on incremental gains not huge ones. Accept that you will have minor setbacks and you will have your bad days but in the end you will have a successful journey. Proven processes are tools for success. Stick with them and you will improve your chances for both significant and consistent success greatly. When you become the expert in that area, then you can make those changes to the process, but not before.

Whether you're in transition or not, the concept of controllable versus non-controllable and desires versus goals is key to your success. When people are frustrated more than likely what they're doing is focusing on what's not controllable versus what's controllable. Here's a simple example; I can control the phone calls I make. The number of calls, the frequency of follow-up, the message I deliver, and the attitude I convey, but I can't control somebody calling me back, I can only influence them. If we would learn to focus this way, we would be much more successful and much less frustrated. I think we can all agree that frustration is a pretty useless emotion.

So the first thing we work on with our clients in transition is to start defining what controllable and uncontrollable is by the use of very definitive examples like making phone calls and receiving phone calls, asking somebody to expand your network and having them deliver a name. We need to stay focused on what we can control and not on what we can only influence. This applies to transition and everything else whether it’s business or personal.

Now let's add goals versus desires. When someone begins their transition we talk about goals that we can control versus desires, which we can only influence, and are not controllable. How does that translate into transition? We focus on four things which are controllable. First, the number of hours you dedicate each week to the search. Second, the number of calls you make each week which does not include those you receive. Third, asking for people to expand your network and not necessarily receiving a name, you can't control that and finally, getting out pieces of paper which translates into resumes and cover letters to recruiters and employers for specific openings. This also includes direct marketing letters to organizations you may have an interest in working with.

If something is a desire, it can always be broken down into specific controllable goals that will get you there. It can apply to anything business or personal. Try it on and see if it fits.

Another thought from my stay in Chicago at the ACHE meeting. Over the years, I have discussed this situation with many candidates and interestingly it has come up several times over the last month.

When you are with an organization and you've reached the crossroads. The crossroads being “I'm not getting out of this position/job what I have in the past, I am no longer enjoying the journey.” You have three choices… But let me preface this by saying, usually when you are thinking in this direction, your work situation has already become somewhat more stressful. So choice one becomes continue on and put up with stress. Not typically a good decision and why? This situation will eventually lead to both mental and physical challenges because it doesn't support or meet your needs or desires. Choice two; Make a decision to leave and transition to a new organization. Not a particularly bad choice, but not always the best choice depending on the situation. We often leave before we should or we leave too late. There is a great deal to be learned by working through these types of situations before you make a decision to leave. I've seen people negatively impact their own stability because of their inability to adjust to these types of situations. And choice three (always the best); work on your own perception of the situation and change it in order to make it work. Will this always be the case? Absolutely not, some situations require a change.

The point I'm trying to make is this – we have three choices but we tend to carry on living with the situation or leaving the organization. Both of these have the potential for negative impact. We are not spending enough time on adjusting our perception and looking at ways to grow within our current organization. Why do we not do this? Because we don't understand the process, we’re afraid or apprehensive about asking the tough questions, we may not like what we're hearing or we may be unwilling to change. But you can learn more from taking this path than you will ever learn from choosing the other two. This choice will force you to be introspective and get a better understanding of who you are and how you're viewed within your existing organization. And even if you still decide to leave, you will do it, knowing that you made the right choice.

When Jim related the response of his race partner to a network blast regarding the race they ran together during our staff meeting, everyone on the call (we all work virtual) agreed that having Jim as your running partner was no different than having Jim as your job search partner. The preparation, the expectation of working hard, having others around you pushing, pulling, cheering you on. It is what he does every day with our clients – and us on those Monday meetings. Typical of Jim, we asked and he said yes to posting it, and typical of those in our network, we asked Rick for permission and he said “whatever you need.” Here is Rick’s email:

I ran one of the best races of my life running with Jim. So let me add to Jim's list of things one can learn from a race:

1. Humans were made to run with one another, not against each other.
2. Competing with a friend, like everything else in life, drives you to do your best. Jim was in better shape and ran the faster race. He hung back to give me a chance to catch up. This drove me to do my best; run faster and compete better than I would have on my own. I finished in the top ten for my age group in the first half marathon I ever ran. I have always had a *Board" when making important life decisions. Jim was my "Board," my wingman during this difficult race. The race started at 6:00 am on a rainy day when the temperature never exceeded 37 degrees. I am not sure if I would have even started the race if it had not been for him.
3. Like Jim, I was very apprehensive about this race. When I agreed to run, I planned an extensive training program. All of this went off track when I was unexpectedly required to travel out of town every week since early March to a location that did not support my training program. What I learned from this experience was not to let unexpected obstacles stand between you and your goals. Running is nothing more than putting one foot in front of the other. Many challenges are nothing more than taking one step at a time and persevering.
4. This took more out of me than I would have expected. I thought I was doing well until it was over and I crashed. There is a time to run you race and time to rest and reconnect.

So many of you inquired about my run in Denver that I felt compelled to give a report for those that did inquire, but also for those who may not have known about it. This will prevent me from missing someone.

Rick Newsome and I had run a marathon relay back in October. I ran the shortest leg and was amazed at how much the altitude affected that short 3.2 mile run.   Rick asked me if I wanted to run the Colfax half marathon in May. Though incredibly apprehensive, I appreciated his gracious invitation and accepted. You must understand that Houston sits at 20-50 feet above sea level and Atlanta and North Georgia around 1,000 to 1,800 feet above sea level. Then there is Denver at 5,280 feet and the memory of my short, somewhat painful previous run.

I never could get a straight answer on how to best approach this other than you will probably never adjust to the elevation even if you go out early. The best I could do was to arrive 12 days early and, because of two friends Deb and Bill Pollick, I was able to train at 8,500 to 9,000 feet. I believed at the time that this would benefit me more. What was really interesting was as the event got closer, more and more people stepped up with information and articles on how to best approach the run. The approach I took based on that information and the wonderful people that supplied it was as follows:

• Hydrate – I drank 96 ounces of water and G2 each day
• Minimize or eliminate coffee and alcohol – I chose to minimize
• Run at about 80% of your top mileage speed
• Focus on cumulative mileage but get in one long run each week
• Eat more carbs – which I did
• Fourteen days minimal time to adjust to altitude – I only had 12

My 10 days in training prior to the event were agonizing, both mentally and physically, because when I started I almost coughed up a lung. I told myself at one point when my training was not going well that it was not necessary for me to run. It would be wiser to pull out. But, as is typical both in life and this kind of preparation, all can change on a daily basis if you’re putting the numbers in. And, in this case, it did. Incrementally, it got better daily though there were occasional setbacks. My favorite saying became “in Houston, I never got winded, but my legs got tired, in Denver my legs never get tired, but I do get winded. It makes you feel like every mile was the last mile.

Even up to the day before the event, I had my doubts, but to my surprise I not only never got winded, I ran my best time in the half marathon to date. I want to thank Rick Newsome for inviting me, and Deb and Bill Pollick for providing the perfect place to train and still work with my clients.

What did I learn from this adventure?

• Collect data
• Develop a plan
• Work your plan
• Keep the faith
• Have fun
• Have a support group

No, no news, is not always bad news. Kyle and I finished our 40 days without alcohol as planned. We both savored our success with a beer in Austin, TX. For me, I had just completed the 150 mile MS150 bike ride from Houston to Austin. When you achieve anything worthwhile it feels good and it builds confidence, something most of us can always use more of I have learned that you need to savor these moments because they can be far and few and take away something of value.

What I learned is that what I preach in transition works and it’s always good to practice what you preach. Passion for the outcome, a plan, focusing on one day at a time, a supportive team around you, and accepting that everyday will not go smoothly, but that in the end you will succeed. I will add that I also learned the power of balance. I will not return to the way I was, a drink every day, but would have a certain number of days alcohol free every week. Any achievement needs to not only have a short term result, but must bring long term positive change.