Over 145 million patients come to US Emergency Departments every year; it takes over 167,000 emergency nurses to provide compassionate care to these patients: whether a child with a fever or a senior struggling to breathe, they are America’s frontline for care.

Many people outside of emergency medicine may not realize that our nation’s EDs provide an accurate and unfiltered view of society. This slice of reality shows humanity at its best and worst. In addition to the joy of saving a life, the occasional thank you and smile that an ED nurse will receive, they may be yelled at, unappreciated, subjected to unpleasant comments, and even assaulted…. by people they are just trying to help.

Yet, 24/7, 365 days per year - days, nights, weekends, holidays, sunny days, stormy days, natural disasters— these dedicated professionals put their personal needs and those of their families aside and dedicate themselves to caring for all types of strangers.

As an emergency physician, I can personally affirm that I could not do my job without them: they are my right hand (and my left), my eyes, my ears, my conscience, and sometimes even my kinder, gentler voice!

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I was honored as a Girl Scouts of Western Ohio Woman of Distinction a few years ago, and I was asked to share some of the lessons or “words of wisdom” that I’ve learned through my own experiences and through others. As I reflect, the Five Key Ways that Girl Scouts help young adults thrive, are applicable and transferrable to every rising leader in general.

Girl Scouts is proven to help girls thrive in five key ways as they:

1. Develop a strong sense of self.
2. Seek challenges and learn from setbacks.
3. Display positive values.
4. Form and maintain healthy relationships.
5. Identify and solve problems in the community.

Read the Girl Scout Difference here .

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“Strength lies in differences, not in similarities.” - Steven Covey

Diversity and inclusion are top priorities in many organizations today, and there are plenty of benefits that come with implementation. First of all, there’s an increase in profitability. A McKinsey & Company report found that companies with leadership in the top quartile for gender diversity were 15% more likely to have financial returns above their industry median, and those with leadership in the top quartile for racial and ethnic diversity were 35% more likely to do the same. On the other hand, McKinsey also found in a follow up that companies with executive teams in the bottom quartile for both gender diversity and racial and ethnic diversity were 29% less likely to achieve above-average profitability.

There’s more at stake than immediate profitability. Through my own experience, I’ve also seen improvements in:

Retention - Diverse leadership communicates that leaders cannot all look and sound the same, and a diverse leadership team helps create an environment where people of all races, genders, sexuality, religions, socio-economic backgrounds can thrive. It creates an environment where employees can see their path to advancement and leadership positions within the industry.

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When an executive leaves unexpectedly or a major personnel changes occur in your organization, the void is felt at all levels of the organization. Rather than rushing to return to a feeling of equilibrium, I believe one of the best ways to make the right permanent hire and position your organization for long-term success and stability is to first hire an interim manager.

Interim managers do more than just “hold down the fort” until a permanent hire can be made. Interims bring their expertise, perspectives, adaptability, leadership and motivation skills, and entrepreneurial mindset to the challenges your organization is facing. An interim executive comes in with an analytical mind and unbiased view to help your organization achieve sustainable results in a short amount of time, allowing you the time to iron out persistent organizational issues and assess your organization’s needs so you are better positioned to make hiring decisions with purpose and wisdom.

Gain fresh perspectives and re-focus on your mission.

Getting the objective outsider view that an interim can provide is important for the long-term health of your organization, especially if your organization tends to promote from within. Often, when a management position becomes vacant unexpectedly, organizations will rush to promote a promising lower-level manager, even if he or she still hasn’t fully developed the skills to be successful in the vacant position. Hiring an interim manager into this position for a short time before you hire internally allows your organization to work out process issues, for example, while bringing the potential internal hire up to speed. The interim can bridge that gap, setting up the internal hire and your organization for success.

Times of transition provide the opportunity to consider who you are as an organization and whether processes currently in place promote the organization’s mission and values. A lack of crisis doesn’t mean everything is running smoothly. When growth slows, mission creep sinks in, goals go unreached, or when urgent issues distract your organization’s leadership from mission-centered issues, an experienced interim’s perspective could be just the breath of fresh air your organization needs to refocus on its unique identity.

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For healthcare CEOs, as the size of the healthcare system grows, so grows their need to balance priorities. By organizational structure, larger system CEOs, including those individuals who are Physician CEOs, often coordinate with multiple individuals reporting to a board of directors. The CEO perhaps has a specific specialty from past experience––finance, legal, medical––with next-level leaders who broaden the operational bandwidth through their specialties.

In contrast to the stand-alone hospital CEO who are more intimately involved in the daily operations of the rural or individual hospital, large system CEOs find themselves in larger cities with more public points of interactions and more team members among the healthcare staff to whom they must stay connected.

Time is always a factor

Hospitals are 24/7 operations, and large systems have hundreds or thousands of people relying on services at any given time. The large system CEO cannot reasonably be involved in these daily functions and resource needs. This CEO is consistently informed by the people they’ve entrusted with overseeing specific functional areas. The CEO must hire the correct people to provide operational knowledge and support who report back on the needs of the system.

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Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?” Self-reflect and visualize your peers and the people you are leading. Do any of these characteristics seem familiar?

• Constantly worries about what people think
• Always feels obligated to fix things
• Has a hard time letting things go
• Starts the day with a list of worries
• Ends the day with a list of worries
• Stresses about staff turnover
• Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team. The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect. Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done. Try this CARE PLAN:

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Non-profit hospitals are beholden to stakeholders (i.e. the communities they serve), not shareholders, and are thus pivotal community assets. While for-profit hospitals report to shareholders and investors, non-profit hospitals have an obligation to use assets for the betterment of the communities they serve. Community benefits can include charity care, expansion of existing services such as trauma care and maternity services, clinical education, increasing access to care for Medicare and Medicaid patients, and promoting community health.

One of the best ways to promote community health and serve the community at large is to create community partnerships and develop relationships with those involved in existing healthcare services in the area. This way, non-profits are not duplicating existing resources and are working toward a common mission of improving the health of the people and communities they serve.

The move to value-based care is slowly migrating to capitated payments. This is an important progression, as the capitated payments model is more person- and outcomes-centered; the focus shifts to prevention and wellness; and hospitals are incentivized to improve health status. The notion suggests that the health of the population will continue to gain importance.

True population health requires addressing underlying social determinants of health, including socioeconomic status, level of education, neighborhood environment, nutrition, activity levels and access to healthcare. It is well documented in the literature that social determinants drive healthcare outcomes. As an example, those with wealth generally enjoy better health status than the poor.

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Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

Listen here.

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Gallup’s State of the American Workplace reports that while the U.S. has more than 100 million full-time employees, only about one-third of them could be considered engaged at work. These are the staffers leaders dream about - they love their jobs and just make their organizations better. At the other end of the spectrum, 16% of employees are actively disengaged and generally miserable at work, and the remaining 51% of employees are not engaged at all – they’re just there.

For a leader, those are some sobering statistics, and should serve as a wakeup call. While engagement is important, chances are, you don’t just want your employees to engage, you want them to be inspired. Suze Orman once said you cannot inspire unless you’re inspired yourself. That means as a leader you should have passion – for the work, for the mission, and for what that means to people and the communities you serve.

Inspired employees impact an organization’s bottom line too, and studies have shown that inspired employees are more than twice as productive as satisfied employees. Inspiring behavior unleashes the energy within people to do their best work. It also helps them connect with an organization’s purpose and meaning.

Change starts at the top and looking at the power of a company with leaders who inspire at every level, Bain & Company launched a research program to understand what inspires people. Their research helped them identify a number of distinct and tangible attributes that leaders can use to create inspiration in others.

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This article published recently in the The Atlantic points out that unexpected, large hospital bills can happen to anyone. This caregiver was hounded by collectors, one even inviting them to connect on LinkedIn! As healthcare administrators, we have a good understanding of our average reimbursement and collection rates, as a percentage of the gross, billed charges. But do we really know what happens when the uncollected charges are turned over to collection agencies? Are we aware when and if they are then turned over or “sold” to other debt buyers? To me, poor treatment by collection agencies and debt buyers is still a reflection on the health system where the patient received their care. Can health systems and doctors afford this type of reputational risk?

I turned to a colleague, a revenue cycle professional and expert - the best I’ve ever worked with in the business. They provided a more balanced perspective:

There are two sides to this dilemma depending whether you are a patient or provider. From the patient perspective, medical debt is increasing and in too many cases crippling, often leading to financial ruin, depression and shattered lives. Statistics show the percent of total bankruptcy, because of medical debt, at over 50% and employers shifting costs through deductibles, now on average over $1,300 and growing, according to the Kaiser Foundation. On top of that, healthcare spending as a percent of GDP is approaching 20%; an unsustainable trajectory. Bottom line, patients and families are harmed by unaffordable medical debt and there is no solution in sight.

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Since the 1990s, I used the nursing process (assessing, diagnosing, planning, implementing, and evaluating) plus a healthy dose of human resiliency in healthcare leadership and my personal life. Little did I know that this training would benefit me when I least expected it. In September 2018, Hurricane Florence made landfall on the coast of North Carolina and with it permanently changed the residents’ lives. Homes were swept away and people feared how they would provide something as simple as the next meal for their families. My family was fortunate because our home only sustained minor structural damage; the only major damage was losing our dock. With hard work, determination and a disciplined process, the dock was transformed into something even better than it was in its previous state.

The nursing process started in the form of preparation. Before the storm hit, we boarded all windows and doors, turned off all utilities and prayed that no one would be injured as we drove away to ride out the storm in Virginia. The process continued as my wife, Angie, and I left to return to North Carolina and assess the damage. We loaded our utility trailer with fuel, building materials, food, water and shelter. By determining safe, accessible travel routes within 24 hours of the storm and leaving the area kept us safe. Constant reassessment of changing travel conditions kept us alert and ready. No planning in the world could have prepared us for the devastation that we would see. When we arrived at our home, we found the lower level destroyed, the main level exposed to the elements, debris as far as you could see, and only broken poles where our boat dock and pier had stood.

Hurricane Florence met the nursing process in North Carolina. Constant implementation of the process (assessing, diagnosing, planning, implementing and evaluating) ensured that the right steps were taken in a structured and manageable fashion. Florence Nightingale is widely known as the founder of modern nursing. Nightingale said “Rather, ten times die in the surf, heralding the way to a new world, than stand idly on the shore.” Over 110 years after her death, and throughout the Hurricane Florence recovery process, Florence Nightingale was a beacon of hope in my life.

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Among the dilemmas facing healthcare executives, the decision to hire more in-house staff or outsource non-core functions of an organization is becoming increasingly common and complex. In the healthcare industry, business process outsourcing (BPO) can allow hospitals to increase their focus on what they do best: caring for patients and serving them well.

BPO includes benefits like lowering costs, increasing efficiencies, increasing focus on core business functions, and partnership with trusted experts in a wide variety of front- and back-office functions. But outsourcing has a cost that is more than just financial. Working with a BPO company requires releasing control, and if the relationship doesn’t work out, it can be hard to recover, both for your organization and your people.

Is business process outsourcing (BPO) right for my organization?

How do you know if it makes sense to outsource a function of your hospital or healthcare company? Start by weighing the costs and benefits to determine if outsourcing makes more sense financially than hiring or training an in-house employee. Ask yourself questions like:

• What specific process or function does my organization need performed? Where is this function lacking in efficiency or cost effectiveness?
• Does my organization currently have the skill set needed to perform this function internally? Locally?
• What is our budget for this function, process, or service? What can we afford?
• How often and for how long do we need this function performed?

If it has been determined that it is financially viable and necessary to your company running efficiently to outsource a service or process, here are some things to consider as your company explores outsourcing options.

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Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

One of the privileges of being the Dad of a little girl is that she sits on your lap and you have little talks from time to time. One I remember in particular is when her mother was out shopping, because that’s what she did when Daddy and daughter spent time together, Francesca looks me in the eyes and says: “Daddy when I grow up I want to marry you” ….. I had to politely explain to her that Mommy wouldn’t like that too much! She then went on to say: “How will I ever find the right person to marry?” I said: “Honey, when you fall in love and if that person treats you as well as I do, then he’s the one.” Matthew you’ve passed that test.

So I can’t leave without a little advice for Francesca and Matthew…..You are starting your life together, what’s the most important thing? The most important thing is LOVE….that’s a great word but there are a lot of things that go into it. For my colleagues in medicine, you know we have to make acronyms out of everything to help us remember….

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How to think critically when solving healthcare operations issues

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue. Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better. With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

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Mentoring has been one of the most rewarding benefits in my career. I have also been the beneficiary of great relationships with mentors and am forever grateful that extremely busy professionals made time for me - and made me feel like a priority - when I was learning my role as a young administrator and a new leader.

There is so much more to the mentor and mentee relationship than just learning the ropes – it’s about being a guide, a coach and a friend. The relationship is mutually beneficial, and I continue to fill both of the roles – mentor and mentee. I have been in the position of the young careerist seeking guidance, as the mentor providing the guidance, and as the mentee who needed the support to progress in my knowledge and experience. My mentors helped shape who I am today, and from their insight and lessons, I am able to mentor others to help them develop their talent, avoid common pitfalls, and guide career paths.

Perhaps the most unique aspect of being a mentee is having the full confidence to ask the mentor about industry or workplace-related questions they might not be comfortable asking others. The relationship is built on mutual trust and cannot exist without a clear understanding that questions asked in confidence stay in confidence.

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For some hospitals, the close of the fiscal year comes with a sense of dread—it’s time to run the gauntlet of another audit.

Though audit requirements vary based on whether a hospital is public or private, for-profit or nonprofit, audits are an inescapable reality for every hospital. The audit process can feel like an irritation, yet another project to add to an already full plate, but audits also bring an opportunity to develop stronger accountability and transparency within the organization.

Preparing for an audit can be daunting, but it doesn’t have to spell disaster for your organization. There are steps healthcare executives can take today to allow a smooth audit process down the road.

Always be prepared.

The best way for your hospital to prepare for an audit is to always be audit-ready. Of course, this is easier said than done, especially if financial credibility and accountability haven’t been made a priority across all levels of the organization. It’s only when you haven’t been keeping up with your finances that an audit is a potential issue for your organization.

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We need to dramatically expand access to counseling

With each passing day…sometimes even within a passing day we are reminded of how mentally sick we have become. Yet, still, the idea of access to sustained mental health counseling and care is not a priority. We spend enormous sums on crisis care. If we just had the will, we could pour enormous resources into the kinds of services that would greatly reduce the need for crisis services. Whatever we spend, whatever it costs, the investments will be more than repaid in the gifts of a more mentally stable nation.

“Community Health Needs Assessments” (CHNA) from Maine to Hawaii identify our “social determinants” of health status. These assessments in reality report out the same sets of concerns. Our nation is too emotionally fragile. This fragility manifests itself in poor nutrition, sad living conditions, loneliness and isolation. The more we seem to be coming together with the advance of communications technology, the more we seem to be using these technology wonders to isolate ourselves. We don’t ride a bike down the street or across town. Instead we join a peloton from a stationary cycle in our home. It’s just so much easier this way.

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There aren’t too many experiences more overwhelming than being sick and trying to deal with the U.S. health care system. All of us have personal stories of disconnected providers and lousy communication. “It’s like nobody talks to anybody around here!”

As a health leader it is always embarrassing to listen to the stories of friends and family who were left on their own. My response was to put in place clinically trained care navigators whose job was to stand with the patient and help them in every way (even if that help meant sending the patient to another health provider). Many other health providers have taken similar steps. But this idea really needs to be as universal as the coverage we want everyone to have.

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It’s Worth the Time and Energy

Co-authored by Jim Wiederhold and Steve Weiner

Committing the time and energy to developing an effective ongoing network is an important skill set crucial to successful healthcare leaders. It’s easy to get caught up in the daily routine, especially with a demanding job. But, the notion of waiting until one is in a career transition to begin building relationships with other professionals is very short-sighted.

Healthcare currently makes up about 18% of the nation’s GDP and is expected to grow exponentially. The many major changes, complexities, and innovations affecting the healthcare system have resulted in a rapidly changing job market requiring different and enhanced skill sets. The industry is quickly expanding and payment/care delivery models are moving away from the traditional acute care hospitals to more convenient, affordable outpatient settings. Innovation and technology continue to have a huge impact on medical care and its delivery.

Recent developments have included Apple and Amazon’s creation of wellness and primary care clinics for employees. Grocery stores have also entered the convenient care market. Amazon has acquired an online pharmacy company to deliver prescription drugs via Amazon Prime. These companies, along with Walgreens and CVS, have invested millions of dollars into the digital health space. Additionally, venture capital firms are responsible for funding over $68 billion into healthcare in the past year!

These new ventures and infusion of capital are constantly generating new jobs and revised job descriptions that reflect the need to address large transformations taking place in the industry. With all this movement, it’s essential to commit yourself to lifelong networking and learning. It is not enough to network at one’s workplace or only with colleagues in similar professions. Although that’s important, it is necessary to reach outside of the comfort zone and develop relationships with professionals in other related industries.

We often hear from our executive level candidates going through the transition process that they did not know as many people as they thought they did. Or, their network consisted of only like-professionals who were experiencing the same types of challenges. These executives now recognize the importance of doing a better job of networking to build meaningful, diverse relationships with others who bring new perspectives, new opportunities, and potentially contribute to successful career growth and development.

Through our experiences, we have found that networking sometimes happens at the most unexpected times. Recently, one of Steve's former traditional hospital CFO candidates -- who was between leadership positions at the time -- experienced this first hand. This individual was sitting in an airport and started chatting with the woman next to him. The conversation turned to work and he discovered the woman was a senior partner with a leading private equity firm. The firm was in need of a top-flight CFO for one of their startup healthcare clients in the ambulatory and urgent care space. After several rounds of interviewing, Steve’s former candidate landed this job!

Networking is something you should always be doing. You can network anywhere.

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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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