I did not go into healthcare administration to be a salesman.
Some rural and community hospital executives will actually make that statement — out loud — while many more have thought it more than a couple of times. Probably in utter frustration. They got their MHA or MBA after all, to run a business, not be a local huckster trying to woo business/customers.
The problem is that the world as we know it for CEOs of rural and community hospitals is rapidly changing in dramatic ways. Lower utilization volumes means that reimbursement changes from government and insurance companies have a more significant effect on the small hospitals. Larger community medical centers, with larger cash flows, can tolerate these financial nicks much easier.
Now, as the still financially undefined concept of population health care makes it way into the strategic plans of regional health systems anxious to capture as many patients as possible, and as Accountable Care Organizations begin to gain traction, the ability of rural and community hospitals to compete for their own markets at a time when yet another tectonic shift in the way healthcare is delivered and reimbursed, is in question.
CEOs of these vulnerable yet critical healthcare resources are in the spotlight. The decisions that they make, or fail to make, over the next five years, will determine whether their organization survives, sees drastically curtailed clinical services (read: doc/mid-level practitioner in the box) or is forced to close.
No one is immune. Recent news reports tell the story of once successful hospitals in smaller communities being forced to cease operations, the victims of a variety of leadership/strategy missteps, poor or unengaged physicians and apathetic residents.
And, importantly, regional health systems that have a growing appetite to offset their own declining inpatient admissions by casting a wider net for “good” patients are putting intense and very real pressure on rural hospitals to hold on to their market share.
While the implementation of DRGs in the mid-1980s and the later impact of the infamous Balanced Budget Act in the late 1990s were crushing blows to rural community hospitals forcing thousands to close, this new market-based assault for their core patients may be the final battle for hundreds of these facilities scattered across America.
This is a fight for survival in which I have more than just a passing interest. Yes, I have economic concerns since some of these organizations are search clients, but I have a deeper belief that these hospitals are an important tool — and potentially important test laboratories — in the overall system to deliver higher quality, safer and lower cost healthcare to millions of Americans.
The answer for these hospitals is not a better reimbursement system that reflects the special needs and challenges of these facilities, although that would be helpful. No, the sustainable answer must come from the counties and cities where these hospitals are located.
If the population is not motivated to fight for and support the physicians and the hospitals, to demand better when clinical personnel or scope and quality of care is lacking, then it is not if the hospital will close, but when.
So who is to lead the fight? Who is responsible for motivating the population, the medical staff and the employees? Well, hopefully, there is a group of people who care passionately about local healthcare. But, in most cases, it starts with the CEO.
If the CEO is not selling the vital role of the hospital for the betterment of the community day in and day out, then chances of a sustainable grass roots wave of support are very slim. Going to the Lion’s Club or Rotary several times a year and talking about what is happening at the hospital is not what we are talking about here. You need to become a full-time sales representative, looking for ways to lock in your community for your hospital.
To get there you must begin with a strategic plan that carefully looks at how many patients leave the market and what you can do to retain some percentage of those patients. But more important, while the plan looks at the here and now, you have to be willing to broaden the boundaries of your box in ways that address the future – value-based, not volume-based, inpatient care.
The key drivers will be lower costs, high quality, exemplary service, and innovation — doing things that are not on your service portfolio radar, like community medicine house calls.
What are your thoughts about what you can do, not what you cannot do?
© 2015 John Gregory Self
JACKSON, Mississippi — There are two ways to approach an interview — with a messaging plan that is based on an understanding of what the client is looking for and the client intelligence to successfully execute, or a more passive approach, simply responding to questions as asked without working in your strengths in your value proposition.
If you feel Plan “A” is the best choice – albeit the option that requires considerably more effort – you would be correct. You stand a much better chance connecting your prior success with the needs of the client if you take this approach. You also will be in the minority, believe it or not.
In a competitive market, where the number of qualified applicants for the best jobs can exceed thirty or forty candidates, why would you opt for an approach that places you at a considerable disadvantage? Let me be honest, there are not any good reasons I can think of, and the ones that do come to mind all reflect negatively on candidates who do not come prepared.
Over the years I have interviewed thousands of candidates. Some I know, most I do not. Either way, I am always amazed when candidates fail to mention important relevant experience and accomplishments. On occasion I have picked up some exciting information that was not even included on their resume, even when they have had coaching from outplacement consultants. When this happens, for me, it is a reflection of poor preparation.
When you do not communicate your story — your relevant experience and quantifiable accomplishments — your chances of advancing in a search drop by as much as 75 percent.
Where you went to school, that you made good grades, your prior employment, or even if you have Fellowship status with your professional credentialing association are no substitute for a gold-plated performance in the interviews.
This is not a hard problem to fix. Simply do your homework. This means reading what you find on the Internet, and reaching out to colleagues you know who may know someone with valuable insight on the employer they can share. Moreover, having 500 or more LinkedIn contacts is a total waste of your time if you do not leverage them for this purpose.
If you attend the ACHE Congress in Chicago, consider attending the session on interviewing at 2:15 PM on Wednesday, March 16. My colleague Nancy Swain and I plan to cover getting prepared for the interview as a component of this 90-minute workshop. If you are in the market, or you are concerned you could be in the market within the next 12 to 18 months, now is the time to get prepared.
© 2015 John Gregory Self
TYLER, Texas — Walt Bettinger, Chief Executive Officer of the Charles Schwab Corporation provides insightful lessons for current and aspiring leaders — service to others should always win out over obsessing about our own needs, that we should take time to get to know the people who serve us, to be honest and authentic when discussing your successes and failures, and don’t trip yourself up in a breakfast interview.
Mr. Bettinger, 54, was appointed CEO and as a member of the Board of Directors in 2008. He was featured in Adam Bryant’s Corner Office column in Sunday’s New York Times.
A summa cum laude graduate of Ohio University, Mr. Bettinger holds a degree in finance and investments. He has also completed the General Management program offered by the Harvard Business School.
Shortly after graduating from high school, Mr. Bettinger’s father, a tenured faculty member at a university in his hometown, told his son that he had quit his job. His colleagues, in a dispute with the university’s administration, had formed a union. Bettinger’s father explained to his very surprised son that he had gone into teaching to be of service to others and he concluded that his fellow teachers were more focused on themselves than the students. He didn’t feel that was in keeping with his principles so he quit. His father got another teaching job, Mr. Bettinger explained, but for an 18-year-old, it was a powerful message.
Nearing college graduation, Mr. Bettinger held a 4.0 grade point average. He really wanted to finish his degree program with a perfect average so he prepared long and hard for his final final, a business strategy course. When the tests were passed out — it was only one sheet of paper “which really surprised me because I thought it would be longer than that.” When the students were told to turn over the paper, both sides of the sheet were blank. The professor said, “I have taught you everything I can teach you about business in the last 10 weeks, but the most important message, the most important question is this: what is the name of the lady who cleans this building?”
Like his father’s decision to resign from a guaranteed job, this moment afforded Mr. Bettinger another powerful lesson. He had seen her numerous times as he came and went to class, but he had never taken the time to ask her name or learn more about her.
“It was the only test I ever failed, and I got the B I deserved. …we should never lose sight of the people who do the real work. I’ve tried to know every Dottie I’ve worked with ever since.”
Mr. Bettinger explained that when hiring he likes to ask candidates about their biggest success in life, and their biggest failure. He is looking for whether the candidate’s view of the world revolves around themselves or others. When asking about their failure, he listens for whether the candidate accepts ownership of the mistake or whether they blame it on others.
Mr. Bettinger said that when he meets a candidate for breakfast, he arrives early and asks the manager to mess up the candidate’s food order to see how they will react, how they deal with adversity — how they respond and how they treat the waiter. (He always leaves a good tip.)
“We are all going to make mistakes. The question is how are we going to recover when we make them, and are we going to be respectful to others when they make them.”
This is great information, especially as companies begin to shift their candidate screening processes to focus as much on their values and integrity as they do their performance. Top performers with bad values can do immeasurable harm.
For Mr. Bettinger, it is all about living up to your principles, paying attention to those who do the real work, and giving them respect, even when they make mistakes.
© 2015 John Gregory Self