In the early 1980s, a Houston hospital CEO was frustrated by his hospital’s anemic financial performance despite the tightening of financial controls, as well as noisy department manager meetings replete with leadership huffing and puffing about dire consequences if things didn’t change.
So this medical center CEO came to believe that it was time to try something fairly heretical. The command-and-control approach would be dumped, the outraged protestations of his senior team notwithstanding. The team members were all from the investor-owned industry and at that point in time command-and-control was the management standard. You could not trust those silly department managers the theory went, they were in their roles because they had the clinical expertise, not the management savvy or a real understanding of accountability. Better that should come from their vice presidents who had master’s degrees in hospital management. They knew better. Wrong, said the CEO.
He decided that the department managers would henceforth act like general managers, responsible for running their own businesses, their department. The vice presidents would step in if the train ran into a ditch, but until then, their job was to support their “general managers” and provide consulting expertise to coach them to success, not control them into mediocrity.
Managers saw their spending limits increase from $350 to $10,000 for purchases. They were given the responsibility for creating their own marketing plans and they were held accountable for meeting their budget projections and managing their physician relationships.
The senior team all but guaranteed to the CEO that without their direct involvement (control) in the day-to-day hospital operations, financial performance would plummet. Wrong, again.
By the end of the first year of this little experiment, the hospital reported record increases in revenue and record retained earnings. It seemed that once empowered, the department managers knew more about how to succeed than their bosses in the executive suite.
The CEO just smiled. So did the managers. Within two years, there were many new vice presidents, and a few new department managers, all who had a different set of skills and mind-set about their role. The new VPs were recruited based on their ability to coach, mentor and cheer for success. They had the knowledge to step in if need be, but they no longer spent all afternoon signing requisitions.
This is an idea whose time has come — again.
© 2015 John Gregory Self
HOUSTON — There are a couple of ways to look at leadership style. Earned respect, and command and control, which is to say, I’m the boss, do what I say. Earned respect requires more skill. It takes more time and energy but will generally produce sustainable results. The I’m the boss approach is easier. It requires less energy or skill/talent. It can produce bottom line results but it is not sustainable.
While this is a concept straight from an entry-level management class with two choices — one with a long-term value and the other not so much — the number of people who hold on to some variation of the command and control model, particularly at the department director/manager level of an organization, is always surprising. This should not be.
First, let me stipulate that management and leadership is something you learn. The idea that leaders are somehow born with the skill strikes me as silly. Leadership is learned by watching good leaders in action or, better yet, being mentored by someone who has earned the respect of their direct reports and other employees for the way they treat their colleagues and the results they produce.
New managers fall into the command and control approach because they simply do not know any better. They stay with it because it is easier and they confuse favorable short-term results with a good management philosophy that works for them. Worse still, they stay with it because they work for someone who also doesn’t know any better and either cannot help them change or are too self involved to invest in a direct report’s future.
The demands that healthcare reform will impose on leaders and managers will be intense. There will be industry-wide consolidation and many jobs will be at risk.
What kinds of managers and leaders will be more susceptible to getting the sack? Those who practice command and control over earned respect because they do not know any better or, more sadly, because they are too lazy to change.
When you think about these two concepts, consider this: Employees working for a leader in the Earned Respect category will almost always offer more than what is expected of them. They will provide their passionate best.
© 2015 John Gregory Self
John has written several blogs over the past 12 months regarding the importance of candidates being authentic in their interviews. Today’s post discusses an approach employers can use to test candidate authenticity and leading to a feeling of trust that they are hiring the right qualified person.
For employers trust is a key factor in making the right decision regarding which candidate to hire. To get to that point of trust, you must first measure a candidate’s authenticity.
Can we trust that the person we are interviewing will act the same way when they show up for work? Can we trust that they will respect our mission and values as well as our employees, or will they become some variation of the ego-driven its-all-about-me tyrant once they get settled (read: comfortable) in their new role?
So how do employers sort through all the carefully constructed answers and spin to find that stream of authenticity that leads to a sense of trust? You will not get there with softball or vague, open-ended questions that act more as enablers of spin than focused inquiries to unearth the substance of what the candidate is really like. I use what Brad Smart, PhD, author of Topgrading, calls “truth-telling” questions. These are questions which force candidates to be brutally honest, or signals that we will verify what they are saying.
In our lengthy face-to-face interviews, I begin by asking candidates if they have read my bio on our website. A surprising number have not, but that is OK since the interview is not about me. But I always mention in my brief career summary that my first career was as a crime writer and investigative journalist for a major daily newspaper in Texas. It is sort of my way of giving them a heads up to minimize the spin without being rude or a jerk when I move to those important truth-telling questions.
I am constantly on the look out for great interview questions — I have hundreds on file but there is always someone with a better way to determine whether a candidate is being authentic or just a spin artist. In Adam Bryant’s Corner Office interview with Sue Desmond-Hellman, MD, CEO of the Bill and Melinda Gates Foundation in yesterday’s New York Times business section, I found a couple of good ones. They were not questions to the candidate, but her thoughts about a candidate when she first meets them. They are similar to actual questions that I have used in the past, but much more succinct:
Sometimes I will immediately follow up with, “When I talk to your current boss, how will they describe your relationship with physicians and employees? Do you talk with them or to them?” “Did your employees respect you, or just comply because you were their boss? What evidence can you provide on that issue?” Or, “What is the one thing your former bosses will say has been their biggest concern, their biggest disappointment, your biggest mistake, or your biggest failure?”
When I ask the “your biggest weakness” question, I now work in to the question that this issue is one area we include on our reference questionnaire.
There is always the chance you will get some pushback. One CEO candidate eerily reminded me of one of the announced Republican candidates for President when he began to tell me not to ask negative questions and then told me what issues I should be focusing on. There is pushback, and then there is that.
In this new era of healthcare reform which will eventually radically transform our business model, hiring a new CEO or executive just because they went to a good graduate school, previously worked for a highly regarded hospital or health system, or has a good reputation, is a major mistake. Yes, you need someone who has great skills, a deep understanding of operational, clinical and financial issues as well as a cutting-edge view of what the future of healthcare delivery will be like, but trusting the conventional wisdom that someone’s past performance is a great indication of future success is a recipe for potential disaster. It happens all the time. As the saying goes, conventional wisdom is seldom right.
You must trust but you also must verify, and then ask this important question: Is this great candidate going to be the right great leader for your organization?
© 2015 John Gregory Self