Graduate Education In A Changing World

Posted on January 23, 2013 by John G. Self

We are moving into an era of extraordinary change.

Healthcare will change because government can no longer afford some of its signature programs including Medicare and Medicaid, and because the quality of care and the level of patient safety too often do not match the price we pay.

As this era of change accelerates, we need to think about the role that graduate education will play in solving some of the challenges we face, specifically how we educate physicians, nurses and other clinicians as well as healthcare leaders.

A CMO candidate who practiced law for more than 15 years described medical school as a place where bad practices and inappropriate attitudes are handed down from generation to generation. “We will never have meaningful and sustainable improvement in the quality until we make changes in how we educate and train young physicians.” Tough talk, but there is increasing evidence that he may be on to something. I will leave that judgment to physicians and physician educators to tackle that thorny issue.

Graduate business programs, including those in healthcare, are also coming under increased scrutiny because they tend to focus on teaching people the hard skills of finance and management practices and less about people skills – leadership, the art and ability of negotiation, or the mindset for innovation. So says Jay Bhatti, a Wharton MBA, who was interviewed by John Hockenberry of NPR’s The Takeway. Mr. Bhatti focused on MBA programs and how they are turning out thousands of students, many loaded with mountains of debt only to struggle to find jobs. “We have a proliferation of graduate education programs and a job market that has shrunk,” he said. The theme of the show was the declining value of the MBA.

In the 1950s and 60s, said Mr. Bhatti, the Fords, McKinseys and Goldman Sachs of the world complained that college undergraduates were not adequately prepared in the field of business management, that it took too long to bring those students up to speed. So began the popularity of graduate management programs. “MBA programs have done a good job of this for 50 years,” Mr. Bhatti said, but the game is changing. He believes that MBA programs must reinvent themselves to prepare students tomorrow’s changing world.

This brings me back to the changing world of healthcare management. There has been a proliferation in healthcare graduate education programs as well, and based on my interactions with students from several schools across the U.S., we will face a critical skill shortfall over the next 10 years. They know the theory of managing hospitals based on a knowledge base that is rapidly becoming outdated. All of this is happening at a time when fewer and fewer health systems offer administrative residencies or fellowships.

In healthcare, like general business, there are more graduates than jobs and many of these indebted students are not prepared for healthcare’s changing world.

This imbalance between curriculum and change, together with a surplus of students from healthcare management programs, will pose some extraordinary career management challenges in the not too distant future.

Making Quality Of Care A Priority

Posted on January 2, 2013 by John G. Self

America’s healthcare model does not consistently produce high quality. In fact, the evidence suggests that this is a massively complex problem that is getting bigger.

Quality of care is shaped by so many variables— literally millions of habits, interactions, poor processes and practices, as well as an industrywide culture that seems to accept significant lapses in quality as a fact of life.

Where to begin? The answers cover the coastline, from intrinsic failings in graduate medical and clinical education, to a culture of acceptance in hospitals where nurses, techs and ancillary personnel are so busy trying to meet the demands of taking care of sicker patients that it is hard to find time to break the thousands of bad habits—virtually automatic responses to problems or events — that lead to, among other things, medication errors, wrong site operations, and patient falls because bed rails were not up and alarms not set, an incident that is only too familiar to my family.

I wonder what it will take for an industry where preventable deaths are such a problem — at a minimum the equivalent of a Boeing 737 commuter jet crashing every day, of every week, of every year, with all souls on board killed—to rise up and say enough is enough? If that happened in the airline industry, the FAA would shut down the offending companies by the third day, at the latest.

I love this industry, but really, we need to be a little more passionate—no, a helluva lot more passionate—about improving quality and protecting our patients and our employees, who, in healthcare, are more likely to be injured on the job than if they toiled on the floors of an Alcoa mill when Paul O’Neill ran that company.

What is the CEOs role in reversing those thousands of bad habits, or in a culture that seems to passively accept that quality issues are just a fact of life?

Performance Evaluation Design

Posted on November 23, 2012 by John G. Self

A best-in-industry performance/employee evaluation begins and ends with a compelling governance-leadership commitment that human capital is an organization’s most important asset—the big differentiator, especially in the service industry. Without this, the program is just more expense that will fail to deliver value.

The other elements of the evaluation plan—the muscular structure—should include:

Thoughtful assessment of every senior executive, manager and supervisor
Development of a depth chart showing every member of management with notes on each individual’s knowledge base, skills, flexibility to oversee other divisions, promotability, etc.
Creation of robust metrics covering all aspects of performance, satisfaction, and service
An ongoing evaluation system that incorporates input on critical indicators from the supervisor, peers, subordinates and customers
Development of an ongoing, real-time measurement system that provides support of the talent evaluation process
Comprehensive quarterly performance reviews of operations and people
Investment in people development at all levels

This approach to talent evaluation should produce meaningful results, not only in the more effective use of this critical corporate asset, but also in measurable and sustainable improvements in quality, safety, service, and financial performance. It must be supported by real investments in an incentivized compensation plan, the technology and training to ensure that this powerful tool is appropriately utilized, and ongoing commitments to invest in the power of the people for education and other professional development programs.

A core element of an effective program is the depth chart, something akin to what NFL coaches use to evaluate draft picks and existing team members through spring training and throughout the course of the year. In the old days, some corporations created a dedicated room for this comprehensive white board chart, and physical access was limited to the CEO, the Chief Human Resource Officer except, for times of performance evaluation meetings with divisional executives. Today, these white board rooms are virtual, with drop down folders providing additional detail on each member of management. Regardless of the approach, having this in-depth information is essential.

A best-in-class performance evaluation program must be designed to make the program a major responsibility of the CEO and the senior leadership team. The CEO must lead and allow adequate time for detailed discussions regarding performance and what can be done to move to the next level. A CEO who feels that he or she cannot afford the time for such in-depth reviews or loses interest might as well walk the halls and tell employees they are not that important.

This systematic approach to performance and employee evaluations effectively destroys the current “silo” evaluation process used by far too many hospitals in the U.S. These programs typically begin with a supervisor completing a form, and ends with an executive signing off on it. This approach precludes or limits meaningful talent management. Far too often, the employee is rewarded for, in effect, surviving another year.

Key performers should be identified and the senior leadership team should know what must be done to retain them, either through future promotion or professional advancement. Discussions should include Plan B strategies if key members of management or clinical services teams leave the organization—who is being developed within the organization to step in on an interim or permanent basis, how will the recruitment be done if internal resources are not available?

In developing a system, designers should focus on positive improvement, a belief in the quality of each employee and with an overarching desire to retain them. It should shy away from any evaluation hurdle that predetermines that each year a certain percentage of employees should leave the organization because they fall into some category designation—as in “Cs”—and require too much investment for improvement.

Over the years, an annual termination trend line may emerge, but if employees learn, or think they have learned, that the percentage is predetermined, or that some calculation for termination was factored into the program design, the program will lose credibility. That was the case for former Ford Motor CEO Jacques A. Nasser, when the unions alleged that the organization’s performance system, roughly based on GE’s highly successful plan, incorporated such a predetermined elimination target that discriminated any certain of their members.

A gold-plated evaluation program that includes a stepped up emphasis on performance—and accountability—will have enough detractors who would like to avoid both. There is no reason to give them an easy target to undermine such an important program.