When Times Are Good…

Posted on March 11, 2013 by John G. Self

When times are good, it is easier to lead. When times are tough, good leaders are the ones who build and retain the strongest teams.

Earlier Sunday, as I sat in the lobby of the Chicago Hilton where the American College of Healthcare Executives will commence their annual congress on Monday, I had a chance to visit with several old friends, CEOs, regarding the challenges they face in running health systems and hospitals.

Here is a sampling of what these accomplished CEOs think, the articles in Modern Healthcare and other healthcare periodicals notwithstanding:

Finding a bigger strategic partner – Look before you leap. Some of the potential bigger partners have their own set of serious financial problems that they are able to conceal. The conventional wisdom is that bigger will afford more flexibility in resolving core, structural problems. It won’t. Moreover, a merger is like a marriage – it should not be entered into too quickly. You need to carefully assess the motives – and the “needs” of the suitor. Nor should a governing board allow itself to be stampeded by a retiring CEO. If you engage a strategic adviser, pay them for the quality of their advice, the ability to offer well-reasoned options, not a self-serving solution.
Get ahead of the curve – Medicare, Medicaid and commercial payers will all reduce reimbursements over the next seven years just as the number of Medicare beneficiaries will explode. Health systems, hospitals and other providers need to redesign their care systems NOW as a cost reduction strategy that will enhance quality, reduce risks and protect financial margins. Changing the way you deliver care flies in the face of existing culture and physician patterns of practice. This type of change will not happen overnight.
Affordable Care Act is here to stay — The Fox News Kool-Aid notwithstanding, CB 2030 – aka Obamacare — will not be repealed; tweaked, but not eliminated. Now is the time for healthcare CEOs to do what they do best: become adept adapters. We are not an industry that enjoys getting out in front with innovative ideas. We tend to punish innovators. Adapting is not to be confused with innovating.
The future of healthcare is now — It is easy to smugly dismiss futurists with claims of reductions in payments from Medicare, Medicaid and commercial payers. We are entering a new era in healthcare – the new normal – where innovators will shine and their ideas will redirect the delivery of healthcare services.

Hiring “Gamers”

Posted on March 4, 2013 by John G. Self

Who we hire makes a difference.

A grumpy housekeeper or cafeteria cashier whose work is mediocre can help drive down patient satisfaction scores.

A physician who is more focused on the money he or she makes than the needs of the patient will impact quality of care and patient safety.

A healthcare executive who is more interested in checking another box in their career advancement plan – focusing more on title and scope of responsibility than the overall success of the organization – is a threat to morale, patient quality, safety and the financial performance of the enterprise.

With a swell of structural change building in the healthcare industry, who we hire will make a big difference. I find it helpful to look outside healthcare, to learn what other industry segments are thinking and doing. There is so much information on this subject that research becomes akin to taking a drink from the proverbial fire hose.

Ryan Smith, co-founder and Chief Executive Officer of Qualtrics, a Provo, Utah provider of on-line survey research platforms, shares something in common with hospital CEOs. He is in a fast-change industry. Hospitals are about to be.

“When everyone is rowing together toward the same objective, it is going to be very powerful …high execution at a high level is very important. The organization is going to change quickly – we are not perfect and we are going to make mistakes. We want to find people who align with that, who will add value to the company in whatever role they are in,” said Mr. Smith in the New York Times Corner Office column on Sunday.

“I am looking for someone (job applicants) who is a ‘gamer’… I want to know the hardest thing they’ve ever done. So, if you were in Korea traveling by yourself, did you go home when things got rough? That’s what I am trying to figure out, because when the ship’s going well, everyone’s good. But when obstacles come up, we’ve got to sit back and rethink, how are we going to navigate these?

Will some people want to jump off the ship? Or will they come in, roll up their sleeves and say, ‘Hey, this is part of it’.”

As the challenges for health systems, hospitals and other providers change, we are re-evaluating our –in-depth face-to-face screening interview to ensure we are finding the people who can roll up their sleeves and take on new challenges that are outside the comfort box, because that is going to be what it takes.

Health system CEOs and their senior leaders need to take a long, in-depth look at their talent pool at every level of the organization to determine their “gamer” census. By the way, Mr. Smith believes you must be truly transparent with your employees. If the challenges are tough and much is expected, and “if we are going to execute at a very high level, everyone has to know where we are going.”

It is not too early to make changes.

Who Says Hotels Deliver Better Service Than Hospitals?

Posted on March 1, 2013 by John G. Self

John Self is traveling today.

The blog post today appeared originally in November 2008. With the recent Time Magazine article on healthcare costs generating some much buzz and outrage, John and the team selected this blog for his Friday story.

Hospitals get a bad rap for poor service and embarrassing cost shifting. We are ridiculed – deservedly, more often than not – for not being able to deliver quality service in the manner of luxury hotels. In addition, if that is not enough, we hear the inevitable stories about the $25 aspirin or the arrogance of some employees who believe that they are the reason patients are there.

Today, I want to turn the tables. As I enjoy this Thanksgiving Day at my “weekend” house in scenic Tyler, a small city about 110 miles east of Dallas, some recent experiences with hotels come to mind, particularly one famous New York establishment.

In the future, when I hear unflattering comparisons between hospitals and hotels, I will ask, what about the $9 orange juice or the two to six hours it took many guests to check in because housekeeping was behind. Or, the hundreds of pieces of luggage sitting on a Manhattan side street because the hotel’s luggage storage was overwhelmed, as were the bellhops, front desk personnel, the waiters, and, obviously, the management team.

I will not use the name of the hotel because I do not want my preferred customer status to revert to that of preferred rodent, but they do make a nice holiday salad. I am just not sure they can run a hotel.

Let’s cut to the chase. The orange juice. I was asked by a harried waiter if I wanted coffee. I did. And juice? Yes, I was dehydrated. The hotel’s heating system dried me out overnight. Wow, there was a lot of pulp in that OJ. This must be hand squeezed, I thought. Then that cautionary little voice in my head sounded the alarm: Be careful, hand-squeezed orange juice is expensive, especially from the hands of unionized New York kitchen workers. I was right. Nine dollars for an 8-ounce highball glass of not-from-concentrate vitamin C.

Now the kicker.

As I was walking from the restaurant I noticed on the counter, next to a carafe similar to the one from whence my juice was poured, a half gallon carton of orange juice — Florida’s finest from the grove stand with lots of pulp. So much for that union worker in the kitchen diligently squeezing oranges. Then I did the math. A half-gallon contains eight servings, according to that manufacturer. At $9 a glass, that means the hotel was recording at least $72 of revenue per carton. Based on volume, I am thinking this enormous hotel property buys each half gallon for, at the most, $1.25 a unit. I do not even want to think about the $7.00 coffee, $19 for fresh berries, the $6 yogurt – probably not fresh – or the $20 scrambled eggs. Then you add the legendary New York taxes. The Big Apple, or at least in this case, a legendary hotel, suddenly becomes the big sucking sound as my wallet is assaulted by a juice carton masquerading as a unionized kitchen worker, sans juicer.

This is not meant to be another naive diatribe about New York’s high costs and ridiculous tax rates. About that there is no debate. Nope. This is a knock on a luxury hotel whose data processing capacity is suspect, whose customer service is worse than uneven, whose maintenance is sloppy, and indifferent executives who scurry about with their European-cut suits, cell phones in hand, with the conviction of an overwhelmed management intern who could not organize a three-car funeral.

The desk chair that was falling apart and that no one came to repair despite several calls to the hotel’s service hotline. The painfully slow service in the restaurants. The overwhelmed, plodding desk clerks and the smartly dressed housekeepers who could not clean the room before 2 PM. No wonder it took some QE2 passengers six hours to get a room while their luggage sat lined up on the sidewalk like the Northwest Airlines’ Detroit baggage claim following a snowstorm.

For those of us who toil in healthcare and have been made to believe that we are inferior humans because we cannot deliver service in a safe,timely, friendly, and cost effective manner, call me.

I will give you the name of a famous Park Avenue hotel where you can go and learn what NOT to do to your physicians and their patients.