Healthcare Reform: Culture and People

Posted on May 11, 2012 by William Gould

I love to talk about organization culture and leadership. What I like even more than talking about it is working on it. In my experience, they are inseparable. You cannot change one without simultaneously working on the other. What happens when we are talking about changing the culture of an entire industry?

Healthcare Finance Management Association (HFMA)

One of the best conversations I’ve had in a long time about culture and leadership took place last week. I was interviewed by researchers from HFMA and McManis Consulting about the Value Project.

HFMA is in its second phase of an ambitious effort to help healthcare organizations prepare for the monumental changes that are occurring in (or, “to”) the industry. The result of this research will be a series of recommendations and road maps to help healthcare organizations navigate the structure, reimbursement, and organizational changes that will be required as a result of healthcare reform. In the end, healthcare organizations are going to have to change, and deliver more value to their patients and their communities.

What I found interesting is that I was one of few Chief HR Officers to be interviewed in this project to date. I’m glad that I was given the opportunity, and I had a few suggestions and opinions to share regarding the project’s focus on “Culture and People.”

Managing Conflict

After a robust, high-energy, and 75-minute conversation, one of the researchers summed up my “radical” rant like this: ”Building the culture to drive this change must include building the leadership capacity to manage conflict.” My response was, “Yes!” I’ll take it one step further: this work is going to require healthcare leaders who thrive in a world of continuous conflict.

Change is Not a Program

One mistake that we often make in leadership and organization development is that we try to reduce the change work that we need to accomplish into neatly defined programs and initiatives. We develop strategies, timelines, and metrics to fit into our strategic plans and organization dashboards. Trying to codify change elements into concrete business deliverables sometimes comes at the cost of really understanding the human side of change. It is difficult to plot the steps of behavioral evolution onto Gantt charts.

Radical change will always be rooted in messy and emotional people issues. Conflict is inherent in change work. But, it is in this conflict where human innovation, strength, and diversity lie. The answers to our problems will be found in the conflict and debate that hasn’t yet occurred. Leadership is about creating this conflict where it doesn’t exist, and effectively leading people to contribute where it does. Change is not a program, it is a set of relationships and social structures. Changing an organization, or an industry is a contact sport.

Back to Reality

As much as I like to debate theoretical constructs, it still comes down to the day-to-day actions of leaders to move their organizations (or industry) through change. Here were a couple of my recommendations about the Value Project:

Involve more CHROs in the research. There are some smart, radical, and strategic thinkers in the HR profession and the industry;
Do not underestimate the importance of organization development and social science research on change. The real work of healthcare reform lies with the people who are providing care to our communities; and,
Challenge traditional business logic and assumptions. As one of my colleagues often says, “Rearranging the deck chairs on the Titanic will not change the outcome.” Focusing exclusively on re-aligning the financial incentives and payment systems will not in itself drive the behavioral changes necessary to create value in our country’s healthcare system.

What are your thoughts about healthcare reform, and the people side of the change necessary to address it?

Candor with Respect

Posted on April 12, 2012 by William Gould

News Flash: My wife recently called me fat. Well, not exactly fat. After work one recent afternoon, I changed into a form-fitted athletic shirt and a pair of shorts prior to going for a run. My wife was leaving the house, and I needed to ask her a question. I caught her as she was backing down the driveway. She stopped and rolled down the window.

When the real purpose of our exchange was completed, she volunteered an additional, unsolicited observation. ”Wow,” she said, “I haven’t seen that little jelly roll on you in some time.” She smiled and drove away.

At first I was indignant. No, I was offended. Then I looked down and confirmed that my well-known, half-hearted muffin top had indeed reared its ugly pudge once once again. Damn. After a year of a flat stomach, someone had obviously managed to slap a baby roll of belly fat on me when I wasn’t looking. I hadn’t noticed. She was correct.

Love and Respect

The exchange and my reaction to it got me thinking about why my wife can deliver such a personal and candid observation when very few other people would have the courage or the leeway to do the same. The answer is simple: because I know that she loves me, and always has my best interest in mind. I am open to her feedback, even when it is critical, and even when I don’t like what I hear.

Candor with Respect

My organization’s leaders have been working to improve what we call candor with respect. I work with a group of great people, and we know that we need to get even better. We need to become more open, honest, and direct in our interactions with each other because that is now required of healthcare leaders in this time of industry tumult and uncertainty. We no longer have the luxury of time for organizational politics. The healthcare reform train is headed down the tracks, and it is going to cause all kinds of collateral damage to the healthcare system the we currently know – that is not necessarily a bad thing.

I find it far more challenging to be so open to honest criticism in the workplace. Ego, positional authority, credibility, and personal insecurities prompt us to create barriers against anything that might be harmful. We don’t always assume that our colleagues have our best interest in mind, and when we do actually get candid feedback of a critical nature, we often assume that the bearer of candid criticism has bad intentions. Because we question their purpose for pointing out our shortcomings, we sometimes assume that it comes from a lack of respect.

But, when such feedback is authentic and sincere, and we are able to set our egos aside, it is not that difficult to see that such candor actually comes from a profound sense of respect.

How do we know the difference? I think it comes down to relationships.

Now, I’m off to change my shirt and do some crunches. What do you think about candor and respect in the workplace?

Managing Work Interruptions

Posted on March 30, 2012 by William Gould

I’ve been busy over the past several months. I accepted additional areas of responsibility in my role, and all of the new demands have forced me to become more disciplined in how I execute my priorities.

It’s been a long time since I’ve actually developed a comprehensive, written work plan to organize my own time; but, I have once again been carefully planning the work, and working the plan. Monthly milestones, weekly targets, and daily task lists have been keeping me focused on achieving the outcomes that I need to deliver. It has felt good to check things off that list, and to visibly see progress toward my goals.

Interruptions

I’ve learned that the more responsibility you accept, the more people need your time. Demand for a leader’s time often translates into unplanned interruptions to their work. Telephone calls, emails, meetings, and groups of people landing in your doorway all create barriers to executing on a detail-oriented work plan. It can become frustrating. As pressure to meet deadlines builds, the natural response is to want to close the office door and to block out the calendar. I need to focus on the work to get it done.

I had an employee come to my office last week. She was anxious and asked if she could have a few minutes. Despite the irritation that I felt over the interruption to my work on a very complex issue over which I had wrestled for months, I gave her my full attention. We spent about 10 minutes discussing a project that she was leading. Her problem was solved. My problem was not solved, and I struggled to regain my focus.

The Real Interruptions

And then it struck me, again. I had been behaving like the interruptions to my important leadership work were those unplanned demands on my time from other people. The real work of a leader is the time that we spend helping other people accomplish their work. The real interruption to my leadership work had been the busy, task-oriented, check-list mentality that I created to try to manage new demands.

Patient Care Interruptions

The trap into which I had fallen is not any different that what I sometimes hear from clinical professionals in healthcare. All of the regulatory paperwork, documentation, and computer work required of their roles prevents them from spending time with patients. This is very frustrating to healthcare workers who largely went into their profession to take care of people, not regulations.

Focus

Whether it’s learning how to accomplish the detail work required of leadership, or managing the compliance and documentation demands of clinical care, the fact remains that we need to get that work done. But, I am reminded about how important it is to maintain the right perspective. Leadership, like patient care, is about taking care of people. When our complaints and frustrations turn against those “pesky” employees or patients, then we have lost our perspective. The good news is that our employees and patients are willing to remind us of our purpose, if we are willing to listen.

How do you manage the demands on your time?

How do you maintain the focus on what’s most important in your leadership or patient care work?