Tuesday, August 31, 2010

Do Retail Health Clinics Complement Or Compete With Primary Care Physicians?

This is the same question that has been faced by many hospitals looking to start up an urgent care center. The primary care physicians usually express outrage that the hospital would compete with them. I have seen this first hand when our hospital contemplated such a move. Never mind that the hours of our center were in the evening and weekends when physician offices were closed. Also never mind that at 5pm the physician's phones shut off and patients got an answering machine that said they were unavailable and that any serious condition should be seen in the hospital's emergency room. I guess that EDs don't present the threat that urgent care centers do.

Well now there is a school of thought that supports the idea that these centers do not actually compete with primary care physicians, but actually help them. Although there may be some patients who use urgent care centers or retail clinics when available that otherwise would have gone to the primary care physician, many more are referred into primary care physicians for followup after an urgent care visit. Also the mix of patients in the clinic is different. Only 40% of these patients even have a private physician compared to 80% in the general population. Finally, because of the hours of operation, many of these patients would be going to an ED as an alternative, not waiting for the physician's office to reopen.

Overall these clinics and urgent care centers are seen as cheap, convenient and providing a high level of patient satisfaction. Maybe the physicians should not be so threatened and view them as a potential referral source that gives patients a great after hours alternative.

More on this later.

Mark Brodeur

Monday, August 30, 2010

Is There A Future For Public Hospitals?

The current economic climate for hospitals has been described as Darwinian. I think this is a fair assessment considering the current level of performance for many small, rural, community hospitals. Many of these are public hospitals that were developed years ago to provide needed healthcare services to isolated communities.

A recent article in the Wall Street Journal has identified that their current bad credit ratings combined with the expected government cuts under healthcare reform, will further cripple public hospital's access to capital needed for health IT and other infrastructure needs. In other word, banks don't lend money to hospitals that really need it, particularly after the recent banking industry crisis.

Two other characteristics of public hospitals work against them as well. Most are small and stand alone. This gives them less of an edge when negotiating purchasing and managed care contracts when compared to the larger systems. As we move to adopting more "Centers of Excellence" again the stand alone public hospital will have a disadvantage. Finally, those hospitals that have been relying on tax subsidies by their local communities will face strong pressures to see these go away completely and have no prospect of any increases.

Some public hospitals have gone from public to private in the past with no problems. I oversaw one transformation in the early 90's. The move did nothing but benefit our hospital and the community. Perhaps more hospitals will be looking at this or even face a much more devastating alternative.

More on this later.

Mark Brodeur

Friday, August 27, 2010

Admitting Medical Errors: One Hospital's Experience

Imagine a hospital that actually encourages its employees to not only admit medical mistakes but tell the patient and family the details of the mistake. In addition, if they find that a treating physician was at fault for an error related injury, they offer the patient and family financial compensation. This sounds crazy and is a bolder move than I would have been willing to try, but apparently it works.

This is not a true study since it is the experience of only one hospital and there was no control group. But according to the Annals of Internal Medicine, the University of Michigan Health System tried this and saw the following outcomes:

1) Overall legal costs went down
2) Number of claims requesting compensation went down
3) Number of claims actually compensated went down
4) Time to resolve a claim decreased

I have heard for years that being open about medical errors with patients and family is the way to address them. But the extent of information shared by this hospital as well as linking it directly to an offer of compensation is something new. I would like to see more studies but University of Michigan Health System's experience certainly supports this approach. The hospital was on a downward trend for claims before this was implemented. But claims dipped well below the tend after this program was put in place so there is clearly a connection.

The message here is that a full disclosure with offer program will not drive up liability costs as one might suspect. In this case at least it had a very positive impact in the other direction. Certainly this is worth serious consideration.

More on this later.

Mark Brodeur

Wednesday, August 25, 2010

The Cost of Medical Care Actually Dropped Last Month

Maybe its too early to get really excited because one month does not make a trend and the cost of healthcare only dropped one tenth of one percent between June and July. But still, a decrease in the cost of healthcare is a big deal. This has been the one constant in the economy that everyone could count on. Healthcare costs will always increase from month to month. We have only had a decrease like the one last month six times in the last 63 years. Maybe longer since records only go back to 1947. And the last time it happened was 35 years ago.

On the other hand maybe it is time to celebrate, at least until the August numbers come out. Of course I would feel better if we knew exactly why there was a decrease. No one seems to be able to explain that. All we know is that healthcare did buck the overall trend which showed a consumer spending increase increase of 0.3% between June and July. The Obama administration has not yet claimed this as a victory for healthcare reform. Nor have the Republicans stated that this is the beginning of Americans abandoning our current healthcare system out of fear. People like us at Compirion would like to think it is because we are helping hospitals improve their operating metrics. But the truth is that the decrease is too small to be statictically significant, at least based on one month's data.

Lets continue to look at this and see what the future months bring.

More on this later.

Mark Brodeur

Monday, August 23, 2010

Six Keys To High Performing Hospitals: Key #6

Today I finish out the list of keys to high performing hospitals as put together by Lawrence Prybil, Ph.D. and Samuel Levey, Ph.D. To say last but not least is an understatement. Today's key is perhaps the most important of all of them.

6) Healthy organizational culture

This concept has not been traditionally discussed, perhaps because it is a bit more difficult to see and measure. In fact in the study, it was cited in only 6 out of the 10 high performing systems interviewed. The culture in these systems was described as having a broad-based commitment to excellence in patient care and operating performance. It was also stated that this culture was not always with the organization but rather had to be developed over time. The culture must embrace the organization's core values and commitment to high performance.

Changing culture in an organization is a marathon, not a sprint. This is something that we work with everyday at Compirion Healthcare Solutions. To assist an organization in changing its culture requires an intense effort over an extended period of time; at least six months. Anything less than this will not have a sustained impact. Managers frequently put a spotlight on a problem area for a short period of time and are gratified to see almost immediate improvement. What they fail to do is follow up a few weeks later to see if the improvement has continued.

This list of six keys is not meant to be inclusive. There were a number of other keys mentioned such as prudent investment in facilities, services and new technology. But these six were considered the most influential on the high performance. If you achieve these six you will have attained a high level of performance.

More on this later.

Mark Brodeur

Friday, August 20, 2010

Six Keys To High Performing Hospitals: Key #5

The fifth key to high performance may seem obvious, but when looking at hospitals that are struggling on their bottom line, it is not so obvious to them.

5) Defined organizational objectives, targets and metrics.

The only surprise to me in the study is that only 6 out of the 10 high performing hospitals in the study mentioned this. It relates to the popular axiom, "If you can't measure it, you can't manage it". All hospitals have great financial measures, quality standards and customer service scores at an organization wide level. These are usually included in a monthly dashboard shared with the Board. But what about at the department level? Does your facility have metrics to track all key performance areas? And how often is this data collected?

We at Compirion Healthcare Solutions often find this kind of data lacking. And if it is collected, it is not done on a frequent enough basis. The Board level dashboard concept must be applied at the department level (and interdepartment level) for all operations. The data should be monitored on a daily basis. Looking at last month's data will not show all of the performance fluctuations that occur. Plus it is too old to be useful for making the needed adjustments.

Gathering daily metrics is only part of the necessary action to achieve high performance. Knowing where you are today is important, but you must also set the appropriate and achievable benchmark for where you want to be. There are plenty of standards out there, some of which may seem unachievable. We have found in working with hospitals that they are surprised at the high levels of performance that they can achieve. We now resort to sharing the risk and providing them a money back guarantee if together we don't achieve this level of improvement.

So first you meed to measure where you are today, then set the benchmark for where you want to be and track your progress with daily measurement. How you get from A to B is an intensive process that is a whole subject on its own.

More on this later.

Mark Brodeur

Thursday, August 19, 2010

Six Keys To High Performing Hospitals: Key #4

Continuing my commentary on the list of keys to high performing hospitals based on a study by Lawrence Prybil, Ph.D. and Samuel Levey, Ph.D., today's topic deals with the ultimate authority for a hospital's operations.

4) Committed and engaged Board of Directors

With the hospital's CEO being the one in the spotlight, not everyone realizes the critical role that the Board of Directors plays. In fact, if they are doing their job well, they will remain somewhat in the shadows as the hospital excels. Usually Board members are only in the news when a hospital is in some kind of turmoil. A high performing Board is proactive, well informed and collaborates closely with the CEO and the Medical Staff. This was identified as a must by 8 of the 10 high performing Boards in the study. I think the other 2 just failed to mention it.

It is interesting that many of the high performing Boards spoke of the journey they took to get where they are today. It is clearly a development process. They spoke of the past when they were more passive and had a limited awareness of their environment and the importance of maintaining strong relationships. I remember dealing with a Board member who was strongly opposed to physician representation on the Board. His attitude was that the hospital would run a whole lot smoother if we did not have to deal with the doctors. This kind of thinking will hold a hospital back regardless of what other positive things are happening.

So how did the transformation happen for these Boards? It starts with education and a commitment by all Board members to be engaged in the process. The hospital can not afford to have valuable Board seats occupied by members with their own agenda or passive individuals who just occupy a chair and enjoy dinner. It also involves having the Board be clear on its role versus the role of the CEO. All high performing Boards understood this distinction. Having a strong trusting relationship with the CEO is essential. Finally, much of the work of strong Boards is done through effective committees. Most Boards are too large to have the kind of in depth discussion needed for many issues. Also there are just too many issues to deal with. So having committees that do most of this before the Board meeting is important. At the main meeting, the in depth work of the committees can be summarized rather than totally rehashed. This allows input from everyone without getting bogged in the details.

The Board is the ultimate authority for a hospital. This is not to say that it is more important than a strong CEO or cohesive Medical Staff. But without this third leg of the stool, the hospital will not excel.

More on high performance tomorrow.

Mark Brodeur

Wednesday, August 18, 2010

Six Keys To High Performing Hospitals: Key #3

I have previously commented on strong value based CEO leadership and a clearly articulated mission, vision, and values. Today I want to move on to the critical importance of clinical excellence and the leadership it takes to achieve it.

3) Strong clinical leadership and capabilities

Eight of the 10 high performing systems interviewed mentioned this as essential to their success. This actually touches on several subjects. The first is my favorite mantra "quality first, finances follow". The second is the critical importance of having a competent and supportive medical staff. To achieve both of these you must have strong physician leadership. No hospital can achieve enduring success without it.

I have seen hospitals that have dissension within the medical staff and conflict between the medical staff and the board. This makes for a dysfunctional environment and will certainly hold the hospital back from becoming a high performer. The analogy that a hospital is a three legged stool comes into play here. It is supported by the Board, the Medical Staff and the CEO. If one of the 3 is missing, the stool falls over. This often requires some give and take on both sides. Some of the high performers mentioned the value of joint ventures with their physician groups. While some Boards may not be willing to share revenue with their physicians, the high performers have learned that sacrificing something in the short run will pay larger dividends down the road when strong relationships have been developed.

Strong clinical performance also extends beyond the medical staff to include nursing which is the backbone of the care provided as well as the other clinicians who provide care and support. Effective leadership in these areas is also key to high performance.

One final thought. With the advent of healthcare reform, there will be a stronger push for fully integrated care systems that include prevention, primary care, outpatient services and hospitalization under a single billing structure. Maybe we will finally see that capitated payment system that we all got ready for in the late 90's. Either way, systems that have all of these elements integrated will excel.

More on high performing hospitals tomorrow.

Mark Brodeur

Tuesday, August 17, 2010

Six Keys To High Performing Hospitals: Key #2

Yesterday I discussed the importance of strong, value based leadership to a high performing hospital. Today I comment on my experience with the second key which involves setting a clear direction at the hospital that others are inspired to follow.

2) Well understood mission, vision and values

This was covered in my previous series of posts on what makes a great leader. But it is certainly worth repeating. There is a reason it is listed under attributes of a great leader as well as keys to high performance in your hospital. When surveyed, trustees from 8 of the 10 high performing systems that were identified for the study stated the importance of a meaningful mission statement, compelling vision for the system's future, and a clearly stated set of core values. It is important that they not only be understood but also supported by all key stakeholders both internal and external.

I have seen firsthand the difference that that a clear, concise and internalized set of mission, vision and values can make on an organization. There is no right or wrong message to convey. But it must be true to the real purpose of the hospital. More importantly it must be lived by everyone in the organization. In some hospitals the mission is just words on a dusty plaque. In a high performing hospital it is the daily motto that actually motivates employees. All key stakeholders from Board members to front line staff should be able to state the essence of the hospitals mission, vision and values from memory because they have been exposed to it every day.

This does not happen easily, nor can you change the culture overnight. It takes months if not years of repeated effort to "spread the mission". I found it useful to post these widely throughout our hospital; to make them a laminated page at the beginning of every Board meeting; to begin every new employee orientation with a thorough explanation of them; and to remind employees every day why we are here.

We talk about, "no money , no mission". I add to that, "no mission, no purpose".

More on high performing hospitals tomorrow.

Mark Brodeur

Monday, August 16, 2010

Six Keys To High Performing Hospitals: Key #1

In an intensive study conducted by Lawrence Prybil, PH.D. and Samuel Levey, PH.D. which covered 123 hospitals in 40 states, they determined the short list of factors that made the high performing hospitals able to achieve that success. This study included interviews with key leadership at 10 high performing health systems. In today's post and subsequent ones I will provide my commentary on these factors. You will note that there is clearly overlap with this list and the ten key aspects of great leadership covered previously. This is no surprise, rather an affirmation of the bond between great leadership and high performance.

1) Strong values based leadership

Nine of the ten systems interviewed stressed how important it is to have strong leadership skills from the CEO. Leadership is different than management. It includes attributes such as commitment to the system's organizational mission and values, stellar communications and relationships with the board and medical staff, expertise in financial management and cost controls, a passion for continuous improvement and strategic vision.

It was also noted that the strong leadership must extend beyond the CEO position to all of the senior management team. Each of them brings their own area of expertise to the organization. Having a top leader who can attract this kind of talent and bring them together as a cohesive team is vital for the high performing hospital.

I can tell you from experience that this is more difficult than some people may assume. First you must create a culture that will be attractive to high performers. Even in today's economy with many people looking for work, high performers are difficult to attract. Then you must get these strong individuals to work as part of a team with other strong willed types. This part can be just as difficult. For some of these types, playing as part of a team is new to them. But it can be done and it must be done to achieve superior performance.

Ultimately though, it falls on the CEO to put this team together and to get them working collaboratively. If it is not happening, it is the Board's responsibility to make the necessary change in the top position.

More on keys to high performing hospitals tomorrow.

Mark Brodeur

Friday, August 13, 2010

Smaller Rural Hospitals Provide Surgical Care That Is Just As Safe As Larger Urban Hospitals

A new study released in the July issue of the American Journal of Surgery compared the compliance of hospitals to the latest safety standards. It showed that smaller community hospitals were as responsive or even more responsive to new safety standards than their larger urban and tertiary care counterparts. It shows that you do not have to go to the big city to have a high quality, safe surgical experience. This is very important since currently 40% of Americans have their surgery in centers that are not large, urban, or tertiary care facilities.

In my years of experience I always knew this to be true, but it is nice to see it documented in a study. Most previous studies have bypassed the care given in the smaller and rural community hospitals. This has helped perpetuate the myth that for the best surgical care you must go to the large teaching hospital with cutting edge, expensive technology. If your surgery is that specialized that you need this type of care you will be referred there. But for more routine operations it was found that the smaller hospitals more quickly adopted new safety standards because there are fewer bureaucratic levels to cut through.

Specifically the study focused on how well hospitals implemented the expanded surgical time out procedure. The basic time out occurs before the patient is put under for surgery to verify that it is the correct patient, the correct surgery and the correct site. The expanded time out has a long checklist of additional safety items to check. Major surgeries such as hip and knee replacements, hysterectomies and colon resections were looked at for the study. It showed and overall compliance rate of 97% for the smaller hospitals with clinicians showing an extremely high standard of care.

So unless a patient needs a Cyberknife or DiVinci device for their care, they should feel comfortable going to their community hospital for surgery even if it is not listed in the U S News and World Report's Best Hospitals in America list.

More on this later.

Mark Brodeur

Thursday, August 12, 2010

Paying Hospital Based Physicians Must Be Contingent On Far More Than Productivity

The pendulum that swung away from making physicians hospital based ten years ago has clearly swung back. Hospitals are moving away from contracting with independent groups for many services and returning to salaried arrangements. But this time the payment arrangements are far more complex. It appears the hospitals have learned from mistakes made in the 90's when hiring physicians was last popular. In that era many physicians benefited from the naivete of hospitals in negotiating these arrangements.

I know of one hospital that plunged headlong into hiring physicians not just for hospital based services but they also set up a large primary and specialty care group. This new practice was largely responsible for the subsequent year's $5 million dollar profit for the hospital. The problem was that the practice itself lost $11 million that year.

There is also the case of two primary care physicians who sold their practice to a large hospital chain and made a big windfall. The chain kept them on seeing their same patients for a nice salary. This continued until the chain decided to dispose of all owned practices and paid these two doctors another nice windfall to take responsibility back for their patients, which they did. They are now back to where they started except they have pocketed two nice checks in the meantime.

Well this time the hospitals have started protecting their investment with payment tied to performance measures. It started with simple productivity measures. Physicians get paid for the number of patients they saw. Then it was discovered that not all patients took the same amount of resources, so RVUs were developed. It soon became obvious that there were other duties involved and time spent in a physician's day can be far more complicated than this.

According to Hospital Review, the following are key factors in payment formulas for salaried physicians today:

-Clinical services provided
-Administrative duties performed by the group
-Call coverage
-Quality measures, which still tend to be process oriented
-Measures tied to strategic objectives
-Professional fees

There are many factors driving physicians and hospitals toward salaried arrangements in today's environment. Clearly hospitals do not need to repeat the mistakes made 20 years ago. But the contracts will need to be based on a number of factors that include volume, complexity, quality, customer service and strategic initiative indicators.

More on this later.

Mark Brodeur

Wednesday, August 11, 2010

A Pilot Project For Tort Reform That's Worth a Try

One of the major areas for reducing healthcare costs that is being largely overlooked by the Obama administration and the new healthcare reform law is tort reform. This is not a popular subject with the Democratic majority because of the support they receive from from all of the trial lawyers. Nevertheless it is an important area to address in today's economic climate and at least one initiative snuck through with some federal funding.

According to the Wall Street Journal there is a pilot program in New York State that looks promising and deserves some wider attention. Rather than allowing many of the cases to just go to trial which occurs under the current system, they are taking a different path using judge-directed negotiations.

Five hospitals in New York City are participating in the program. They are looking to reduce their malpractice costs by revealing any medical mistakes early, quickly offering settlements and using special health courts that have been set up where judges can negotiate agreements before they go to trial.

The pilot is being funded by the federal government for three years at a cost of $3 million. But the goal is to reduce the $1.4 billion spent each year in New York State on medical malpractice premiums. Some of the savings will come from quicker and hopefully more reasonable settlements, but the big savings will be from reduced attorney's fees for both sides. Obviously the trial lawyers association is not behind this pilot project.

Some will argue that we already have a mechanism in place to negotiate settlements and many cases end that way. Hospitals will argue that most of those are nuisance suits that are settled just to avoid the cost of going to trial. This process with a judge directed health court to hear cases should get the nuisance suits thrown out entirely.

I applaud New York State for this pilot and the Federal Government for funding it. I will be anxious to see the results.

More on this later.

Mark Brodeur

Tuesday, August 10, 2010

When Addressing ED Throughput, Don't Forget To Check The Back Door

Yesterday's post covered the anticipated increase in ED visits for most hospitals because of the impact of healthcare reform. As hospitals prepare for this they will most certainly look to improve ED throughput, which is certainly what I would recommend. Many efforts I have seen hospitals attempt focus on the front door of the ED to get patients into the system faster. This is important but it is usually only part of the solution to faster throughput in the ED.

A number of approaches have been tried to get patients into the treatment cycle faster. Door to doc time or door to treatment time is a metric we all look at. Some innovative approaches have been used to shorten this. Some of them work and some of them don't. For example, hospitals have tried a policy of not using the waiting room unless absolutely necessary. The idea is to have enough treatment rooms in the ED to whisk new arrivals instantly into a room. This gives them the idea that treatment has begun. But the plan backfires when a patient waits an hour in a room without seeing anyone. Its like entering a crowded restaurant and immediately getting a table only to wait an hour for the waiter to show up. To improve throughput you need to begin service earlier.

But while many hospitals do effectively reduce waiting on the front end, fewer recognize the impact of the backlog on the back end of the ED. I'm talking about the patients waiting to be admitted upstairs. Disposition to Admit time is the metric to look at. Admit is defined as the patient has left the ED and is in an inpatient bed on a unit. Not all EDs recognize the significant impact this can have on ED throughput, patient satisfaction, ED productivity and ultimately new ED business.

The primary reason that ED patients who need admission remain in the department is the lack of available beds upstairs. We sometimes see a lack of cooperation from nursing staff to accept new patient in available beds, but usually its because the beds are full. And often they are full with patients who have been medically ready to be discharged for hours. They just haven't left yet. This is often because they are waiting on a family member who works or because the attending physician makes rounds late. These are both challenging issues but they can be addressed. We have helped many hospitals do it.

So when focusing on improving ED throughput, don't forget to address the inpatients lingering in the beds upstairs. Your ED bottleneck may well be bigger at the back door than it is at the front.

More on this later.

Mark Brodeur

Monday, August 9, 2010

Prepare for Increased ED Usage Under Healthcare Reform

Healthcare reform will provide insurance coverage to millions of Americans who are currently uninsured. Many of them seek access to healthcare only through Emergency Departments. The initial thought would be that once they get health insurance coverage under the new reform law that they would immediately stop using the Emergency Department inappropriately and go instead to primary care physicians thus causing ED visits to decline. But actually just the opposite will likely occur. There are a number of factors that point to a surge in ED volume under healthcare reform. These include:

1) It is a misnomer that the uninsured use the ED more than insured patients. Many of them (though certainly not all) are wary of accumulating large bills. Suddenly having coverage will more likely drive them to seek healthcare. Since they have not established a relationship with a primary care physician or clinic, they will likely begin by going instead to the nearest ED to flash their new health insurance card.

2) Currently the biggest users of EDs are Medicaid recipients. Under reform, their ranks will increase by nearly 16 million. Their trend of using the ED to access the system will continue at least for a significant period until stronger primary care access is established. The new recipients will be much more prone to visit their local ED than they are today.

3) The new healthcare reform law does address improving access to primary care providers over time, but unfortunately it is much more effective in increasing the demand first. There is funding and incentives to create innovative models of care such as medical homes. But first of all these will take time to get approved and developed. Second they will take time to get staffed. And third, it will take time to shift usage patterns into these settings. In the meantime, EDs will stay busy.

Massachusetts has frequently been looked to as a model of what will happen under healthcare reform because they have had a law since 2006 requiring health insurance for almost everyone. They reported a 7% increase in ED visits between 2005 and 2007. Their increases may not be overwhelming but they still remain above the national trends.

How do you prepare for the anticipated increase in patients? A surge plan is certainly beneficial, but we have found it to be much more effective to focus on streamlining your current daily operations. Reducing ED throughput and facilitating earlier discharges has never been more important. We at Compirion Healthcare Solutions have assisted many hospitals to achieve amazing improvements in these areas and would be happy to meet with you to help your hospital prepare for the changes ahead.

More on this later.

Mark Brodeur

Friday, August 6, 2010

Public Opinion Seems Strongly Against Healthcare Reform

This week Missouri voters drew national attention by solidly passing a measure that would ban one major aspect of healthcare reform; the requirement that everyone purchase some type of insurance. The measure is largely symbolic since federal law will take precedence over state law in this case, but the Missouri voters were well aware of this when they voted. In fact it was publicized by some that voting for this measure may jeopardize some federal funding down the road because of the embarrassment it would cause the Obama administration. That didn't seem to matter to Missouri voters who passed the measure with a more than two to one margin.

The Missouri Hospital Association weighed in on the matter with a mailer to all Missouri residents strongly opposing the measure. They made a very good point. If there is no mandatory health insurance coverage then who pays for the services consumed by the uninsured who certainly can't afford to self pay. Voters don't want it covered through taxes. So I suppose it is to fall on the shoulders of the providers to eat these costs. The MHA argues correctly that this could threaten the very existence of some struggling community hospitals.

The Tea Party and others also make a compelling argument that we want less government intrusion into our personal decisions. This certainly may fall into that category. But I argue that being able to provide needed healthcare services to someone regardless of their ability to pay supersedes that personal decision. Will that person who decides not to purchase health insurance also decline any medical treatment that might possibly be needed? I don't think so, nor should they.

Right now healthcare services are available when really needed for anyone. By putting our heads in the sand and saying we will not pay for some will not make those costs go away. Yes, healthcare costs are too high and yes, there are ways to improve the efficiency of service delivery and payment. But just ignoring the cost of the uninsured will not address these issues.

More on this later.

Mark Brodeur

Thursday, August 5, 2010

Ten Aspects of Strong Leadership: Point #10

Today I finish up my commentary on the ten aspects of leadership that were put together by Chuck Lauer. He has done a good job of covering all the bases for distinguishing strong leaders from weak ones. The final point sounds like an entreaty to all leaders.

10) Have courage

There is no safe comfort zone for leaders particularly in trying times like we are seeing now. A leader must be willing to take risks that will ultimately benefit the entire organization. At the same time he or she may be putting their own career on the line, but that's what it takes. To paraphrase a popular saying, 'When the going gets tough the leaders start leading'. This does require courage even if you have solid information to base decisions on. In the real world, the proper direction to follow is rarely that clear cut.

At this point I would like to recap the 10 aspects of strong leadership.
1) Leading is not the same thing as managing
2) Don't live in a bubble
3) Cherish and respect employees
4) Choose a clear mission
5) Demonstrate integrity
6) Be transparent
7) Embrace responsibility
8) Share credit
9) Leadership isn't for everyone
10) Have courage

This is a pretty comprehensive list, but it does help to define who is a strong leader in the healthcare field. How do you measure up?

More on this later.

Mark Brodeur

Wednesday, August 4, 2010

Ten Aspects of Strong Leadership: Point #9

We are nearing the end of the list from Chuck Lauer on important aspects of leadership. But there are still several important points to make.

9) Leadership isn't for everyone

There is a saying that leaders are born and not made. You need to have that intestinal fortitude it takes to deal with the pressures of leading. In my CEO days I can't even recall how many times people came up to me and said, "I sure wouldn't want your job. Its too much stress". Of course this doesn't include the physicians who were convinced that the job was a cake walk and anybody could do it.

Most of those who do not have this inner strength needed recognize that fact and do not pursue a leadership role. Unfortunately there are some who are missing this key element but pursue the career field anyway. They usually get chewed up by the pressures and stress of the job. While no one enjoys the negative and stressful aspects of a leadership position, the strong leaders can cope with these and move on to the more positive aspects.

And that is the other side of being born to lead. Strong leaders derive great internal satisfaction from the accomplishments that a leader can help direct. While doing this he or she remembers that they did not do it alone. I forget the movie where a character says, "I love it when a plan comes together". But that is the satisfaction that a great leader feels. I have felt a strong sense of accomplishment over the years for the things that our team has achieved. This more than offsets the other stresses that come with the job.

Leadership is an opportunity that is also filled with a great deal of responsibility. Strong leaders live for this.

Tomorrow we will wrap up the series on leadership.

Mark Brodeur

Tuesday, August 3, 2010

Ten Aspects of Strong Leadership: Point #8

As we begin to wrap up the ten aspects of leadership, there are still some important ones to cover. Today's topic is recognizing the efforts of those around you as your organization moves forward.

8) Share credit

This skill like some others is linked directly with being secure as a leader. I have seen insecure leaders over the years be quick to grab credit for anything positive that happens. It seems they need to justify their existence by claiming responsibility. A few delusional ones even believe that they did it alone. I know someone who felt that he alone was irreplaceable. Everyone else around him was inconsequential and could be easily replaced. This is the antithesis of a strong leader.

Chuck Lauer states that a leader is best when people barely know he exists. This is tough for some leaders for many of us are drawn to the spotlight. But sharing it with all the people who make good things happen is extremely important. Recognizing someone publicly is a powerful motivator for them. We all want recognition. It may be the strongest reason why many people do what they do. One of the best bits of advice I got was to recognize employees who did something particularly well by sending a thank you note extolling their virtues to their home. This way it is seen by their spouse and family. It also is more personal and heartfelt.

The other side of publicly sharing the glory is stepping up and taking the blame alone. To publicly admonish employees in public will not achieve the desired result. It will destroy morale. Praise in public and criticize in private is a very true axiom. Everyone will realize the part they played in a failed initiative. A true leader is someone who takes it for the team and moves on.

More on leadership tomorrow.

Mark Brodeur

Monday, August 2, 2010

Ten Aspects of Strong Leadership: Point #7

Moving on with Chuck Lauer's list of leadership traits, today I want to cover one that can be clearly seen in many leaders but is even more obvious when it is lacking. Not everyone who is elevated to a leadership position has everything that it takes to lead. A leadership role is very demanding and you must be willing to take on these challenges.

7) Embrace responsibility

There are two aspects of taking on responsibility and decision making. The first is making that enlightened decision in a timely manner and the second is standing by it under pressure. Regarding making the right decision, it must be fair and balanced taking into account all the factors in play. These are usually contradictory so the decision making is much more difficult. Responding without knowing all of the facts can be bad, but being frozen with indecision during critical times is certainly worse.

Great leaders actually enjoy the challenge of taking on responsibility and making the tough decisions. These are people who thrive under stress. Not that they go about purposely creating stressful situations. There are some people who do that. But great leaders derive an inner strength under stress and find a way to show peak performance. They do not waffle under challenge of their decisions. Any tough decision, even the right one is bound to have some challenges to it. Making the right decision in the first place is a leadership skill. But sticking with it under challenge is just as important.

Clearly this is not for everyone. I have seen people in leadership positions who freeze under pressure or back away from tough decisions hoping that they will resolve themselves. Obviously these people do not survive long term in a leadership position. The organization is looking for someone to take charge and take a stand. Even if they do not personally agree with a position, many people will follow a leader who clearly articulates his or her position.

It is during times of crisis that strong leaders clearly differentiate themselves.

More on leadership tomorrow.

Mark Brodeur
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