Build Key Relationships

As leaders progress up the executive ladder, their ability to build effective relationships becomes much more important to their success.

There is a delicate balance to be struck between being viewed as successful based on your experience as well as your ability to connect with people. When this becomes unbalanced on either side of the equation, the results can be very negative.

To build relationships with depth, start with sincerity and a genuine interest in people. Since most executives have limited time, it is important to identify the individuals where these solid relationships are important. For executives, I refer to this as their "stakeholder list". This could be anyone who will have great influence on the success or failure of the executive.

To Increase a relationship with another individual, consciously move it along that corridor from stranger toward friend. I'm not saying you have to reach the ultimate goal of friendship but you do have to keep moving the relationship forward.

When you move the relationship forward you affect what I call "the filter". The filter is how that person sees you. When there is a relationship on some level, that filter tends to be very positive. What does that mean to you? The other individual tends to let in only things that support that favorable impression. On the flipside, if that filter is negative, it tends to only let in negative information. A simple analogy could be the following: Who would you fire first: a stranger or a friend? Who would you hire first: a stranger or friend?

Some useful tactics to enhance relationships:

  • Sincerity
  • Be a listener with enthusiasm
  • Find connecting points – common interests, experiences, etc
  • Find their passion – what are the things that excite and motivate them?
  • Consistency- keep a predictable tempo to the relationship
  • Caring
  • See the world from their perspective
  • Find ways to help
  • Be proactive about the relationship

To be successful, work to strengthen key stakeholder relationships.

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Are you creating and executing a roadmap that will assist you in moving up within your organization?

The whole concept of internal transition or advancement for executives I find is often neglected. Like overall career planning, without a roadmap, executives have no rudder or direction in mind.

As a result of having no real advancement direction or plan, these are the most prevalent outcomes:

  • Career growth in their current company is slow to nonexistent
  • They leave the organization too early and possibly create a negative ongoing pattern predictable change

Neglected areas are often:

  • No plan for growth within the organization
  • No key stakeholder list
  • Lack of appropriate self-promotion
  • Poor outcomes alignment with immediate boss
  • Weak political acumen
  • Ineffective soft skills
  • No clear vision and strategy
  • Lack of developing a strong team

These are certainly not all of the issues but key ones I often see. Setting a roadmap, following the path and focusing on the key areas needed for your success will help you reach your end goal. That next stop on the career path may be within your existing organization or you will be well positioned for that next opportunity outside the organization.

What is that old saying?

What is that old saying? "If you don’t know where you are going you will never get there."

Enjoy the drive!


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As the health care system confronts the need to change and adapt in the new era, leadership is required throughout the entire organization.

Nursing Leaders are the centerpiece of care delivery and are extraordinarily vital and influential in carrying out the mission and vision of any healthcare organization. As a result, their leadership has a direct effect on the quality and fiscal outcomes that are of vital importance to an organization.

At Wiederhold & Associates, we know an organization can optimally increase a nursing leaders’ capacity for successful outcomes through professional Nursing Leadership Coaching. It is the single most powerful way for a leader to achieve their potential for superior leadership, strategic thinking, and measurable results.

Coaching is customized to every situation and organization, with outcomes driven models implemented to ensure success.

Who can benefit?

  • Senior Nursing Executives
  • Nursing Directors and Managers
  • Newly hired Nursing Executives who wish to position themselves out of the gate for great success
  • High potential Nurse Executives who can benefit from expanding their strategic thinking
  • Nurse Executives who want to continue to provide optimal leadership for the patients and the people who care for them

Nursing Leadership Teams

Team Coaching is different from training in that it specifically targets the needs of a group, while providing direction to challenge them to meet a targeted outcome. Teams that can benefit from our approach include:

  • High functioning teams wishing to expand their capacities
  • Teams experiencing significant changes or challenges
  • Newly formed Nursing Leadership Teams

Want to move your organization forward?

Invest in your core: Nursing Leadership.

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The majority of us plan for our children’s college education, or to get married or stay single but unfortunately very few executives plan their careers. Many potentially successful executives fail to climb the executive ladder because they don’t plan where they want their career to advance to.

Healthcare professionals can progress in their careers, but only if they position themselves for success.

In my experience, less than 5% of healthcare executives plan their career. Most, as I would say, “wing it”; taking advantage of opportunities as they present.

I describe career planning like building a straight fence. You define where you want to go and then identify the points and steps it takes to get there.

Successful executives complete a gap analysis: what are they missing for experience and skills. Skills fall in two categories: hard skills and soft skills. Executives often focus on the hard skills areas and miss the needs for developing soft skills: communications, conflict management, effective messaging, emotional intelligence, relationship building etc.

Through my work with executives in transition, 95% of people in transition lost their job due to a lack of emphasis and engagement in the soft skills.

Preparing to climb the ladder requires a plan that includes the skills both hard and soft to be successful. Successful executives must master emotional intelligence and navigating the political landscape to stay at the top of that ladder.

Here’s to your success!


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When you think of an --Effective Leader-- what comes to mind?

You might picture someone who never lets their temper get out of control, no matter what problems they are facing. Or you might think of someone who has the complete trust of their staff, listens to their team, is easy to talk tThese are qualities of someone with a high degree of emotional intelligence (EQ). Research shows that EQ scores climb with titles from the bottom of the corporate ladder upward toward middle management. Middle managers stand out with the highest EQ scores in the workplace because companies tend to promote people into these positions who are level-headed and good with people. The assumption here is that a manager with a high EQ is someone for whom people will want to work, and always makes careful, informed decisions.

These are qualities of someone with a high degree of emotional intelligence (EQ). Research shows that EQ scores climb with titles from the bottom of the corporate ladder upward toward middle management. Middle managers stand out with the highest EQ scores in the workplace because companies tend to promote people into these positions who are level-headed and good with people. The assumption here is that a manager with a high EQ is someone for whom people will want to work.

But things change drastically as you move beyond middle management. For the titles of director and above, scores descend with CEOs, on average, having the lowest EQ scores in the workplace.

The truth is that for every title the top performers are those with the highest EQ scores. Even though CEOs have the lowest EQ scores in the workplace, the best-performing CEOs are those with the highest EQs. You might get promoted with a low EQ, but you won't outshine your high-EQ competition in your new role.

Your emotional intelligence is completely under your control. Work on your EQ and it will boost your performance. Your effort can also ensure that you don't experience declines as you climb the corporate ladder. Even if your employer promotes you for the wrong reasons, you'll still outperform your contemporaries.

To help you get started, here are some EQ-boosting strategies for leaders:

  • Acknowledge Other People's Feelings
  • When You Care, Show it
  • Keep Your Emotions in Check
  • Sleep
  • Remove Negative Self-Talk

Focus on your EQ and your executive performance will soar!

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For years now, turnover rates for CEOs in the healthcare industry have been high. While they peaked at 20 percent in 2013, even today these rates remain decisively higher than in other industries. In the ever-evolving world of healthcare, it can be challenging for CEOs to plan for their departure. Even something as simple as deciding when to break the news to their team can involve endless considerations.

The plight of healthcare CEOs is unique in this regard. In many other prominent industries, it’s common for CEOs to give notice of their departure just weeks or even days in advance. On June 11 of this year, Twitter CEO Dick Costolo made an announcement that he would be stepping down on the first of July. In some industries, the announcement of departure may even take place after the CEO has already stepped down and a successor has been selected.

For CEOs in the healthcare industry, their departures are rarely that simple. While crafting a succession plan is crucial for all outgoing CEOs, sometimes just picking a date to make the announcement can be difficult.

Robin Singleton serves as the executive vice president and practice leader of National Healthcare Practice at DHR International. Singleton says if a departure announcement is made too early, the CEO might simply be fired. On the other hand, if they announce their departure too late, the board will not have adequate time to ensure a smooth transition.

According to Singleton, the average announcement of a CEOs departure in the healthcare industry comes between 9 and 12 months ahead of time. Paul Esselmen, senior executive vice president and managing director at Cejka Search, says that the transition time depends on the circumstances under which the CEO is leaving. At a minimum, Esselmen says that a CEO should provide 60 days’ notice to both their board and the executive team.

Singleton says that CEOs give their boards such advanced notice due to the culture in the healthcare industry. “They have a deep sense of commitment ultimately to their patients and they want to make sure their culture is protected,” says Singleton. For more information, visit:

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Are You Ready to Embrace the Possibilities?

Coaching comes in many forms but the goal is to help you become the very best version of yourself as a leader, executive, and whole person. Executive coaching is like a blend of therapy, strategic discussion, and athletic training.

The focus is on your advancement as you define it, a definition that usually evolves over time. It is important to find a coach with experience working within your industry and the vision to help you realize your evolving personal goals.

What does Executive Coaching aim to accomplish?

Coaches facilitate a process of change or development which enables individuals and organizations to realize their potential.

If you're considering coaching, here are several key benefits:

  • Better Performance - greater productivity, career advancement, business results
  • New insights - about yourself, how you're perceived, where you can improve
  • Accelerated action - advancing faster and with greater precision
  • A safe place to dialogue- talk through challenges and gain perspective
  • Greater Awareness -of perspectives, beliefs, and attitudes that may be limiting your success
  • Support and encouragement - it feels less lonely at the top
  • Feedback that others won’t share
  • Help with improving specific skills - communication, delegation, conflict management, team building, persuasion, etc

Effective coaching requires someone to have a desire to learn and grow.

If you're the type of person who wants to grow and improve, and is willing to trust someone to support you, I highly recommend working with a coach.

Ready to get started?

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Compensation comprises everything from salaries to bonuses to stock options and it’s a subject with many perspectives in the healthcare industry. An Executive Compensation Survey in 2014 sought those divided opinions from over 400 respondents and the results were quite revealing. The survey results were published by HealthLeaders Media Intelligence in a report titled “Reforming Executive Compensation to Accelerate Change.”

A total of only 18 percent of those surveyed said no enhancements were necessary in their executive compensation structure and a mere 7 percent said that their organization’s executive compensation was aligned ideally with their organization’s strategies. In contrast, 82 percent admitted that either minor or even major enhancements were needed. Ultimately, in order to meet the needs of the healthcare industry today, more than a third of those surveyed said that changes are needed in executive compensation strategies.

Nearly a third of respondents said that, while changes were needed, there was no plan yet in their compensation strategy to address evolving patient care objectives in the industry. Additionally, a sizable minority of those surveyed said that they did not expect their organization to modify their team incentives in preparation for the shift from free-for-service to value-based purchasing.

Looking at the executives themselves proved interesting as well. In the case of organizations with medium to higher levels of net patient revenue, a majority of executives received a greater portion of team-based incentives. Additionally, 43 percent of executives surveyed admitted that their organization had not taken steps to match incentives with values such as clinical outcomes.

Operating margins played a role in compensation also. Nearly half of all those surveyed said that operating margin targets formed the very basis of their individual incentive payments. To learn more, you can download a complimentary version of the report here:
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Today, the concept of population health is more important in the healthcare industry than ever before. It has played a large role in many healthcare trends from payer-provider collaboration to hospital-community partnerships. Yet it remains a somewhat subjective term with many different views and interpretations.

The term “population health” first originated in 2003 with David Kindig and Greg Stoddart. They described it as “the health outcome of a group of individuals, including the distribution of such outcomes within the group.” Yet many criticize this definition for being incomplete, saying it focuses only on outcomes and not on the actual healthcare providers that directly influence those outcomes. In a recent survey of healthcare leaders, only two out the 37 surveyed cited the 2003 definition. The prevailing opinion is that this definition itself is in need of an update.

A large number of healthcare leaders saw population health primarily as “an opportunity for healthcare systems, agencies, and organizations to work together in order to improve the health outcomes of the communities they serve.” Other survey participants like Dr. Richard L. Gilfillan, president and CEO of Trinity Health in Michigan, cited the Triple Aim Initiative. The Institute for Healthcare Improvement developed the Triple Aim initiative, which includes improved care, improved outcomes, and reduced costs. Many of the other healthcare leaders who participated in the survey saw the discussion on population health as an opportunity for healthcare systems and agencies to collaborate to improve health outcomes for the populations that they care for.

While there may not yet be a comprehensive, universal definition of population health, the discussion itself shows that the attitudes of care providers are constantly evolving as they work to make the health of their patients a top priority. For more information, visit the resources below:

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The first few weeks and months of an executive’s tenure are critical. Getting it right can dramatically accelerate the transformation of a new recruit or promotion into a fully functioning business leader. But getting it wrong can be very costly.

In fact, recent studies indicate that 30-50% of newly hired leaders fail and leave within 18 months. Failure to establish key relationships and failure to align with company culture are indicated as leading factors that derail new executives early in their leadership roles.

Organizations that spend thousands or hundreds of thousands of dollars in efforts to recruit key talent, recognize the critical importance of ensuring cultural fit as part of the hiring process. But often, the rigor, focus and attention given to the recruiting process don’t seem to carry forward to a solid commitment to assimilate and positively onboard new executives.

Executive onboarding is far too important to leave to chance. The stakes are high for the individuals and the corporations involved. The impact on revenues, employee morale and the company’s corporate image when an executive fails in a newly-assigned role are felt by the organization long after the executive has departed.

Onboarding, not orientation.

Onboarding is not the same as orientation. Consider whether your organization’s internal process achieves the following:

  • Identifies executives’ strengths and developmental areas, and ensures they have the key competencies for success
  • Brings role clarity
  • Accelerates integration with organizational culture, strategy, and leadership team
  • Maps key relationships
  • Delivers critically timed feedback from key stakeholders
  • Offers counsel on goal identification
  • Provides early warning indicators and hazard avoidance

The Solution for Success

Our Onboarding services pick up where the executive search process ends, and help organizations integrate new executives in a more structured and effective way. Focusing on the early stages of an executive’s tenure, we reduce the time it takes for new executives to start making a meaningful impact, and maximize the leader's personal engagement with the organization and culture. We believe in customizing our program to our clients needs and work with new hires and internal promotions.

Connect with us on LinkedIn and join our Active Network Program.

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Becker’s Hospital Review recently published a comprehensive roundup of statistics related to rising healthcare costs. This week’s blog looks at some of the key takeaways.

With each passing year, healthcare spending in the United States has continued to rise and 2015 will be no exception. To fully understand these rising costs, we must understand where the money is being spent as well as how much we are actually spending.

In examining costs in the healthcare system, it’s important to appreciate the occasionally confusing distinction between cost in comparison to charges and payments. A hospital’s charges are simply list prices for the medical services they offer. Such “charges” are merely the point where insurers begin to negotiate discounts for their members. Actual payment depends largely upon one’s healthcare plan. For instance, the payment rates set by Medicare are typically less than the actual cost of care. Hospitals themselves must also consider input costs, which consist of everything from the salary of clinicians to the cost of buildings and equipment.

The cost of hospital services themselves has been increasing. In 2000, expenditures on hospital services totaled over $400 billion. By 2013, that number had gone well over $900 billion. Between 2011 and 2013 alone, the prices hospitals set for common procedures increased by more than 10 percent.

Recent statistics from Kaiser State Health Facts showed that the average day’s stay at a state or local government hospital in 2013 cost $1,878; that price wasn’t far off from the average stay at for-profit hospitals, which totaled $1,791. In looking at for-profit hospitals in different states around the nation, North Dakota had the highest cost per day at $3,714 and Maine had the lowest cost per day at $815.

While healthcare spending today is certainly increasing, it’s worth noting that it is increasing at a lower rate now than in past years. Some of the lowest premium increases for employers and their workers were seen in 2013. Generally speaking, a wide variety of factors contribute to the diminished increase in overall costs, from sequestration to a historically weak economic recovery. Many predict that the situation is only temporary though. The Centers for Medicare and Medicaid Services (CMS) project that, between 2015 and 2023, healthcare spending will grow 6 percent annually.

Out-of-pocket healthcare costs consist of both premiums and deductibles. In 2013 alone, Americans spent $339.4 billion on out-of-pocket costs. Between 2000 and 2013, these costs saw a 68 percent increase.

This year saw a steep increase in the price of prescription drugs with a 13.6 percent jump in costs. In contrast, the average annual increase over the last five years was only 6.8 percent. All in all, the Kaiser Family Foundation found that between 2000 and 2013, health expenditures increased on prescription drugs by more than 123 percent.

Finally, the “Cadillac tax” is also expected to influence employer healthcare costs. It consists of a 40 percent excise tax on certain costly plans that employers provide for their workers. Ultimately, the tax is meant to reduce healthcare costs and, if current employers do nothing to change their health plans, about one third of them will incur this tax by 2018 according to a recent survey.

For the comprehensive roundup of healthcare cost statistics, visit: http://www.beckershospitalreview.com/finance/50-things-to-know-about-healthcare-costs.html
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For Dr. Loren Hamel and Dr. Benjamin Chu, the key to innovation within the healthcare industry lies with people. Dr. Hamel serves as CEO of Lakeland Health, an organization responsible for numerous hospitals, practices, and clinics across Southwestern Michigan. Dr. Chu serves as executive vice president of Kaiser Foundation Hospitals and president of Kaiser Permanente Southern California. Both men have demonstrated their ability to make big changes by taking a closer look at the people in their systems. In their eyes, focusing on the experiences of patients and caregivers alike is crucial to innovating in an evolving healthcare industry.

Dr. Hamel recently faced a daunting task in addressing the mediocre patient satisfaction scores at Lakeland Health, stuck between the 25th and 50th percentile. Yet his ultimate solution would take those scores to the 95th percentile a mere 90 days after his new ideas were implemented. This was achieved through a “Bring Your Heart to Work” campaign, which succeeded with little to no additional financial resources and a lot of help from Lakeland Health’s employees.

Dr. Hamel asked staff and caregivers to take an emotional interest in the experience of their patients. He described the process saying, “Every time you interact with a patient, tell them who you are, what you’re there to do, and then share a heartfelt why.” The “why” was designed to make the patient’s fears and hopes a top priority for the employees interacting with them. Not only did patient satisfaction skyrocket but many in the work environment also became less tolerant of coworkers with rude or impolite attitudes.

At Kaiser Permanente, Dr. Chu, much like Dr. Hamel, had to consider how performance data offered a window into the affairs of his organization. Kaiser Permanente launched a system called POINT, or Permanente Online Interactive Network, to offer providers a closer look at performance data for physicians. Dr. Chu describes transparency of performance as crucial, particularly for physicians.

Dr. Chu also sought to decentralize Kaiser’s healthcare campus, even rebuilding several medical offices. First, they sought the opinions of their members before looking to administrators, physicians and nurses to seek their opinions on changes that could be made. Talking about these reforms, Dr. Chu said, “If you take the time to really think about a framework that taps into the hearts and minds of the frontline people, you can really accelerate transformation in a big way.”

While technology played a key role for both Dr. Hamel and Dr. Chu in understanding their organizations, it was their focus on people that ultimately yielded innovation. This was a focus on patients, members, staff, caregivers, and even administrators, which helped to create something new and better than what had existed before. For more information visit:


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Early in my 30 year career in executive recruitment and coaching, I was responsible for recruiting and training sales executives at NCH Corporation. I find my background in sales training to be extremely helpful as I work with executives in transition.

When I was in my sales position with NCH corporation, I learned several key things:

  • We had clear plans and targets for sales and we didn’t go home until those were met. We had the tenacity to reach out and make contacts and have clear goals to achieve.
  • People buy from people they like. The primary focus is to build relationships with clients as part of the sales cycle.
  • Practice is essential and role playing is a key part of training.

Executives in transition are shifting from leading and operating organizations to selling a commodity, themselves. A successful transition, like a successful sale takes focus, energy, a clear plan, and intentional action. You have to know your product, have a clear brand, a value statement, know your market, identify your sales targets, and be confident in representing your product.

I find most executives have no formal background or training in sales and often feel very unprepared for the demands of a successful job transition and search. My role is to be a coach and guide, to help executives in transition find their rudder, set their course and make a successful journey.

Executives successful in transition are the ones who use the time in transition to learn more about themselves and their goals for the future. Creating the right attitude and exuding confidence is a key to mastering your transition and achieving your goals.

In my practice I primarily work with healthcare executives. So I know the market, the role demands, and the key tools required to be successful. I not only provide my clients the tools, I provide the coaching and support for clients to learn through their journey and find a successful path forward.

I’m proud of the many executives I have helped through my 30 years and find the wisdom and experience to be a valued commodity for my clients.

Here’s to your success!


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Hospitals & Health Networks (H&HN), a publication of the American Hospital Association (AHA), featured an article this month on the traits needed to be a successful CEO in today’s environment. This week, in the second part of a two-part blog post, we’ll look at some of the new challenges and the new skills needed for success.

The ideal CEO must be data-driven. Paul H. Keckley, managing director for Navigant Center for Healthcare Research and Policy Analysis, says that hospital performance data is now available to both buyers and patients alike. Today, more and more insurers are using these commercially available analytics, so it is important for CEOs to be familiar with such data also.

CEOs must be motivated to take action as well. Peter Rabinowitz, executive recruiter and president of P.A.R. Associates Inc., says that when a board wants to rationalize the organization, a CEO may be tasked not only with building the organization up but also taking people out when needed. While a changing healthcare environment sometimes means layoffs, there are other times when employees can simply adapt to new roles. For instance, Scripps Health in San Diego underwent complete operations reorganization and saved hundreds of millions in costs, all without a single layoff.

Clinical competence is another quality CEOs must aspire to. Boards will frequently look to physicians as ideal CEOs, but this might very well be a mistake according to Phil Dalton, senior vice president of physician strategies at VHA Inc. “They [physicians] are highly intelligent and talented, but their experience is generally not in running organizations,” says Dalton. Michael Rowan, president for health systems delivery and COO at Catholic Health Initiatives, says that nurses are often far more likely to have the management background to take on such a leadership role.

Financial focus is another especially important skill in light of the realities of declining Medicare payments and the recent requirements of the Affordable Care Act. “It means having to think about efficiency across the entire spectrum of care,” says Carol Geffner.

Geffner also pointed out the importance of matrix management. Traditionally, hospitals are vertically organized into departments: radiology, cardiology, etc. However, now that hospitals are changing, Geffner says that horizontal structures are being created as well. “Now that hospitals are becoming health systems, they have to have not only these vertical structures, they are creating horizontal structures,” Geffner says.

Resolving conflict is another vital skill, since change is constantly afoot in healthcare. Leonard J. Marcus, founding director of the program for Health Care Negotiation and Conflict Resolution, says that two steps are needed to change conflict to consensus. First, he says fears must be acknowledged and addressed as they crop up. Secondly, he says that it is important to find ways in which the organization can meet everyone’s common interests in some form or another.

Agile learning is another skill that all CEOs must have and it might very well be the most important skill. At Korn Ferry, the world’s largest executive search firm, learning agility is actually considered the leading predictor of success in leadership.

Finally, strategic vision is critical. While innovation and creativity ranked very highly, strategic planning and critical thinking were listed as the top skills needed to lead in the world of health systems in the coming years.

To learn more, visit the AHA’s online publication, Hospitals & Health Networks: http://www.hhnmag.com/Magazine/2015/June/cover-new-health-care-CEO
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After 21 + years in the career development business, I have seen the unique skill sets required for effective healthcare leaders. One key I have discovered is that effective leaders are continuous learners who never stop growing and developing their skills and talents.

I have found important learning traits that effective leaders require:

  • New levels of perception and insight into the realities of the world and also into themselves
  • Extraordinary levels of motivation to go through the inevitable pain of learning and change
  • The emotional strength to manage their own and others' anxiety as learning and change become more and more a way of life
  • New skills in analyzing and changing cultural assumptions
  • The willingness and ability to involve others and elicit their participation
  • The ability to learn the assumptions of a whole new organizational culture

An essential part of effective leadership and growth is networking. Wiederhold & Associates has developed the most in-depth premium network of senior healthcare professionals in the country. The Premium Active Network program was developed for individuals who see the value of networking, gaining visibility in the industry and building mutually beneficial relationships.

At Wiederhold & Associates, we are a leading provider of career development, transition services and executive coaching to the healthcare industry. We help individuals and organizations with the tools and resources to develop and sustain exceptional leadership performance. Through networking and coaching, we are always focused on relationship building with a personal touch.

Throughout the year, I will be sending periodic communications through email and social media that will keep you informed of topics on leadership effectiveness and managing your career for a lifetime.

Here’s to your success!


Connect with us on LinkedIn and join our Active Network Program.

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Hospitals & Health Networks (H&HN), a publication of the American Hospital Association (AHA), featured an article this month on the traits needed to be a successful CEO in today’s environment. This week, in the first part of a two-part blog post, we’ll begin looking at some of the new challenges and new skills needed for success.

For decades, Jon B. Schandler acted as CEO of White Plains Hospital in Westchester County, just North of New York City. In 2010, seeing retirement on the horizon in just a few years, Schandler worked to create a seamless transition of leadership as his hospital sought to develop more specialized services and find physicians to provide them.

Schandler ultimately found a worthy successor in Susan Fox, an MBA and an RN. Not only had Fox worked as a pediatric intensive care nurse, but her time as senior manager of consultants at Ernst and Young gave her over a decade of experience in strategic planning and managing integrated physician operations.

Fox came to White Plains Hospital as senior vice president of administration in 2010, and spent the next five years honing her skills. Her background in nursing led her to introduce multidisciplinary rounds, coordinating care with everyone from therapists to case coordinators. Today, Fox is CEO and revenues are up while the average length of stay is down at White Plains Hospital.

While this particular hospital is a success story, hospitals all around the country struggle to find the crucial leadership and vision they need. CEO turnover rates are currently at record highs, averaging over 17 percent in the past five years. White Plains Hospital is just another example of the vital importance of finding skilled CEOs in a healthcare industry that is constantly evolving. And the ideal candidate will have a unique combination of skills.

First and foremost, an ideal CEO must be adaptable to change. A recent AHA survey found that over 80 percent of hospital executives see change management as one of the most critical of leadership skills. Carol Geffner, president of Newpoint Healthcare Advisors, says that bringing about change requires both imagination and flexibility. Geffer believes that healthcare is just beginning to move from volume to value simply because reimbursement often does not support value-based care.

Next week, we’ll explore some key traits in detail: the need for CEOs to be data-driven, financially focused, motivated to take action, adept at resolving conflicts, skilled in matrix management, and willing to gain a greater understanding of clinical competency.

To learn more, visit the AHA’s online publication, Hospitals & Health Networks: http://www.hhnmag.com/Magazine/2015/June/cover-new-health-care-CEO
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Rick Schooler is a man whose daily work hinges on his ability to prioritize different objectives. As Chief Information Officer (CIO) and Vice President of Orlando Health, he says he is occupied with as many as 100 or more projects in tandem ranging from his work in the supply chain to pharmacy retail. “I’ve been in healthcare for 24 years and I learn something new every day,” says Schooler.

Schooler’s top priorities at Orlando Health are those that are required by regulation. “We take care of what’s absolutely required first, and then those things that are ‘should dos’ or are a ‘nice to have,’” says Schooler. A formal IT governance process ensures that the flow of money and resources is first diverted to that which is mandatory, as well as things that are truly strategic for the organization. Only after those priorities are addressed can Schooler set to work on other tasks. He describes his management style as “transparent” and says his management team has a firm understanding of their business. Ultimately, he says that their time, money, and efforts must be spent on those things that will bring the most value.

Security is also vitally important in the role of CIO. Everything from data loss prevention to antivirus programs is Schooler’s responsibility. Data loss resulting from hacking is a very real threat that Schooler says can only be met by spending the money needed to combat it and having a team of intelligent and skilled IT professionals to defend against it.

According to Schooler, one of the greatest challenges he faces in his work is knowing that, with limited resources, there will always be someone who will be left unhappy. He says that the essence of demand management is working to ensure that his organization does not make the wrong person unhappy.

Finally, in looking to the future, Schooler says that CIOs will be forced to use demand management as a tool to assess offerings within the cloud, such as tech platforms. He sees the job of CIO as evolving into coordinating information management, rather than actually implementing it.

To learn more about Schooler’s priorities as CIO, visit: http://www.fiercehealthit.com/story/demand-management-biggest-challenge-orlando-healths-rick-schooler-qa/2015-05-12?page=full
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Medicare recovery audit contractors (RACs) are costing hospitals significant sums in terms of expenditures related to managing audits, denials and appeals. Some hospitals report spending hundreds of thousands of dollars, even millions, addressing RAC audits. The hospitals say the money would be better spent on improving the healthcare provided to patients.

The American Hospital Association (AHA) conducted a RAC survey September 2014, which was answered by 402 hospitals; 311 hospitals completed all questions in the survey. As a result, the AHA is calling for a reform of the RAC payment structure. One problem: RACs are paid a commission—between 9.0% and 12.5%—on each claim they deny. Hospitals say the contingency fees should be eliminated so that RACs are no longer incentivized to deny claims.

The AHA cites evidence to support its conclusion, including the fact that “more than 70% of appealed hospital Medicare Part A denials are fully overturned at the third level of appeal, when the case is heard not by a contractor, but by an administrative law judge.” Additionally, it can take years to settle claims that are disputed.

Legislation to improve the situation is pending; if passed, the law would “replace the RAC contingency fee structure with a flat fee to reduce the financial incentive for overzealous auditing practices; rationalize payments to RACs by lowering payments for poor RAC performance; fix CMS’s rebilling rules to allow hospitals to rebill claims when appropriate; and require RACs to base their inpatient claims decisions on only the information the physician had when treating the patient.”

In the meantime, hospitals are continuing to add new staff and hire consultants to process their appeals and manage the RAC audits. The burden is especially great on smaller hospitals. A seven-page report published by the AHA includes case studies and an overview of the various processes used during RAC audits. You can access the report at: http://www.aha.org/content/15/hospsurveyreport.pdf
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While cost reduction efforts at hospitals and health systems typically emphasize internal cost structures, it’s important to look at other factors to address new payment models and evolving types of insurance plans. That’s the advice of Jim Blake, Managing Director at consulting firm Kaufman Hall, who has published a helpful overview on how organizations can use a more encompassing approach to cost-reduction efforts.

His view is that hospitals and health systems will need to use a “total cost” strategy in order to remain competitive in the new environment. Organizations that take a proactive approach to implementing a total-cost strategy will be able to navigate future developments from a position of strength. Waiting for external pressures to reach a boiling point is fraught with risk and will leave little room for error.

Blake suggests developing a roadmap that links needed investments to the benefits they are expected to deliver in terms of improving internal cost structures as well as reducing the total cost of care. A key area for potential new investments involves data analytics, which will help an organization more accurately quantify goals and benchmark their performance against specific metrics.

Key factors vary across different parts of the country. The article notes, for example, that “per capita health expenditures in Connecticut and Maine are far higher than those in Georgia and Arizona. Even more telling, research has shown striking variations in healthcare costs within small areas, variations that are not readily explained by demographic differences and are more likely associated with differences in how healthcare is deployed, used, and practiced.”

Approaches to reducing costs under fee-for-service models (e.g., better management of capital, labor, overhead and supply costs) can have little impact in value-based models that rely on total population health and care coordination with partners. Fee-for-service models also provided minimal incentives to improve clinical effectiveness, which is now critical. Other factors to consider include service-line distribution. It’s important to review operations to determine if a health system is providing similar services at multiple facilities that are geographically close in proximity.

To learn more about this holistic approach to cost-reduction efforts, you can access the article at: http://www.kaufmanhall.com/thought-leadership/resources/full-details/why-hospitals-should-tackle-the-total-cost-challenge
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Hospitals & Health Networks (H&HN), a publication of the American Hospital Association, featured an article this month that helps executives stay on top of the critical issue of care coordination. With the increasing importance of value-based care models, knowing the relevant key factors will not only help you improve the quality of care but simultaneously enable increased efficiencies.

Accountable care organizations (ACOs) are one element of this changing landscape, but other approaches to population health management are also in play. The AHA article provides C-suite executives with a helpful checklist that will ensure you have all the bases covered, including:

Assigning Accountability – The article lists five factors that executives should consider in terms of accountability, including the need to assign a dedicated team to be responsible for care coordination.

Improving Referral Systems – A list of six points will help you focus on ways to streamline the referral process, including the need to have a referral tracking system that combines all of the pertinent data in a single, easily accessible system.

Building Relationships and Agreements – It’s important to be clear about the scope of responsibilities for various partners, and equally important to document their responsibilities to help measure and ensure compliance.

Providing a Patient Support System – Increasingly, patients are being required to help manage their own care, and clear communication with patients is paramount to improving health outcomes.

Maximizing the Value of EHR Systems – Six items to consider about EHR systems, including how your organization can extract the greatest possible value from this data, especially in terms of sharing the data and making it available to the care team in “real time,” as it is entered into the system.

Improving Communication – Almost 50% of healthcare-related errors occur during handoffs among different providers; the article lists five items that will help you prevent errors due to poor communication.

Implementing Changes – Being slow to implement a comprehensive strategy for care coordination carries substantial risks in value-based payment models; make it a top priority to get ahead of the curve.

To learn more, you can access the article and its checklist at the H&HN website: http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/May/royer-readmissions-EHRs
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