High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Many hospitals face a challenge among key stakeholders. That challenge is a brand/reputation shift toward value based care. Mission, Vision and Values typically reflect claims of high quality and customer service, but key stakeholders (physicians, patients, families, employers, payers and regulatory bodies) are not buying the slogans of the past. In today's world, healthcare providers must demonstrate that they are living up to the value based equation (low cost, seamless, patient-centric, high quality care). Stakeholder demand and regulatory requirements drive organizations to demonstrate measurable results in cost, service and quality.
Creating a performance excellence environment is a highly successful leadership approach to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:
Engage your people: Develop Governance, Leadership and Management structures to engage your key players, especially physicians and other clinical thought leaders to lead the effort. Create a shared Vision of Achieving Value Based Results. Now it’s time to execute your shared Vision.
Evaluate your data; identify best practice: Engage all key players in identifying essential metrics to understand your current performance and identify opportunities for improvement in Operational/Financial, Service and Clinical performance.
Know your process and design your process (es): Utilize advanced process management methodologies to identify current processes that yield current results. Establish consistency in your process improvement methodology. Identify best practices. Design your processes to achieve results.
Hardwire/Standardize best practice, process design to ACHIEVE
Sustainable results will be achieved from your Action, if you are focused on Continuous Operating and Quality Improvement. Remember you may FAIL (“First Attempt In Learning”). Establish your culture of Performance Excellence. Start small, simplify, be resilient, be persistent and be unrelenting in your approach to achieving results. Be prepared to embrace “Polarity Thinking.” Every good conversation begins with good listening. Listen to your key stakeholders. Listen to understand, not to respond. Physician integration and value based strategies inherently present divergent opinions. Learn the power of leveraging Inquiry AND Advocacy: two critical leadership competencies. That’s how leaders achieve results.
Value Based Metrics:
Everything is a process
Gain an understanding of your current processes
Identify your best practices
Design process to achieve best practice performance
Re-evaluate your performance to see if you are consistently achieving improved performance
Modify your processes when necessary to consistently achieve higher levels of performance
Hard-wire your processes to ALWAYS achieve best practice performance
Never stop monitoring to verify your preferred state performance/outcomes.
Never stop monitoring to verify your preferred state performance/outcomes.
Train for it (all Key Players)
Build consistency of approach
We are facing a critical era of transformation in healthcare. As organizations strategize to find stability through turbulent times, managers, directors, and executives will feel added pressure to achieve continuous, dynamic results.
The success of each department will depend on a single crucial factor: Is there a "boss" or a "leader" in place?
A "boss" refers to an individual who is in charge of the employee or an organization. He exercises control over employees, orders, assigns tasks and duties to them and is entitled to take decisions on some matters. Bad bosses will motivate through fear tactics, defer blame to others, take credit for other's successes and bully members into producing results.
The term "leader" is defined as an individual who possesses the ability to influence and inspire others towards the accomplishment of goals. Communication coupled with integrity compel people to follow. Great leaders think about what their body language, facial expressions, and tone of voice communicate to their staff. They often take the time to say things face-to-face rather than through email in order to build trust, develop relationships, manage conflict, and encourage employees. Leaders pull the best out of each member and inspire group success.
It is important to note that the teams which produce the most effective and long-lasting results are the ones that are directed by leaders, not bosses.
Where bosses fail, leaders prevail. If you've noticed that you have more bosses than leaders in your organization- all is not lost. Aspiring and current managers, directors or executives can begin improving their ability to lead. Wiederhold and associates offer specialized assessments as well as a number of training programs designed to develop quality leaders that are custom fit to your organization. If you are interested in learning more, just let me know.
Here's to your success,
“If you can’t describe what you are doing as a process, you don’t know what you are doing.” Such a profound quote by W. Edwards Deming, largely recognized as the Father of the Quality Movement. Dr. Deming's famous 14 Points, originally presented in Out of the Crisis, serve as management guidelines. The points cultivate a fertile soil in which a more efficient workplace, higher profits, and increased productivity may grow. These management principles have a direct correlation to navigating the path to achieving results in the uncertain healthcare industry of today.
Deming’s 14 Points for Leadership/Management
While traditionally applied to product manufacturing, Deming theory has direct application across multiple industries, especially when rising consumer and regulatory requirements demand greater value. View healthcare service delivery as a product in high demand from consumers (patients, families and others). Expectations of lower cost and superb quality, delivered in a highly patient-centric and service-oriented environment, create an imperative healthcare systems must meet to remain relevant.
The focus of this article is to bring home the reality that EVERYTHING IS A PROCESS. “If you cannot describe what you are doing as process, you do not know what you are doing.”
Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care. Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.
The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:
The next essential element of a performance excellence culture is to define the “HOW” the organization will be led through:
Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery. As highlighted in previous articles:
This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Performance Management. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of: Operational/Financial, Service, and Clinical Performance. Now you need a methodology to achieve your desired outcomes.
Physicians and other care providers work within a defined process everyday of their lives when addressing and resolving patient needs for care. What is done when presented with multiple patients with complex healthcare needs? SOAP is a traditional approach to addressing patient needs:
The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. The SOAP note originated from the Problem Oriented Medical Record (POMR), developed by Lawrence Weed, MD. It was initially developed for physicians, who at the time, were the only health care providers allowed to write in a medical record. Today, it is widely adopted as a communication tool between inter-disciplinary healthcare providers as a way to document a patient’s progress. SOAP notes are now commonly found in electronic medical records (EMR) and are used by providers of various backgrounds. Prehospital care providers such as EMTs may use the same format to communicate patient information to emergency department clinicians. Physicians, physician assistants, nurse practitioners, pharmacists, podiatrists, chiropractors, acupuncturists, occupational therapists, physical therapists, school psychologists, speech-language pathologists, certified athletic trainers (ATC), sports therapists, occupational therapists, among other providers use this format for the patient's initial visit and to monitor progress during follow-up care.
It is a well-defined thought process. Complete a SUBJECTIVE EVALUATION, an OBJECTIVE EVALUATION, an ASSESSMENT and a PLAN. Engage patients and family members when seeking to understand what is happening with a patient (Subjective). Gather facts/data regarding what is happening with a patient through diagnostic procedures (Objective). Review the information gathered and knowledge gained from the evaluations (Assessment) and take action to address what has been presented (Plan). Why not apply a similar process that is highly effective to leadership and management. That is a process management/performance management approach.
The days of simply making claims of high-quality, service-oriented and low cost care delivery are gone. Patients, families, communities, payers, regulatory agencies and other key stakeholders demand proof of performance. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. Once you understand current performance through data analytics, you need tools to achieve continuous improvement.
There are many theories of performance/process management. Theories and practices have evolved over time. Many are inter-related and draw on common practices. Process Management philosophies include, but are not limited to:
The common thread in all methodologies is an unrelenting focus on seeking improved outcomes in everything we do:
Performance Management Simplified
High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Creating a performance excellence environment is the best to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:
Engage your People
Evaluate your data; identify best practice
Know your process and design your process
Hardwire/Standardize best practice, process design to ACHIEVE
Key Take Aways:
The Problem – Across the nation, health systems are reporting a sustained decline in Emergency Department utilization, resulting in decreased admission rates and reduced patient days. Regardless of the cause (Healthcare Reform, economic challenges, rising unemployment, etc.), the impact is clear – an average 3-5% drop in census and a significant loss of revenue.
The Emergency Department Imperative – On average, 12-15% of Emergency Department visits result in patients being admitted, which accounts for approximately 40-50% of a facility’s total admissions, and a contribution margin between $1k - $15k per admit. The direct connection between Emergency Department utilization, subsequent admissions and the resulting revenue indicates that the success of any facility in this changing healthcare landscape depends on increasing the number of times that new patients pass through the Emergency Department doors. Health systems operating Trauma Centers will have contribution margins exceeding the national average.
The Million Dollar Question – Understanding the concept of countering a declining census by increasing Emergency Department utilization is easy, but successfully operationalizing that strategy may not be. Simply put, how does one hospital or health system get more patients into their Emergency Departments than another? Although there are many potential answers to that question, experience shows that the most effective solution is for a facility or health system to develop a highly functional Regional Referral Program.
The Regional Referral Solution – Health systems should be able to successfully capitalize on its current Trauma status and market itself as regional destination, which will significantly increase patient admissions. A key to success will be aligning referring facilities, physicians, and transport providers through an efficient Transfer Center operation. Your organization will be able to benefit from those opportunities. Additionally, current successes show that facilities and health systems that have implemented Regional Referral Programs have grown their influence significantly garnering patient care and admission opportunities from facilities far outside of traditional referral patterns. This has proven beneficial because the payor mix of patients being referred from out-of-area tend to be equal to or better than the receiving facility’s current Emergency Department mix, resulting in a 15 to 1 return on investment.
Regional Referral Program Priorities – Numerous successful hospitals and health systems have developed very effective Regional Referral Programs by prioritizing the following:
Identification and Development of Key Service Lines – Determining which specialties (Trauma, Cardiology, Neurology, Pediatrics, etc.) the facility wishes to specifically solicit patients for. The goal is to develop a solid reputation as the “go to” receiving facility for the targeted service lines.
Aligning Physician Partners – The success of any Regional Referral Program depends on the participation and support of the facility’s physician partners, whether by promoting the program with regular visits to the region’s referring facilities, or by being consistently available and accepting patients. To achieve this, successful Regional Referral Programs have implemented effective Hospitalist Programs to receive the patients and specialist compensation programs that reward participation.
Transfer Center Utilization and Marketing – Effective Regional Referral Programs require three primary components; necessary specialties, physician participation, and a simple, consistent way for facilities to refer their patients. Structured Transfer Centers tie the entire referral program together with “one call does it all” ease, coordinating patient transfers from the initial request through completion of the transport. Mature Transfer Centers will also provide extensive operational reporting and key patient flow analytics for hospital administration. Focused marketing strategies can also convert the Transfer Center from a passive patient flow processing service into an aggressive volume builder for the facility or health system. Proven techniques can be employed to grow desired business through sound relationships with the referring parties.
Note: There are generally two methods of implementing a Transfer Center service; a facility can develop the service in-house or they can seek out a professional third-party Transfer Center service provider. An internal Transfer Center allows the facility or health system to maintain strict control of the staffing, customer interactions and processes, but a professional external Transfer Center will generally provide outstanding service delivery at a fraction of the cost.
Regional Referral programs are showing exceptional returns in the form of increased Contribution Margins per referral. The chart below – based on actual Regional Referral Programs – highlights the benefits:
Transfer Center Costs – Studies of current successful internal Transfer Center services show that the average cost per transfer request is approximately $230 for new centers and $190 for established centers (assuming a daily request volume of ~12). For facilities or health systems that prefer to forego the expense and coordination of operating their own Transfer Centers in favor of utilizing the expertise of a professional external service, the cost is obviously significantly lower – with no associated reduction in the contribution margin per transferred patient.
Conclusion – For hospitals or health systems seeking to counter the downward trend in Emergency Department utilization and subsequent census declines, it is essential that they develop a Regional Referral Program. By establishing themselves as “centers of excellence” in key service lines, partnering with their physician specialists, and easily facilitating patient flow through efficient Transfer Centers, facilities can continue to thrive even in today’s constantly shifting healthcare environment.
Solution - We can provide a comprehensive assessment of the opportunity for your organization to expand your market as a Regional Referral Center with a state of the art Transfer Center.
✔ Current situation
✔ Market potential for referrals
✔ Business plan for the recommended approach with a Return on Investment analysis
✔ Sensitive issues
✔ Hospital capacity readiness
✔ Medical Staff readiness
✔ Hospitalist Program effectiveness
✔ Case management strategies
✔ Nursing coordination
✔ Administrative and Medical Leadership buy-in
Please let us know if you would like to explore the assessment of the potential for your health system. We look forward to possibly assisting you with this important project.
By Joy W. Goldman | Leadership Coaching
In the March, 2017 newsletter, I introduced the topic of trust and highlighted five ways leaders increase trust in their organizations. Today, I wanted to provide an overview of two very practical tools that can be used to engender trust in ALL relationships, regardless of how challenging you may find some to be:
Conversational Intelligence and Polarity Thinking
You can deepen your learning on Polarities during an upcoming Wiederhold & Associates webinar on Aug 1.
Wiederhold & Associates Webinar
August 1, 2017 - "Polarity Thinking"
Register ASAP to obtain needed pre-work for this interactive webinar
No Fee For Premium Active Network Members and current clients.
Judith Glaser in her book, Conversational Intelligence, asserts that ALL work is conducted through conversations. Think about it! Is there anything you do that does not involve a conversation? From a pure productivity perspective, think about the time you could save if most of your conversations were impactful.
During July’s webinar, Cliff Kayser and James McKenna, two phenomenal executive coaches, illustrated in their usual humorous way, one element of effective conversations: The power of leveraging Inquiry AND Advocacy: two critical leadership competencies. The May/June 2017 issue of Harvard Business Review included an article that talked about four key attributes that distinguished high performing CEOs: the ability to be decisive was one of them. As a leader, “telling,” and “advocacy” is essential in certain circumstances.
The most powerful leaders know how to leverage advocacy AND inquiry, and they know when they’re being effective, and when they risk derailment. Signs of an overuse of advocacy may include noticing that they are doing most of the talking and others aren’t offering their opinions; leaders may notice that their audience seems less engaged. In the extreme, they may also notice that not too many people are following them!
Glaser’s levels I and II conversations consist of “telling,” or using questions that are geared toward eliciting what the leader already knows to be true. They are using inquiry but only with a goal to validate their own thinking. Glaser discusses the more powerful level III conversation that is focused on “Sharing And Discovery.” Level III conversations ask questions for which the leader doesn’t know the answer to the question.
When leaders ask questions that come from a place of curiosity, we tap into our audience’s prefrontal cortex and quiet their amygdala, the primitive part of our brain, which kicks into high gear when we feel threatened. Creativity and trust come from our prefrontal cortex: through sharing and discovery conversations.
In healthcare, our habit is to look for problems. Simple problems often have a right or wrong answer. Complex problems/ situations rarely do and are better served by leveraging interdependent tensions or pairs: polarities. Come to the webinar in August to learn more about leveraging Inquiry AND Advocacy.
I look forward to our next conversation!
Joy W. Goldman RN, MS, PCC, PDC
Executive Director, Leadership Coaching
Wiederhold & Associates
Because you've been a part of the Wiederhold & Associates Network, we wanted to share some exciting news with you first.
As you know, networking/connecting is essential to your success both while in transition and gainfully employed. Networking with a purpose is a vital component of anybody's career success but is often terribly neglected. Being intentional is necessary.
Therefore, we have formalized a streamlined process to make it easier for you to expand your network through Wiederhold Intentional Networking (WIN) program. Becoming an active WIN participant will enable you to:
The WIN strategy gathers key information from each premium active network member and targets meaningful matches within our client list. As an active member in our program, W&A will introduce you to key members of our current network, helping you gain significant connections that you would not otherwise have access to. Remember, most of our clients are Vice President through C-level executives.
Once you have made the connection, we will send you a short anonymous evaluation form. Each member's feedback will bring value to helping our clients grow their skills in effective networking/connecting as well as passing along current industry trends.
Here's to your success!
During a recent goal-setting cycle, I worked on setting reasonable, although loftier, strategic goal metrics due to significant LEAN expert resourcing for my management team to focus on making transformative leaps in process improvements rather than small, incremental changes. In analyzing the strategic goal area of preventable patient harm, the Patient Safety Composite observed to expected ratio baseline was 0.629. A ratio above 1 is undesirable and a ratio below 1.0 is highly desirable. So, 0.629 is excellent, correct? Instead of improving the stretch goal by 5%, we considered 10% improvement. That is stretch goal, chest pounding, we are doing a fantastic job material!
Amid this goal setting, I was at the beach watching the news and drinking a cup of coffee readying myself for a day of fellowship, bocce ball, and sun. The local station in Myrtle Beach, SC ran a story with some interviews regarding the Target Zero – South Carolina’s Highway Safety Plan 2015 -2018. The plan was developed by the SC Departments of Public Safety and Transportation with many stakeholders including the SC Highway Patrol.
At the time, South Carolina’s 5-year average highway mortalities were ~800 per year. Immediately, I thought what an audacious goal considering they do not have control of every aspect of the events – human error, human disregard for rules, or processes/design flaws/mechanical failures. Think about this strategy compared to preventable patient harm with a Just Culture mindset as illustrated below:
If South Carolina is setting a target of zero highway fatalities, what is preventing me/us from setting a target of zero for preventable patient harm? The way we analyze data with observed to expected ratios with results below 1.0 informs us we are doing better than expected and inadvertently depersonalizes this issue. At 0.629, we were knocking it out of the park. At the end of the day, it is about perspective. The interviews shown on the newscast drove this point home for me. The interviewers asked residents around South Carolina two separate questions regarding goal setting for decreasing highway fatalities. Please view the video for about 2 minutes (from WMBF News in Myrtle Beach, SC) here.
Again, the Patient Safety Composite observed to expected results of 0.629 were fantastic! Well, not for the 53 patients harmed that we, as an industry, deem to be preventable. So, how will you set future goals and allocate resources to achieving those goals? Are small incremental improvements satisfactory or do we look to transform our thinking, people, and processes to achieve Target Zero for Preventable Patient Harm?
The Internet has changed the game for job seekers. The paper resume has been swapped out for a LinkedIn profile. Face-to-face meetings have been replaced with Facetime. Your local word-of-mouth reputation is small potatoes next to someone with a well-developed online presence. When it comes to the Internet, you are who Google says you are.
Fact: 92 percent of recruiters “Google” potential candidates according to a social recruiting survey. LinkedIn is the clear favorite, with 94 percent of recruiters searching it to find top talent. Potential employers also look at Facebook, Twitter, Google+ and really anything that search engines render when your name is entered.
Be Informed. Monitor your personal brand. The first step in protecting and building your online brand is by knowing what is being said or has already been said. It’s impossible to control everything that is written about you, but even though you can’t always control what is published, you can at least know and respond to it.
Monitoring your personal brand is a two-step process. First, you figure out what is being communicated around your personal brand currently. Second, create a positive plan to improve it, build upon it.
You’ve Googled yourself and found that there is at least one article that really gets in your craw. Perhaps it’s misleading, a lie, or just not flattering, and it is published on a website you have absolutely no control over. You want to wave your magic wand and just make it disappear. What can be done?
1) Get legal involved. You may have a case if:
2) Create and publish online through news publications and social media platforms such as LinkedIn. This is the most effective way to rid yourself of unwanted search results over time. How it works: Say you have a negative news article you want to push off the front page of the Google search results. The more content you publish with your name mentioned the more likely positive search results will be rendered when your name is searched. It should be noted that it takes time to push negative articles down the list and off the first page of results. This is due to a number of complicated algorithm factors, all dependent on Google’s rules surrounding credible content. For example, it will be much easier to bury an article posted by a local or regional paper than it would an article or video posted on CNN. Reason being is that the more credible or popular the site is, the more weight Google gives it. So your goal should be to match or overtake the negative article with your original content published on equally credible sites.
Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.
Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.
The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:
The next essential element of a performance excellence culture is to define the “HOW” organization will be led through:
Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery.
As highlighted in previous articles:
This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Knowledge Management/Knowledge Transfer. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of:
The days of making claims of high-quality, service oriented and low cost care delivery are gone. Regulatory requirements and consumers of healthcare demand demonstrated proof. On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is intended to improve Medicare by helping you focus on care quality and focusing on making patients healthier (population health management). The Quality Payment Program’s purpose is to provide new tools and resources to help organizations to provide patients with the best possible, highest-value care. The Quality Payment Program has two tracks to choose from:
Healthcare providers are required and must report key measures of performance in order to maintain a competitive edge and to maximize reimbursement for services rendered. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. The best place to start is to define your measures, based on industry standards. Engaging your Governance, Leadership and Management representatives, as well as other key stakeholders, in defining performance metrics is essential to gain a common understanding. Begin by gathering potential sources of industry standards (see table).
The quest for appropriate data analytics to measure, monitor, report, analyze, improve and control can be challenging. Once sources of industry standards have been identified, engage stakeholders in organization-wide effort to define your measures of Operational, Service and Clinical metrics:
Nursing Leaders think strategically about the work they do, often considering the needs of their organizations, their staffs, and the patients they care for as their primary focus of their careers. Rarely, however, do they spend much time thinking about a personal strategy for their own careers.
If you are in the middle of your leadership career or heading to the end of traditional employment, making the next phase of your career the most intentional and thoughtful of your life is within your reach. At Wiederhold and Associates, we have witnessed the tremendous outreach nursing leaders can have when they take their careers to the next level. Be it within the same position, or a new direction, the strategic career does not wait for opportunities to come along.
Strategic careers are often designed and created by individuals who have developed shifts in thinking that utilize an increased awareness of themselves to confidently self-determine their offerings and value. Learning to communicate that value to others is a key part of the strategy.
Taking stock of new or unrealized potential is the work of our organization as we expertly coach leaders to understand their career trajectory and make self-determination strategic goals for the most optimal work experiences. We have been honored to work with great leaders and assisting them to achieve their potential is some of the most important work we do.As an experienced consultant in strategic and transformational change, Diane has an extensive background in helping leaders develop and succeed. Her healthcare experience spans three decades as a healthcare administrator, clinician, and graduate school educator. To learn more, click here.
Wiederhold and Associates is partnering with Yaffe & Company to host a series of discussions with select healthcare leaders across the country to examine the issue of executive recruitment, retention and leadership development. The gatherings will take place in cities such as Dallas and Houston, Denver, Chicago, San Francisco, Philadelphia, and New York, offering an opportunity for top-level executives and state hospital associations to network and share their opinions.
The CEOs and other high-level executives who run our nation’s healthcare institutions form an important framework of our entire system. In recent years, a maze of migration has formed: in major urban markets, as well as outlying areas, these executives are coming and going from one position to the other, more often than ever. Sometimes, this happens for legitimate reasons. But all too often, it occurs because of a hiring mismatch, or misunderstandings between the board and the executive team, or some other reason that may have been avoided. The effect on our nation’s healthcare organizations, combined with the lack of viable succession plans in many institutions, is costly.
How much better off would we be if we could strengthen our country’s healthcare leadership overall? Imagine a system where many more of our healthcare executives are finding their best personal fit, and functioning in the places and positions where they are most likely to be successful. This series addresses these issues and opens the floor for candid discussion among our nation's top executives in the healthcare industry.
In prior articles, we have touched on many aspects of effective networking, whether in transition or not. Building a broad and deep network is so essential to one's success that it cannot be ignored.
What I have personally observed over a 28 year period and confirmed through colleagues is clear: We can't make it without solid key relationships. Many people will find expanding their network to be challenging, but with practice and effort, you can begin to make meaningful and fruitful connections.
If you are looking for career advancement, you must become the most effective networker you can be. Include these three components when you're expanding your network and I promise you will find success.
Here's to your success,
If getting a promotion is important to you, then it is time to sit down and look at the external and internal factors that will influence your strategy of advancement.
The very first and most important step in your career advancement strategy is to define what success is to you. From my observations, too many individuals choose a path that is somebody else's dream rather than their own. It's how you define moving up that really counts. It's also hard to be passionate about a direction that isn't your dream.
The internal factors are all about you. This is where you exert the highest level of control. Are you being intentional about putting yourself in a position to be promoted? [Click to read more]
If you are seeking to move to the next level within your organization, there are a few items that need to be explored:
I call these external factors because you can only influence them not control them. Your answers to these questions may suggest that the only way you're going to move up is to move out. If these external factors align with an internal promotion, then you have additional steps.
By defining your goals, developing a strategy, and become intentional about executing your plan, you can increase your chances of advancement immeasurably.
Here’s to Your Success-
In this time of rapid transformation of care delivery, financing and business models, successful project management is more critical than ever. Whether a major facility or IT project or operational projects such as new staffing models, population health initiatives or business process enhancements, projects of all types benefit from project and change management expertise. Well run projects have a far greater chance of coming in on time and on budget. Organizations with high-performing projects realize project success more than twice as often as do their counterparts with low-performing project management.
Successful projects share several key elements, including: committed, supportive leadership, a clear definition of success, trained project management professionals to drive change through each phase of the project and engaged and informed stakeholders who will support and adopt the changes associated with the project.
What do these critical factors mean for a typical healthcare organization?
The role of leadership cannot be under-estimated. Studies have shown a direct correlation between senior leadership engagement and project success. Senior leadership commissions the project and approves the project charter. In addition, senior leadership engagement is critical throughout the lifecycle of the project: as champion for the project, in active monitoring of its progress, taking decisive action when issues are escalated and removing roadblocks that are beyond the influence of the project team.
A well-crafted project charter provides the framework for the project: its scope, the strategic and business objectives to be achieved and timelines. It identifies the stakeholders to be considered and involved. A well-crafted charter provides the basis for the project plan. Equally important, the project charter establishes what is out of scope which provides focus for the project team, creates clear expectations of the project and prevents scope creep.
All managers are responsible for managing projects. But, not all projects are alike. Nor are all project managers. Some managers naturally bring the change, time and project management skills needed to lead a project. However, even the most naturally gifted can benefit from project management training. The more complex the project, the greater the need for trained, experienced project managers. The number of disciplines and departments involved, the degree of transformation required, the criticality of timing, the need for IT changes and the cost of the project are all considerations in determining the type of project manager best suited for the project.
Too often, projects are de-railed due to lack of key stakeholder engagement, understanding and adoption. The discipline of project management includes a thorough assessment of stakeholders impacted by the project, their needs and the best means of engagement. This assessment combined with time tested change management processes improves the level of stakeholder understanding, participation and adoption to ensure that project goals and outcomes are achieved. Stakeholder engagement is a critical investment in long term project success that cannot be over-looked.
There is an array of resources available to establish the discipline of project management throughout an organization, both internal and external. For organizations with an Enterprise Project Management Office (EPMO), internal project management experts can be tapped to provide training and resources for their non-EPMO project management colleagues. Training programs that offer project management certifications are a rich source of education. Local chapters of these organizations, colleges or other community organizations are also a good for source of training and networking. Independent project management consultants can offer an array of project management resources to support an organization’s needs, both educational and contract project management. Any combination of these resources can fill gaps while an organization builds the internal project management competency and infrastructure to ensure the success of projects throughout the organization.
These fundamental steps lead to a greater discipline in managing projects, minimize risk and create a culture that can effectively manage the innovation and change required for future success.
Practice Management Consulting and
Connect with Theresa on LinkedIn
If you find yourself in transition one of the worst things you can do is limit your job search. Do not say things like, “I don’t want to live in . . . . that part of the country,” or “That job is too small”. There are several reasons to cast a wide net:
You have nothing until you have a job offer. Work to get the cards in your hand and do not ever turn down a job that you don’t have. Cast a wide net in your job search- you will be surprised to see what you catch. For professional help with your transition, please contact us at www.wiederholdassoc.com
According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022. In fact, the shortage is anticipated to be twice as big as when Medicare and Medicaid were introduced in 1965.
Nursing plays a huge role in the success of our hospitals and healthcare systems today. Developing and retaining great nurses has never been more important.
Many organizations have "diamonds in the rough" just waiting to be discovered. The very skills that make effective nurses such as creative problem-solving skills, exceptional communication skills, and emotional intelligence are the foundational building blocks required to make exceptional leaders.
However, being a good nurse doesn't always naturally translate into becoming good a nurse manager. Like many others who are promoted into management roles, nurses are generally not offered a great deal of assistance as they move into these new and challenging positions. Their raw talent must be inspired and carefully cultivated to become a thriving leader. With proper guidance, the transition into a senior leadership role can be very successful.
To maximize the success of our nursing clients, we have partnered with Nursing Leadership Coach Diane Scott, RN, MSN, ACC. With her strong clinical background, Diane has a deep understanding of the nurse executive role. Coaching is customized to every situation and organization, with outcomes driven models implemented to ensure success.
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.
Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”
A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.
As previously highlighted in Achieve Results through Physician Alignment, Integration and Engagement: Governance and Value-based Care is Here to Stay, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.
Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:
More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion
Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:
Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:
Previous articles addressed physician engagement in Governance of the Physician Enterprise Organization. This article focuses on physician engagement in Leadership and Management.
Leadership and Management:
In addition to active engagement in governance, physician leadership and management is recommended. A dyad leadership model fosters a culture of engagement among physicians and support staff. The model includes physician leaders and operational leaders working in partnership at all levels:
Physician leaders and managers in the dyad leadership model typically maintain an allocated time in clinical activities, in addition to allocated time in leadership/management activities. The prorated allocation of leadership/management time should be tailored to scope of responsibility and accountability.
An Operating Team, comprised of dyad partners at the executive and operational leadership level, should meet on a routine basis (weekly or bi-weekly) as a team to share ideas and build consistency within the physician enterprise. The Operating Team maintains accountability and responsibility for translating organization-wide goals and objectives to action. The team ensures that strategy is translated into operations. Action plans and tactics are developed to achieve strategic and operational results.
The Operating Team should meet with Site Lead Physicians and Site Supervisor/Managers on a routine basis to hard-wire operating norms. Regularly scheduled meetings of all Site Lead Physicians and Site Supervisors/Managers provide an opportunity to share best practices, build consistency and to give the practices a sense of being part of a group practice, as opposed to being isolated in individual practices.
Executive and operational leadership team members should develop a routine of rounding at all practice locations. Building relationships with practicing physicians, other providers and support staff is essential. Day to day problem solving is best achieved through active engagement of leadership, management and staff. Those who are closest to the delivery of care typically have the most innovative ideas for how best meet the needs of patients/communities services. Routine rounding also provides the opportunity for leadership to engage with patients and families to gain a better understanding of the patient experience.
An example organizational chart is provided below to give direction to leadership and management structure (see below). It should be noted that functional structure and infrastructure in the organization is most effective with limited layers of leadership and management, maintaining active relationships between leadership and staff. The organizational model is designed to expand horizontally, as opposed to vertically through creation of additional layers. Operational leadership should be tailored to the scope and diversity of specialty types within the group.
Support functions are essential to success of the physician enterprise. Finance/Accounting, Revenue Cycle, Marketing/Public Relations, Information Technology, Human Resources, Facilities/Maintenance, Purchasing and other support functions may be centralized on an enterprise-wide basis or may be structured in direct support of the physician enterprise. It should be noted that functions are highly specialized in support of a physician enterprise. Whether centralized or in direct support of the physician enterprise, it is essential for operational and executive leadership to engage directly with leadership and management of the support functions to develop a common understanding of organizational needs and performance expectations. It is recommended for support functions to be actively engaged with governance sub-committees.
Key Take Aways:
In its 2016 global CEO survey, Price Waterhouse Coopers reported that fifty-five percent of CEOs think that a lack of trust is a threat to their organization’s growth.
Stephen M. R. Covey, in his book: “The Speed of Trust,” asserts, "The ability to establish, extend, and restore trust with all stakeholders – customers, business partners, investors and coworkers – is the key leadership competency of the new, global economy."
Paul Zak, in the January/February 2017 issue of Harvard Business Review and the feature article: “The Neuroscience of Trust,” states that employees in high trust organizations are more productive, have more energy at work, collaborate with colleagues and stay with their employers longer than in low trust cultures. Regardless of industry, your job as a leader is to create a culture of trust.
In our work with clients, we coach them around the following five behaviors which are scientifically proven to promote trust:
While not always easy, leaders who are committed to creating a culture of trust will continue to be disciplined around these 5 behaviors- especially in hard situations. As employees become more emotionally engaged with leadership, productivity and retention will naturally increase.
Joy W. Goldman RN, MS, PCC, PDC
Executive Director, Leadership Coaching
Wiederhold & Associates