Mental Health "Parity"​ Isn't Enough

We need to dramatically expand access to counseling

With each passing day…sometimes even within a passing day we are reminded of how mentally sick we have become. Yet, still, the idea of access to sustained mental health counseling and care is not a priority. We spend enormous sums on crisis care. If we just had the will, we could pour enormous resources into the kinds of services that would greatly reduce the need for crisis services. Whatever we spend, whatever it costs, the investments will be more than repaid in the gifts of a more mentally stable nation.

“Community Health Needs Assessments” (CHNA) from Maine to Hawaii identify our “social determinants” of health status. These assessments in reality report out the same sets of concerns. Our nation is too emotionally fragile. This fragility manifests itself in poor nutrition, sad living conditions, loneliness and isolation. The more we seem to be coming together with the advance of communications technology, the more we seem to be using these technology wonders to isolate ourselves. We don’t ride a bike down the street or across town. Instead we join a peloton from a stationary cycle in our home. It’s just so much easier this way.

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Direct Support Works! Care Navigators Improve Outcomes Save $$$

There aren’t too many experiences more overwhelming than being sick and trying to deal with the U.S. health care system. All of us have personal stories of disconnected providers and lousy communication. “It’s like nobody talks to anybody around here!”

As a health leader it is always embarrassing to listen to the stories of friends and family who were left on their own. My response was to put in place clinically trained care navigators whose job was to stand with the patient and help them in every way (even if that help meant sending the patient to another health provider). Many other health providers have taken similar steps. But this idea really needs to be as universal as the coverage we want everyone to have.

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Never Underestimate the Value of Networking

It’s Worth the Time and Energy

Co-authored by Jim Wiederhold and Steve Weiner

Committing the time and energy to developing an effective ongoing network is an important skill set crucial to successful healthcare leaders. It’s easy to get caught up in the daily routine, especially with a demanding job. But, the notion of waiting until one is in a career transition to begin building relationships with other professionals is very short-sighted.

Healthcare currently makes up about 18% of the nation’s GDP and is expected to grow exponentially. The many major changes, complexities, and innovations affecting the healthcare system have resulted in a rapidly changing job market requiring different and enhanced skill sets. The industry is quickly expanding and payment/care delivery models are moving away from the traditional acute care hospitals to more convenient, affordable outpatient settings. Innovation and technology continue to have a huge impact on medical care and its delivery.

Recent developments have included Apple and Amazon’s creation of wellness and primary care clinics for employees. Grocery stores have also entered the convenient care market. Amazon has acquired an online pharmacy company to deliver prescription drugs via Amazon Prime. These companies, along with Walgreens and CVS, have invested millions of dollars into the digital health space. Additionally, venture capital firms are responsible for funding over $68 billion into healthcare in the past year!

These new ventures and infusion of capital are constantly generating new jobs and revised job descriptions that reflect the need to address large transformations taking place in the industry. With all this movement, it’s essential to commit yourself to lifelong networking and learning. It is not enough to network at one’s workplace or only with colleagues in similar professions. Although that’s important, it is necessary to reach outside of the comfort zone and develop relationships with professionals in other related industries.

We often hear from our executive level candidates going through the transition process that they did not know as many people as they thought they did. Or, their network consisted of only like-professionals who were experiencing the same types of challenges. These executives now recognize the importance of doing a better job of networking to build meaningful, diverse relationships with others who bring new perspectives, new opportunities, and potentially contribute to successful career growth and development.

Through our experiences, we have found that networking sometimes happens at the most unexpected times. Recently, one of Steve's former traditional hospital CFO candidates -- who was between leadership positions at the time -- experienced this first hand. This individual was sitting in an airport and started chatting with the woman next to him. The conversation turned to work and he discovered the woman was a senior partner with a leading private equity firm. The firm was in need of a top-flight CFO for one of their startup healthcare clients in the ambulatory and urgent care space. After several rounds of interviewing, Steve’s former candidate landed this job!

Networking is something you should always be doing. You can network anywhere.

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Health Coverage Should be... ...as Portable as We Are

The historical model of private health coverage in the U.S. has been to obtain it through your employer. This model doesn’t work anymore. We need a system of care that reflects current culture. The social contract of employment has changed, so health care access needs revision too.

We’re not lifetime employees anymore.

My parents were part of a generation that spent their entire careers with one employer. Company-sponsored health coverage worked well because there was so little movement. Many employers even granted continued coverage in retirement. It is long past time to acknowledge how much this social contract has unraveled. People entering the workforce have a much greater probability of multiple employers while living in many different geographies. Only governmental employees now seem to build long tenures of service.

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Working Naked

The human body is the most brilliant machine ever created and the quintessential work of art. The headline above is not referring to your creativity and accomplishments in your clothing optional private abode; it is taking literary license from 19th century Danish author, Hans Christian Andersen.

Reflect on the fairy tale, The Emperor’s New Clothes. The Emperor (leader) was a vain man, concerned more with appearances, accolades, and maintaining his current position than the harsh realities that others faced. His subjects were afraid to express their honest opinions to him, fearing they might be deemed unfit for their position or even stupid. The climax of this tale occurs when he is fooled by some weavers into wearing a “spectacular new suit” that, in fact, doesn’t exist at all. The Emperor is allowed to parade through the town naked. Finally, a mere child blurts out in honesty that the Emperor is wearing nothing at all.

Leaders at all levels of an organization run the risk of being caught naked at work, but this risk increases as one ascends the ranks. People see pleasing their boss as important, essential to keeping their jobs. Most leaders would proclaim they are wise enough to detect blatant deception, but it is often more subtle than that. Very often what happens is filtering; direct reports present the info that makes them look good and their boss is expecting. This filtering of information is equivalent to a slight degree of course variation which becomes obvious 100 miles or more into the journey.

What would Mr. Andersen say to leaders today?

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Can our Board be better? A few considerations

The best healthcare boards are dedicated to the success of the organizations and communities they serve, have a sincere hunger to stay up-to-date and informed about industry standards and stay curious about emerging trends. Board members have to be well educated on the issues, well prepared for generative discussions, and be mindful of the interests and concerns of stakeholders. Being a contemporary healthcare board member demands a great deal and, in turn, can provide a rewarding experience.

Boards play a critical role in the long-term success of organizations. In addition to the expected fiduciary responsibilities, healthcare boards are tasked with promoting and embodying the mission and vision of the institution and advocating for its well being while setting aside self-interest. Advocacy includes ongoing education of politicians and civic leaders, fundraising and networking with potential donors, and telling the organization’s “story.” It is imperative that the board builds relationships in the community in order to expand services to meet community needs and partner with other aligned organizations.

The highest functioning boards share similar traits: absolute fiduciary responsibility inclusive of finances, safety, quality and the employee and patient experiences; development, implementation and monitoring of a long-term strategic plan; and establishing leadership goals and monitoring performance compared to the goals. Additionally, most not-for-profit boards are self-perpetuating so a key responsibility for today’s board is selection of new board members. Now more than ever, an important criterion for board member selection should be diversity. In this case, diversity should be considered in the broadest sense.

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Are hospitals and provider health systems where innovation goes to die? The Subtlety of Influence and Partnering for Innovation

Politicians, businessmen, and even housewives ask the questions: “Why is healthcare so complicated? Why can’t it be simpler?”

They even demand: “I need care, tell me the price, and don’t make me wait so long.”

Amazon knows me as a member of Prime and maintains my information securely in the cloud. Amazon knows where I live with my saved data/information and then delivers to my house in three days or even less. They know me. “Why do I have to keep filling out the same paperwork at my hospital every time I arrive? It is my regular appointment with my same doctor and the same office and hospital. Why don’t they know me by now?”

Apple has all those apps I can just download from the app store for service, education, entertainment or every day conveniences.

“If physicians and hospitals are so sophisticated with all their expensive equipment, why can’t I just get an app to simply make an appointment, review my bill and pay utilizing PayPal?”

“I’ll tell you what causes a real headache, trying to pay a bill after a stay at my hospital.”

Finally, “Why can’t I just download my healthcare information and take it with me wherever I go?”

Industry-wide, we providers are internally focused on creating results; too often myopic in our approach. Ongoing comparisons within the healthcare industry are continuous and judicial yet we restrict our world toward outmaneuvering only the local competitors; however, our patients are judging us by the expectations created outside of healthcare through their engagement in the broader world of technology and business.

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The Path to Better U.S. Health Care must have room for ‘All of US’

In recent weeks Democratic candidates seeking the party’s nomination have given their preferences about how to reform U.S. health care. My experience in over 30 years of community hospital leadership led me to agree with the comments of John Delaney that Medicare-For-All would be a financial disaster for the vast majority of American hospitals. Very few U.S. hospitals have costs at or below Medicare payments.

Yet I don’t agree with Congressman Delaney’s statement that we shouldn’t touch the private health coverage market that covers 100 million Americans because those people will want to keep their coverage. I think there are a great number of Americans in the private coverage spectrum who have been saddled with enormous up-front deductibles and large co-payments and ever-narrowing health provider options who are ready to talk.

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Formula for a successful career transition

Being unemployed is not a comfortable feeling. Not only does it disrupt your carefully laid out routine and impact your lifestyle, but it also makes you question your abilities. But the “why” of your transition is something that you must strive to move beyond. You will have to in order to transition into a new role successfully.

Over the years I’ve worked with many people. Exceptionally brilliant individuals. People you would never imagine needing the help of a transition coach, but through a series of events, found themselves in that most vulnerable position. The phrase, “it can happen to anyone,” most definitely applies here. And while we like to feel we are special and tell ourselves, “no one understands my situation,” or “my situation is different because…”, that’s just not true. Yes, there will be parts of your story that make your story unique, but on the whole, there is a formula you can follow to ensure success.

Formula for transition success (A+B+C+D+E+F+G+H+I=NEW JOB):

  1. Be coachable and embrace being uncomfortable. What does being “coachable” mean? It means adjusting your mindset from that of the “teacher” to the “learner.” With a small shift in your mindset you open yourself to self-reflection which leads to personal growth.
  2. Be passionate about finding your next opportunity. That’s the only way you will weather the bad days. Being passionate is nearly impossible to fake. If you are questioning your passion or rolling your eyes at this bullet, it may be time to re-evaluate your career. Ask yourself, what would make me truly excited to go to work every day? Write it down and reflect on what you see there. Because if you don’t truly want it, you are wasting your time. A career shift may be in order.
  3. Have a positive attitude. Much of your success in transition hinges on your mindset. A positive attitude is essential. It not only makes you look like a more appealing candidate, but it will see you through to the finish line. Transition is a journey with many positives along the way if you care to see them.
  4. Be confident. Make sure your confidence is at its highest level. Confidence is like a bank account; you must make deposits regularly. Use positive self-talk as deposits. Stop any negative thoughts in their tracks and replace them with positives as much as possible.
  5. Put your baggage away. Put any emotional baggage behind you so you can focus on the future. This is key. You will not progress in your search if you cling to baggage. Allow yourself some time to process and wallow, but then put it firmly in the rearview mirror. Future employers can smell baggage a mile away!
  6. Remember your advantage in being unemployed -- you have more time to prepare. Sure, this may be the first time in 20 years you’ve had any time off, but resist the temptation to adopt the vacation mindset. This doesn’t mean you can’t take time with your family or take that trip to Hawaii for a week. But you must view the transition process as a job once you return. Put yourself on a schedule, set specific daily goals. “I will call xx number of people.” “I will apply for five jobs today.”
  7. Differentiate yourself from the competition. You have to differentiate yourself from your competition both on the alignment side for each position you interview for and the relationship side when you meet new people. You must be able to answer the question, “What do you do exceptionally well, better than most?” If you are unable to answer this question, call on people who have worked with you and ask them.
  8. Focus on what you can control. Activity equals results. In transition you should focus on hours per week, calls made/attempted, expanding your network with every call, and getting paper out. “Paper out” is represented by a cover letter and the resume for a specific opening either with the recruiter or directly with the employer or creating a marketing letter.
  9. And lastly, you have to be intentional. You must move through the steps intentionally and consistently. What does intentional truly mean in this instance? It means being thoughtful and strategic. Thinking through every phone call, every application submitted and every cover letter written. Be in the moment.

As with any math problem, the correct formula above must be followed, in its entirety, to obtain the right answer or in this case – the desired result. Skipping steps not only renders a different answer/outcome, but also shortchanges you on what you are truly seeking – a successful transition. At the risk of sounding like your 8th-grade math teacher, in order to get an A, you must show your work!

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The Pursuit of Balance

Long term success in life is rarely achieved by perpetual crisis management and the ability to work around the clock to meet a deadline…not that great leaders and successful individuals don’t have that ability and need to deploy it from time to time! One of the keys to sustained success is balance. Balance should not be viewed as a goal that is attained; rather a dynamic state in need of frequent adjustment…like a see-saw.

Plenty has been written about time management and work life balance, each method with its own merits. If you have taken some of this published advice and it has brought you success, don’t change a thing. If you continue to struggle, I urge you to read on.

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Turning your wiz bang digital solution into reality through effective implementation

In this episode on helping digital startups sell their solutions, I want to focus on the issue of implementation. It is certainly important to have a wiz bang digital solution. Equally important is how to implement the solution and manage the changes it causes. All startups should understand the concerns the hospital C-suite has around the implementation process. Specifically, the startup must be prepared to answer the following:

  1. Is the company going to take responsibility for all the administrative hurdles including the IT security approval? Customers want assurance that the company is going to answer all inquiries and assist with completing documentation. Additionally, customers will want the company to track the progress of all approvals and follow up as necessary.
  2. Does the company have previous experience with change management? Although the hospital may have a performance improvement team skilled in change management, it is important for the company to have people who also understand this complex process in order to work collaboratively.

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Clearing Healthcare Hurdles and Building a Client Base

In my last blog post I discussed the challenges digital health startups face when trying to sell to hospitals and health systems. In this post I suggest some ways to overcome the hurdles and succeed in building a client base.

Startups need to be realistic about where they are in their product life cycle. As I mentioned previously, hospitals are risk adverse with tight budgets. These organizations want proof that your solution is actually going to have the impact you claim. Early on it is beneficial to look at smaller organizations for “proof of concept.” Ambulatory settings, such as ambulatory surgery center or multi-specialty clinics are often good places to alpha and beta test a new solution. These organizations are often nimbler, and as a result, more receptive to innovation. Smaller healthcare settings may present easier access to administrators and clinicians who can help get your solution implemented. Additionally, the information security requirements may be easier to address in smaller settings.

As a startup in healthcare you must understand the economics of the US healthcare system.

There are two key questions you need to answer as you build your business model.

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Selling to digital to a hospital? Think like the CEO

The pathway to success for digital health startups is challenging. Hospitals are often looked at as the point of entry for digital startups. Trying to work with large hospitals can pose challenges for early stage start-ups for several reasons:

1) Hospitals often are a part of larger systems. As a result, there are multiple layers to the approval process with multiple decision makers prolonging the sales cycle. In my experience as COO of an academic medical center the time from initial interest to contract can exceed two years. Furthermore, complex deployment processes add to the timeline for pilot implementation.

2) Hospitals and health systems have narrow margins. Most hospitals have margins of 2-4%. The Congressional Budget Office has forecasted that up to 50% of hospitals may face negative margins by 2025. There is competition within the budget for both new and replacement capital. Furthermore, there is reluctance to add ongoing new expenses to capital budgets. Read the complete list here.

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Lessons from Global Health Development: Insights from Four Change Models

This is Part 3B of this three-part series.

Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights.

Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?

Some Questions for Cross-Benefit

Organizational leaders are inclined to plan and motivated to implement. How can leaders apply the individual-based MI change process, especially its relentless focus on the “why,” to better empower others to engage in large-scale challenges?

Organizational leaders and MI counselors are tempted to pursue short-term results over long-term empowerment and are challenged to sustain progress. How can they employ the iterative, escalating scaling process and longer-term, biologic view of SEED-SCALE to advance in a manner that harnesses the human energy of self-direction and local ownership? Read Full Article.

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Good Operations is Good Strategy

Good operations is good strategy. Operational excellence. Blocking and tackling. Within health systems, the ongoing importance of good operations should be highlighted as a foundational element of every strategic plan. Good operations is a “no lose” strategy that positions a health system for success regardless of the many external forces providing new challenges. Value-based contracting, risk-sharing and Medicare break even strategies are all dependent on the fundamentals of sound operations. Operational Excellence requires strong and improving performance across a broad spectrum of metrics related to safety and quality, customer service and cost efficiency.

Safety and quality. Our consumers have historically assumed that a healthcare system – especially one with brand recognition – provides a safe environment and good clinical quality. They have had little information to guide decisions related to safety and quality. Health systems must compare performance against top quartile performers and make the changes necessary to achieve this level of achievement consistently. And make the information available to the public in a discernible manner that is meaningful to consumers and motivating to caregivers. Safety and quality must be embedded within any strategic plan.

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Joy in Leaders = Joy in Work

Focusing on joy, especially in work, is gaining momentum. It has my attention! It is clear to me that the mindset and habits are exactly what great leaders have and do and what developing leaders should concentrate on.

It is very tempting for any leader, especially those in healthcare, to focus on what’s wrong, what needs to be fixed. It’s time to view the situation through a different lens…we need to focus on the meaning and purpose of our work. This is a distinct advantage for those of us in healthcare, our mission is making peoples lives better. Joy is not in things, it is in US. IHI describes pride in workmanship as a fundamental right; having the connection to meaning and purpose promotes such pride and is the basis of joy.

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Lessons from Global Health Development: Harnessing Methods of Change

This is Part 3A of this three-part series.

Read part 2.

This Part 3A briefly reviews four change methods and Part 3B will compare them

“I have no idea how to change anyone. But I carry around a long list of people in case I ever figure out how.” - Anonymous

Eliminate four billion dollars of waste from a large healthcare system next year. Increase the CMS TPS (Total Performance Score) for a hospital from the national average of 38.1 to 60 in two years. Reduce maternal, child and infant mortality in Nigeria by 50% in three years. These are large-scale improvement goals – at healthcare system, hospital and population health levels, respectively.

Improvement at the community, organization and individual levels are all connected: improvement requires change and all change is personal. An organization is a group of people with a common purpose; and a community is a group of people with the potential for acting together (Taylor). While communities and organizations are made up of individuals, how they evolve and change is not merely an additive process of how each individual changes. Societies and organizations are complex adapting systems and their advancement matures through their disciplined movement.

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Hats off to the standalone hospital CEO Why I find Rural/Small/Stand-Alone-Hospital CEOs so Impressive.

“Stand alone” hospital presidents provide a great deal to admire.

I was the lead in a recent strategic retreat and the CEO was incredibly impressive as I watched her interact with her board, her physician leadership and her administrative team. Once again it rekindled my awareness of how small hospital CEOs have to do it all. They are the engaged in the community, lead in the facility, influence the physicians, head Human Resources, know all the staff by name and can even be involved in the revenue cycle, IT and compliance departments. There is very little this CEO isn’t aware of from governmental changes to the one physician or nurse who leaves unexpectedly. There is no cushion. There is no room for error. It is a pure survivability issue. They must know everything and be involved in everything. As they look around them, there are few, if any, people to delegate to within the organization. They have the community depending on them as one of the key employers if not the largest of their city. System CEOs on the other hand have delegation capabilities and can look to corporate for support and capital. While a smaller hospital CEO bears the brunt of this responsibility.

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Influencing Your Team: 10 Leadership Traits that Drive the Ability to Influence Teams

All leaders will openly admit that they could not do their job without their team. However, as humans, I’d bet that most of them, in a moment of frustration, have thought “it would be easier if I just did it myself.” Why? Because influencing people is a gradual process, not simply a decision with immediate results.

Accepting the reality that no matter how brilliant or hard-working you are, you will always need your team which means you need to learn how to influence them.

Master the following attributes and you will be well on your way.

10 Leadership Traits that Drive the Ability to Influence Teams

Grateful Attitude - As a leader you are always on stage and therefore need to possess and portray a grateful attitude. Start your day with a ritual that grounds you; whether this is prayer, meditation, exercises, reflecting on loved ones, etc. When your day gets tough, reflect on, or re-enact your gratitude ritual.

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Lessons from Global Health Development: Relief vs Development

This is Part 2 of a three-part series
Read Part 1.

“Help! I need somebody! Help! Not just anybody. Help!” – The Beatles

When a cry for help begs a response, how do we assure that productive help, not just good intention, actually happens?

When faced with failure, what does a responder do? As an expert/advisor, you have a choice: correct the specific failure or strengthen the system (Taylor, Just and Lasting Change). To make this decision, it is critical to discern: is this an event-induced “disaster” – Ebola, Tsunami, Hurricane – or is it a chronic, systematic, or lifestyle-induced failure? In medicine, the difference is how a physician treats a patient with emergency trauma vs a patient with a chronic disease. The global relief vs development challenge has a healthcare leadership parallel: rescue or strengthen.

Why does it matter?

Diagnosis before treatment. This sounds simple, but when immediate relief is needed, the help reflex to correct or fix seems obvious. Yet, the best intended responses vary greatly in their effectiveness. Because often what helps in relief now, hinders development later – having the opposite of the intended effect. When dysfunction occurs, the temptation to intervene with mandated action may be warranted, but it can also compromise an organization’s culture or a community’s ability to evolve. This is a core dynamic of social change if local energies are to be harnessed. Read Full Article.

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