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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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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Meet the Mother of Strategy: Hope

A mentor of mine is often quoted: "Hope is not a strategy!"

Indeed, there is a world of difference between hoping things will improve and implementing a well thought out plan. However, nothing can ever change or improve unless we can imagine it as such. Once it is imagined, there must be some belief or "hope" that this vision can be realized. Now that's where strategy comes in, making the vision a reality.

As leaders, we must start by inspiring hope, not by asking for the action plan. When your team believes they can make a difference, they will. It is very obvious in healthcare: patients would never come to us without the hope that we can make them better. Hope is not just for our patients, it is for every member of our team.

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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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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 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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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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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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Developing leaders must navigate the hallway of hell

Enhancing our own leadership development along with the novice and advanced leaders on our teams is mission critical in healthcare today. The environment that we are challenged to be successful in is very harsh — increasing the cost of technology and pharmaceuticals, the ever-increasing cost of labor, on top of declining reimbursement.

The formula for success appears simple enough, but the challenge (as always) is the execution. Clearly, educating leaders and enhancing their skills will yield great outcomes; yet the material that must be mastered is not intuitive, and the skills must be practiced over and over to be mastered.

One of the first lessons to be mastered is abandoning time-tested strategy, focusing on maintaining current productivity and volume levels, and being content with the fundamental processes currently in place. In other words, leaders must be comfortable being uncomfortable, embracing the feeling of being unsettled. Read Full Article.

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Leadership – What It Is and What It Isn’t

There are likely more articles, books, blogs and seminars pertaining to Leadership than any other subject. In addition to our formal education and training as a leader, we have learned leadership traits from mentors, bosses, and other leaders over the years; we’ve learned what aspects of leadership we admire, and consider motivating and successful, AND...WHAT ASPECTS WE DON’T.

As a leader, leadership is not about you. Leadership is about those you serve and support, those you impact around you. I’ve learned over my career that command and control may yield short term gains in performance, and in emergent situations may be needed. However, if the goal is to create and sustain a high performing, forward thinking and dynamic organization and one that attracts the best talent, managing through fear and intimidation will not cut it. Relationships, trust, loyalty and truly caring about people, will build a resilient, loyal, high performing organization. Read Full Article.

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Off Track – Now What?

It happens. The organization is off plan…by a lot; and it is not the first time. More than a modest correction or a “wait until next month.” Many factors were likely involved, but the relentless dynamics of the market have overwhelmed a longstanding management team. It is akin to a cyclist who has slipped back from the peloton due to chronic cadence deficit – and now the gap is widening.

When a leadership change is made while the organization is on plan, it is often political. When an organization is off plan, and a leadership change is NOT made, it is often political (or paralysis). But when performance is off plan and the board and/or corporate office makes a CEO change, what are the key considerations?

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What is Authenticity?

Authenticity is a part of your brand, it is being who you are. Taking a deeper dive into the word, I questioned what are the traits of authenticity? These top characteristics rose to my mind when I think of an authentic person or leader:

  1. Self-awareness – A high level of courage and comfort with being in your own skin. You cannot be authentic, if you don’t love or respect yourself.
  2. Confidence – The higher the self-confidence, the more authentic you can be as there is no “shame” in being you.
  3. Vulnerability – Recognizing your imperfections as Brene Brown would say, accepting those and allowing yourself to feel emotions. It’s ok to be a leader and not have all the answers or know everything. That is why you hire intelligent people! As leaders we live in a fishbowl, but it is unnatural to keep all feelings bottled up inside and not expect the stress to build up. Carve out some safe “zones” of time, place or people to acknowledge your emotions and let them out.
  4. Consistency – Your word means something, you are dependable. People learn to expect certain behaviors from you. Consistency builds trust that leads to authenticity.
  5. Values driven – At the core of every authentic individual is their values. You need to know what you stand for and articulate it. Be willing to stand for those values and defend them. Build your vision around those values.
  6. Passion – Another common trait that most authentic people seem to display is passion. True commitment to themselves and the people and things around them, and it comes through in their communication.

Authenticity is a valuable leadership trait. In an increasingly complex and competitive industry, we are consistently making tough decisions. Being authentic to ourselves, our teams and our organizational values helps us remain grounded and navigate through challenging conversations and a fast-paced dynamic environment. Authenticity is also contagious. If you want to create an authentic culture, you certainly must lead by example. And as Brene Brown shares from her research, innovation and creativity stem from vulnerability and authenticity. So, let go of your ego and embrace your authentic self!

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A True Understanding of Beauty Can Make Us Better Leaders

While in college, I agreed to meet someone at our church. No one else was at the building. It was 1:30 in the afternoon. I was able to let myself in, because I had a calling that required me to have a key. As I think back on it, I cannot remember who I was meeting or why; I just remember that this person stood me up. I sat for an hour in the foyer. Staring out at a gray, rainy sky, I thought, “What a miserable day!” I lived in Monroe, Louisiana where we would get a lot of rain. If every rainy day was a miserable day, I was going to have a lot of miserable days. I chose then to look for the beauty in that day. Everything looked clean and shiny from the standing water. I appreciated the different shades of gray. I saw bright sunlight peeking out through the clouds. I beheld that it really was a beautiful day, and my mood lightened considerably.

Frederick Longbridge said, “Two men look out through the same bars. One sees the mud and the other the stars.” Both are incarcerated. Both are in a bad place, yet one sees hope, and the other sees despair. One sees beauty and the other ugliness. Many people feel trapped in their lives, their work and their circumstances. They see so much of what is wrong and so little of the beauty that surrounds them.

The lens of seeing the good can be a powerful tool for anyone and especially for a leader. When we look for the good in people, we will find it. When those we lead know that we see good in them, they feel valued and respected. They want to prove that our faith in them is well-placed. They will often rise to meet our expectations. If we find concerns in their performance, we are able to weigh those concerns against all they bring to the table. We would not so blind our eyes to tolerate any kind of bad behavior. There must be accountability. Yet a strong tendency to look for the good is more likely to be right and to be effective in leadership than a strong tendency to look for the bad.

When we face great challenges in our organizations, we may see them as an opportunity to survive or perish. We should remember that the great men of history are made or revealed by the great challenges that have been thrust upon them or they have imposed upon themselves. Winston Churchill found his place in history because he was prime minister in England’s darkest hour and rose to meet the challenge.

In the movie, The Fellowship of the Ring, Frodo says: “I wish the Ring had never come to me. I wish none of this had happened.” Gandalf answers him saying, “So do all who live to see such times, but that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil.” Most organizations are faced with serious threats. We must not see these as our doom. These are beautiful opportunities to rise to greatness as leaders.

My own Christian faith is the source of my next thought on beauty. It occurs to me that Jesus Christ must see each of us as beautiful. I am certain that there are some expressions that He is not pleased to see, but I do not believe that He sees any of us is ugly. So, what makes us beautiful to Him? To answer that question, I want to take you to an assisted living facility in Rochester, New York.

It was the Christmas season. We had gone as a family to visit a beautiful, octogenarian couple we knew from church. We had with us three-year-old Abigail and infant Michael. Small children get a lot of attention in assisted living facilities. As we were leaving, we were invited into a public room that had the feel of a living room. In this exchange of laughter and joy, I captured with my camera a remarkable image of Abigail standing in front of a very old woman holding her chin with the tips of the fingers of her upturned hand. Each gazed on the other with a look of pure love. As I have studied the picture, it occurred to me that Abigail only saw beauty. I thought about all the grandparents and great-grandparents all over the world, many of whom are quite weathered and withered with age who are adored and are seen as beautiful by their perfect grand and great-grandchildren.

I am sure that you have known where I was going with this. We are seen as beautiful by Jesus Christ, because he loves us. This has caused me to realize that if I ever see someone as ugly, it tells me far more about where my heart is and should not be than it does about the other person. When we love people, they are beautiful to us.

So, a true understanding of beauty has brought us to love. The kind of love that I am speaking of is philia or brotherly (or sisterly) love. When we truly love, we cannot abuse. We seek the interests of others. We are as merciful as circumstances can allow. If hard choices must be made, we implement them as softly as possible. Love is one of the great and essential leadership qualities. Our ability to see beauty is a powerful indicator of our mastery of that love.

someone in their 80s

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The Empowered Physician Leader

Today’s healthcare environment is shifting at an ever-increasing pace. The transition to community health focused care is both daunting and challenging for most organizations. Now, more than ever physician leadership can play a crucial and important role.

Setup Your Physician Leaders for Success

Before we begin, it’s foundational to understand how physicians view leadership. Physicians are trained to work independently, they value their autonomy and can be reluctant to delegate authority. All good qualities if you’re the patient. My colleague once said me, “these trauma surgeons are sure difficult to work with.” My response, “Of course they are. They are trained to take charge, assess situations quickly and be right, every single time. And If I’m critically injured, that’s who I want taking care of me.” But yes, when we ask them to take on the mantle of administrative leaders, they need our help.

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Mitigating Decision-making Errors Along a Transformation Journey

In Part A of this two-part article on decision-making errors, the main categories and types of decision and judgement errors were reviewed along with some associated logic fallacies.

So What?

Two practical questions emerge. First, what can we do to improve our judgement? A combination of antidotes is often recommended to mitigate the untoward effects of these decision traps: being humble and aware, knowing yourself and knowing others, and following a process are the top three. The first, being aware, is like telling a pitcher to “throw strikes” (well-intended, but not of great practical help – this is what the pitcher is trying to do but it does not help him/her do it!). The second, to know oneself, is harder than diamonds and steel, according to Benjamin Franklin. The third, following a process, offers the most tangible promise for something we can actually do that can consistently make a difference.

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The Power of Simplicity

My father taught us, “If you want to be happy, simplify, simplify, simplify.” He loved the quote from the movie, Amadeus, in which the Austrian emperor told Mozart that his music had “too many notes.” My father did not agree with the criticism of Mozart’s music, but felt the quote was great for describing anything from cluttered architecture and art to overly complex solutions to problems. His house that he built from steel is pictured with this article. It is an expression of his design and artistic philosophy: clean, smooth, uncluttered, simple lines.

Albert Einstein said, “The definition of genius is taking the complex and making it simple.” Steve Jobs surely met this definition as he brought us the power and complexity of computing through as simple a user interface as possible. He took the complex and made it simple.

We often find that we cannot complete all of the tasks that are already on our “to do” lists let alone other tasks and goals we should be adding. We can choose what is most important to us and drop some good things from our list that are standing in the way of our accomplishing better. Advice I received from the book, Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland and JJ Sutherland, helped a lot. Give yourself a short deadline. I needed to write an application to the Texas Medical Board to start a hospitalist fellowship. It seemed to me like this should take several weeks to complete which I did not have so I kept pushing it down on my to do list. I gave one of my hospitalists and me two hours to complete the application. We were done, and the application was accepted. My inner OCD wanted to overly complicate the task. I needed to simplify. Read Full Article.

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What learning to fly taught me about handling adversity

""When everything seems to be going against you, remember the airplane takes off against the wind, not with it", Henry Ford.

Ask any pilot if they remember the first time they flew the airplane alone. And you’ll get a resounding yes! The solo flight is a milestone in each pilot’s life, it’s the time when preparation and opportunity all come together. You are alone in the airplane, no instructor by your side correcting mistakes, keeping you safe, it’s all up to you.

Although my solo was over 20 years ago, I remember it as though it were yesterday. The weather, the sounds of the engine and the wheels rolling down the runway. But what I remember the most about that day is looking over to my right and seeing that empty seat next to me, knowing I was completely responsible for returning this aircraft safely to the ground, intact.

Whether your piloting an aircraft, an organization or a team, how you face and ultimately handle adversity will largely determine your success or failure. What my instructor taught me long ago was a simple lesson, the goal for each flight is for takeoffs to equal landings, what happens in between is up to you and will determines your success in achieving this goal. Read Full Article

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Systemizing Healthcare: The Integrator Role

This is Part 2 of a Four-part Leadership Transformation Series (LTS). (Read Part 1 Here)

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on the changing role delineation of leaders.

The leadership need for ‘the Integrator’ is re-shaping traditional CEO and COO roles.

A few decades ago, the role of ‘the Integrator’ in healthcare leadership did not exist – at least not in the form needed today. Unlike roles with new names – CTO, CMIO, CPHMO, etc. - the same titles of CEO or COO may be used for a healthcare system, yet the shapes of these roles bear little resemblance to those with the same titles used in a hospital or other ‘vertical.’

While a hospital administrator/CEO is expected to stay close to the pulse of acute care operations, the system CEO is expected to transcend operations to assure an aerial view/perspective, i.e., to become more visionary and system-focused. The transition from hospital to system requires a view that is less entrenched with how we have run hospitals and more focused on the population served. Despite use of the same title for both roles, it is the difference between being ‘tied down’ and ‘freed up.’ (REAd Full Article)

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The Fourth Discipline: Transition Management

Leadership Transformation Series

This is Part 1 of a Four-Part Leadership Transformation Series (LTS).

2012 Womens Olympic Triathlon finish in London - After two hours of racing with the best in the world, what would one or two seconds in transition time have meant for the top three athletes?

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how the nature of our work is changing.

Many compare the healthcare transformation journey to one of our oldest Olympic sports: “It’s a marathon!” Although this might reflect the persistence, resilience and endurance sentiment, I offer an analogy upgrade from one of our newest Olympic sports: “It’s a triathlon!”

Why?

First, transformation requires mastery of multiple disciplines. We – and our organizations - may have competency in one or two disciplines, but adaptive learning is required to develop and integrate the different and stronger skills needed for next level or breakthrough performance. We cannot count on simply doing more of the same ‘one foot in front of the other’ plodding and grinding to advance our mission – our people are burning out. Unlike in the run or bike, the first triathlon discipline – the swim - does not ask as much of the legs. While the upper body provides most of the forward propulsion, for swim speed it is more important to reduce drag. Drag is not a material factor in running, but it is in running our organizations – and barnacles, barriers and anchors come in many, mostly self-inflicted, forms.( Read Full Article)

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