A CARE PLAN for Burnout Prevention

Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?” Self-reflect and visualize your peers and the people you are leading. Do any of these characteristics seem familiar?

  • Constantly worries about what people think
  • Always feels obligated to fix things
  • Has a hard time letting things go
  • Starts the day with a list of worries
  • Ends the day with a list of worries
  • Stresses about staff turnover
  • Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team. The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect. Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done. Try this CARE PLAN:

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Podcast: Getting Your Hospital to Act Like a Startup

Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

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Does your hospital know what happens when your bill goes to collections?

This article published recently in the The Atlantic points out that unexpected, large hospital bills can happen to anyone. This caregiver was hounded by collectors, one even inviting them to connect on LinkedIn! As healthcare administrators, we have a good understanding of our average reimbursement and collection rates, as a percentage of the gross, billed charges. But do we really know what happens when the uncollected charges are turned over to collection agencies? Are we aware when and if they are then turned over or “sold” to other debt buyers? To me, poor treatment by collection agencies and debt buyers is still a reflection on the health system where the patient received their care. Can health systems and doctors afford this type of reputational risk?

I turned to a colleague, a revenue cycle professional and expert - the best I’ve ever worked with in the business. They provided a more balanced perspective:

There are two sides to this dilemma depending whether you are a patient or provider. From the patient perspective, medical debt is increasing and in too many cases crippling, often leading to financial ruin, depression and shattered lives. Statistics show the percent of total bankruptcy, because of medical debt, at over 50% and employers shifting costs through deductibles, now on average over $1,300 and growing, according to the Kaiser Foundation. On top of that, healthcare spending as a percent of GDP is approaching 20%; an unsustainable trajectory. Bottom line, patients and families are harmed by unaffordable medical debt and there is no solution in sight.

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The Wedding Toast: Lessons in Leadership from Love

Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

One of the privileges of being the Dad of a little girl is that she sits on your lap and you have little talks from time to time. One I remember in particular is when her mother was out shopping, because that’s what she did when Daddy and daughter spent time together, Francesca looks me in the eyes and says: “Daddy when I grow up I want to marry you” ….. I had to politely explain to her that Mommy wouldn’t like that too much! She then went on to say: “How will I ever find the right person to marry?” I said: “Honey, when you fall in love and if that person treats you as well as I do, then he’s the one.” Matthew you’ve passed that test.

So I can’t leave without a little advice for Francesca and Matthew…..You are starting your life together, what’s the most important thing? The most important thing is LOVE….that’s a great word but there are a lot of things that go into it. For my colleagues in medicine, you know we have to make acronyms out of everything to help us remember….

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Are tech solutions the only solution?

How to think critically when solving healthcare operations issues

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue. Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better. With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

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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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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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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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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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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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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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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.

Take the Joy Quiz.

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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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Lessons from Global Health Development: Sustainable Change Contrarian

Part 1 of a three-part series

“We cannot solve our problems with the same level of thinking that created them.” ― Albert Einstein

In the U.S., some refer to healthcare system change as an oxymoron. It is complicated. It is hard. And while progress has been made, we have a long way to go.

But if such change in healthcare is challenging in the richest nation, then imagine it in low resource countries. In many sub-Saharan African countries, healthcare must compete with investment in other more impactful determinants of health such as education, food security, and sanitation that, if present, are weakly established. Layer in different governments, languages/dialects, and cultures; include frontier rural locations, tribal influences and religious differences and the challenge to improve health and healthcare in countries such as Tanzania, Madagascar, and Nigeria can feel truly overwhelming.

Historically, the traditional approach to both change in U.S. healthcare and global development has been to identify needs and direct resources, typically money, at the perceived needs. This pattern has resulted in little success and in many cases, regression, harm and/or increased costs. In global development, despite over a trillion dollars channeled to low resource countries in the past two decades, little progress – and often regress – has resulted (Taylor, Empowerment On An Unstable Planet). In U.S. healthcare, it has created and perpetuated a medical industrial system that is three times as expensive as other countries for almost median outcomes. The lesson? Funds are zero sum limited; human energy is not. And the only real empowerment is self-empowerment.

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Good Leaders Drive Results!

Leaders are expected to be creative problem solvers, challenge the status quo and visualize problems before they occur. Your success as a leader is largely dependent upon how quickly you seek improvement in broken processes, develop new procedures and maximize efficiency and effectiveness.

Below are three tips to help you stay in front of the curve when managing your people and organization through change and drive results: Read Full Article.

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Sustainable Population Health:

Part B – Catcher or Pitcher?

Part B of this article addresses how growth plans of healthcare systems distinguish population health management from community and public health.

Part A of this article clarified the terminology and implications of Community, Public and Population Health. So what does all this this mean for healthcare system leaders’ growth plans?

Healthcare providers have historically played catcher, “receiving” patients who sought care. Access meant being available when and where patients sought them. The transition from volume-based care to population health management requires a role change of providers from catcher/receiver to pitcher/initiator. The transfer of utilization and intensity (and possibly actuarial) risk to providers requires providers to be economically accountable for care and the health of a population. The good news is that this is a better alignment with the societal view of healthcare as a service (in economics, a ‘good’ with a cost) that is necessary but not a value-add. The bad news for providers is that this is contrary to traditional culture and payment incentives. This change is not a transition, but a transformation that involves many transitions.

Is Less Healthcare Better?

From a community and public health perspective, success involves preventing disease and reducing the demand for healthcare services. Success for providers often means growth in healthcare services. Traditional revenue growth for providers involved price and quantity (P & Q). Providers feel conflicted: more P and Q meant economic success, but now, with increasing “value-based” care (more-risk, if not full risk), less P and Q means success.

Studies have called out pricing as the primary reason why costs in the U.S. are significantly higher than in other developed countries (Uwe Reinhart, ‘It’s the Prices Stupid’). Increasingly transparent societal forces are serving to limit growth in P. And the ascendance of population health management is serving to put downward pressure on Q – the quantity of health services provided. Read Full Article.

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Eating Live Frogs and Other Strategies to Organize Your Work

Mark Twain said, “Eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day.” When I first read this quote, I thought it was just a bit of silliness and good fun, but I read once that it meant that you should tackle your most dreaded task first. This is good advice for often dreaded tasks are not as difficult as we feared. We just need to get started.

My long-range calendar is kept in Outlook, but I do not use Outlook to keep track of what I need to do today. I have often found myself ranging over the hospital so I would not have immediate access to my desktop computer. I also want to be able to talk on my phone and look at my schedule at the same time. So, to prepare for tomorrow, I pull out an unlined 3 x 5 index file card. Orienting it in a portrait layout, I write the day of the week and the date at the top. Below this I write in my known schedule for the day. If meetings are back to back, I write them with no space in between. If I have time between meetings, I leave space to write in commitments that will be made that day.

If you have a job with clear and regular boundaries between work and personal time, it may be practical to keep two separate calendars. But those of us in leadership, especially hospital leadership, find the boundary between work and personal time to be very fluid. We may have to come in early one day to meet with the surgeons and the next day stay a couple of hours into the evening for hospital committee meetings. Under these circumstances, it is critical that there only be one calendar on which is kept all work and personal commitments. One of Steve Jobs’ daughters understood this principle well. When her father would commit to spend time with her, she would call his secretary and have her add the event to his calendar.

If someone helps you with your schedule, it may be necessary to give them access to your Outlook calendar so that they can schedule meetings for you. If you feel you need privacy, it is possible to add things to your Outlook calendar such that others can see that the time is blocked but cannot see how you labeled the event.

On the backside of the 3 x 5 index file card, I write my “to do” list. These are things that I want to get done in my open time between meetings. As things are completed, I cross them off. Anything uncompleted by the end of the day, can be added to the next day’s “to do” list. For me there is always something to carry over on my “to do” list to the next day for I am a very ambitious “to do” list writer.

So how do we prioritize our “to do” list? We can begin by looking at our list in terms of a Johari window. Tasks can be divided into urgent & important, not urgent & important, urgent & not important and not urgent & not important. We must be careful about how we characterize our tasks. We may think that something is not important, but we can make a serious mistake if we decide that a task in unimportant while our boss thinks it is extremely important. We can lighten our load and focus our energies by removing things that are truly not important from our “to do” list. In the short term we must tackle urgent and important tasks, but in the long run we want to complete our tasks that are important while they are still not urgent.

There is merit in quickly knocking out easy tasks that are important, but we must not allow our sense of accomplishment to excuse us from tackling difficult tasks that we need to get done.

No is a word that I do not like to say to my superiors. I was hired to make things happen and to get things done. I was hired to be a solution to problems. When given a problem, I want to serve, I want to help. This can result in overloading my schedule. After starting a job as a physician leader, I was invited to sit on several committees. Early on I was given advice by one of my bosses that I should limit the number of committees that I sat on. So, I asked him to give me a number of how many committees he thought I should be on. As I accepted these committee assignments, I let them know that I had a limited number of committees that I could be on and that I might have to step down from their committee if the hospital needed me somewhere else. I had the advantage that I oversaw 22 physicians and four nurse practitioners who each needed to sit on at least two hospital committees. With so many providers needing committees, I struggled to find places for them all. When I needed to step down from one committee to take on a more important assignment, I was always able to replace myself with one of these providers.

Stephen Covey listed “sharpen your saw” as one the seven habits of highly successful people. A carpenter who only saws and never takes the time to sharpen his blade will be very unproductive sawing with a dull blade. We must take time to plan, prioritize and organize our work. This gives our work focus and power. We feel more effective, because we are more effective, and that sense of accomplishment brings joy and meaning to our work.

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In Praise of Corporate Tension

“Corporate will be here next week to help…”

“Corporate is sending out a team in person to review the project.”

“Corporate is coming out for a visit.”

These words can immobilize the most courageous of hearts. Many at the clinical sites believe corporate exists to disrupt and provide self-enhancement for the corporate individual making the demand. The incoming request often appears as a consistent disruptor to the local individual who is focused on the hospital, clinic or community issues. As a non-corporate individual, you are at the site addressing immediate and multiple priorities. The demands can range from concerns for improving patient care, addressing colleague concerns or responding to the corporate enhanced financial issues to name just a few of the more common daily agenda items. In fact, you may even be reacting to a situation affecting the greater importance (?) of your immediate supervisory interacting environment (i.e. keeping your local boss happy). Whatever the corporate demand at the time, it can seem to distract from the work necessary to be successful at the site. Furthermore, from the limited view in field, the request can sometimes make no sense as to its timing or priority except “Home Office needs it now.”

The tension between the entities in the field and the corporate power is real. The euphemism of “Corporate,” with all of its priority setting, sweeping powers, and down-flowing time demands can cause untold tension and disruption at the sites. However, corporate has its own demands and in the final measure is often made up of people just attempting to survive and succeed. Good leaders are conscientious individuals balancing competing demands, shifting priorities, and seemingly continuously adjusting metrics driven by someone else’s “higher-up” tinkering. Both sections of the organization contain people searching for a positive impact. Same organization. Different pressures. Competing language. How does that language sound as a result of differing views? Let’s take a look and listen in: Read Full Article.

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The Cultural Leadership effect -- it starts with you

The leadership team is responsible for strategy. It is a major portion of our many meeting agendas. We have all seen or created the list of items and our strategy focus may vary from how to enhance our service line growth, to retaining and recruiting more nurses, or focusing on the improvement necessary to boost the patient scores and much, much more: however, as leaders we all know what must always be forefront on our strategic agenda, taking care of our employees.

How many times have you seen where the Administrative Team gets together, decides they are all going to Round together, and their assistants (with repetitive internal mirth) agonizingly make the schedule, coordinating whereby everyone can Round together. It lasts for a few months, weeks or even never gets completely off the ground despite the many studies showing its benefit. It is not out of leadership neglect, but the daily re-prioritization battle that necessitates our lives. Nevertheless, the focus on your employees must always take precedence.

The questions must then be asked: How is this precedence displayed? How do you show you care about your employees? Read Full Article.

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