Decision Making Traps: Decider Beware

Leadership Transformation Series

This is Part 4A in this Four-part Leadership Transformation Series (LTS); 4B will follow.

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

This article focuses on how we make decisions: 4A Reviews decision-making errors.

4B Addresses how to mitigate decision-making errors

Leaders – and their organizations - succeed or fail based on their decisions. Yet the evidence is clear that our decision making is perilously fraught with biases and irrational behaviors of which we are not even aware. These biases are so ingrained in our psyche that, like water to fish, we cannot imagine that they are even there, much less clouding our view – regardless of how “well-intended and objective” we believe we are. In short, bad decision-making is largely hard-wired.’ Just as many medical errors are associated with unexplained variation in medical decision-making (How Doctors Think), so too are many leadership errors are associated with unexplained variation in management decision making.

Traditional change is oriented in the past; it involves more, faster, better, but not different (Daniel Prosser). Transformation is future-oriented; it requires the creation of something from nothing, i.e., letting go and giving up something in the past to create something new. This means that, to do transformation well, it is even more important that our hidden decision biases be flushed out and made explicit. Leaders on a transformation journey are at higher risk for decision making traps and consequences than in traditional change. Said differently, leadership decision making in transformation is less forgiving.

A brief review of categories and types of decision and judgement errors include the following: (Read Full Article)

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What Southwest Airlines can teach us about running our own organizations

In an industry where its competitors have frequently gotten into serious financial difficulty, Southwest Airlines has maintained profitability every year for the previous 45 years. This is an amazing accomplishment. We will explore some of the strategies that Southwest Airlines has used to drive that success.

Southwest Airlines has only ever flown one type of airplane, Boeing 737’s. All its pilots, flight attendants, ground crews and mechanics are trained to work with every plane Southwest owns. Southwest must maintain a parts inventory for only one type of plane. I see two lessons to be learned from the strategy. The first is the value of simplicity. The second is the importance of sticking to your strategy. I am sure that over the years they were tempted at times to buy smaller planes to service smaller markets and to buy bigger planes to service foreign markets. Southwest did not yield to the siren call of chasing every potential customer. They would only pursue those customers who fit within their business model.

Southwest Airlines does not believe that the customer is always right. The late Herb Kelleher, former CEO of Southwest Airlines, said that the customer is not always right. “And I think that’s one of the biggest betrayals of employees a boss can possibly commit. The customer is sometimes wrong. We don’t carry those sorts of customers. We write to them and say, ‘Fly somebody else. Don’t abuse our people.’” So, what does this approach do for Southwest’s customer service? My own experience is that Southwest employees have always been warm and gracious to my family and me. But for more objective evidence we will look at the Temkin Experience Ratings. Southwest has rated number one for customer experience among US airlines every year since 2011 except for 2015. Read Full Article.

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Five things every CEO needs to do

It is a truth. As CEOs, we are pulled in many directions. The incessant priorities, though seemingly always valuable, will consistently distract us from our most meaningful impact. How does a CEO maintain their focus and discipline on what is important when everything is significant? They must focus on what is central to the organization’s success. The following five imperatives will aid in this journey:

1) Visible Listener:

The CEO must be a good listener who spends time greeting, listening and positively interacting with the individuals on the floors and in the clinics. Ninety-Five percent of your time should be spent listening. Hearing from the people doing the work who can keep you informed of the issues they are solving through the work-around of their own ingenuity. You have an opportunity to develop relationships, listen for trends, solve problems and gain credibility as a CEO who cares about the people enough to make them a priority in your busy day. Read Full Article.https://www.rodneyreider.com/blog/2019/2/7/five-things-every-ceo-needs-to-do

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The Operating Model: Closing the Strategy-Execution Gap

Leadership Transformation Series

The Operating Model: Closing the Strategy-Execution Gap

This is Part 3 of a Four-Part Leadership Transformation Series (LTS).

Read Part 1 and Part 2.

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 leaders operate.

You have a strategy. How do you rate your organization’s execution of that strategy on a 1-10 scale? For most, it is not high – or as high as they would like. Closing the strategy-implementation (aka, the knowing-doing or what-how) gap is the leadership Achilles heel of any business, but especially for hospitals, a business recognized by Drucker as the most complex organization to lead. Given that his observation pre-dated some of today’s larger and more evolved and blended academic-community healthcare systems, the complexity he referred to then has only increased. Across industries, the results of studies consistently identify unsuccessful execution for the vast majority of strategies; and the results of CEO surveys cite execution as the biggest current challenge, but reasons for such failure and concern vary widely. A sampling of HBR articles on the topic cite too much of an internal focus, poor CEO preparation in both strategy AND execution, “a people problem.” (Read Full Article)

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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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Rural Health's Specialty Lies in the Special Care

It was my first time back to a rural hospital. Though I had practically grown-up in rural health – both with frequent visits as a volunteer and as a support services employee – I had not been within the walls of a rural hospital in many years. And never had I been in one as a healthcare executive.

I arrived early, intending to look around and meet a few staff to better prepare me for a meeting with the Critical Access Hospital’s Board of Directors.

One of my first interactions was with a nurse coming out of a patient room. She was clearly emotional. Practically crying. I had seen the impact of caring for patients over the years. But this was not that. No, it was not simply a nurse and patient, but something much more. Even with my many years of experience, I didn’t yet know what I didn’t know – or regrettably, perhaps had forgotten. (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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How to ‘Stop the Insanity’ and Pave the Way to Real Achievements

I am sure you have heard the old adage “the definition of insanity is to keep doing the same thing over and over again expecting a different result.” I would like to expand to that definition “and doing something without appropriate planning and expecting a better outcome.” Have you ever witnessed an unexpected result or outcome followed by a flurry of activity which is expected to positively impact the outcome? The danger of this reactionary activity is the false sense that the problem is being solved. Reactionary activity may address the fringe of the problem, but the root cause remains festering and aggravating the organization. To help with the risk of confusing activity with root cause problem solving, I suggest the Four Steps to Achievement, or what I like to call P8. Read the 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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When is achieving all your goals not good enough?

We’ve closed the books on another year, and it’s time to review your performance. Maybe you’ve completed all your goals -- congratulations you’ve failed. Failed? How could that be, I’ve completed all my goals? And therein lies the problem, you didn’t set your goals (or the bar) high enough for your own performance. Goals by definition are aspirations and should be set high enough to stretch the organization and yourself in new directions. If you are constantly beating your goals, you’re not stretching enough.

But why don’t we set our goals high enough? Well, it’s complicated. It has a lot to do with you, and with equal parts of your companies’ culture and goal setting process.

Take this simple test: Read Full Article

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Patient Care Experience Beyond the Medicine

INTEGRATING SUPPORT SERVICES AND FAMILIES FOR PSYCHOSOCIAL CARE.

He is that family member we all know, regrettably often looked upon as bothersome, annoying or cantankerous. Throughout my career in home health, skilled nursing and acute care, these family members are at every level – anywhere that involves caring for vulnerable patients.

One doesn’t even have to be in patient care – simply working in healthcare means each of us will likely deal with these troublesome family members at one time or another.

I was still a teenager when I first encountered “the husband” as we came to know him. Little did I know that those few days with him would have an impact upon my entire future, and that of my very role as a healthcare leader.

Interacting with patients’ families while working both in dietary as a dishwasher/server and facilities as housekeeping/maintenance taught me the importance of both support services and family members within the patient care experience – beyond the medicine. Read Full Article

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A visionary leader is proactive

Reactive vs Proactive Leadership

I do a lot of reading on leadership. About 2 years ago, I read a book in which the author briefly contrasted reactive and proactive leaders. The author said that reactive leader does not seem to anticipate problems and does not see them coming until they are blowing up in his face. The reactive leader is constantly putting out fires. The proactive leader on the other hand sees problems just as they are starting to grow, or even before they begin, and calmly takes quiet and gentle steps to correct and avert so that the conflicts and disruptions are minimized or even completely prevented.

A reactive leader may be confronted with ugly contentions for any combination of the following reasons:

  1. Does not see the problem or consider that it might develop.
  2. Sees the potential problem, but does not want to be bothered over something that “might” happen.
  3. Sees the problem, but is afraid to act.
  4. Created the problem by misguided attempts to solve other problems.
  5. Enjoys contention and creates problems in part to create sparring opportunities or opportunities to assert dominance that are ego driven rather than leadership required.

The proactive leader does as Walter Gretzsky did and skates “to where the puck is going, not where it has been.” He has an eye to future disruptions. He sees the problems and is ready, willing and unafraid to act. He does not shy away from healthy conflict resolution, but prevents or minimizes unhealthy contention within his organization. He may disrupt his organization to move it where it needs to be to survive and thrive, but he will not allow his organization to be disrupted to no purpose.

I recently read an online article that presented reactive and proactive leaders as two equally valid leadership styles.i The reactive leader is presented in this article as strong in the surprise conflict, but weak in anticipatory leadership and the proactive leader as strong in long-range planning, but weak when called upon to “shoot from the hip.” I could not disagree more. A reactive leader is responding to whatever hits him and cannot have a firm hand on the tiller of the organization. For the proactive leader, the ability to extrapolate likely future scenarios and to predict human nature and act with vision and foresight does not make one unable to act upon the present urgencies and emergencies. Indeed, a proactive leader who has an eye to the future will be able to craft acute conflict resolution that is long lasting and strengthening to the organization.

Now, here is the part that stuns me, yet I have seen time and time to be true. This unknown author says that the reactive leader is often seen as the stronger leader, because he is often seen with guns blazing at a terrible dragon he is slaying for the organization, even if he is the one who fed and nurtured that dragon. The proactive leader is too often seen as weak or irrelevant. Why is he even needed? The organization seems to run itself. He often addresses problems discretely allowing key stakeholders to save face in front of the rest of the organization while bringing them effectively back on track. So much of what he does is unseen so it is assumed that it is not happening.

iPROACTIVE OR REACTIVE LEADERSHIP, WHICH IS MOST EFFECTIVE IN THE WORKPLACE? VICKY BAILEY, 2016-12-02

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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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Want to build your culture -- start by sweeping the floor!

Over the years, I’ve heard many stories, inspirational stories on leadership, one of my favorites involves President John F. Kennedy and his first visit to NASA in 1962. As the story goes, the President was touring the facility when he came across a janitor carrying a broom down the same hallway as the touring President. Kennedy, a great lover of people stopped him and asked him what he did for NASA, not missing a beat he replied, “I’m helping to put a man on the moon”.

As I reflect on this, I’m struck by the absolute simplicity of this statement, but also the way it speaks volumes. This individual clearly understood that he was an integral part of the team, no matter what the role. If he did his job well, he contributed to the overall success of the team, engineer, scientist, astronauts etc. His job, although different in almost every way imaginable from his colleagues, still contributed to achieving the overall goal, that of putting a man on the moon. Read Full Article

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Focus on Culture for Patient and Family Care: Beyond the Medicine

As healthcare (including acute care, nursing homes, home health and all downstream providers) moves towards a greater focus on patient/family satisfaction, the model of healthcare must also evolve, for both the government and patients/families will be closely reviewing these in determining healthcare provider(s) of choice. A satisfied patient is a more compliant patient, making for a more engaged patient. Providers at every level must now move beyond the patient centered approach, into an understanding of the patient/family perspective and be willing and able to convert input to action and measurable goals, benefiting staff, patients and families. Read Full Article

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Miracle-Gro® or Roundup® - Which One Are You Using on Your Network?

Why is it that some people thrive and others survive in business? Much of it comes back to their network. A network is like a garden. You have to water it on a consistent basis for it to grow. However, most of us put our heads down and focus on daily tasks. We say that we are too busy to network. We end up neglecting our networking garden and focus mainly on what others can do for us. Unfortunately, this self-referenced behavior is the equivalent of spraying Roundup® on your lush networking garden that you worked so hard to create. So what’s the cure?

Reciprocation is the Miracle-Gro® of networking. Without it, your network will shrivel up and look like you won a pallet of Roundup®. Here are three ways to rethink how you network, which can start to produce some Miracle-Gro®:

  1. When you talk to an executive recruiter next time, see what you can do to help them find a new client (not only a referral to a candidate). Go out of your way to introduce them to someone you know that might take their call. This can do wonders for your relationship with the recruiter.
  2. Instead of thinking of suppliers or vendors as another salesperson, invest time in getting to know them personally and see if you can introduce them to someone that might make a difference in their business. Remember that vendors may visit hundreds of organizations each year and their network could be very large.
  3. Focus on informational networking rather than looking at how you can find a new position. Invest in the relationship, find out about their journey and see what you can do to add value to the conversation. You might decide to follow up with writing an article that is relevant to the other person.

By investing in relationships over the long-term, thinking of others first and finding ways to reciprocate, you will develop a beautiful networking garden for many years to come.

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Take your team to first place -- by putting yourself last

Many high performing companies have discovered the value of servant leadership, which simply defined is serving others first. When leaders make this simple, but fundamental mind shift, the culture and the organization will follow as will bottom line results. Employees working under leaders who put their needs first, build self-confidence, make decisions more autonomously, have greater job satisfaction and engagement, and are more likely to practice this same style with their direct reports.

How does servant leadership build organizational and team performance? Read Full Article

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Healthcare Integration: Ship-to-Shore Work and the Ultimate Weapon

Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.

Despite asserting to my Dad, in my youth, the growing impact of technology, e.g., pilotless planes, long-range capabilities, etc., he remained convicted of the mantra “the ultimate weapon is the man on the ground.”* My Dad and his colleagues, some of whom made it past D-Day, are heroes. I have since learned that there were others “on the ground” back in the U.S. who heroically enabled these heroes. During the planning for the largest invasion in modern history, a significant challenge was figuring out how to get our troops from ‘ship-to-shore.’ The U.S. federal government knew how make large ships to get our troops across the English Channel, but they could not get our troops to the shore. Enter Andrew Jackson Higgins, who was described by Dwight D. Eisenhower in 1964 as “the man who won the war for us.” (Read Full Article)

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Changing Landscape and Designation Within Rural Healthcare

The landscape within rural communities was very different in 1977 than it was 20 years later when Congress created the Critical Access Hospital (CAH) designation through the Balanced Budget Act of 1997. The intent was to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. In the 20+ years since, healthcare and the settings in which it is provided (and subsequent regulations) has continued to evolve.

Recently, there was H.R. 2957, Save Rural Hospitals Act. Creating a Community Outpatient Hospital (COH) designation. The focus would maintain the vital economic contribution the health system makes to the community, expand funding opportunities, along with telehealth and transportation for accessibility and improved quality of care. Read Full Article

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Is it 'Mission Impossible' for healthcare? Why mission-driven leadership is still the answer.

Healthcare has been in a tremendous period of change, mergers, acquisitions, leadership restructures, and new and improved strategic plans and priorities fill the time of most leaders. During this time of change, many leaders may wonder privately, does the mission of this organization still matter? Or is it only about the bottom line?.

When looking at high performing companies outside of healthcare, they all share some things in common, first, they have a clear and well spelled out purpose/mission. This is important so everyone, front line staff to executives can understand the why we are here, and how we will define success. This is not just a feel-good statement, and properly developed and executed this has the potential to pull people forward, especially during uncertain or difficult times. Read Full Article

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