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 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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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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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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The healthcare leadership matrix, how to create a 'win-win' after the deal is done

The healthcare environment continues to undergo rapid and profound change with mergers, acquisitions and new business models forever changing the landscape of how we lead and deliver healthcare for the next millennium. In my previous article, I discussed the concepts of leading your team through complex problem solving. Today the focus is on you, the leader, how you successfully navigate yourself through new relationships, complex reporting structures and multi-entity healthcare business models.

As leaders in this new matrix and/or multi entity models, we are challenged to rethink our leadership style and model into a much more collaborative and creative approach to be successful. New relationships, business or otherwise require us to lead together, build upon individual and team strengths and become much more resilient to change. In my experience, I’ve had the opportunity to both model and observe what I call best practices when leading in a highly complex and matrix environment:

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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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Franchise Ownership a Viable Option for Healthcare Industry Executives in Transition

Healthcare executives are discovering numerous reasons to turn to franchise ownership. In growing numbers, they are becoming entrepreneurs, whether they are new to healthcare or grizzled industry veterans. Healthcare leaders are fulfilling important personal and career goals by investing in franchise opportunities; here we’ll discuss the most common:

1. Providing Additional Security

The healthcare industry evolves rapidly, and there's no end in sight. The industry's future remains murky with ongoing talk and political steam of substantial healthcare reform. Franchise ownership is appealing as it can provide a secondary source of income independent of your employer. If there’s a sudden change in your organization or the industry overall, you won’t have all your eggs in one basket. Whether you’re planning on continuing in healthcare for the long haul or wanting to bridge out of healthcare in the coming few years, owning a “manage-a-manager” franchise model and scaling the business over time can provide added family income to rely on and enjoy. The number of people with a business on the side is growing rapidly, and few side gigs offer the earning potential or predictability of franchise ownership.

2. Helping to Build a Nest Egg

Franchise and business ownership is also a great way to diversify your investment portfolio and prepare for retirement. You can enjoy a reliable income while building a valuable future asset that can be sold for a premium or passed as a legacy to your children. By following in the footsteps of other successful franchise owners and reinvesting profits into additional locations, you'll grow your net worth exponentially faster than putting all your savings in a mutual fund.

3. Offering a Fresh Start

Most new opportunity seekers are pleasantly surprised to discover the wide variety of franchise opportunity choices spanning 90+ unique industries. It’s definitely more than just French fries. A hefty majority of new franchise owners choose a business in a completely new industry, not related to healthcare or the sector where they’ve been employed. Your diploma and your resume do not limit your options. Many people yearn to pour their strengths and energy into a fresh, new challenge. Strong franchise opportunities with a proven business model and streamlined training systems are the bridge for thousands of new entrepreneurs to blossom in new lines of business with much less risk. It’s a vehicle to succeed at something, gain more control over your destiny, and enjoy more flexibility rarely found in a corporate executive’s lifestyle.

No matter your reasons for considering franchise ownership, you don’t have to look far for success stories. Take Carey Winkel as an example. She spent 70 hours a week working as President of Commercial Operations for Sunrise Medical before switching gears and buying a cleaning franchise. In her first four years, her region won the company's national growth award three times!

Brian Foster is another great success story. He worked as a healthcare executive for over 30 years for the Illinois Hospital Association. After contemplating his future, he met with FranNet and was introduced to the idea of owning a franchise. He’s fallen in love with being his own boss, with a thriving business that’s poised to earn income for many years to come.

If you’re trying to transition from your career as a healthcare executive (or any other career) to franchise ownership, let us help you. At FranNet, “creating success stories” is our motto. We match aspiring entrepreneurs to the right opportunities for their strengths, goals and needs. To get started, give me a call at 770-579-3726 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

Leslie Kuban is a nationally recognized franchise industry expert, CFE (Certified Franchise Executive) and owner of FranNet in Atlanta; a locally owned and operated franchise consulting firm. Leslie and her team have helped close to 500 individuals and families achieve their dreams of business ownership through a no-cost, extensive educational and coaching process.

Connect with Leslie online or call 770-579-3726 to start the conversation today.

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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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It takes a team - the story of a turnaround that could have and should have happened

As discussed in the blog, Success or Failure: Healthcare Can Not NOT Change, healthcare is a business. And, considering the economic contribution they make throughout their region, it is big business. With each hospital closure that hits the media, it is not simply the services provided that is at issue, but the financial impact to the community as well.

Serving as a consultant at a very impressive $40M health system, I dove deep into the Community Health Needs Assessment and each component of the strategic plan. My initial task was to meet one-on-one with each member of the executive team and department heads – of course my daily rounds (LBWA) meant I was meeting front line staff throughout the day each day – before reporting back to the Board of the Directors at the end of the month.

Meeting with the CFO, she was gravely concerned with the system’s operating margins, which were the narrowest they had been in her entire 12-years. She provided me with benchmark data showing the continuous decline over the last several years.

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Leading Your Team Through Complexity

Leading and working in healthcare has always been complex, never more so than in today’s healthcare environment. Increased regulations, government reforms, alternative based payment models, rising consumerism and expectations have come together in a perfect storm swirling around the industry. On top of this, the world economy has become a destabilizing factor as we realize now more than ever how interconnected we are to our world partners, almost a giant game of Jenga, where one false move by a world leader could topple the whole tower.

So how do we lead in an era of increasing complexity and more ambiguity than ever before? In previous articles I’ve discussed the importance of mission and a common set of values to ground the organization and guide our decision making, and this is foundational. However, in this article I would like to discuss the skills and the leadership maturity it takes to lead successfully in a complex environment.

I’m going to use the term “maturity” here, not necessarily the chronical definition of age, but the maturity that comes with leaders who have had numerous and diverse leadership experiences. Leaders who have seen enough, had their share of successes and failures to understand the important role they play in guiding the decision-making process.

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