Who's Running the Show?

Strategy–The land of small ideas

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Hangin’ by a thread

“It will feel better when it quits hurtin’.” Well duh.  It will also feel better when we stop self-inflicting the hurt.

To help me understand how things work I need to decompose issues, not into small parts, but into a series of pictures or shapes.  The pictures I come up with represent my particular perspective of how things look.  That can be a far cry from how others view them.  Maybe that stems from when I was a child and enjoying putting puzzles together upside down.

Instead if hitting myself over the head with a hammer, I set aside the easy pieces—those with straight edges and the four corners.

The puzzle was equally complete no matter whether you worked with the picture or just the shapes, but the exercise was quite different.  The advantage in doing it my way is that upon staring at 500 pieces of cardboard backing I had to bring different problem solving skills to the table.  The disadvantage is that once I could picture the solution in my mind, I lost all interest in completing the last few pieces of the puzzle.

I find myself looking at coming up with a reasoned approach for attacking the large provider healthcare business model.  Puzzle pieces are scattered across my desk; some right-side up, others right-side down.

Here’s where the process breaks down or breaks up—I am sure the direction is irrelevant.  How does one change someone that either does not want to change or one who thinks change is not needed?

Just because you think you’re being followed does not mean you are paranoid—it could mean you are the only one with enough focus to know what is happening.  Charging someone eight dollars for a bag of popcorn to keep your business afloat is not insightful, frankly, it is embarrassing.  Charging forty dollars to check a bag on a plane does not earn a CEO the Baldridge Award, it only allows the airline to lose less money, to stave off inevitable bankruptcy a little bit longer.  Eastern, Pan-Am, Braniff, TWA, Republic, Northwest, Piedmont, Midway, Independence.  They proved the same thing.  Continuing to use the same failed strategy delivered the same failed result.  Just because the first five people to jump off the garage roof couldn’t fly doesn’t mean you can’t.  Or does it?  Bigger wasn’t better, was it?

What does it cost to fly from New York to Seattle?  It depends.  What does it cost to have an angioplasty on Philadelphia?  It depends.  Did the airlines adopt their pricing model from hospitals, or was it the other way around?  Does it matter?  Probably not.

The land of small ideas, like Monty Python’s silly walks.  Somebody actually comes up with these ideas.  I doubt it is someone on the board.  People who lead do not one day lose their marbles and decry, “Our model is not working, let’s start charging passengers if they sit during the flight.”

If staying afloat requires a hospital to charge eight dollars a unit for Tylenol, the land of small ideas is winning.

Why business strategies are so rigid

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From mathematics–In a Nash equilibrium, no player has an incentive to deviate from the strategy chosen since no player can choose a better strategy given the choices of the other players.

My rewording of the corollary, “No employee who disagrees with the corporate strategy remains an employee.”

Is your mission statement merely decorative parsley?

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What is your organization’s mission, your vision, your goal?  Can you articulate it?  If yes, write it below in the space provided.

Okay.  Why do you have a mission statement?  Is it of any more value than the parsley on your Denny’s Grand Slam breakfast plate, or is it actionable?  What does it tell you to do?  Is it something to which all of your employees can contribute?  Can you measure if your actions helped meet the mission?  Does the business strategy result from the mission statement?

Here’s one you probably haven’t thought of.  Let’s say every one of your employees puts your mission statement into action.  Does that improve your organization, or does it bring it to its knees?  Your mission statement either communicates your mission or it does not.  What does it say to your employees, to your customers?  If it does not create a message that makes you unique, fix it or dump it—or say, “We are just like those other guys down the street.”  Just because it communicates, does not make your mission sustainable.

Here are some real examples of hospital mission/vision statements.  Read them and see if you begin to understand why I think the hospital business model is in trouble.  I have not published the name of the hospital, as that is not what is important to this discussion.

Providing exemplary physical, emotional and spiritual care for each of our patients and their families

Balancing the continued commitment to the care of the poor and those most in need with the provision of highly specialized services to a broader community

Building a work environment where each person is valued, respected and has an opportunity for personal and professional growth

Advancing excellence in health services education

Fostering a culture of discovery in all of our activities and supporting exemplary health sciences research

Strengthening our relationships with universities, colleges, other hospitals, agencies and our community

Provide quality health services and facilities for the community, to promote wellness, to relieve suffering, and to restore health as swiftly, safely, and humanely as it can be done, consistent with the best service we can give at the highest value for all concerned

We are caring people operating an extraordinary community hospital.

Ensure access to superior quality integrated health care for our community and expand access for underserved populations within the community. Create a supportive team environment for patients, employees, and clinical staff.

Let’s look at some of the million dollar words in the mission statements of some highly regarded hospitals.  Ensure, foster, promote, participate, create.  Comprehensive.  Involved, responsive, collaborate, enable, facilitate, passion, best, unparalleled, .  These statements were written by well paid adults.  These statements are awful.  They are awful because they are fluff—unachievable.  They are well intentioned but meaningless euphemisms.

Hospital mission statements are inclusive to the nth degree.  They also seem very similar.  If a perspective patient read your mission statement and read the mission statement of the hospital down the street, could they tell which one is yours?  Probably not.  Who among you has a mission statement which excludes anything?

So, let’s say your board is debating if you should buy the machine in Monty Python’s hospital skit—the machine that goes “Ping.”  Which of the mission’s goals does that support?

How do you make them better?  For starters, make them short. Very.  One writer wrote, “If I had more time, I would have written less.

Southwest Airline’s mission statement—be the low cost carrier.

Dramatic pause.  Something either contributes to the mission or it does not.  Leather seats and free lunches do not.

 

 

The mathematics of change

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There are three people in the ER. One of them is a physician, one of them is an executive, and one of them is a consultant. They see a machine unplugged and standing against a wall in the waiting room.

And the executive says, ‘Look, the technology in this hospital is not used.’ And the executive says, ‘No. There are machines in the hospital of which at least one is not used.’

And the consultant stood there in silence guessing neither of them really cared what he thought about the machine.

At least one.

A mathematical term meaning one or more. It is commonly used in situations where existence can be established but it is not known how to determine the total number of solutions.

How many things can be changed regarding the business of healthcare that would have a positive impact on your business model? At least one.

Wayne Newton’s 4th law of relative immobility

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Last night I was speaking with a woman at a gathering of graduates from my high school.  She got into the subject of reading glasses and then commented that she first learned she needed regular glasses since the age of four.

As she was not wearing glasses, I asked her if she’d had Lasik.  No, she said, “I always hated how I looked in them, so I quit wearing them in high school.”

“Don’t you miss being able to see things?” I asked.

“Not really.  This is how I’ve seen the world for the past thirty years.  I’ve grown comfortable with how I see the world.”

I think many business leaders have the same perspective.  They get comfortable with how they see their world—comfortable with the issues and how to address them.  Given the choice, people will stay in their comfort zone.

Do you remember your physics?  Relative motion is the branch of physics that studies the motion of the body relative to the motion of another moving body (Newton).  For example, if you are in a train and another traveling at the same speed pulls alongside you, it appears to both set of passengers that neither train is moving.  If your train decelerates it will appear to you the other train has accelerated.

Now, take the perspective of someone standing on the platform viewing the two trains.  To that person, there is no illusion.  The bystander can see exactly what is happening; who is moving forward and who isn’t.

Some business leaders get caught up in what I call Wayne Newton’s 4th law of relative immobility.  When they look out their windows at the executive in the hospital across the street, it appears they are both moving at the same speed and at the same direction.  That is how they have seen the world each day for the last several years.  They look at each other, wave, and then go about their business, knowing their competitor hasn’t passed them or changed course.

But you and I know why it looks that way to them.  The reason they have not been passed is because neither hospital is moving forward.  The reason they do not perceive a change of direction is that they are both moving in the same direction.  In actuality, there is no motion.  Only an outsider can see neither hospital is moving.

HIT: Your most solvable big problem

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Two incompatible things are a type A personality and heart disease—I speak from experience.  I usually run six miles a day, three miles out and three miles back.  A few weeks ago I started hitting a wall after two to three miles and found myself having to jog/walk back to the car.  Wednesday I hit the wall after a mile, hands on my knees and gasping for air.

The air thing bothered me because that is what happened during my heart attack in 2002.  As I tried to make it back to my car I had to stop every few steps to catch my breath.  As I made it to a field and lay down several people stopped to ask if I needed help—this is where the incompatibility I mentioned comes into play.

I did not want to impose.  One of those who stopped happened to be a cardiology nurse and she was not taking no for an answer.  Dialing 911 she stated “I have an older gentleman, 60-65 having trouble breathing.”  That got my attention—all of a sudden my age seemed to be a much more important consideration to me than whether or not I could breathe.  “I am 55,” I corrected her.

Knowing how close I was to my home I tried unsuccessfully to get the EMTs to stop by my house before going to the hospital so I could get my laptop.  After three hours of tests, and without concluding why I had trouble breathing, they ruled out anything to do with my heart and sent me home.

I think knowing when to ask for help and accepting help relates a lot to healthcare IT; EHR, Meaningful Use, ICD-10.  These are each big, ugly projects.  There are several things that can happen on big, ugly projects, and most of them are bad.  This is especially true when the project involves doing something for the first time and when the cost of the project involves more than one comma.

Now we both know there is nobody with years of experience with Meaningful Use or ICD-10, and there are not many people who have one year’s experience.  So why ask for or accept help?  The truthful answer is because there are some people who know enough to know what to do tomorrow, and from where I sit the toughest part of every project is knowing what to do tomorrow—how to get started, and what to do the next day and the day after that.

Meaningful Use–Are you following the crowd?

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I remember the first time I entered their home I was taken aback by the clutter. Spent and wet leaves and small branches were strewn across the floors and furniture. Black Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The windows.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.

And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

“Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives. Sort of like all the scurrying around Meaningful Use.  The normal has been subsumed by the abnormal, and in doing so has created an entire entity which is slowing devouring the resources of the organization.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid on a daily basis. When I talk with hospital executives they are marching headstrong into the Meaningful Use abyss.

It makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about it they always have an answer. It all boils down to something like, “We simply can’t turn down the money.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid.  It’s gotten to the point where no matter how goofy things get, as long as they are consistently goofy, they are not goofy at all.

This is the mindset that enables leaders to be fooled by their own activity. Busy replaces thinking.

Patient Experience Management: Why Men Can’t Boil Water

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There was a meeting last week of the scions of the Philadelphia business community. The business leaders began to arrive at the suburban enclave at the appointed hour. The industries they represented included medical devices, automotive, retail, pharmaceutical, chemicals, and management consulting. No one at their respective organizations was aware of the clandestine meeting. These men were responsible for managing millions of dollars of assets, overseeing thousands of employees, and the fiduciary responsibility of international conglomerates. Within their ranks they had managed mergers and acquisitions and divestitures. They were group with which to be reckoned and their skills were the envy of many.

They arrived singularly, each bearing gifts. Keenly aware of the etiquette, they removed their shoes and placed them neatly by the door.

The pharmaceutical executive was escorted to the kitchen.

“Did your wife make you bring that?” I asked.

He glanced quickly at the cellophane wrapped cheese ball, and sheepishly nodded. “What are we supposed to do with those?” He asked as he eyeballed the brightly wrapped toothpicks that looked banderillas, the short barbed sticks a matador would use.

“My wife made me put them out,” I replied. “She said we should use these with the hors d’oeuvres.”

He nodded sympathetically; he too had seen it too many times. I went to the front door to admit the next guest. He stood there holding two boxes of wafer thin, whole wheat crackers. Our eyes met, knowingly, as if to say, “Et Tu Brutus”. The gentleman following him was a senior executive in the automotive industry. He carried a plate of freshly baked chocolate chip cookies. And so it went for the next 15 to 20 minutes, industry giants made to look small by the gifts they were forced to carry.

The granite countertop was lined with the accoutrements for the party. “It’s just poker,” I had tried to explain. My explanation had fallen on deaf ears. There is a right way and a wrong way to entertain, I had been informed. Plates, utensils, and napkins were lined up at one end of the counter, followed in quick succession by the crock pot of chili that had been brewing for some eight hours, the cheese tray, a nicely arrayed platter of crackers, assorted fruits, a selection of anti-pastas, cups, ice, and a selection of beverages. In the mind of our wives, independent of what we did for a living and the amount of power and responsibility we each wielded, we were incapable of making it through a four hour card game without their intervention.

I deftly stabbed a gherkin with my tooth pick. “Hey,” I hollered “put a coaster under that glass. Are you trying to get us all in trouble? And you,” I said to Pharmacy Boy, “Get a napkin and wipe up the chili you spilled. She’ll be back here in four hours, and we have to have this place looking just as good as when she left.”  I thought I was having the neighborhood guys over for poker; I was wrong. So were each of the other guys. We had been outwitted by our controllers, our spouses. Nothing is ever as simple as it first appears. We didn’t even recognize we were being managed until they made themselves known.

Who’s managing the show at your hospital, you or the patients?  The answer to that question depends on who owns the relationship, who controls the dialog.  If most of the conversation about your organization originates with them, the best you are doing is reacting to them as they initiate the social media spin, or try to respond once the phone started ringing.  It’s a pretty ineffective way of managing.  It’s as though they dealt the cards, and they know ahead of time that you are holding nothing.

There are times when my manager isn’t home, times when I wear my shoes inside the house—however, I wear little cloth booties over them to make certain I don’t mar the floor.  One time when I decided to push the envelope, I didn’t even separate the darks from the whites when I did the laundry.  We got in an hour of poker before I broke out the mop and vacuum.  One friend tried to light a cigar—he will be out of the cast in a few weeks.

There Are No Pink Unicorns

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Below is my proposal/synopsis for a management book I am writing on leadership.  I look forward to any thoughts and ideas you’d be willing to share.

There Are No Pink Unicorns

If you are thinking, “Not another book on how to manage,” take a deep breath because that is exactly what this is, not another book on how to manage.  It is a book on how to fail, something with which we are much more familiar.

Those management books are written by smart people, funny people, kids who climb on rocks…They are written by people with PhDs from places like Harvard and MIT, and for the most part are only understood by people with PhDs.

Most management books are written with one objective—telling managers how to succeed, telling them how to lead.  They are self-help books, written mostly by people who have never run anything more than a lemonade stand.  Most of these books blur the line between Cosmo and The Economist, and what they are—companies run by great leaders—are as rare as Pink Unicorns.

It is difficult to describe something to someone neither of you have seen.  What were you doing the last time you saw a unicorn?  How about a pink unicorn?  When is the last time you met Genghis Kahn to swap leadership secrets, or spent time with your kindergarten teacher prepping for a board meeting?

The popular management books address leadership traits as “secrets.”  That may part of the reason there are so many failed, failing, and under-performing businesses.  Referring to leadership as a collection of secrets imbues leadership with a certain unimpeachable mystique, something available to a select few, and something akin to the search for the Holy Grail or Noah’s Ark.  If great leadership or even good leadership is so difficult to witness and to attain, there is almost an implicit excuse for leaders who require leadership help to fail.

That got me thinking; would there not be more benefit describing something familiar to everyone, something other than Pink Unicorns?  Employees do not sit around the break room saying things like, “I sure hope Mr. Pufferdink figures out the secrets to why this place is so screwed up.”  Instead they say, “This place is screwed up.”  “Pufferdink is killing us.”  “Our customers hate us.”  They say these things to anyone who will listen—their spouse, the dog, the person sitting next to them on the flight to hell.  They tell those people because if they told the people at work, one of two things will happen; nobody will listen and nothing will change, or they will be fired.

At one time or another we have each attended the identical happy hour meeting.  It is the meeting where you and your colleagues, after several shaken dirty Grey Goose martinis, start to re-engineer your company.  The remnants of the tortilla chips and salsa are pushed to the far corner of the bar table along with the salt and pepper shakers.  You scoop the crumbs to the floor, remove your Mont Blanc pen from the inner pocket of your jacket, unscrew the cap, and begin to write on the damp bar napkins which held your drinks.

You realize quickly that your scribbles are melting on the wet napkins much like the wicked witch from the Wizard of Oz.  You wipe the vodka rings from the table, grab a fistful of dry napkins from a passing waiter, and wistfully order another round of drinks for the new management team.  Stay with me on this because I think this point is key—within two rounds of drinks you have probably outlined an accurate list of several of your firm’s major problems, have begun to outline ideas about how to fix them, and have defined barriers to the successful implementation of those solutions.

How to lead and manage are not secrets, nor should they be treated as such.  The required skills do not require special conjuring by the three witches in Macbeth.  They require observation, an ability to ask basic questions, a willingness to listen, and the courage to understand that you do not have all the answers.

There are no Pink Unicorns defines the questions, the pain points, and how to break the cycle of Pink Unicorns.  It does so using language, ideas, and pictures that do not require a PhD to understand them.

The Spandex Insecurity—the Ego has Landed

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Now before you get all upset about the sexist picture, at least read a little bit of this to see why I selected it. Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my MP3. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained (McKendree Spring). Men and women. Customers and companies. Most parties will deny they are competing, yet neither will yield. The customer is always right–Turns out it makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. If anything, were you to listen to what CSRs are instructed to do for the callers and compare that with what they are instructed not to do for the callers, it’s clear that their mandate is to minimize the negative impact to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute an insurance claim?