There Are No Pink Unicorns

Posted by

0

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.

My Healthcare Hero

Posted by

0

Hero has become such a disposable word.  I thought it might be of interest to share the meaning of the word from the eyes of a ten-year-old, my son.  Father’s Day is always extra special to me, because without this story there would not have been any more Father’s Days for me.

Forgive me for stealing a minute of your time for these few paragraphs.  Although I rant about the healthcare system, and independent of whether it needs changing and how to change it, I am quite a fan.

Two years ago my 10-year-old son was given a writing assignment to draft a paragraph about his hero.  He wrote the following about an event that happened when he was 4,  which I since framed and placed on my night stand—the spelling errors help authenticate the narrative:

“An amblence driver is my hero. He saved one of my familys members lives, My Dad. One late night my dad had a hart attack (I had a horrible ear ake.  We called the hospital and an amblence came to take my dad.  The driver took him to the hospital (it takes 30 minutes to get there going 60 miles an hour.)

I love to read and write, and as you know, I can be critical of those who do and don’t, but this is the best piece of writing I have ever read.

Happy Father’s Day

The Spandex Insecurity—the Ego has Landed

Posted by

0

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?

Healthcare 2.0, Web 2.0, etc

Posted by

0

I am a huge fan of the phrase, “What if?”  Thinking is vastly underrated, especially by those who don’t—think, that is.  Where are all the what-iffers?

On the overrated side are the 2.0’s and 3.0’s.  Those terms connote a handful of things, none of which are particularly helpful.  It is as though those in the web 2.0 club see themselves as having arrived; as being somewhere better than those still mired in the one-dot-oh’s that comprise their cloistered universe.  Maybe it is just a level of enlightenment or attainment which comes from having been to the mountain top.  They Tweet with their David Attenboroughish British accents, revealing tidbits information heretofore unknown to the 1.0 crowd.

May I suggest the problem with the dot-ohs is the notion that there is some sort of deliverable, some point at which one is no longer striving to get to the oh-ness because one has arrived.  Then what?  I think that is why the uptake of the dot-oh concepts by the C-suiters is so low.  Web 2.0.  Health 2.0.  Social Media 2.0.  They are still paying for all the one-dot-oh initiatives, initiatives which for the most part failed to deliver.

There is no end point, no date in late October where anyone can say with any credibility, “We’ve arrived at the dot-oh end point.  It is a silly notion to believe that any of these initiatives are ever complete or exist in isolation.  I propose we use new nomenclature, something which suggest does not have an endpoint.  A transcendental number, a number with no end.  Irrational—like me.  Pi—π.  Health π.  Web π.  Social media π.

Part 2: Are 7 sigmas 8 too many?

Posted by

0

The worst part about being wrong in public is having an audience.  Yesterday marked the eight-and-a-half year point since my heart attack.  I celebrated with a six mile run.  Instead of hiding my car keys under the bumper like I always do, I stuck them in the pouch of my MP3 case.

I was back within the hour and in a hurry to get to my water bottle that I had locked in the car.  No keys.  After considerable thought and machinations of my considerable cerebral skills I decided to retrace my steps; all twelve thousand of them.  Still no keys.  I called my wife and she retraced my route.  No keys.

I had apparently out-thunk myself.  We called AAA to get them to make us a key, and waited—two hours.  After several failed attempts Sparkie finally unlocked the car.  I opened the door, placed the palm of my right hand on the keys, reached across the seat for my water bottle…

The keys, locked inside the car right where I had left them.  No need to worry about missing any subsequent MENSA meetings.  My wife simply gave me the look—men, you know the look.  It is the one that means I will not tear into you now; instead I will save this for when I really need it.

I threw all seven of my sigmas at solving a zero-sigma problem, looking for a complex solution when an easy one would have worked.

Patient Experience Management (PEM) solutions are often approached in the same manner—sigma overkill—reengineering some arcane, one-off process without taking time to understand the real nature of the problem or its outcome.

In yesterday’s blog we drew a comparison between clinical PEM and non-clinical PEM (http://wp.me/pyKA6-Ih).  We also inferred that non-clinical PEM processes are not unlike some of the process employed by hotels.

So, what might be done to improve non-clinical PEM?  What easy wins can be achieved?

When you arrive at a hotel for an event or an overnight stay where do you go?  You go to Reception or to the front desk to check in.  When you leave you go to the same place to check out, or you bypass the process and simply leave.  You can do that because you have been a guest of the hotel.

Now let us look at the same process at a hospital.  Where do you go?  You go to Admissions, and to leave you go to Discharge.  Other than hospitals, can you think of another establishment that uses the terms admissions and discharge?

Prisons.

Admission and Discharge are suggestive of many things, but the feeling that does not spring to mind is the notion that anyone working at the prison cares much about inmate experience management.  Admissions and Discharge do not evoke warm, welcoming feelings.  They do not lead you to feel that your stay is in any way voluntary.  In fact, even ignoring that the medical vernacular for the term discharge is often used with adjectives of color—the yellowish discharge—the term discharge infers that you do not have permission to leave until you are discharged.

Ever notice the big open space right next to admissions?  Know what it is called?

The Waiting Room.  What happens there?  You wait.  It is a special, nicely furnished place designed for you and others to do nothing, prepared for you to waste your time.

Your appointment was scheduled weeks ago.  You are probably apprehensive and a little worried about what may happen to you over the next few hours or days.  You have blocked out your calendar to be there—taken off from work, arranged for a baby sitter, and arranged for someone to prepare meals for the children while you are away.  You probably needed someone else to adjust their calendar to ensure you get to the hospital on time.  The hospital told you when to arrive.  You are there on time but someone somewhere is not ready for you.

Did they forget you were coming, or does the very nature of having a waiting room infer that their time is more valuable than theirs?  The hospital is not only okay with the idea that you will be made to wait, they have preplanned it as part of the patient experience and built a special place for that activity to occur.

This waiting experience reminds me of my flight arriving at the airport only to find out that there is no gate at which to park the plane or no attendant to roll the jet-way to the plane’s door.  How is this possible?  Have they not known for the last several months that every day at such and such time this plane will be arriving?

So, here we are.  We have not even been admitted and our non-clinical patient experience is already negative.

Sometimes the best solutions are the first ones overlooked.

Patient Experience Management: For Adults Only

Posted by

0

This post is the first in a series that may make you rethink everything you think you know about Patient Experience Management.

Last week I checked in to a hotel for three days; seventy-two hours.  I was at the hotel for an event that required ninety minutes; one-and-half hours.

A few weeks prior to my stay someone told me where I had to be, how long I would be there, and what I would be doing.  My reservation was made, and I sorted out how I would get to the hotel.

The check-in process was flawless.  My room was ready.  My wakeup calls were timely. The room was serviced daily.  Plates with food arrived.  Plates without food departed.  The requirements for my ninety minute event were met and I was escorted to the correct room.

On hour seventy-two I checked out of the hotel and I received a copy of my bill.  The last thing I encountered was having someone asking me how my experience was.

Try thinking the remainder of this discussion through with me.

Of the seventy-two hours I was at the hotel only two percent of it (1.5 hours) had to do with my reason for being at the hotel—the presentation I was giving at the HFMA.

So, you may ask, how did it go?  The speech or the stay at the hotel.  Two different experiences.  Let us say that my speech tanked, or that people couldn’t find the room, or that the projector did not work.  If someone asked me, how “was your speech,” I might conclude by saying, “The speech was awful, but the hotel was great.”

On the other hand, what if the hotel lost my prepaid reservation, was only able to give me one night instead of two, made me sit in the lobby for two hours because my room wasn’t ready, could not get the air conditioning working in my room, and then billed me for two nights instead of one.

If that was the case I would conclude that my experience was awful, and I would go out of my way to let everyone know about it.

To those who want to argue that a hospital is not a hotel I will concede the point.  However, I will argue that for those who actually wish to significantly improve patient experience management that much of the improvement can be made by treating it as a hotel, and by treating your patients as guests.

For the time being, let us agree to have this discussion separate and apart from the Emergency department—we will address the ED in a later post.

The patient experience, which many claim to be managing, may be grouped into two parts—the treatment, and then everything else that happens to you from the time you schedule your visit to the time when you finish paying you bill.

Most patients fully expect their experience of their treatment will be very positive—that is why they came to the hospital.  Patients know that for treatable issues they will leave the hospital better than when they entered.  Therefore, it is a given that they will rate their treatment experience as a positive one.  A positive treatment is considered de rigueur.

However positive, the patient often views their treatment experience as the result of the procedure they underwent.  If they came in for their gall bladder and leave without their left leg, no amount of explaining how well the amputation went will convince them their experience was positive.

Both inpatients and outpatients spend the bulk of their time in the hospital undergoing non-patient experiences and suffering through ineffective and impersonal processes.  All patients spend most of their time simply as visitors, as customers, as guests of your facility.  Unfortunately, few hospitals spend much time improving those processes that are common to all patients.

To improve in the area of patient experience management, break the person’s experience into two categories; clinical and non-clinical.  While there is merit in reengineering the processes around a hip transplant, doing so does nothing for everyone who did not have a hip transplant.

Over the next several posts I will suggest what can be done to improve the non-clinical patient experience in a way that can change how people view your hospital.

Is this today’s evolving healthcare strategy?

Posted by

0

Did the large provider healthcare model go from making all the ducks better to only making some of the ducks better?  Please let me know if the concept depicted below makes sense.

Thanks

The Hospital Business Model–a 1 page perspective

Posted by

0

Patient Experience Management

Posted by

0

Have I mentioned I am an unapologetically type A person, for the most part an off the chart Meyers Briggs INTJ? This morning I awoke feeling no more querulous than usual—that would change rather abruptly. In general, I make it a rule never to learn anything before having my first cup of coffee. Unfortunately, today wasn’t going to be one of those days. In fact, my mood was a direct result of the instrument pictured above.

These days I am using this device to make my coffee as my espresso maker’s LED screen is displaying a message telling me my grinder is blocked—sounds a little like something two tablespoons of Pepto should be able to fix, doesn’t it? Google was no help—three hits, each instructing me to send it back to the dealer for a $350 repair. Sounds more like a response you’d get regarding a car, not a coffee maker.

I brought this pot home, a gift from my client in Madrid. It works using the same principles as a pressure cooker. Water is placed in the bottom; an espresso grind goes above the water.  Steam is forced through the grind, past a metal sieve, and into the container where as it cools it is reconstituted as a liquid—coffee. Anyway, as my coffee is cooking, I notice the metal sieve sitting on the counter. It seemed like too much work to turn it off, rinse the pot, regrind the coffee, and wait the additional five minutes. I was too tired for a do-over.

Too bad for me. Now, I’m not sure if what happened next would be found under the topic of fluid mechanics, converting steam into thermal energy, or general explosives, but it would have made for an entertaining physics experiment. In what appeared to play out in slow motion—like the Challenger explosion—actually occurred in a fraction of a second. It seems the metal sieve does more than strain the grinds from the steam. It also prevents a thermonuclear reaction. Apparently when the pressure passes the fail-safe point, the reaction proceeds to the next logical step. That step, which I observed, involves coffee and grinds exiting the pot so rapidly that before I could blink they covered the kitchen walls, counters, and floors as far away as ten feet. (It was actually pretty impressive to watch.) I was informed that once I finish writing about my travails I will be attending to the mess.

The scene reminded me of one of the forensic shows on cable. I halfway expected the medical examiner Dr. Henry Lee to walk through my door to examine the splatter pattern.

The choice I faced was to do it over, or deal with the consequences. I was in a hurry, consequences be damned—it turns out that it wasn’t the consequences that would be damned. My guess is that I’m looking at at least thirty minutes of cleanup work.

It pays to invest the time to do something right the first time—I refer to that as the DIRT-FIT principle; sort of like dealing with patients. Let’s say a certain patient call takes nine minutes to handle correctly. As many of you have observed, there are two ways to go about this. You can do it over a period of several four minute calls because your people don’t want to get dinged for exceeding their handle time allotment, or you can allow the people to talk until the patient’s need is solved.

As patients, we know you prefer the first approach. Patients prefer the second approach.

What if there was no Meaningful Use?

Posted by

0

On April 16, 1912 there was an article in the Daily Register in Anytown, Nebraska titled “Local Man Drowns.”  The article went on to note that a local man was lost at sea.  I paused for a moment trying to recall from my high school geography class the name of the ocean bordering Nebraska—there is not one.

It did not take long to realize that the newspaper was guilty of being more than a little parochial.  April 14, 1912 was the day the Titanic sunk.  The man in question had been lost at sea in much the same manner that the real headline of the story had been lost by the newspaper.

I think a lot of important healthcare IT headlines are being lost, and those loses can in large part be attributed to the puppet masters at the ONC and CMS.  It is difficult to swing a dead cat in a hospital cafeteria without hitting someone discussing Meaningful Use.  On the other hand, you could swing a blue whale without hitting someone talking about ICD-10.

The headlines are both buried and misinterpreted.  Some of the HIT headlines merit being repeated—feel free to use a highlighter on your screen to be able to locate the important ones.  Trying to meet Meaningful Use:

  • Is optional.
  • Does not mean you will meet it.
  • Could require most of your IT resources.
  • Means you may not have enough resources focused on ICD-10.

While these may appear to be trivial comments, misapplying your efforts could cost a large hospital more than tem million dollars.  Then figure another ten million to rectify the mess.

Ask yourself one question before you hire a pricey consulting firm to help you figure out how to meet Meaningful Use.

“What would we be doing if there was no Meaningful Use?”

Then do that.  Meeting Meaningful Use was never a part of your business strategy—you probably will not find it written in your three-year plan.  Did anyone sign off on the notion of spending millions of dollars to complete a task that has no ROI and has a reasonable probability of failing?

If it so happens that in pursuing your original strategy you can still meet Meaningful Use that is good.  The reverse is not so good.