Tuesday, August 18, 2009

Is a Hospital also a business?

A Hospital is not a business, or is it?

Everyone would agree that an average Hospital and an average widget factory are worlds apart, but are they? Some would think that I should be placed in an asylum for even asking this question.

Most businesses know that to succeed a good vision, well thought out strategic plan and efficient business processes are needed to succeed. Many hospitals do have a good vision, few have a well thought out strategic plan and even fewer have efficient business processes. The staff of a hospitals, especially Physicians regard themselves as craftsmen rather than workers, they deal with life and death every day, to them business processes only hinder their work. When I consulted for a large hospital I asked some of the staff to describe their processes, on answer I received from an Anesthetist was “I think, I do”. To some extent her view is justified since Physicians and nurses highly customize what they do depending on the patient. In a hospital there are myriads of ‘special cases’ and unlike businesses each case matters and cannot be discarded as an outlier. So one thing is clear, a patient is THE most important component of a hospital, while probably to a widget factory it is the widget.

So now I ask a different question, how can we apply the best practices of the business world to a hospital? The answer is simple by tailoring best practices so that the patient is a central component. Implementing Electronic Health Records is probably the biggest challenge the healthcare industry has every faced. Some of you reading this may remember the 1980s for the uninspired music and John Travolta’s dance moves, but some, especially in the banking industry remember it as the period of transformation. Banks went through tremendous changes, they instituted a clearing house for faster cashing of checks, implemented ATMs and added ‘personal’ to personal banking. They knew the challenges they faced, they knew that they needed to change and they had a planned strategic vision for the future. By having clearing houses clear checks almost instantaneously customers were greatly benefited, but the real beneficiaries were the banks themselves. The Healthcare industry in general and hospitals specifically can take a page from this era for their own EHR implementations; the big difference is that banks exchanged financial transactions whereas healthcare providers will exchange healthcare transactions. The EHR record itself contains a lot more information that a simple check cashing transaction and the bank approach cannot be directly copied, but it could prove to be a good place to start. The point I am trying to make here is not that the banking model is THE model for healthcare but that businesses have gone through many trials and tribulations, why not use the lessons they learned to avoid the same mistakes?

Stay tuned for an article on how the concepts of Corporate Performance Management can be applied to healthcare.

Wednesday, October 15, 2008

The Downside of Passion

A colleague of mine recently saw a bit of social research that reported people's perceptions of behaviors that deserve firing. One that stood out for me was that the respondents felt that managers who displayed emotions too strongly and displayed excessive histrionics (especially profanity) in the workplace should be fired. This gave me pause.

I am a passionate person in many ways. One of the things about which I am very passionate is my work. Another is my relationships. I hold strong feelings about both and upon reflection I must admit that there have been times in my past when I have earned the firing that these folks want for such managers. I have managed to generally avoid the profanity, but I have been loud and judgmental and have felt out of control at times. These were clearly moments when I was not being good to myself and the end results of such behavior are not often good. While it is incredibly difficult to change fundamental beliefs about things, it is possible and incumbent upon us all to manage our expressions of belief. I have learned to manage the passion by making sure that I focus in on the value-adding aspects of my work and the loving processes in my relationships.

In this age of much discussion about the critical role of emotional intelligence, this is an important change to make. I suggest that everyone take a hard look at their expressions of passion and put a sock in it when it is not value-adding for the work. I include in this passion about things like politics, religion, and personal issues that tend to swamp us emotionally. If you can't manage your passion at work by re-directing its energy, at least take some time off and deal with yourself appropriately. It will help everyone have a better work experience.

Friday, September 12, 2008

The Guide to Hosting Successful Meetings

Meetings serve many different functions here at MLC, everything from weekly internal staff meetings to multi-million dollar contract negotiations. While our meetings cover a wide range, they are known by our clients and our team for being very good. This is because they are productive. I thought I'd take the time to share a couple of the characteristics of MLC meetings, which add up to a pretty robust system for achieving our three requirements. If you are able to follow these simple steps, you will greatly improve your meetings chance for success. Ask yourself: do you do the following things? Would they make your meetings more successful? Enjoy!

1) Have an agenda
Creating an agenda, and sending it out to meeting participants ahead of time, lets everyone know your meeting is the real deal. This may already be the status quo at your organization (so do it!) or it may be an entirely new concept (so do it!). Most importantly, and most overlooked, put the purpose of the meeting on the agenda! Is the purpose to determine the status of Phase III of Project B? Or is it to determine which sponge vendor to go with? Or is it to name the band? A good purpose statement will help the facilitator and attendees to come prepared (in terms of mindset and documents) and know what the outcome should be.
A good agenda will have the following:
• Purpose Statement
• Start Time
• End Time
• Date
• Location
• Attendees
• Facilitator's Name
• Agenda Topics (and time for each topic, if desired)
We had a client that held meetings where nothing was ever accomplished. We were warned that if we wanted to get anything done, we'd have to go one on one with people. Well, we set a meeting and sent the agenda out ahead of time with a purpose statement and stuck to that agenda. Attendees came, and they showed up on time, because they knew that we had a goal to accomplish! They came prepared (with documents and in the right mindset) and didn't waste time in the meeting.

2) Start on time
This also created a powerful message in the company just mentioned, and will certainly do so in any organization where nothing runs on time! It says that the meeting is important. We always make the promise that if a meeting starts on time we'll do everything in our power to end it on time - again an often novel concept in organizations!

3) Take Notes
There's a genius Dilbert cartoon where the usual suspects are doomed to repeating strategic planning sessions each quarter because no one takes notes and no one remembers the strategic initiatives. While it may seem silly to take notes on what seems to be a non critical or easily "rememberable" meeting, I have found that it most definitley pays being safe than sorry. Taking notes is an absolute necessity in brainstorming, and oftentimes what starts out as a formal meeting has quite a bit of really great brainstorming that you do not want forgotten . . . Assign a notetaker (and put their name on the agenda). In some cases, we'll have a previous meeting recap at meetings by the notetaker to refresh our memories on what we were talking about. Another option, which we do at our staff meetings, is record the meeting and make it available to attendees (and those that were not able to attend) online via SharePoint.

4) Facilitate Properly
If all else fails, facilitate your meeting! Some of our clients yell at each other in our meetings, others repeatedly nod their heads at the boss man. Proper facilitation can lead you to your desired outcomes whatever the "tone" of the meeting.
As a facilitator, your primary goal is to ensure that the meeting is heading in a good direction. Be careful! This doesn't necessarily mean what's on the agenda! I beleive having a good facilitator is much more important than assigning a "time keeper" to ensure the meeting agenda is followed precisely. Healthy discourse is where great ideas and solutions are borne. You don't want to stifle creativity - especially if it’s the bosses or the clients! Based on a very successful practice of one of our older clients, we have begun instituting a "Parking Lot" in our facilitated meetings. The "Parking Lot" is a place on a white board or flip chart to write down unrelated topics that come up that are dropped for later discussion. If the meeting agenda is centered on what is needed to complete a project, and Bill and Judy get in a conversation about a new marketing concept, it is up to the facilitator to guide the discussion that way or put it in the Parking Lot for later. If there is time at the end of the meeting, go over these topics or put them on the next agenda.
Facilitation is a craft. Understanding when to push people along or let a topic develop, whether to start on time or wait for key participants, or what type of presentation to create, is a skill that can be developed. Also important is not to impose a meeting structure that is strikingly different than your current "meeting culture." Change for the better is a good thing, but not if everyone is immediatley put off!

5) Bring the right collateral
Things seem more "real" to people when they can hold them. I find handouts to be a great addition to most meetings. People are generally more receptive to something right in front of them as opposed to on a projected screen. Death By PowerPoint is a real phenomenon! Is there a uTube clip you could show to stimulate discussion or prove a point? An interesting article? A picture? Pictures, charts, and diagrams are great additions to stories or examples. I also find passing things out, as opposed to have it all piled up and waiting, to produce more stimulous.

6) Keep it light
Keep it light! Checklisting a list of tasks does not usually constitute a good meeting. People will participate more (hence the reason of getting everyone together in the first place!) if the meeting is enjoyable (read: NOT cold or sterile). The facilitator must use their judgement to decide how much joking around is ok, but some is almost always tolerable.

7) Meeting Recap
Always leave time on the agenda (at least 5-10 minutes) for a meeting recap. If the meeting is more informal or short we don’t waste time recalling everything that is said. Instead we focus on reviewing Action Items (if there were any) and when the next meeting will occur. A solid meeting will have a solid wrap up and closure.

8) End on time
If you end on time, people will be more willing to attend future meetings, plain and simple. Getting out earlier is the "bribe" for starting on time and staying focused. If you're meetings are very popular (good for you!), still end the formal meeting on time, but don't shove people out! Continue informally . . .

9) Follow Up
A meeting should never stand on its own! One of our most successful methods of getting people to follow up on meeting Action Items, or to generally stay involved, is to immediatley send out emails relating to the meeting. This may be the meeting minutes, the list of Action Items and their due dates and owners, it may be the invitation for the next meeting. Staying in contact with the attendees will ensure that they wont forget about your meeting as soon as they step out the door!

10) Create your meeting brand!
If your meetings are repeated (or you repeatedly hold meetings) create a brand around your meetings – set an expectation and make it high! This way, people will know what to expect whether its a Sarah Bowlin-run meeting, or if its the Accounting Group weekly meeting, or if Acme Inc. meeting with a customer. They will know what to expect. Some ways to brand your meetings are:
• Name your meetings, so that attendees have something to call it (Hey, are you going to Marketing Sessions this afternoon? Or if your organization’s more loosey goosey: “Chad, you goin’ to Bill’s Brainstormin’ later?).
• Make a logo to go with the name. It could be the company logo along with the name of your meeting. What about a slogan (or an overall objective?)
• Create consistent collateral. The agenda, PowerPoint, and handouts should have the same format each meeting.
• Talk about your meetings outside of your meetings. Send out a reminder email, ask for feedback, etc.
Understanding how to run a good meeting and then actually running one is an often underappreciated skill set. But rest assured, it will be noticed. Make the meetings an extension of your own personal brand and the success of your meetings will positively reflect on to you.

Ok, so use the tips above or not, but remember one thing: what you put into a meeting is what you get out of it. Have the right people, provide the right environment, and include the right tools and your meeting will accomplish what you wanted it to.

Thursday, September 11, 2008

Value is the currency of healthy business relationships

Relationships in business, like in our personal lives, requires a little give and take. All parties need to bring something of value to the table, or the relationship is off-balance. "Value" can be measured in a variety of ways; money, companionship, loyalty, trust . . . the list goes on.

One of the most prevalent values in a business relationship is information. Salespeople give information on new products, coworkers share information on company happenings, and colleagues on industry and economic news. How many of your relationships are based on information exchange?

For information to be truly valuable a critical component must be in place: trust. Information is only as good as its source. You trust your vendors to give you reasonable rates and to be true to their word. You trust sales people to give you accurate information on new products. You trust the news from your coworker about your boss being fired is accurate.

In a salesperson's relationships with his clients this perception of a necessary value is magnified. Two things must be present in the salesperson: (1) They must be seen as a good source of information and (2) They must be trusted. With those two values in place, the relationship will provide value back them (hopefully in the context of sustainable sales, new leads, or even as a confidant). Of course, its not as black and white as this. Gestures, also provide value. Unless, of course, they are empty gestures. "Clues" as to how people are feeling (such as sending thank you cards, asking and genuinely caring about their families, etc.) are important in creating a lasting bond. And these little things are not so little. They're what creates trust. These bridges take a long time to build, but in the end are far more rewarding than one-time transactional sales, or a stale, one sided relationship.

Whenever I meet someone new, I like to provide value immediately. Feedback is an excellent mechanism, when used correctly. A story (whether to provide entertainment, or a moral) is always a good way to add value to a conversation. In emails, which have become so prevalent, I like to add a bit more to my "thank yous" and "it was a pleasure speaking to you" (which are becoming, in my humble opinion, empty gestures). I attach a YouTube clip that I think the recipient might be interested in or learn something from, or an industry article. As a salesperson, it is part of my value proposition to know things in my area of expertise and pass them along. Passing on unrelated but valuable information through my colleagues and clients adds value to our relationship overall. I ask good questions when colleagues are telling stories. Questions unlock new avenues of thinking, and can awaken the genious in each and every one of us! When possible (And when not obnoxious!) I share information on my own life; articles published, photos from a recent trip, eh, blog postings. . . .

And, over time this builds trust. Trust that I know what I'm talking about and that I care about our relationship. And that is the basis for a valuable relationship.

Tuesday, July 29, 2008

The Bottom Line

In the end you can have planned all the right behavior and learned all the right principles and committed yourself to being good to yourself even when it hurts, but if you do nothing then nothing happens, nothing changes, and you cannot be good to yourself in any way that matters. The bottom line is that you must DO SOMETHING.

In the very United States of America we value a bias toward action. Get up and get moving is the American way. The bias toward action produces some interesting aspects to the national character such as being really good at solving problems, but not so good at defining them. Defining problems does not fit with the bias toward action because an exercise in seeking goal clarity does not feel like the American version of work. So, we expend tremendous amounts of resource solving problems that we don't have or that don't matter while the really important things are ignored. But regardless of the downside to an action bias, remains a strong part of being good to yourself. The key is that the action bias be coupled with showing up, paying attention, adding value, and embracing accountability.

The action bias on its own will only guarantee that something happens. Action taken in a context created by the previously mentioned four other factors not only makes something happen, it makes the right things happen for you and for everyone around you. After all being good to yourself is not just about not turning the gun on yourself, it is about building and sustaining the social support networks that we all need for health and hardiness. Being good to yourself demands that you are also good to others, not because you focus on the others but because you guide your behavior by these principles and not by strategies for manipulation. I have seen many people with extensive social networks gained by working at looking like a friend, but relatively few that earn friendship by honest work at being the best version of themselves that they can be. I guess it is the "work" part that makes the difference.

It does tend to be more work to establish good habits than to continue familiar ones - after all it means change and we know that no one changes behavior just because it is a good idea to do so. There must be some compelling motive. Here you are truly all on your own because you can't go online and find a motive, it must come from inside you. The value of the change must speak to your deepest needs and make you humble enough to become a learner in your own life.

Okay, it isn't easy, but it is simple. That is sort of how the universe works. That which is really important is really simple and really hard for us humans. No matter, we can deal with anything together that makes us impotent as individuals.

Tuesday, July 8, 2008

He's Back

The next piece of the personal goodness puzzle is the the most difficult for many people to adopt. It is embracing accountability. We are not a really good society for embracing accountability anymore. I think we were at one time. Perhaps in the world that Normal Rockwell drew. There is just so much sense of entitlement these days. Personally I blame the trial lawyers. Many of them make a good living by encouraging people to think in terms of entitlement rather than accountability. I would like the trial lawyers to have a stronger sense of ethics about what you actually take to court. They seem to be consumed with chasing chances to impoverish one person to enrich another along with themselves. I do know that I could never win an argument over this point with a good trial lawyer, but I have the feeling nonetheless. After all, aren't we entitled to a legal profession that serves as the first line of defense against silly litigation? Just kidding.

In reality the responsibility for choosing accountability over entitlement is a personal one. Each of us has the job of making reasonable sense of life for ourselves without seeking to hurt others. Embracing accountability in life is the most self-affirming thing that a person can do. Accountable people are seldom victims. Entitled people are always victims. Victims have no healthy source of personal power. (Before you freak out, I do recognize that there is such a thing as a legitimate victim. A person hit by a car in a crosswalk with a walk sign lit is probably a victim. He or she did nothing to create their victimness. If there were no crosswalks or signs perhaps crossing the street unarmed would constitute encouraging victimness. I hope you get the difference.) Accountable people have power because authority goes hand-in-hand with accountability. Embracing accountability gives you the authority you need to meet that accountability. That authority is power in reserve that should be used judiciously to get things done. If you seek no accountability you can have no authority. That means that you cannot be considered the author of solutions or improvements or failures. Successes give us something to support our sense of effectivness. Failures teach important lessons - if we survive them. By the way, you are not entitled to survive your failures. You may be aware that embracing the accountability that goes with being the driver of the car opens the possibility that you might fail and not survive. Embracing accountability for the safety of children can put you in harm's way as they learn what not to do. Embracing accountability can cost you your job if those around you are good at passing blame. So, though it is definitely required for being good to yourself, accountability has a dark side as well. Be accountable if you would be rewarded. Be accountable if you would be recognized for accomplishment. Be accountable if you would be a real person who deserves respect and affection. Next we will cover the last of the five magical ways to be good to yourself. Stay tuned.

Tuesday, May 27, 2008

Being Good to Yourself, Again

Okay. If you show up and you pay attention, you are forty percent of the way there. But it gets harder. This is where you begin to make choices about how you will be a part of things that get done. This is where you choose the quality of your actions. I believe that the standard that we must apply is to choose those actions and only those actions that add value. For me that is what quality means in the context of human life, whether it is public and organizational or private and interpersonal.

That being said, it does not do much to remove the dilemma. Defining value is only a step closer to the answer and not all of the answer. Value is a construct like quality or leadership or love. We tend to know it when we see it, but each definition leaves us wanting more clarity.

We solve this dilemma by operationalizing the construct. We operationalize adding value by measuring the value added. This should be easier in the workplace than in personal relationships. I don’t know anyone that keeps track of the number of smiles that they can stimulate on faces of family members, or the number of thank you’s that they receive on a daily basis. We may not even be aware of such things let alone practicing data capture and analysis. It doesn’t matter that your relationship measures lack scientific rigor. It matters that your goals in relationships are things like creating smiles and thank you’s and the occasional, “I needed that.”

At work it is often not about what we choose to do but about what we choose not to do. When Warren Bennis was researching one of his books on leadership he was asking people what leaders did that encouraged followership. One of his interview subjects said that his leader “didn’t waste his time.” Some managers think that they add value because they keep people busy. Trust me; people know the difference between real work and busy work. Real work adds value and busy work does not. Patrick Lencioni, in his book, “The Three Signs of a Miserable Job” said that people must have a clear idea that their work matters, and that it has relevance for others. He said that they must be able to measure their contributions in a way that does not depend upon the subjective views of superiors.

So, if you are a manager avoid busy work like the plague, and if you are an individual contributor resist doing things that don’t matter to customers (the final arbiters of the worth of our work). You may then find yourself choosing behavior that adds value or at least questioning what you are doing. You may have to upgrade the ways in which you pay attention in order to define value, but that’s okay. You can’t really add value without showing up and paying attention anyway.

All right, I will concede that none of this is fish in a barrel easy. Jesse Ventura is quoted as saying something like the following:

When it comes to bringing values to life – to doing the
good, right, and appropriate thing…we're always working
at it, we're never totally there, and the challenge starts
all over again with each new tomorrow.

There is no way to argue with that. If it were easy we would all be doing it all the time. Simple does not equal easy. I think that one of the primary reasons why the overarching goal of physical medicine is to “do no harm” is because medicine has so much potential for harm running along with its huge potential for healing. We all need a sort of Hippocrates in our lives to give us some rules to follow. I have shared three that my friend offered to me with his advice to “be good to yourself.” There are two more to come. Stay tuned.