Healthcare reform: Leadership at the local level…a case study

The context

The head of The family Medicine Department, University of Minnesota has a long history of developing physicians who have been influential in the field. He is committed to developing a self-sustainable program that will continue despite the external challenges. But the latest round of challenges before him is immense. Family Medicine lies at the cornerstone of healthcare reform. Yet state budgets to support Family Medicine resident education have been slashed by two-thirds. Hospitals and other healthcare systems that utilize and support resident training are unable to fill the void. Faculty have not received pay increases in several years, despite being asked to do far more. Indeed the business model of simultaneously providing care to the indigent and developing the next generation physicians is in jeopardy.

The intervention

The head of the department of Family Medicine decided he needs greater leadership support from his people. He provided three days of Strategic Leadership Tools™ training from The Leader’s Toolbox, Inc. followed by the formation of Toolbox teams who are expected to utilize the learning to address some of the department and clinics most pressing issues. These teams receive coaching support to ensure they use the tools correctly and focus on the right issues. The first teams addressed were tasked to develop plans and recommendations around the question: How do we building strong local leadership teams that can more quickly and effectively implement change. A second group will focus on the challenges of creating advanced family medicine practices given the new healthcare environment. The results

Three Critical Competencies for Healthcare Reform

The fundamental Challenge of Healthcare Reform

Imagine that you, a non-physician, were given a white coat and told to diagnose and subsequently treat a patient who was close to death. That analogy is similar to physicians who almost universally have no formal or practical experience to lead and implement massive change. It is actually worse than that.

Now imagine that you are an accomplished tennis player. The road hasn’t been easy. There were countless hours of practice, tournaments, and individual coaching. You learned the rules and decorum which everyone agrees and adheres to. Then one day you are selected to be on the soccer team of a foreign country. No longer is success based solely on your individual performance or capabilities. This is truly a team sport. There are new rules, language, and skills which are generally followed. In some countries when the fans are unhappy with the result they are not only rude, but sometimes come out to the field ready to do battle.

This describes the transition faced by many healthcare leaders. They are all individually accomplished and have received recognition and often their leadership posts because of their technical capacities. But the game, language, rules, and the nature of the interaction with the players have changed. BUT TYPICALLY NOT THE SKILLSET OF THE PHYSICIAN LEADERS!

Already overworked, less appreciated by their professional peers, and overwhelmed by the task in front of them, physician leaders on the front line juggle the challenge of meeting the requirements of the current game, treating patients and meeting the financial objectives, and build the capacity to play in a new, yet undefined game. Once exception: The rules of soccer have been defined. The rules of engagement and winning are clear.

I am pleased to share with you that Getting It Done: Field Tested Strategies for Clinical and Financial Success was published yesterday by the publishing arm of the American College of Physician Executives. I contributed a chapter that describes how a highly successful clinical organization overcame the years of animosity with the hospital organization with which it had decades of rivalry. The improved relationship served as a new foundation for the two organizations to build a new hospital. There are many similar and instructive examples in the book to show how collaboration and significantly improve outcomes and financial success. The book is available from Amazon.

The Great Minnesota Budget Shutdown: A leadership void

Minnesota welcomes you

Here in Minnesota we are just hours away from a government shutdown. The two political parties are playing chicken with one another and it appears that the citizenry is about to lose. The night before the deadline, the two sides called it a night…and no new talks are scheduled. For those of us who have lived here for several decades we cannot understand how we got to this point. Before I moved here I always wondered what kinds of people could tolerate that awful climate and wondered whether there was actually civilization so far north. We have a saying. “It’s harder to get people to come to Minnesota than to get rid of them.”

What made this such a wonderful place despite the climate is the willingness of people to see a larger good and to work toward the benefit of the whole. At the end of the day people were willing to come together for the greater good. Perhaps it was part of the culture of the predominately Scandinavian culture, whatever it was, this was a great State. We had great government, schools, infrastructure, theater, etc.

Now each party espouses similar values, but the actions seem otherwise. We have moved from a government working philosophy of pragmatism to dogmatism. Each side has a worldview that they want to realize and in the process miss the value of the other. As a result of the two sides digging in, the real issues are not being tackled. If the amount of time people had to spend for the preparation of the shutdown could have been used on some real issues, more progress could have been made.

THE BIGGEST CHALLENGE AT WORK

The biggest issue I see amongst the coachees I see in my practice: How to get out of the survival trap. The challenge: How to take on the more important work, leave the lessor work behind…and still meet the expectations of the boss.

Most people:

• Don’t think they can take on any more work
• Feel that much of what they do is less important…but expected to be completed anyway
• See there are longer range issues to be addressed, but these are not valued by their managers
• Feel there is no way out of the box

Myers Briggs, Leadership, Love, and Power

Many studies have been undertaken to determine whether a particular leadership style is most beneficial for leadership success. There seems to be a correlation to the type of leadership work that needs to be performed with the type of style the leader most beneficially can possess. The implication is that the primary style of the leader needs to modulate to fit the needs of the circumstances being faced. Unfortunately few people have the capacity to change their inherent stripes…even adapting one’s style to accommodate the needs of someone else may in and of itself be daunting enough. In other words, the identification of style is a rather ineffective means to help leaders improve their capacity. It may provide some interesting insight, but few have the capacity to use the information in a meaningful way.

WHAT ORGANIZATIONS VALUE IN LEADERS

Background

I recently came across an article from Chief Executive Officer Magazine describing the most important characteristics for leaders to possess based on a 2008 survey conducted by the Hay organization. The article begins noting, “Only a handful of organizations have even begun to tap into their primary resource, their people, much less give them the means to do what they are capable of doing.”

So what do leaders feel is valued? First tier of valued competencies are strategic thinking and execution. Second tier: Decision-making, technical competence and team work. The rest on the list are far less valued. What does this imply?

Percent that value the characteristic most

1. Strategic Thinking	50%
2. Execution	40%
3. Decision Making	33%
4. Technical Competence/Expertise	33%
5. Team Work	30%
6. Inspiring Leadership	26%
7. Influence	17%
8. Emotional Intelligence	15%
9. Creativity	11%
10. Resilience	10%
11. Capacity to Learn	9%
12. Other	5%

Accountable Care Organizations: Building the Capacity for Change

A discontinuous change often occurs with a new invention, an alliance with organizations with complementary skills, and, as is the case here, the stroke of a political pen. The new healthcare legislation mandates a new paradigm of care—one that is clearly understood by no one. How can healthcare leaders plan for and implement a significant and fundamental change from what currently exists without first understanding the fundamentals of the new system? It requires the ability to change the tires when driving down the freeway at 70 miles per hour. Yes the toothpaste is out of the tube and there is no way to get it back in.

How personal stress deteriorates organization health: Part 1

Psychologists know what you know. A certain amount of stress is good to get you going and focused. Too much of it reduces performance—even leads to sickness and disease. Most people feel like they have far too much stress in their lives and wonder what tactics they can use to address it.

The professional responses to the feelings of stress traditionally have been:

1. Make sure you have some time with family or do the things that are personally meaningful to you
2. Learn how be more productive—do more stuff in shorter time and focus on the things that are important
3. Get exercise—or take a yoga class, but whatever you do, breathe deep
4. Confront the elephant in the room
5. Learn how to interact more effectively with others

These are all meaningful strategies that lead to greater work/life effectiveness and better health. The suggestions above are helpful and typically deal with the symptoms and not the cause of the issue. In my more than 25 years of coaching individuals I find that the source of people’s concerns typically center around these four areas.

How to deal with complexity: Finding Common Ground

Last week I partnered with the Center of Integrative Leadership (Carlson School of Business) and The Global Food Safety Leadership (Veterinary School) of the University of Minnesota on a forum to improve our understanding and response to the issues surrounding antibiotics and agriculture. The event was sponsored by the Minnesota Departments of Health and Agriculture, Board of Animal Health, and the Minnesota Sustainability Council.

We consciously brought together for the first time in Minnesota the broadest diversity of participants  to address this contentious topic.

Over the day-and-a-half long event, the participants spent about a third of the time learning more about the topic from experts, a third learning new tools approaches to address the complexity, and the remaining time utilizing the new learning and tools to address the issue at hand.

Background

The challenge of properly feeding humans on the planet is one of the most critical issues facing us earthly inhabitants. Antibiotics play a central role in the solution. But using antibiotics comes at a cost…some we are aware of and some have yet to be proven conclusively. Some of the causal detrimental factors that we have assumed are not borne out by the limited research that has taken place thus far. In short the use of antibiotics is a paradox. A central challenge to our existence is to both maximize the benefits and at the same time limit the potential perils of antibiotics.

Prior to this engagement knew almost nothing about the topic. I subsequently learned a great deal not only about the topic, but once again saw first-hand the value of framing issues properly.

Ordinarily most of us come at such complex issues with a set of unchallenged assumptions, language, and incomplete knowledge. We are likely to see those who hold alternate points of view as wrong, misinformed, or maligned. When the opposing points of view are put on the table, the natural response is for the opposing perspectives to clash. Each side fights for rightness…and little good comes as a consequence. There is lots of heat and little light that emerges from the interaction.

Antibiotics utilization through the lens of paradox

The experts were very clear. Though they spoke one seeking to maximize the benefits and the other to minimize the perils of antibiotic use, both made it clear from the start–they each could have taken the other side of the question and defended their positions equally well. There was no right or wrong—resolution required embracing “both.”

We Westerners are uncomfortable with those intractable challenges that have no simple solutions. We want clear directions and easy and direct execution. For us to take an alternative path, we need different language and tools.

What brought the group together was the vocalization and subsequent realization that antibiotic use is a paradox whose implications are unclear given the knowledge we currently possess.

Outcomes of the conference

Framing antibiotics and agriculture as a paradox helped the group realize that it had far more in common. It created the space for most of the participants to realize the need to hold off judgment. It helped them realize the power of working together.

The group developed five objectives that were critical to more effectively addressing the concerns. They focused on five areas:

• Knowledge/Research Gaps
• More effective research approaches to the topic
• Creating greater knowledge and awareness of the complexities in the community
• More effective public policies and strategic regulation

Unlike most typical interest centric groups, this conference paved the way for a broad coalition to work together, using a broad spectrum of talent, skills, and interests to pursue a more holistic and comprehensive approach to this challenging issue.

Next steps

Most of the highly contentious issues facing our nation  are paradoxes. Where else could the common ground approach be utilized? The Leader’s Toolbox and the Center for Integrative Leadership continue to look for settings in which we can add more light. Your thoughts are welcome.