Partner, Phillips DiPisa   

This is the fifth of five posts from our most recent white paper.

A New World

There was a time in the not-so-distant past when success in healthcare was simply tied to keeping your expenses down and managing your division effectively.  It was a slow-moving, closed system; those, who could (to use a baseball metaphor) find the right players, put them in the right positions, and manage from above, were the winners.

Going forward, it’s a whole new ballgame.

 
Possible Call Outs:

“… the profile of the ‘ideal’ healthcare executive has necessarily evolved.

“Influence – not authority – is the new coin of the realm.”

“It’s no longer possible to manage entirely from one central point.”

“Industry changes have caused organizations to rethink the way they deliver care and reevaluate their relationships with other institutions.”

“Technology is at the heart of 21st century healthcare and leaders need to be comfortable defining, interpreting, and acting upon data using the latest tools.”

Partner, Phillips DiPisa

This is the fourth of five posts from our most recent white paper.

Transparency

The lack of absolute control and authority at the top leads to a need for more transparency – both inside and outside of the organization. 

The executive who makes all the decisions can afford to hoard all the information.  But as the matrix organization takes hold and complex interdependencies become the norm, everyone needs to understand how the pieces fit together and what their role in success is.  It’s no longer possible to manage entirely from one central point.

Outside the organization, transparency has become a requirement as well. Consumers are more educated (they routinely shop for doctors on the Internet and make selections based on outcomes); the media has infinitely more information; board members, community leaders, and other external stakeholders can see into your operation with more speed, more clarity, and more depth than ever before.

Today’s top leaders are astute regarding these changes, and they’ve learned to organize around them.  We know of a CEO, for example, who recently took the helm at a mid-sized community hospital.  His predecessor had an old-school style and ran a top-down, closed shop.

The new CEO, in refreshing contrast, has taken an entirely different approach.  He blogs, he runs “town hall meetings” with staff and the community, and he goes out of his way to share information – good and bad – across and outside of the organization.  He’s thrown open the doors of the institution, working from the understanding that there’s no hiding anymore.

To be continued…

By Dan Phillips

Partner, Phillips DiPisa

This is the third of five post from our most recent white paper.

2. Technology

The matrix organization is necessarily more dependent on technology.  Decisions need to be made quickly, and key players are often spread across departments, job functions, physical locations, and even organizations.  Those who can’t (or won’t) use the latest technology to bring people and information together in real time will be at a distinct disadvantage.

In the past, of course, executives tended to use less technology as they moved up the ladder, turning over routine tasks to others who did the note taking, scheduling, typing, etc.  But this is about much more than administrative duties – technology is at the heart of 21st century healthcare and leaders need to be comfortable defining, interpreting, and acting upon data using the latest tools. 

Consider something as straightforward as reporting, a function which until recently was entirely retrospective and largely viewed in paper format.  A hospital CEO would view census data from the previous month, for example, and make adjustments accordingly going forward.  Today, this information is relayed via a real time dashboard, and that same CEO is likely to find himself/herself huddling daily with staff to make decisions.

The impact of technology reaches beyond the hospital walls as well.  We live in a 24/7 world now, and leaders must have an orientation that matches up with this reality.  Here, as well, the hiring process must screen for those individuals who are facile with technology; owning a laptop or cell phone is simply not enough.  Senior executives need to be comfortable with PowerPoint, Excel, texting, blogging, smart phones, and other tools that will help them communicate their vision and respond quickly to the dynamics of the marketplace.

We ask candidates as a matter of course now to describe how they use technology in their work and in their lives.  Successful healthcare organizations of the future need executives who are not simply aware of technology, but living it every day.

To be continued…

Partner, Phillips DiPisa

This is the second of five posts from our most recent white paper.

1. Matrix Management

As recently as ten years ago, some of the most successful executives in our industry were “top-down managers” – decision-makers who used a command and control approach in running their respective organizations or divisions.  They sat at the top of a pyramid-shaped organizational structure and had both authority over, and responsibility for, everything below them.

Those days are coming to an end.  Industry changes have caused organizations to rethink the way they deliver care and reevaluate their relationships with other institutions.  Funding is limited at federal and state levels; access to capital makes it difficult for hospitals to invest in IT and infrastructure; economies of scale are needed in order to drive down costs as well as to exert leverage over payors and vendors.

Externally, this has resulted in hospitals banding together (not always by choice) as part of larger systems.  And whether that means affiliations, partnerships, joint-ownership of assets and staff, or some other hybrid combination, the notion of a stand-alone institution is disappearing.

Internally, changes are taking place as well.  For example, in an effort to provide better, more efficient care, many hospitals are organizing by service line, rather than by department as they had in the past.  As a practical matter, that means that those in charge of a particular program – cardiology, for example – need to work across many areas (OR, ICU, telemetry, radiology, rehab, etc.), most of which they do not directly manage or employ.

For executives, these fundamental changes mean that accountability no longer resides with one person or within one department.  To put it another way, the ability to lead through influence – not authority – is the new coin of the realm.  Those who succeed are skilled at influencing competing agendas —enabling them to be effective in this fluid, less structured environment.

From a hiring perspective, careful interviewing has become more important than ever before.  It’s no longer simply a question of reviewing resumes and finding someone with a specific number of years in a certain leadership role or a pedigree from a well-respected organization.  Finding executives who have a strong team orientation (favoring the use of “we” over “I”) and who thrive on ambiguity is more important than ever.

To be continued…

Partner, Phillips DiPisa   

This is the first of five post from our current white paper.

“We got to think differently.”  
- Brad Pitt, as Oakland A’s General Manager Billy Beane, in Moneyball
I’m a longtime baseball fan.  And so when they came out with a movie based on one of my favorite books – Moneyball – I was eager to go see it.   I wasn’t disappointed; I thought Brad Pitt did a terrific job playing the A’s general manager, Billy Beane. 

But I have to admit, I had forgotten one important thing since reading the book a few years ago:  Moneyball isn’t so much about baseball as it is about change. 

In the case of the 2002 Oakland A’s, who had the lowest salary budget in baseball that year and, therefore, an inability to buy their way to success, change meant finding a different way to assess, recruit, and utilize baseball players and their skills. It nearly worked for the A’s that year, and it fundamentally and permanently changed the game of baseball.

As I watched the movie, I was reminded of how entrenched the healthcare industry can be in doing things a certain way. Not in the same way as major league baseball, necessarily, but certainly to a similar degree.

The impact of this touches every aspect of our business, not the least of which relates to executive recruiting and hiring.  Thanks to rapidly rising costs, ongoing changes in rules and regulations, and widespread dissatisfaction among stakeholders of all types, the profile of the “ideal” healthcare executive has necessarily evolved.

What worked in the past won’t work anymore; as Billy Beane observes, “We got to think differently.”   Here then, are three areas in which healthcare leaders will need to excel:

To be continued…

Partner, Phillips DiPisa

This is the final of seven posts from one of our previous white papers.

Winning Teams Need to Be Led

Skilled or not, your players need leadership.  As a long-time CEO client of mine likes to say in describing his role, “I’m like a lion tamer, standing in the center of the ring with the lions surrounding me.  If I don’t keep the lions on the pedestals, they’ll start eating each other (or possibly me!).”  It’s a graphic analogy, but the point is well-taken:  Good leaders know how to keep strong team members challenged and working together…but not at each others’ throats.

In the world of sports, there’s probably no better example of this than the annual NBA All-Star Game.  The greatest players in the world gather for what is invariably a poorly played game of basketball.  With 10 superstars on the court – each of whom is used to handling the ball 30% of the time – spectators witness a wealth of talent … but a poverty of team.

As the leader of your institution’s team, you may need to intervene, removing overlapping or competing players, even if they have talent. 

In today’s competitive, rapidly changing healthcare environment, success comes down to assembling and leading great teams. When it comes to team-building, remember always that teams are indeed far more than the sum of their individual members. 
Towards that end, take a page from the world of sports and focus as much on building and running your great team as you do on hiring and mentoring your individual players.

Partner, Phillips DiPisa

This is the sixth of seven posts from one of our previous white papers.

Winning Teams Aren’t Afraid to Be Coached

A few years ago, one of our clients was experiencing some growing pains.  Half the management team had been there 20 years or longer, the other half, less than three.  The CEO was recruiting quality people, but as a unit, they were dysfunctional.  He was committed to them working together but he didn’t have the skills to make it happen.

So he brought in a professional facilitator – an organizational development consultant who was skilled at turning players into teams. Some executives left, but in the end, those who remained understood that they would only get the wins they wanted if they worked together.

In our experience, senior management is often reluctant to bring in outside expertise.  Whether it’s a fear of looking weak or a concern with airing the institution’s “dirty laundry,” organizations have a tendency to try and fix everything from the inside.  Bear in mind, however, that there’s not a successful professional athlete in the world who doesn’t have a coach.  Tom Brady has one; LeBron James has one; Derek Jeter has one.  They all understand that talent alone is only one factor.

“Outsiders” bring skills to the table that you and your team may not possess.  They can also provide an important, fresh perspective that “insiders” just don’t have.

To be continued…

Partner, Phillips DiPisa

This is the fifth of seven posts from one of our previous white papers.

Winning Teams Cultivate Team Players

David was a top hospital CFO with 20 years under his belt in roles with ever-increasing influence.  He was an absolute expert at what he did.  But because he was responsible for managing the finances of the institution, he believed that the hospital revolved around him.  He was selective about the information he shared and his treatment of other functions and departments caused a number of people to go elsewhere.  It wasn’t until David was eased out of the organization that the rest of the senior staff truly began working together.  Some people do more harm than they’re worth, despite their capabilities. 

But cultivating a team atmosphere isn’t just about removing the bad apples.  It also requires establishing a culture and work ethic that rewards collaboration.  Examples of this include:  getting your group involved in multidisciplinary committees so that members understand and appreciate the role of others; developing succession plans that demonstrate a commitment to the organization as a whole; and tying your team-building efforts together by establishing incentive compensation programs and metrics that are linked to team goals.

The idea of the team player as hero has become cliché, but only because it’s so true.  Just as a successful coach pays more attention to winning a division title than to grooming the next league scoring champion, one of your key tasks as a leader is to build an organization that reinforces team behavior.

To be continued…

Partner, Phillips DiPisa

This is the fourth of seven posts from one of our previous white papers.

Winning Teams Take a Long-Term View

After bringing in Doc Rivers as coach of the Celtics at the start of the 2004 season, Danny Ainge, the team’s President of Basketball Operations, felt tremendous pressure to get rid of him shortly thereafter.  Rivers coached the Celtics through one of their worst seasons in the team’s history, and many people wanted a quick fix.  It was only Ainge’s belief in Rivers, his system, and the culture he was creating that enabled Rivers to keep his job – and win a championship just a few years later.

Similarly, we worked with a community hospital CEO who came into a situation in which the staff had become complacent.  The hospital had been a big player in a small pond for a long time, but it wasn’t working anymore.  Like Danny Ainge, the CEO understood that worthwhile changes occur over time.  Over the next few years, he brought on a new CFO, COO, and business development executive. Within a few years of establishing his new team, the CEO oversaw the implementation of new satellites, new outreach, new joint ventures, an updated look, and an extensive renovation.

Real change takes time.  Building winning teams is not so much about completion as it is working a plan and making forward progress.  This may mean assigning executives into varying roles until you start to see the results you need.

To be continued…

Partner, Phillips DiPisa

This is the third of seven posts from one of our previous white papers.

Hospital Leaders Must Think of Themselves as “Team Builders”

The “Rick Pitino Story” – one in which a change in the team changes the fortunes of a once-heralded leader – is one we’ve seen repeated over and over again in the healthcare industry. 
Consider the example of Paul, CEO of a mid-sized New England hospital.  It took Paul three years to pull together the right mix of senior leaders who worked well as a team.  But after a few years of outstanding results, three of the hospital’s brightest stars left for bigger opportunities.  Paul has managed to replace them with other highly skilled individuals, but he has yet to reestablish them as a winning team.
In our experience, winning teams don’t just happen … they need to be carefully engineered, maintained, and led.  With that in mind, here are five things to remember when reaching for your championship ring:

1. Winning Teams Need Rebalancing

Betsy was COO of a community hospital in Maine.  After she resigned to step up to a CEO position, her former employer found Bob, an experienced COO who seemed perfect to step in and fill Betsy’s shoes. 

What the hospital soon realized, however, was that Betsy’s “soft skills” and knowledge of how the organization really worked reached far beyond the specifics of her job description.  Her close relationship with the CNO kept the nursing staff productive; her strong communication skills allowed her to step in and soothe the often prickly CFO; her ties to the local community gave the hospital flexibility in moving capital projects forward. 

It’s important to remember that organizations have “working norms” and that these are bigger than any individual.  Betsy understood how things got done, and when she left, everything stopped working.  The hospital finally decided to back-fill her departure with two hires – Bob for the more traditional COO role and another executive who took on Betsy’s “behind the scenes” work.

Keep in mind, as well, that the loss of a key player may present an opportunity.  Just as you rebalance your financial portfolio every year to make sure your allocations are right, a change in your team is a chance to reevaluate how your organization functions and to consider embracing a fresh approach.

The key is to remember that people are not cogs – they balance and compensate for one another.  Losing one from the mix can have far-reaching repercussions for a team’s performance.  Make sure that when a senior leader moves on, you take the time to assess how your entire management team will be affected and respond accordingly.

2. Winning Teams Take a Long-Term View

After bringing in Doc Rivers as coach of the Celtics at the start of the 2004 season, Danny Ainge, the team’s President of Basketball Operations, felt tremendous pressure to get rid of him shortly thereafter.  Rivers coached the Celtics through one of their worst seasons in the team’s history, and many people wanted a quick fix.  It was only Ainge’s belief in Rivers, his system, and the culture he was creating that enabled Rivers to keep his job – and win a championship just a few years later.

Similarly, we worked with a community hospital CEO who came into a situation in which the staff had become complacent.  The hospital had been a big player in a small pond for a long time, but it wasn’t working anymore.  Like Danny Ainge, the CEO understood that worthwhile changes occur over time.  Over the next few years, he brought on a new CFO, COO, and business development executive. Within a few years of establishing his new team, the CEO oversaw the implementation of new satellites, new outreach, new joint ventures, an updated look, and an extensive renovation.

Real change takes time.  Building winning teams is not so much about completion as it is working a plan and making forward progress.  This may mean assigning executives into varying roles until you start to see the results you need.

Winning Teams Cultivate Team Players

David was a top hospital CFO with 20 years under his belt in roles with ever-increasing influence.  He was an absolute expert at what he did.  But because he was responsible for managing the finances of the institution, he believed that the hospital revolved around him.  He was selective about the information he shared and his treatment of other functions and departments caused a number of people to go elsewhere.  It wasn’t until David was eased out of the organization that the rest of the senior staff truly began working together.  Some people do more harm than they’re worth, despite their capabilities. 

But cultivating a team atmosphere isn’t just about removing the bad apples.  It also requires establishing a culture and work ethic that rewards collaboration.  Examples of this include:  getting your group involved in multidisciplinary committees so that members understand and appreciate the role of others; developing succession plans that demonstrate a commitment to the organization as a whole; and tying your team-building efforts together by establishing incentive compensation programs and metrics that are linked to team goals.

The idea of the team player as hero has become cliché, but only because it’s so true.  Just as a successful coach pays more attention to winning a division title than to grooming the next league scoring champion, one of your key tasks as a leader is to build an organization that reinforces team behavior.

To be continued…