Living Well Journal

No Place for Custodians

2012-05-29T15:38:34-04:00

Great quote from recent Becker's Hospital Review: "5 Things Nobody Told Me Before I Became CEO"

Jim Dague, President and CEO of Indiana University Health Goshen (Ind.).:

"Planning and visioning should be a CEO's strongest skill, and the way you spend most of your time. As a candidate for CEO positions, you realize you'll be the leader of the organization, but there's a very lonely moment when you sit in the big chair for the first time and that organization is waiting for your vision, your leadership. This is not a custodial job. There are too many people in these top positions that think they're custodial and can keep things the same. Too much is changing in healthcare to think that way. For example, a hospital's heart program shouldn't be the same as when you walked in the door 10 years ago for your first day. If you're going to be a custodian CEO, and you don't have a vision, please don't accept the job."

5 Things Nobody Told Me Before I Became CEO

No Place for Custodians

2012-05-29T15:35:38-04:00

Great quote from recent Becker's Hospital Review: "5 Things Nobody Told Me Before I Became CEO"

Jim Dague, President and CEO of Indiana University Health Goshen (Ind.).:

5 Things Nobody Told Me Before I Became CEO

Is your doctor On-Call for you 24/7?

2012-05-26T08:10:00-04:00

Healthcare innovations are frequently not "new" but "rediscovered" ideas that have worked on a small scale before scaling up.

One such innovation is primary care physicians directly contracting with patients for 24/7 access in exchange for a monthly access fee. What a concept: a direct physician-patient relationship, self-funded and governed by the qulaity of the service delivered to the customer ... Naw, way too radical to ever work!

Forbes.com: Affordable Concierge Medicine?

But run the numbers ... wouldn't take too many patients in such a plan to cover the fixed practice expenses and make the struggling primary care office a going-concern!

Memorable Leadership: The Boys of Pointe du Hoc

2012-05-24T02:06:10-04:00

In a few days we'll be celebrating Memorial Day -- may I suggest a moment of reflection upon the memorable leadership that was on display on June 6, 1945?

Here's a link to an article in The American Spectator that compares the leadership qualities of two great American Presidents as they reflect upon the sacrifices made on D-Day. It includes Ronald Regan's speech on the 40th anniversary of D-Day at the site of the epic assault at Pointe du Hoc, Normandy by the US Army Rangers.

http://spectator.org/archives/2011/06/06/remembering-d-day-with-ike-and/print

Be sure to take 9 minutes and click through to watch the YouTube clip of the Pointe du Hoc speech, and marvel at the leadership that was exhibited by every man on that momentous day. Wow. Just Wow. May we never forget.

Where's the Mojo?

2012-05-18T09:22:26-04:00

On March 19, I shared an article by Chuck Lauer from Modern Healthcare re: CEO Paralysis. I've had a number of conversations since then with friends in my profession around the country, and I'm more convinced than ever that Chuck nailed it.

Healthcare leaders are simply under seige, they face risky horizons full of uncertainty, and too many of them are discouraged and just trying to hang on until retirement. This truly concerns me.

Our country needs the intellectual capital and experience of these wonderful people to forge a new "accountable-care" model for the future. Yet something in the DNA of the profession militates against the kind of innovative leadership we need to get there.

I've identified 3 general categories that describe all to many folks in healthcare leadership:

a. Some of my most experienced colleagues fall into Category 1: "Hunkered-Down." Just hang on, keep your head down, don't try anything that hasn't been done somewhere else and hold on til retirement. Life is not happy for them and the best years of their lives and careers are slipping by. How can they regain their "mojo," their confidence, focus and zest for life and work?

b. Many mid-careerists in healthcare fall into Category 2: "Dangerous Opportunities." They see the transformation that must occur in their institutions and wonder how to successfully navigate the uncertainties. Who can help them unpack, sort and choose from among their options and plan their actions?

c. Lots of emerging leaders fall into Category 3: "Skating to where the puck WILL be (not where it's been)" (credit to ice hockey great, Wayne Gretsky). Our healthcare institutions will be, indeed MUST be, vastly different in the next 10 years and these are the people to make it happen! Where can young leaders find help in evaluating and adapting their strengths to the glaring "white space" on the org chart?

Our world is full of opportunity cloaked in the guise of danger. And I'm finding some valuable examples of people in other industries who have renewed/revived their careers where disruptive innovations and technologies have changed the rules of the game. I'll be exploring some of those lessons in the weeks to come.

The "Four Big Bets"

2012-03-22T10:17:45-04:00

Today's Wall Street Journal carries an insightful article by David Wessel [ Healthcare Law's Many Unknown Side Effects ] quoting Paul Keckley of Deloitte on The 4 Big Bets that the law is simultaneously placing:

Will the mandate that individuals buy insurance pull 'young invincibles" into the insurance system?
Will employers prefer paying a $2000 penalty rather than offer insurance?
Will cash-strapped states implement their piece of the program?
Will the changes restrain costs over time or increase them?

Wessel cites a statistic that I've been pointing people to over the past decade: "As of 2010, 55% of Americans got insurance through work compared with 65% a decade ago." We have been experiencing a structural shift in how we pay for healthcare for many years, and that shift is moving away from employers. I find it unlikely the assessment of a $2000 penalty, to avoid a $15,000-20,000 liability, will dissuade employers from off-loading employees to a publicly-funded healthcare system. Kekley says his clients tell him: "If my competitor drops benefits, I'd want to be out the door just behind them."

Fundamentally, the new healthcare law that is to be vetted by the U.S. Supreme Court next week lays the groundwork for the de facto shift to a federalized health care payment system. " [And] despite all the assertions about what it will or won't do, no one really knows how it's going to work. The U.S. has rarely attemted antying of this scale before," Wessel says. "It's hard to know because the law turns so many dials oin the Rube-Goldberg American health-care system."

I agree with the David Wessel. The complexity of U.S. healthcare calls for incremental, not comprehensive, changes at the state level.

Not a Time for the Faint-Hearted

2012-03-19T12:09:01-04:00

Best read of the week is Chuck Lauer's latest opinion piece in Modern Healthcare entitled This is the Worst Time for CEO Paralysis

I could not agree with him more.

Too many of my friends in this profession around the country are dispirited, discouraged and hunkering-down to just try to hold on to The Way It Is. Neither they nor their institutions can afford to do so. Leadership is not a safe calling but it is an honorable one when leaders put the future welfare of their people and their organizations first. Break-throughs often come at the point of crisis.

"As a healthcare executive, you have to deal with a lot of the unanswered questions ahead, but the worst thing you can do is just stop and wait to see which way the wind blows. You need to be preparing your institution for the future, because the future will come sooner than you think."

"Whatever happens to ObamaCare, accountable care organizations will move forward, in one form or another.... I don't know exactly what form ACOs will take, but the model of tight integration is here to stay."

"The old system of fee-for-service reimbursements that encouraged high readmissions doesn't have a future. We are headed into a new way of managing population health, with payment based on meeting standards for quality of care, patient satisfaction and outcomes."

"Despite all the evidence, plenty of executives are still wondering whether any of the changes before them will come to pass. I think they are in denial. I think they want to return to the good old days, when life was simpler. But this is wishful thinking. The world has changed and healthcare is changing with it, and whoever lives in this bubble is due for a rude awakening."

"This is not a time for the faint-hearted. As with anything worthwhile, there will be winners and there will be losers. But for those who are dedicated to healthcare as a calling and are willing to embrace change, this is a thrilling time. Becoming a success will take all your skills, ingenuity, smarts and not a little bit of luck."

Servant Leadership: Lessons Learned on the way Down

2012-03-14T10:05:14-04:00

"If we aren't planning to be servants, we need to look for a job somewhere else..."

Bernie Brown served with distinction as CEO of one of the largest healthcare systems in the nation. Leader, teacher, author and friend to all he met, Bernie has been a mentor to me for nearly two decades.

As we reminisced over lunch recently, I was reminded of the wonderful book he wrote in 2008: "Lessons Learned on the Way Down: A CEO's Perspective on Christian Leadership in a Secular World." It's a very easy read, composed entirely of small vignettes of real life experiences that taught him timeless truths about leadership.

Selected as CEO of his hospital at age 31, he "spent the next 30 years learning how to be its leader." What he learned was that Biblical principles, applied to real life, really work!

Servant Leadership is a topic of considerable research in the management literature. Bernie realized that the principles of it have been recorded in the most widely read book in history. "It was a revelation to discover that God's definition of leader was our definition of servant."

I can't think of a better book to recommend to my colleagues, young and old.

Are we buying Ambulances when we should be building Fences?

2012-03-12T12:02:00-04:00

Is it better to buy ambulances to park at the bottom of a cliff to pick up those who fall, or is it better to build a fence on the edge of that same cliff?

A new book on my To Read list is Zero Trends: Healthcare as a Serious Economic Strategy, by Dee W. Edington of the University of Michigan's Health Management Research Center.

Here are excerpts from a web post by Jack Bruce [ Zero Trends ], a helpful abstract of Edington's premise and findings:

"Most define health as “the absence of disease.” However, a much stronger definition of health is “energy and vitality.” Employers don’t simply want employees who are staying out of the hospital. Rather, they want employees who are energized, engaged and thriving in the workplace."

"Edington maintains that an unhealthy workforce cost an organization more than just the expense of treating illness. The cost of poor health hits employers through absences, short-term disabilities, workers’ compensation, and ineffectiveness on the job and impact on co-workers. Only when we grasp these outcomes of poor health can we understand the total value of health."

Precision Medicine - - More Complex than Expected?

2012-03-10T06:27:00-05:00

On Feb 15 I posted a blog entitled "Precision Medicine" from and article in the New England Journal of Medicine, looking at the future of the personalized-medicine movement (genetically-engineered, customized treatements).

The Wall Street Journal cites another fascinating NEJM article (3/8/12), just one month later, that reveals "a tumor's genetic makeup can vary significantly even within the same tumor sample....tumors are really like a moving target... as they are growing or when they're exposed to different drugs, they change."

The more we come to know about cancer, the more we realize what we don't know. Read the article at:

NEJM: Tumor Heterogeneity and Personalized Medicine