Jerk Alert!

How many jerks have you worked for in your career?  Personally, I've worked for some doozies:

•  The system COO who took credit for all the work done by my team to design, construct and open the new rehab hospital.  He invited his golfing buddy to speak at the ribbon-cutting but didn't invite any of the team or physicians who actually opened the hospital
• The Regional VP who ordered me back to work on weekend after I had driven 8 hours to see my wife, saying "if you leave right now, you can be back in town by 3 a.m." and then called a budget-planning conference call with all the hospital CEOs for 7 a.m. Sunday morning.
• The Division President who took actual joy in publicly firing his hospital CEOs, usually at regional meetings, in front of their colleagues.  And at one regional meeting said, "Fellas, look to your left.  Now look to your right. One of you won't be here by the end of the year."
• The infamous hospital company President & CEO who would fly a troubled hospital's Administrator all the way to the corporate office just to fire him. And then send him home.     

Last week in INC. magazine, there was an article titled: "Jerk Alert: The Real Cost of Bad Bosses."

In this article, the author stated:

• 65% of employees say they’d take a new boss over a raise. 
• Three out of every four employees report that their boss is the worst and most stressful part of their job.
• Bad bosses not only make employees unhappy—they make workers unhealthy as well.

Also, in a study of 30,000 managers, employees cited five top flaws of what bad bosses fail to do:
 

1. Fail to inspire 
2. Accepts mediocrity 
3. Lacks clear vision and direction
4. Unable to collaborate and be a team player 
5. Fails to walk the talk..

 

 Therefore:

Why aren’t these people fired and who condones this type of leadership? Ethically speaking how can a company keep these bosses who can cause morale issues, ethics issues, productivity issues, compliance issues and employee turnover?  

What is the “cost” of keeping these “bad” bosses. They have to know that they are ineffective and yet keeping them says what?  What about the impact of bad bosses on the bottomline, the impact on share prices and profitability...isn't there a fiduciary responsibility to get rid of these folks?
There are enough issues to deal with in a hospital, without keeping bosses that tend to be a “cancer” growing. Aren’t we in a “preventative maintenance” mode in healthcare, then why not in companies?  Be preventative with this issue. Either fire them or retrain them.

Who's Got The Monkey??

I changed offices this week to accommodate some construction on our wing of the building and as I was cleaning out my closet, I found a box of little plastic monkeys, hundreds of them in a variety of primary colors.
  

Now you might be thinking that I'm running a little Tiki Bar out back of the hospital or maybe taking that 3-for-1 boat drink special at Happy Hour alittle too seriously, but in reality I bought those monkeys on purpose, to illustrate a very important management concept.

Back in 1974 (yeah, I've been around that long...), William Oncken and Don Wass wrote a classic article for the Harvard Business Review called "Who's Got The Monkey." Their notion was simple:  As a business manager, every time someone comes in your office, it is because they have a "monkey on their back", a problem that they need to solve and their goal is to get that monkey off their back by giving it to you.  

"Hey, Bob, I was wondering if you could help me finish my budget for 2013.  It's due on Friday and I've got so many priorities right now that I could really use your help!"  

"Sure, Dave.  I've already got mine done...it wasn't as complicated as I thought it would be...so I'd be glad to give you a hand."

Now as I watch Dave leave my office, I notice a curious thing:  He no longer has a monkey on his back.  Why?  Because he left his monkey with me and now its on my back.  

I've seen this happen thousands of times, particularly to new managers.  And especially in healthcare, because we pride ourselves on being "helpful" (hey, why else did you go into hospital work??) and so we're suckers when it comes to letting people leave their monkeys with us. 

Want to be helpful? Look at it this way:  If you successfully hand off your monkey, then your problem becomes my problem.  Then you don't have a problem anymore, do you?  And I can't help someone who doesn't have a problem.  So in order to be the most helpful to the most people I have to make sure they all have their monkeys.

Making sure everyone keeps their monkeys is just good management.  It is good personnel management because you hired that manager to do a particular job.  If you do their job for them, what are you paying them for?  It is their job to identify problems in their departments and to solve them.  And it is good time management.  If you do their job, who is doing yours?  Nobody.  So you get more and more behind in your own duties...not what you get paid for.  

So I bought my box of monkeys to illustrate the point to my Management Team.  We discuss the Oncken & Wass article, talk about times we've let this happen to ourselves and I leave each one of them with alittle plastic monkey to put on their desk to remind themselves "Monkeys:  Don't let folks leave your office without 'em!"

Read the original Oncken & Wass article at: Who's Got the Monkey? - Meilink.net

 

Where Are We Going? And Why Are We In This Handbasket??

One of the easiest jobs in the world is being a consultant:  Organizations pay you for your opinion and are therefore motivated to accept your advice.  You also enjoy the "Wizard of Oz" effect (discussed in one of my earlier blogs) of being the man behind the mirror who, through this consulting effect, uses existing staff (Dorothy, Toto and friends) and resources (Yellow Brick Rd) to accomplish the very task YOU were hired to accomplish (Back to Kansas!).

One of the hardest jobs in the world is to explain the customer, peers and clients the rationale behind your recommendations.  "We're going to do what? Why??

I'm basically a hired-gun change agent, specializing in organizational turnarounds.  Most of my work has been in hospitals, specifically specialty hospitals like psych, rehab, and long term acute care.  But I started out as a psychologist, so I look at things--including hospitals--behaviorally.  

My current project has gone very well.  I've been here about 10 months and the inpatient census has more than doubled, reaching record levels.  Yet, I was recently asked by the Board of Directors of the hospital to explain why I had chosen to focus on driving inpatient volume rather than patient & physician satisfaction.  And what's the focus for 2013??  I explained the entire concept with a single slide....

But first:  A little psychological history & systems.  In 1943, Abraham Maslow published his paper "A Theory of Human Motivation". His theories parallel many other theories of human developmental psychology, all of which focus on describing the stages of growth in humans. Maslow was unique in the field of psychology because he studied successful, optimized, highly functioning people like Albert Einstein, Eleanor Roosevelt and Frederick Douglass rather than mentally ill or distressed people.

Maslow theorized a hierarchy of needs (Physiological, Safety, Belongingness and Love, Esteem, and Self-Actualization) that needed to be met in order for an individual to grow psychologically toward "self-actualization"   His hierarchy is usually illustrated as a pyramid with the largest and most fundamental levels of needs at the bottom (physiological, safety) and the need for self-actualization at the top.  Maslow theorized that the most basic needs had to be met before an individual would desire (or be motivated) to achieve the next level of needs.  Simply put, Billy won't want to focus on his self-esteem (Esteem) if he's living in a cardboard box under the bridge (i.e., his Safety needs have not been met). 

Back to my story:  I've always thought organizations/hospitals are like people, particularly in the way they grow and change. And so I "borrowed" Dr Maslow's theory and applied it to organizations and gave it a really hip, important-sounding name:  The Hierarchy of Organizational Actualization.  

And here's what I told the Board of Directors about volume vs. patient satisfaction:  Just like in Maslow's hierarchy, its hard for an organization to focus on/want to improve patient satisfaction (a higher level need) when it is in imminent danger of closing (fundamental need). 

 We operationalized the Hierarchy into 5 key strategic goals for this year, the "High Five!', we call 'em.  And you can see our progress towards goals, having achieved both our "Foundation" needs and "Key Success Factors" needs and now focused on the "Values" needs of service, quality and pride, on our way to Vision.

So while my detailed "strategic plan" might be 68 pages long, it boiled down to this: Fix the fundamentals first, thereby building the foundation upon which we'd then build patient satisfaction and customer service, leading ultimately to an organizational "self-actualization" in terms of mission, vision and values.  

Class dismissed!

 

PREHN'S LAWS OF HEALTHCARE ADMINISTRATION, Part Deux

Here’s an update to my previous post on the Laws of Healthcare Administration, sayings or quotations from friends, colleagues, and other sages about the perils of “Life in the Big Chair.” 

1.                Simpson’s Law of Simplicity:  Either this will work out OK or it will make for an interesting story. 

2.                Brock’s Bylaw:  Speed + Execution = Results

3.                Morrison’s Mantra:  Anytime a major charge or shakeup happens at your hospital, your staff will have 3 questions:  (1) What about me?  (2) What about me? (3) Oh, by the way, what about me?

4.                CEO Caveat:  Never let them see you sweat.

5.                Johnson’s Judgment:  Every once in a while, you just gotta throw a dead body out in the hall.

6.                Viator’s Verdict:  You might as well take all the undeserved praise, because you’re gonna get all the undeserved blame.

7.                Morrison’s Maxim:  Hospital CEOs should change every 3 years because if you haven’t created enough enemies in 3 years to get yourself fired, you’re not pushing hard enough.

8.                Prehn’s Proclamation:  If it ain’t working, use a bigger hammer.

9.                Prehn’s Prescript (previously known as Prehn’s Rule of Free Drinks at Happy Hour):  The cheaper the product, the more consumers will complain about the quality.

10.           CNO’s Conundrum:  CNOs who seek equality with CEOs lack ambition. 

11.           The Simpson Elucidation of the Chain of Ridicularity:  The longest distance between two points utilizing as many people and forms as possible in a corporate chain of command in order to review and analyze any requested decision or action without there ever having to be a substantive decision. 

12.           Prehn’s Precept:  When you don’t know what you’re doing, walk fast & act worried.

13.           Shane’s Sayng:  Show up, act interested.

14.           The Law of Crisis Management:  I’ll panic when it happens.

15.           Jim Injunction:  Volume cures all ills.

16.           Colin Powell’s Quote:  You can’t make someone else’s choices. You shouldn’t let someone else make yours.

17.           Andretti’s Axiom:  If everything is under control, you’re not going fast enough.

18.           Weinstein’s Wisdom:  Sometimes its paranoia, sometimes its just sensitivity

19.           Prehn's Perrill:  My job ate my life.

20.           Aleen's Advice:  When your boss is manic, rise to the level of their mania to communicate an adequate sense of urgency.

21.           Aleen's Advice:  (to nursing staff) You will NEVER get in trouble for being nice to a patient/family member.  Get them what they need to be comfortable.

22.           Harrison’s Three Laws of the Universe:

a.    Hurry up, get to the point, I don’t have a lot of time

b.    Don’t sweat it, most of it turns out to be B.S. anyway

c.     I don’t have to be the smartest guy in the world, I just have to be the smartest guy in the room

23.           Lee's Law of Timing:  If you have to have an answer right now...it's no! 

a.    Corollary - Lack of planning and/or preparation on your part does not constitute an emergency on mine.

b.    Prehn’s Expediency Formula:  Results are simply a matter of time & money.  The more money you have, the less time you need.  And vice-versa.  R = f [T:$]

24.           Reformation of Martin Mull’s Observation:  Being a hospital CEO is like having a bowing alley installed in your head.

25.           Granger’s Grail:  Understand reality.  Define perception.

26.           The Law of Distributional Dynamics:  When the sh*t hits the fan, it won’t be evenly distributed. 

27.           A Few Good Hospital Administrators:  “You can't handle the truth!  I have a greater responsibility than you can possibly fathom. You have the luxury of not knowing what I know…And my existence, while grotesque and incomprehensible to you, saves lives...You don't want the truth. Because deep down, in places you don't talk about at parties, you want me on that wall….”

28.           The Bear Bryant Theory of Succession:  You don’t want to be the coach who replaces Bear Bryant.  You want to be the coach who replaces the coach who replaces Bear Bryant.

29.           Captain James T Kirk’s Advice on Advice:  “One of the advantages of being the captain, Doctor, is being able to ask for advice without necessarily having to take it.”

30.           The Elenbaas Idiom:  Honor performance, growth and results. (Ron Elenbaas)

31.           “Like Throwing Moon Pies at Mardi Gras”:  Sometimes all your customer, physician, or staff want is a token of their “special-ness.”  It is not the size or value of the token that matters, it is the fact that they got it and someone else didn’t.

32.           Ashleigh Brilliant’s Axiom:  “I don’t have a solution, but I certainly admire the complexity of the problem.”

33.           Dale’s Dictum:  If you want to gather honey, don’t kick over the beehive.

34.           Carnegie’s Credo:  You can’t win an argument.

35.           General Patton’s Law of Battle Strategy:  Pick your battles so they’re small enough to win and big enough to matter.