The TLT Roundtable

The TLT Roundtable

While together in Nashville, representatives of the Top Leadership Teams 2006 sat down to talk about the hallmarks of leadership and teamwork in a discussion moderated by HealthLeaders Media Editor-in-Chief Jim Molpus.

Jim Molpus, editor-in-chief, HealthLeadersMedia: Sometimes a leadership team is just great by chemistry, but how did you start to create one?

Jeffrey M. Fried, FACHE, president and CEO, Beebe Medical Center: I don’t think we set out to build a team, we set out to build a high performance organization. The next step was to build a team that could lead us and make it happen.

Patrick Quinlan, M.D., CEO, Ochsner Health System: We use a modified General Electric method for evaluation, promotion and feedback. Leadership is not about one team. It’s really about multiple teams. We actually have 7,000 leaders—it just depends on the situation. We had to have some structure that’s readily understandable and could be executed by many people at different levels, so we developed consistency with a common goal and method in mind. Turning around a 7,000-member organization with multiple locations is difficult, so we chose something that lent itself to scale and was not about people but more about a process and beliefs.

Warner Thomas, president and chief operating officer, Ochsner Health System: The key for us was having a system so there’s consistency in how we evaluate and develop people across our organization. It doesn’t matter if you get a review in finance or nursing or a medical area--there is a consistency in how you’re evaluated. We evaluate on consistent principles and beliefs, and that structure has helped us to bring people along. We don’t have to exit people. People understand they’re either part of that performance culture or not. If they’re not, they end up leaving on their own. If they want to be better, they get better through that process, because they get honest, developmental feedback consistently.

Kimberly T. Shank, executive director, Wichita Clinic: Our clinic has developed a lot of interest in the Good to Great concepts. You can have wonderful facilities, but you need great people, and without those great people it’s difficult to be successful. It’s also important to get the right people on the bus. When I came into this position I had been with the clinic for several years. I had a peer group with eight senior managers, and within a year, two of those positions had turned over. Interestingly enough, the people we filled them with had been with the clinic in those departments previously. Even though we turned over what turned out to be 25 percent of our senior leadership team, we replaced them with people that had been with the organization and had great chemistry, so there was a certain amount of proactive forethought and a certain amount of luck.

Molpus: How do you take what you’ve learned about putting together a leadership team and make it portable?

Thomas: We saw the GE model as one we felt was transportable, but what we were concerned about is that culture and beliefs are not transportable. The tools are transportable, but it’s not for the faint of heart. It’s a challenging process to go through, but if you’re serious about it, the tools are transferable. The focus and direction and beliefs you use have to be your own.

Richard A. Schaffner, Jr., executive vice president/chief operating officer, Beebe Medical Center: I agree. There’s any variety of systems out there to utilize, but you have to have almost ingrained in your organization what your culture is going to be. Like my colleague said, you’ve got to be able to get on the bus. I think a lot of us have been in organizations where that’s a challenge, because finding qualified people is very difficult. At Beebe, we’ve tried to build upon the long tenure of a lot of our folks and the culture that has been there, but you clearly have to be in the position to make those tough decisions if someone doesn’t seem to be meeting those expectations.

Thomas: If you look at Good to Great, it’s a great book with a lot of great concepts. But if you start trying to transport things, all of a sudden people think, “They read a book and now they’re going to bring it in and we’re going to do that here.” You have to paint a picture about why it’s applicable to you and then hold with those concepts. When we created our evaluation system four years ago, I think everybody wondered what we were going to do the next year. And then the next year came around, and we did the same thing. Then we did it again. Now people know we’re serious and that this is what we’re going to do. Consistency is extremely important.

Quinlan: Really, the system is the pipeline, the content is up to you. I read somewhere that CEO stood for clarity, example and optimism. I think you really have to lead with that--and it has to be in plain English, it has to be heartfelt, and has to resonate with people. You have to hit those common denominators so that everyone says, “OK, this is the real deal.”

Dick Rogers, vice president, human resources, ConnectiCare, Inc.: At the end of the day, the culture is what defines you. In our case, the strategy and the culture are clear to our employees. Our various systems are put in place to reinforce them. Everybody gets their bonus on the same four criteria--financial performance, membership growth, quality and member satisfaction. We talk about them all the time. You can’t underestimate the importance of communication and giving clear messages to people so there is real clarity on exactly what you mean again, again and again.

Thomas: One other thing, I think it’s how you lead and what you do in an adverse situation--and not just ours. Whether you’re building a facility and have to talk with the physicians about a compensation adjustment or if you’re looking at your patient satisfaction scores and they’re not where you want them to be, those are adverse situations. How you lead during adversity and challenging situations says much more about your organization than when you’re in times of success. That’s when your employees watch to see what you do and if you change your leadership style during adversity. That’s when employees feel like leaders show their true colors as an organization and as a team.

Molpus, HealthLeaders: How do you plan for turnover on your leadership team?

Quinlan: We faced a moment of truth post-Katrina. Folks just had to move on, so we lost about 100 physicians. We replaced them, which I think says a lot about the strength of the organization and the environment. But the key is not about a culture built around people, that’s a culture of personality rather than clearly defined, clearly executed and clearly ascribed-to beliefs. If you can’t put it down on paper and people don’t resonate with it, then that’s just the talk of the culture, it’s not the life of the culture. The idea of selfless leadership and servant leadership is not about you, it’s about your principles and how you use those principles in your daily activities. That’s the dry stuff like the evaluation process, because that’s what people experience and act upon, and you recruit and retain to that framework. It’s about the framework, it’s not about the people.

Fried: In the state of Delaware we have a quality award that’s modeled after the Baldridge award, and one of the things we learned after going through that experience is that succession planning is something that needs to happen throughout the organization. We’ve done a pretty good job at the senior level, but we’re now drilling down into the organization and we’re identifying people within the organization who can be leaders and developing them so that when there is transition, there are people who are ready to step up to the plate.

Rogers: We’re a fairly small organization of about 500 people, so turnover and particularly turnover in key jobs is a significant issue for us. In each of the last several years, we’ve developed what we call both a succession and retention plan. We look at who the key contributors are--those who have a significant impact on the profitability of the company, current and future leaders of the business--we identify and keep track of them to make sure that we’re doing everything we can both from a retention as well as from a development standpoint. But, frankly this is a real challenge for us.

Ida Schnipper, senior vice president, operations, ConnectiCare, Inc.: In operations, I have eight direct reports, and every year when we start our business and budget planning cycle I rotate the directors through a role of overseeing the budget planning processes for all of operations. They sit with their peers going through line items so they get to know each other’s business and get the chance to sort of role play what it would be if they were in my shoes and having to make budget cuts. Once I sent the director of the call center to run our billing and enrollment area as an interim, so he would have an opportunity to spread his wings and see what it’s like running operations in that perspective. Particularly in an organization where there are not a lot of positions above director, it gives them a chance to practice their skill sets and experience a different part of the business in the event that somebody were to leave.

Molpus: At Wichita Clinic, how do you maintain a leadership culture and extend it to the physician staff?

Shank: One of the things I tell physicians coming into the organization is that I’m really not a CEO. My role really is chief facilitation officer. I’m facilitating resources and facilitating their practice and trying to create and preserve our culture of being physician-owned and physician-governed. They know that we’re here to take care of them, and that resonates with people. Physicians have a tendency by training and personality to be very independent, and we try to maintain a culture that fosters and nurtures that. That’s one of the things that has helped us with our recruiting. We spend a lot of time with physicians in all of our locations, in all of our specialties, with a lot of face-to-face communication. I’m a big believer in the management-by-walking-around theory. We’ve started doing more in terms of physician development in trying to foster their management and administration skills.

Molpus: In healthcare organizations, teamwork for the sake of teamwork is fine, but which systems for rewarding teamwork are most effective?

Rogers: At the beginning of each year we develop a list of 10 goals and objectives. They are communicated down through the organization to every employee, so everyone is on the same page, focusing on the same objectives, and has goals that support those objectives. Everyone knows that they’re rewarded on the overall organization results.

Schnipper: In specific departments there are always team goals in the performance plan for the year. Individual productivity may be weighted for some incentive, but the bigger focus is on how the team did.

Schaffner, Jr.: We’ve tried to get a little more laser like. It was difficult trying to convince everybody of 40 organizational goals, so now we have essentially four. We look at the national patient safety goals, our hospital quality measures outcome goals, customer satisfaction goals and financial goals. That’s basically what our team incentive is based upon. As far as individuals go, we’ve got a fairly structured annual appraisal process that calculates out to sort of a personal financial gain or loss for employees, so that starts to make it personal. At one time, everybody in the organization was frustrated because they didn’t feel they were part of the overall financial performance. We’ve really worked with them to explain that everybody really is part of that. Everybody feels much more of an attachment to the quality measures and the patient safety goals, so it’s been important for us to tag in the financial aspect, as well.

Molpus: What are the team-building factors you use in managing physicians, and in particular, in the area of improving core CMS measures?

Schaffner, Jr.: We’ve really tried to communicate better. Our challenge has been to gather the information in a way that is personalized for the physicians. Before, we talked organizationally, and that wasn’t as successful as when we gathered the data and distributed it to the physicians specifically for them. We enlisted a number of physician champions to develop protocols that their peers would follow. Our medical executive committee discusses this on an ongoing basis with the department chiefs to make sure that everybody understands the implications. Initially a lot of our physicians thought it was something that just the hospital was going to be graded on. They realized that they were going to be graded, too, and they’ve begun to embrace the changes.

Molpus: As CEOs, how do you find the right balance of being a leader versus a team member? Are you a coach, a cheerleader or none of the above?

Fried: You’re really all of the above, depending on the situation. You go back and forth all the time. You need to be flexible as a leader: Sometimes you’re going to lead, sometimes you’re going to follow.

Quinlan: My job primarily is to try to understand what we’re trying to do and be able to recruit people who do things much better than me. That cascades throughout the organization, and the focus on getting the job done. It’s extremely situational, because our company is much different than it was eight years ago and will be much different next year. Being able to adjust with the people around you is the key. It’s hard to describe, but easy to see the results when they work or they don’t work.

Molpus: What are the cultural elements that you take outside the team to build relationships with vendors and partners?

Fried: One of the most critical elements for building a team is trust, so we try be transparent about everything that we do. In a small hospital in a small community, we recognize there are no secrets Everybody knows everything anyway, so why try to hide it? We’re up front about everything. We put everything on the Internet or on the intranet for employees. We act as if every decision we make can be on the front page of the newspaper, and I think it helps us make better decisions.

Quinlan: We have a conference room that is surrounded by pictures of our history with the five founders in front of us. They were people of tremendous courage who bet their future on founding the clinic in 1940, and who had a higher purpose in mind. You have to go with the higher purpose and challenge people to do the right thing. If you, yourself, are honest and willing to admit fallibility and say, “Let’s leave something for others just as we have a legacy that we’re stewards of,” it really makes a difference.

Audience question: Can you give an example of a really great partnership situation that you have been able to create?

Thomas: We’ve changed our group purchasing organization in the past 18 months, and we have a very strong relationship. It feels different, not just because of the economics and how we’ve set up the arrangement, but because we really believe they care about our success. They’ve really gone above and beyond. They were one of the first institutions that helped us immediately after the storm. They got all of our major suppliers on a conference call and within 12 hours had trucks running to us with what we needed. That’s something we couldn’t have done ourselves. They raised money for our employee relief fund. But beyond the dollars, every time we needed something, they were there to help us. I think that’s going to pay in spades for them, and it paid off for us. It’s a different relationship--it’s not transactional, and when it comes up the next time, it’s not going to be, “Well, how do I get another quarter point out of you,” it’s going to be about how do we help each other succeed.

Molpus: Do you have advice for your counterparts in healthcare who may not have a very good leadership team? What can they do to turn the ship around?

Quinlan: In our group, we talk about the deathbed conversation: Did you make a difference in life? Did you fulfill your potential? How were your relationships? What do you want out of life? It’s that principle-based leadership. If you don’t have principles, don’t expect other people to.

Fried: Set very high standards. In our case, we’ve never been disappointed--we’ve always met or exceeded the standards that we’ve set.

Shank: Everyone needs something larger than themselves to believe in and contribute to. If you can’t create that type of culture, it’s going to be difficult. You also have to have courage to make changes when it’s necessary to build a strong team.

Rogers: I believe a mission beyond just making money is important. It’s the “why” you do something. Then it’s the process of making sure everyone is on the same page and that we are all executing against that plan.