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Leading Change is Tough from the Back of a Limo

 |  By Philip Betbeze  
   February 10, 2012

If you're a regular reader of this column, presumably it's not only because you hope to glean some ideas about how to prepare your organization for the massive amount of change bearing down on you, but also because you've demonstrated a lot of leadership ability yourself.

It may also be presumed that you've made your climb the right way through hard work, calmness under fire, tough decision-making, and long-term vision.

Well, you won't find much of that here this week. Instead, I have a shining example of a few things you might not want to do if you're in charge.

You probably already know this, but if you're looking for a way to demonstrate vision and execution from your team to meet the challenges associated with healthcare reform, it's best not to do your business from the back of a limo.

News this week that the former chief executive of a debt-burdened Brooklyn hospital had the hospital buy him a $33,000 limo was one of the most titillating headlines of the week. Yes, the story leads with the fact that Wyckoff Heights Medical Center is seeking "whatever we can get for it," according to new CEO Ramon Rodriguez (it is the New York Daily News, after all), but if you read past the first few paragraphs, the story turns rotten and sad—and not at all funny.

The fact that former CEO Rajiv Garg rode around in a limo is by far the least troubling information. In fact, after checking out the various conflicts of interests revolving around the former CEO and several former board members, you're more amazed than amused. You wonder why it took a state advisory panel's recommendation that Wyckoff, part of a group of financially struggling Brooklyn hospitals, merge and restructure, for all of the scandalous news to start coming out.

As in many provocative stories that involve misdeeds at the highest level, the activity was pretty blatant. In fact, this episode is so conflict-riddled, and possibly criminal, that you start to wonder who wasn't involved. Let's hear a round of applause for a group of about 100 doctors at the hospital who worked to challenge Garg and the board's leadership last winter. Unfortunately, they were largely ignored until they paid a visit to the district attorney.

Nearly a year later, it turns out that not only was the former CEO riding around town in a stretch limo, but he was having the hospital pay outstanding bills for consulting services ordered by him, and now no one can figure out the projects that the consultants worked on. Also, several former trustees had cozy business relationships with the former CEO or hospital entities and are now under investigation from the local district attorney's office.

Amid all the jokes, let's not lose sight of what's serious and important about this sort of abdication of leadership at the top level of an organization. Fraud, by its nature, is difficult to discover. But wouldn't it have been better if the CEO had been ousted and the board culled a year ago?

Let's stipulate that for the record, a stretch limo isn't going to add to your leadership cachet. But you knew that already. A lot can be learned by the way the new CEO is being so open about cleaning up the culture at the hospital.

Rodriguez came to lead Wyckoff from the Brooklyn Work Group for Health Systems Redesign, which is charged with the aforementioned state directive to merge and restructure the group of hospitals. He's been an open book about what he knows about the past misdeeds and vows to make sure that going forward, there's not one set of rules for the connected and another set for everyone else. But it strikes me that those changes may be too late for the community to save what it sees as an important institution.

So what's the key lesson to take from all of this? As a senior leader, you can be bold and visionary with quality improvement projects. You can work hard on changing culture from one of suspicion to one of collaboration. You can install the high-tech software and services to keep track of your billing and collections, you can make huge investments in your electronic medical records, you can hire all the physicians you want, and you can even remake your hospital as an accountable care organization.

But none of it will work if your colleagues don't trust you and your intentions, and certainly not if you're suspected of being on the take. The necessary but not sufficient tool you need to make any of this work is your good reputation. All the rest is window dressing—or, in a more appropriate metaphor, a stretch limousine.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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