Are you the Boss from Hell? Chances are if you have to think about that, then you aren't. Bad bosses usually come to work each day wrapped in a thick blanket of obliviousness. Think of Michael Scott, the dunderheaded manager for Dunder Mifflin on the NBC sit-com The Office. He hasn't a clue.
A new CareerBuilder.com survey of 8,038 workers from a variety of industries shows that the domain of bad bosses stretches far beyond the cubicle haunters of that fictional paper supply company in Scranton, PA. In fact, 43% of those 8,038 surveyed workers say they've quit a job at some point in their lives because of bad bosses.
Unfortunately, according to the survey, healthcare has its fair share of Satan's lieutenants. Included in those 8,038 workers surveyed between Nov. 12, and Dec. 1, 2008, were 634 workers at "large healthcare organizations with 50 employees or more." Tellingly, 21% of those healthcare workers—one worker in five—say they would fire their boss if they could. Just as with the at-large survey group, 43% of healthcare workers reported quitting at some point in their career because of a bad boss. In addition, 22% of healthcare workers rated the performance of their current bosses as great, 39% rated performance as good, 26% rated it fair, and 13% rated their boss' performance as bad.
"What makes a bad boss?" the healthcare workers were asked. The top two complaints by more than 86% of respondents were "doesn't listen to employees," and "talks down to employees," followed by "unreasonable demands," "yells constantly," and "steals other employees' ideas."
There are other tell-tale signs. Does the laughter choke off when you enter the break room? Are chirping crickets the only feedback you get at staff meetings? When you approach, do your workers dart their eyes, scramble to answering phones that aren't ringing, slap at the panic bar on the fire door, or just shudder and look down? Has someone defaced your company photo hanging by the bulletin board? Did they use a Sharpie to scrawl a Vandyke, horns and tail, and the caption 'Prince of Darkness'? These are clues.
Peter Stark, a management consultant from San Diego, identifies a heaping handful of dumb things that bad bosses commonly do in his new book Engaged: How Great Leaders Build Organizations Where Employees Love To Come Back To Work.
One of the biggest errors bad bosses make, Stark says, is in their inability to control their emotions. Usually, the emotion they can't control is anger, which in turn earns bad bosses a reputation for moodiness. "It's almost impossible to get rid of that label," Stark says. "Everybody is walking around the organization asking 'is it a good day or a bad day?' The key is to respond consistently and appropriately in all situations. The question I ask bosses is 'how much can you handle before you lose it?'"
Rash, impulsive decisions that send the whole organization into a needless tizzy also sap enthusiasm and productivity. "The boss shouts out a decision and everybody has to react, and then 30 minutes or 30 days later the decision has to be refined or changed," Stark says. "Involve others more in the decisions on the front end. Ask more questions. Get more engagement from the people who are going to be impacted by these decisions. It makes it so much easier."
Beware the bosses who take undue credit, because they are the same guys who will assess undue blame. "Everybody knows these guys. With them every meeting is like a warm up for an opera. 'Me, me, me, me, me,' " Stark says. "They love to talk about themselves when everything is going right, but when things go wrong they become masters at pointing out what's wrong and who we blame."
The Boss as Best Buddy is also a problem area. "To try to get people to like you will probably create problems for you as a leader," Stark says. "In the long-term best interests of the patients and the healthcare organization, you may have to make decisions that not everyone will like, but you need to make it and people will adjust to it."
There's the No Bad News Boss, who surrounds himself with people who've learned to tell him what he wants to hear. "If somebody has a contrary opinion, the leader gets hostile and rejects it. People eventually say 'I'm not even going to bring it up because it won't be appreciated or acted upon,' " Stark says.
There isn't enough space here to list all the archetype bad bosses that Stark has identified. However, the common thread that these bad behaviors share is a failure to communicate, which means listening as much as speaking. "The best bosses are the ones who ask questions and listen, versus the ones who come in and talk," Stark says. "The more leaders communicate, the more they indirectly tell the people they work with 'I really do care about you and value your opinion.' "
It's easy to joke about all this, but it's serious business too, especially given the demand for healthcare workers in this country and the costs associated with recruiting and training replacement workers. If one in five of your employees wants to axe you, you've got a turnover issue on your hands. Yes, recent studies have shown that the demand for healthcare workers may be softening during these unsettling economic times, as people with jobs hunker down. If your employee retention strategy is the recession, however, you probably shouldn't be a boss.
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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As healthcare companies react to the pressures of the tightened credit market, some will inevitably default on their obligations. Lenders to healthcare companies have become familiar with the routine: slow pay, no pay, and then notice that a bankruptcy has been filed. Once in bankruptcy, very few companies emerge intact. On average, only 7% of all bankruptcy reorganizations result in the company becoming a thriving concern. The remaining companies liquidate with creditors recovering less than 100 cents on the dollar. Two prevalent reasons companies fail to emerge are the time and expenses of a reorganization.
Receivership
A less common but historically tried-and-true alternative to bankruptcy is a receivership. Receiverships are primarily creatures of state law. Prior to the federal bankruptcy laws, when a company became insolvent, individual states had statutory provisions for liquidation under court supervision. This was accomplished by appointing a receiver over the business. Although more recent bankruptcy laws have changed the landscape of remedies for insolvency, receivership remains an effective remedy for lenders.
A receiver is an "officer of the court" who gathers, markets, and sells all assets of a company. In a typical receivership, after marketing is done for a reasonable period, a purchase agreement is negotiated. Then the receivership court approves the sale and the sale is consummated. Once the sale is consummated, the receiver distributes the cash generated by the sale in accordance with the state law priority scheme (secured creditors first, then unsecured creditors, and lastly, equity holders) and the case is then closed. Frequently, where healthcare assets, such as surgery centers, hospitals, or skilled nursing and assisted living facilities, are the subject of such a sale, the facility remains intact and continues to serve the community.
Appointment of receivers
Today, receiverships are typically sought by a creditor with liens against a company's assets. The secured creditor will sue the company for repayment of the debt owed and seek, as one of its remedies, the appointment of a receiver. Receivers are usually appointed early in a case. An appointed receiver will operate the business as profitably as possible but will also normally market the company or its assets for sale. Particularly for healthcare companies, receiverships may provide a less expensive resolution for defaults while keeping healthcare facilities intact and servicing their communities.
Receiverships have a number of advantages over a bankruptcy filing. First, an independent third party operates the business, not the old management that may have an emotional attachment to the business or, even worse, an embattled mentality. Less-than-satisfactory management is often cited as a primary reason for poor operations and ultimately bankruptcy filings. For example, in nonprofit healthcare entities, management may not have its incentives aligned with the successful operation of the business, or the board of directors in place may only meet very infrequently. Neither scenario is conducive for struggling healthcare entities facing bankruptcy. Instead of allowing poor or absentee management to continue to run the business as is the case in bankruptcy, appointing a receiver allows the best interests of the company to prevail.
Lower costs
Second, the cost of a receivership is often lower than a full-blown Chapter 11. Once a receiver is appointed, the displaced management members usually do not have a role. No creditors' committee (and its attendant counsel and advisors, all paid by the company) is appointed. While a receiver must be compensated, unlike a trustee in bankruptcy, a receiver is usually not paid a commission. And unlike bankruptcy, no plan, disclosure statement, solicitation, or confirmation hearing is necessary for a receivership. As a result, court costs and attorneys fees are significantly lower. Third, because there are fewer roles in a receivership compared to a bankruptcy (no debtors' counsel, no creditors' committee), the process often moves more quickly. The receiver manages most aspects of the reorganization, including the sale of assets and distribution of funds. The faster process usually also translates to lower costs. An additional benefit to the secured creditor is the greater control it has over the sale and distribution process under a receivership as compared to bankruptcy proceedings.
Shortcomings
The chief drawback to a receivership is that the secured creditor normally foots the bill in the event there is a shortfall in revenues that are used to support operations and the costs (usually the receiver and his or her counsel). Before embarking on a receivership, secured creditors should make certain that revenues and cash flow will be sufficient to allow for a reasonable marketing period. This will ensure that the secured creditor will not be forced to support the company during the receivership, or worse, contributing sales proceeds, otherwise payable to it, to the cost of operating and administering the business in the receivership.
Another drawback is that there can be more "home cooking" in a receivership than a bankruptcy. Filing an action in the hometown of the business in receivership can result in the court being more sympathetic to the local entity rather than the out-of-town creditor. State courts may not be as familiar with commercial disputes as with other types of disputes. One way to alleviate the "home cooking" problem is to file the matter in the local federal district court as opposed to the state court where the facility is located. One last drawback to receiverships is that companies with appointed receivers can still file bankruptcy.
When a creditor is considering its remedies against a healthcare company that owes it money, particularly secured creditors, keep the receivership option in mind. It is likely to be a cheaper, faster, and simpler solution.
Joseph A. Sowell and John C. Tishler are partners with Waller Lansden Dortch & Davis in Nashville, TN. They may be reached at joe.sowell@wallerlaw.com and john.tishler@wallerlaw.com, respectively.
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Many of you who regularly read this column are hospital CFOs. You have my sympathy these days. You're trying to figure out how to project financial success, or at least, financial independence, through 2009 and beyond. Perhaps you're just trying to survive. You've already been hit with huge investment losses, a lack of access to capital, and in many cases, rapidly declining volumes. It's hard to deal with that level of triple-witching that so quickly soured good economic times for the industry, but you aren't standing idly by.
You're trying to deal with the uncertainty of future revenues through a variety of measures. You're taking a hard look at eliminating money-losing services. You're tightening up on the supply chain, you're postponing needed investments in technology as well as bricks and mortar, and you're working on refocusing the strategic direction of the hospital or health system through a cracked lens. But those solutions take time. Meanwhile, the positive hit to the bottom line from laying off staff is almost instantaneous, and hospitals are taking advantage of it.
Not a week in the past half-year has gone by in this newsletter without at least one hospital or health system announcing a 6%, 7%, or even 10% across-the-board staff reduction. It's true many of these layoffs don't include clinical staff—many such positions are still in shortage, in fact—but the cutbacks are pretty brutal on administrative staff—people who are hard to replace should the economy turn.
On the other hand, recessions offer opportunities for resizing often-bloated organizations. And I'm going to give you the benefit of the doubt by assuming that many of the first people laid off at any institution are the low performers, but in times like this, it's often hard to be so surgical. This recession hit lightning-quick, so as responsible CFOs, you've responded in kind. Often in times of such strategic stress, it's difficult to cut with a scalpel rather than a hatchet. And it seems to me from the news reports that across-the-board cuts can't, by definition, be made with any precision.
I'm concerned that even financially secure organizations are cutting too deeply. You should act quickly to contain the financial damage during any business downturn as drastic as this one seems to be, but be careful not to destroy any hope of recovery should the business climate turn around as quickly as it soured. Many CEOs and CFOs I've talked to over the past couple of years have said how they appreciate the level of scrutiny being placed on their organizations by outside individuals—one recently remarked to me that hospitals and health systems are being judged on the same metrics as public companies—especially when it comes to being able to borrow. But let's remember something here: Nonprofit hospitals are not public companies, and never will be. You have more flexibility in good times and bad, so take advantage of it.
It's easy to fire good people, and of course it's the last course of action you'd like to take. But once they're gone, it's not nearly as easy to rehire them and continue on your merry way. If you've spent years in time and talent building your market position and operational excellence, don't destroy it permanently in a short-term attempt to minimize your losses. You'll take heat, but you can justify keeping good people even in bad times, because in the long term, those losses in talent might not be so easy to recoup even if the economy turns quickly.
When it comes to taking prudent measures, lay off people if you have to. It's up to you to decide how much is too much.
P.S. Check out our two new blogs on leadership and marketing. I think you'll be happy you took the time.
Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at pbetbeze@healthleadersmedia.com.Note: You can sign up to receiveHealthLeaders Media Finance, a free weekly e-newsletter that reports on the top finance issues facing healthcare leaders.
Amid a major restructuring and an expected announcement of several hundred job cuts, the chairman of the largest group of doctors at University of Chicago Medical Center has resigned. Skip Garcia, MD, chairman of the University of Chicago Department of Medicine since May 2005, has stepped down. He will, however, remain on the faculty, according to a letter issued to faculty and staff at the medical center. In a letter to faculty, the chief executive of the medical center alluded to Garcia's departure as related to the problems the medical center was having dealing with the economic downturn. The university would not comment further nor would it disclose the number of layoffs that will be announced.
CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests filed by Viant, Inc., and PRG Schultz, USA, Inc. have been withdrawn. Viant and PRG’s protests were resolved February 4, which means the stop work order has been lifted, according to CMS.
The Government Accountability Office (GAO) had 100 days to issue a decision after the unsuccessful bidders filed their protests November 4, 2008. The GAO had been set to render a decision on the protests on February 9 for Viant, and February 11, for PRG Shultz.
The RACs by jurisdiction are as follows:
Region A: Diversified Collection Services
Region B: CGI Technologies and Solutions
Region C: Connolly Consulting, Inc.
Region D: HealthDataInsights, Inc.
"If you have put your RAC preparation on hold, it's time to start finalizing your strategy. And it's time to become familiar with the contractor in your area," according to Kimberly Anderwood Hoy, JD, CPC, is the director of Medicare and compliance for HCPro, Inc.
As a result of the protest settlements, these RACs will be subcontracting with PRG-Schultz and Viant. (PRG-Schultz will work with Diversified Collection Services in Region A, CGI in region B, and HealthDataInsights in Region D. Viant Payment Systems will work with Connolly Consulting in Region C.) PRG-Schultz and Viant will have different responsibilities—including possible claim review—in the various regions.
Editor’s note: To view this information on the GAO Web site, visitwww.gao.gov/decision/docketand enter file #400443. For additional details from CMS, visit their Web site atwww.cms.hhs.gov/RAC.
This story first appeared as a breaking news item from the editors of The Revenue Cycle Institute, a division of HCPro, Inc. The Revenue Cycle Institute is a multidimensional resource for healthcare professionals offering consulting and on-site education for a range of revenue cycle issues.
Massachusetts public health officials have begun monitoring heart programs at Massachusetts General Hospital and at St. Vincent Hospital in Worcester after discovering that they had high death rates in 2007 among patients who underwent cardiac catheterization procedures. An analysis of mortality data showed that 43 of 1,543 patients died at Mass. General and 16 of 112 patients died at St. Vincent. The death rates were significantly higher than the state average for patients who undergo the procedure to remove blockages in their coronary arteries.
Jim Houser has stepped down as chief executive of Nashville-based Saint Thomas Health Services, a victory for physician leaders who had questioned his leadership. But it remains to be seen whether a shift at the top softens potential budget cuts that have some doctors concerned about the future of its four hospitals. In casting no-confidence votes against Houser's leadership less than two weeks ago, medical staff leaders at three of those hospitals raised concerns about how proposed budget cuts and a move to a more centralized management could affect patient care.
UnitedHealth Group is testing a new model of healthcare that many policy experts say holds great promise but has yet to prove itself. Under the medical home model, the insurer will try giving doctors more authority and money than usual in return for closely monitoring their patients' progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them more for the overall quality of care patients receive.
A Brevard County, FL, hospital system has been exchanging $100 gas cards in recent months for copies of bills showing what its competitors charge for certain medical procedures. Wuesthoff Health Systems says the price data it is accumulating will allow it to compare its rates for services and procedures covered by various health insurers. It says it also plans to make the information available on the Internet so that cost-conscious patients on the Space Coast can comparison shop before deciding where to have scheduled surgeries.
Kansas Gov. Kathleen Sebelius is near the top of President Barack Obama's list of candidates to head the Health and Human Services Department, a senior administration official said. Other candidates, including former Clinton White House chief of staff John Podesta, remain in the mix. A decision is not imminent, a senior administration official said, speaking on the condition of anonymity.
