“Leadership is one of the great stupidities of management consultancy.”

Shitty Work Thing

A … thing … for healthcare administrators braving their way through shitty work things

Airfares in and out of Las Vegas’s McCarran International Airport are relatively inexpensive.

That’s good because that’s where you are.

But you’re not on the strip, nor touring the Hoover Dam, nor hiking in the Grand Canyon.

No, you’re at Clark County’s most infamous tourist attraction: America’s largest landfill.

You’re standing on a mountain of garbage in the middle of the 2,200 acre Apex Landfill with nothing but trash all around you. There are the remnants of bulldozed refuse for as far as you can see. There are neon-colored puddles of liquid at every step. There are so many birds they block the sun.

And that stench! It’s enough to take your breath away.

Standing in the middle of America’s largest landfill wondering how the heck you got here is what it feels like to go through a shitty work thing as a healthcare administrator. People suck. Bosses are assholes. The job’s requirements are out of touch.

You’d love to sit down and rest: trash. No matter how high you try to climb: still standing on trash. The path out: through lots of trash.

It’s lonely. It’s depressing. It’s difficult.

Time and again I’ve seen healthcare administrators get stuck in a rut at work and struggle to climb out — including myself.

This is My Story

Her assistant phoned and asked for my presence. I immediately made my way to her office. We exchanged hollow pleasantries.

“Have you seen the movie Sophie’s Choice?,” she started.

“No,” I responded. It wasn’t the first time she’d attempted to use the premise of a movie to communicate something important. So I knew something was coming.

“It’s the story of a Holocaust survivor.”

“Okay.”

She got to the point.

“Sophie arrives at Auschwitz with her two children. The Nazis force her to choose which child gets to live — her son or her daughter. She agonizes over the decision and ultimately chooses her son.”

That’s dark, I thought to myself.

It was the beginning to the end of something that just six months prior felt like a remarkable opportunity.

It was the beginning to the end of something that just six months prior felt like a remarkable opportunity.

The department I was leading had been eagerly gobbled up by an organizational restructuring as part of a shiny new unit created to carry out an exciting new strategy. I was excited! The forefront of change! A career-altering moment!

But a week into the new world I was ask-told to take leadership over a dysfunctional department in addition to my cutting-edge program responsibilities. “I think you have capacity,” she said.

A few days later I followed with a dutiful yes after convincing myself of the “opportunity.”

But it was too much. The problems on one side kept me from the opportunities on the other. It was an exhausting six months of slow progress, limited access to leadership, murky communication, 30+ direct reports, limited HR support, non-existant IT support, angry colleagues, torturous meetings, missed (unrealistic) deadlines, and even a co-worker backstabbing.

My reward was this excruciating conversation.

“Drew, you have a Sophie’s choice to make,” she presented, “You must choose between this amazing opportunity (it wasn’t), working for a great boss (they weren’t), and doing important things for the company (it was a disaster) or going to work in an area you’re passionate about (true), as part of a new department (uh oh), for someone who until this moment has been your peer (backstabbers are never pleasant to work for).”

“And since both of those leaders are at the director level you’re going to have to become a manager.”

Six months of landfill walking had climaxed with a Choose Your Own Demotion Adventure.

A Shitty Work Thing is Difficult and You Need a Little Help

It wasn’t supposed to feel like this. It wasn’t supposed to be like this. It wasn’t supposed to be this.

But here you are.

Shitty work things are shitty because they get in the way of doing good work — which is the reason we got into healthcare administration to begin with. Being a healthcare administrator is already hard enough. Add a shitty work thing on top and the job can quickly become undoable.

So I created a … thing … for healthcare administrators braving their way through shitty work things. It’s called, wait for it … Shitty Work Thing for Healthcare Administrators.

A shitty work thing is just that: a prolonged period of job dissatisfaction stemming from something shitty at work.

Shitty Work Thing for Healthcare Administrators is designed to help you move through it. It’s part reflection, part inspiration, and part motivation. Shitty Work Thing for Healthcare Administrators delivers twenty emails over twenty work days to help you focus on the work, tune out the noise, and find a path out.

That’s what we’re after: getting to the other side. Because there is a path out of this landfill.

This experience — this right now — is something you’ll learn from. And you’ll get to apply what you learned to new situations with new employees, new bosses, new projects, and new anything else that needs to be managed. Going to work will become enjoyable again.

But that’s getting ahead of ourselves.

My friends made it through shitty work things. My colleagues made it through shitty work things. Employees that worked for me made it through shitty work things. I’ve made it through shitty work things.

As in the cases of all those, you just have this difficult task before you: getting through yours.

They did it. We did it. I did it. You can do it.

And the twenty emails of Shitty Work Thing for Healthcare Administrators were crafted to help you do just that.

Learn More: Shitty Work Thing for Healthcare Administrators

The “Now What?” moment is a moment of action

Four days into a department reorganization and my new boss called me in for a conversation that concluded with, “Do you want to be the contact center manager?”

“NO!,” I silently shouted. I had been looking forward to focusing on building the population health program I was originally hired for and I didn’t have the slightest clue of what was required to manage a contact center.

“I think you have the capacity and capability,” the senior vice president ask-told, “Why don’t you take a few days to think about it and let me know.”

There really wasn’t any answer to give except “Yes.” So I did.

Now what?

The healthcare delivery operating environment is regularly producing “Now what?” moments — a moment when an administrator has beed told, asked, or discovered they now “own” a business problem that must be solved and find themselves in a moment of reflection asking, “Now what?”

Often the question is in silence to one’s self. Occasionally, people are more fortunate and get to ask it a little louder to a committee or an executive team. But even that can get tricky because topical expertise is a fleeting attribute in a fast-paced operating environment.

We’ve seen “Now what?” come in a variety of a flavors, but some seem to be more common, including the ask-tell flavor told above.

Another frequent variety is the execution imperative. There is a moment that arrives after the strategic planning activities of analysis, thought, and discussion when the new strategy must be operationalized and there isn’t a clear path forward. “Now what?”

Or our favorite, the innovation mandate. Someone, high from above, declares, “We need to be more innovative!” And proclaims to all in attendance that they must come up with three innovative ideas by the next meeting. “Now what?”

The last, which we cheekily call the oh-shi!, is when it becomes apparent to an administrator that the operation is facing a significant business problem — brought about by internal or external forces — that will impact the department, service line, or organization in some influential way. “Now what?”

“Now What?” moments often come from a place of fear, inexperience, or the unknown.

But the “Now What?” moment is a moment of action.

It means it’s time to do something. It’s time to shift attention to making something happen. Go.

There’s a long list of available actions. Do some research. Phone a colleague. Meet with IT or HR or project management. Plan a pilot. Discuss with your boss. Call a partner.

But the moment is now.

Don’t wait for permission, for more information, or for someone with more expertise to appear like I did in the contact center. Those weeks and months is a valuable time for doing. Because there is a moment that follows “Now what?” when no action is taken.

We won’t talk about that one. That moment is much more painful with much less individual agency. And, crucially, avoidable.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

Formalizing The Way We Work — An Organized Way of Working

For at least the last decade — perhaps longer — companies have been explicitly trying to adapt to a VUCA world.

Volatility.

Uncertainty.

Complexity.

Ambiguity.

Volatility refers to the speed and turbulence of change. Uncertainty means that outcomes become less predictable. Complexity refers to the growing interdependence of social and economic forces. Ambiguity indicates the haziness of reality.

These are the general conditions of our industry (professional services) and the industry we serve (healthcare delivery).

In short, it’s crazy and uncertain out there.

Awareness and readiness become paramount when VUCA is the prevailing reality. Awareness and readiness allow a company to respond to problems and take advantage of opportunities, both of which are in abundance in a VUCA world.

To respond to problems and take advantage of opportunities a company must be organized.

Being organized becomes essential to existence and scaling.

Being organized is a competitive advantage. That’s the key to existence.

Being organized allows more work to be completed. That’s the key to scaling.

Being organized allows decisions to be made by the most appropriate employee. That’s the key to creating a responsive company.

Responsive to customers. Responsive to the market. Responsive to each other.

To become organized, we must:

Share, process, and make as much information available to as many people as possible
Turn knowledge into learning and improvement
Encourage everyone to contribute

With the goal of creating reliable, repeatable, and adaptable ways of working.

Reliable, repeatable, and adaptable ways of working provide exponential benefits.

All of them can be summarized with the “Beamed to Mars” principle. It asks, if a co-worker happens to be beamed to Mars tomorrow, could someone in the organization step-in and fulfill their current responsibilities?

Mars excursions happen all the time: weeks of vacation, a series of sick days, family emergencies.

The red planet is not a lonely place.

Perhaps the greatest benefit of organization is that which rolls up to the individual employee: it allows for greater autonomy and creativity by routinizing the work that can be routinized and creating slack to work on more interesting and difficult problems.

That’s our operating goal. To organize the company, the work our employees do, and how that work is informed and created.

Becoming organized starts with the company’s intention:

Help middle manager administrators transform healthcare delivery.

It continues with outlining our company’s principles, the foundational beliefs that drive our behavior and reasoning:

Start Now. Go Fast. — as in moving appropriately quickly and efficiently with a willingness to experiment our way to the best solution
Know-How — as in expertise and skill in everything that we do
Execute. Start Again. — as in getting things done is our ultimate outcome

Then it continues with our performance expectations of every employee:

Be Curious — to explore, to learn, and to improve.
Be Flexible — in your approach, acceptance of responsibilities, and in providing assistance.
Be Ready — be prepared, be responsive, and be aware.
Take Initiative — to get started, to communicate effectively, and to make things better.
Contribute to the Whole. The responsibilities specific to your role are important. We also request that you contribute to building a company.
Commit to the Approach. We have designed a way of operating. Follow along or help us find a better way as everything is open to improvement.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

A theory for successful healthcare delivery transformation

Middle Managers, Technology, and Widespread Experimentation

Healthcare is changing.

The Patient Protection and Affordable Care Act (the ACA, “ObamaCare”) has been the catalyst for change occurring in the healthcare delivery industry. The Affordable Care Act is almost assured to carry that crown eternally as the industry navigates through this next round of healthcare reform under a new administration.

Though healthcare reform is often spoken of as a discreet event, the reality is that transformation has been, and continues to be, a series of ongoing events. Transformation is occurring and efforts to improve quality, reduce cost, and improve access will only continue.

Three important questions arise from this reality:

1. Where is healthcare transformation occurring?

2. Who is responsible for implementing healthcare transformation?

3. How is healthcare transformation being implemented?

The answers are the story of healthcare transformation.

Empowered middle managers will determine the success of healthcare transformation.

Healthcare transformation is continuously creating new operational requirements. Provider organizations (physician groups, healthcare systems, payers, clinically integrated networks) respond to these requirements, problems and opportunities, with strategies determined by executives. But as they have always been, middle managers are tasked with implementing and executing strategies.

Healthcare transformation is occurring where healthcare is being delivered: in places like the clinic, the radiology department, the contact center, and the case management department. The individuals charged with leading the clinics, the radiology departments, the contact centers, and the case management departments are those that are implementing these changes.

Middle management, often maligned, is crucial to healthcare transformation. We believe healthcare delivery transformation is really a story about empowering middle managers with access to technology. But it’s difficult to be a middle manager today: their plates are full, technology constraints they and their staff experience are real, and the velocity of industry change is increasing.

Middle managers have three resources to implement and execute strategies: people, process, and technology.

Historically, middle managers have only had true agency over people (like hiring, training, and promotion) and process (such as determining the way in which employees do the work and how customers experience the service). Technology (or the systems that managers and employees utilize to do the work) has been the domain of the CIO and the IT department. As healthcare delivery has grown more complex and technology needs more intense, the CIO has been forced to focus on more strategic IT needs like ICD-10, new EMR implementations, and issues related to mergers and acquisitions.

Technology, as a resource for middle managers for which they have decision-making power to implement and customize, is key to successful industry transformation. Cloud platforms are now allowing organizations to truly empower middle managers with all three resources needed to implement the strategies of transformation: people, process, and technology.

At the moment technology is becoming almost necessary, it is also becoming a barrier.

While not every problem is solved with technology, nor does every opportunity require technology, increasingly solutions are dependent upon technology. Just like other industries, technology is becoming central to the actual delivery of service and facilitation of business processes, moving away from technology as a series of support applications. Opportunities abound for technology beyond the core systems already in place to consume process in healthcare delivery organizations.

Healthcare delivery organizations are in need of a new flexible, complementary technology layer to adapt to this new operating environment.

For example, the EMR is a necessary piece of technology. It’s the workhorse technology of healthcare delivery. It ensures stringent adherence to process. But the inherent rigidity and weight mean functionality, existing or promised, hasn’t adapted well to the requirements of an evolving operating environment. The EMR has not adapted to the flexible requirements of healthcare transformation.

Healthcare delivery requires a better way to become responsive to problem-solving and responding to opportunities brought about by transformation. It requires a flexible, complementary software solution that can be implemented anywhere, connect with anything, and is perpetually customizable.

But IT departments are not resourced for this change. And professional services will play an enormous role as departments transition.

The IT department has — unintentionally — become a roadblock.

This is important because the velocity of industry change requires a new commitment to speed, scale, and scope, where speed is the pace at which ideas are implemented, scale is how ideas are spread throughout the organization, and scope is the number of implemented ideas.

IT has unintentionally become a roadblock. Technology now touches almost every aspect of healthcare delivery. Given this growth and new requests that come along with it, IT leaders have been forced to create a bureaucracy that allows only the most important and pressing needs to be addressed. This bottleneck prevents progress in an environment that is demanding more and more technology to support organizational initiatives.

Side Note: I’ve received pushback from IT leaders on this notion of being a roadblock. Of course! Of course! Not every IT department and leader is this way. But if the idea of being a roadblock is something that makes your hair standup, I implore you and your staff to reflect on the following questions:

Are you helping middle managers solve their business problems? If the answer is anything other than an immediate “yes,” you might have a problem.
What is your initial reaction to a new technology idea? If it’s a project request form, explaining why something is going to be different, or something similar, you might have a problem.
Do you employ more business analysts and developers than desktop support or other other hardware jobs? If it’s the latter, you might have a problem.

For good measure — survey the last ten people that emailed, phoned, or stopped you in the hallway asking for help. What was the outcome of each?

There’s still time to make it right if you’re unhappy with the answers.

Okay, back to it.

The same cost-cutting and value-improving pressures facing operational departments are facing IT, too. With pressures to reduce headcount, an increasing number of projects, and rising support requests, increasing needs from operational departments become more difficult to fulfill. Technology needs of operational entities are viewed as a lesser priority with the focus on other strategic priorities and enterprise initiatives like ICD-10, Meaningful Use, privacy and security, EMR replacements, technology issues related to mergers and acquisitions, clinical data integrations, etc.

IT must transition into a role as technology facilitator, helping to diffuse technology-supported solutions as quickly as possible. This mentality will allow organizations to take advantage of new competitive priorities and improvement opportunities.

An organizational commitment to speed, scale, and scope, through IT diffusing technology throughout the organization, is imperative to embracing transformation. It allows departments and middle managers to launch more pilots and find out quickly which operational initiatives work and those that don’t.

Because the secret to innovation and successful transformation is widespread experimentation.

As commonly held as the notion that organizations must innovate to continue to create value is, healthcare delivery organizations continue to struggle to ensure that innovation is systematically part of their culture, part of the day-to-day approach of solving problems or taking advantage of opportunities.

While great progress has been made in finding new ways to deliver healthcare, there is truly only one way to continue to figure it out: try more ideas. Successful innovation is simple: widespread experimentation.

Admirably, healthcare delivery has long been experimenting. It’s the essence of the scientific method, the pilot method, trial and error, Plan-Do-Check-Act cycles, Kaizen, process improvement, etc. Whatever the organization calls it, it’s imperative to do more of it.

One way to approach innovation: Pilot Projects

If innovation is the way into the future, and it most certainly seems to be, healthcare delivery firms must embrace widespread experimentation and make the tools, both tangible and intangible, acceptable, available, and accessible.

Creating responsive healthcare delivery firms.

Organizations that empower middle managers with people, process, and technology are responsive healthcare delivery firms. Creating responsive healthcare delivery teams allow middle managers to more quickly solve problems and take advantage of opportunities brought about by healthcare transformation.

The responsive healthcare delivery firm empowers middle managers with agency over people, process, and technology with the intention of piloting as many new ideas as possible.

Responsive healthcare delivery teams allow middle managers to more quickly solve problems, take advantage of opportunities brought about by healthcare transformation, and move organizations forward.

It’s almost certainly the only way to successfully transform.

Central Management Podcast | Radhika Palta

A podcast for healthcare’s middle managers

Radhika Palta had to call the metaphorical fire department to help fight a fire in her first week on a new job.

Middle management is in a golden age. But it’s harder than ever to be a middle manager. Central Management is stories, tips, and wisdom to make it easier to be better.

Central Management is made possible by Status:Go

Status:Go is a technology implementation partner for healthcare delivery provider organizations. Learn about our work at CentralManagement.work.

This week’s guest on the Central Management podcast is Radhika Palta, administrative director for the surgery department of a West Coast academic medical center.

“Most of the time, I think, your success is how you deal with the outcome of the really challenging stuff that you go through.”

The highlights of our discussion:

4:30 — Radhika introduces the story of her first week on a new job and the near meltdown that met her

7:20 — Details of the drama!

8:20 — Of course, she almost quit

11:10 — A plan comes to light!

12:40 — Of course, she didn’t quit, and tells us why

14:00 — Radhika recounts the steps she took to begin solving the problem

17:10 — The solution!

19:00 — In summary, lessons learned

Central Management Podcast | Jordan Woods

A podcast for healthcare’s middle managers

Middle management is in a golden age. But it’s harder than ever to be a middle manager. Central Management is stories, tips, and wisdom to make it easier to be better.

This week’s guest on the Central Management podcast is Jordan Woods, heart and vascular service line director for a large healthcare system located in the Midwest.

“I enjoy the challenge of trying to be a chameleon and work well with anybody and be effective and appreciated by a lot of different types of people.”

The highlights of our discussion:

2:50 — job responsibilities of executing on executive project vision, whether he participates in developing that vision or not

8:20 — the impact of dictated quick-turnaround deadlines on manager and employee engagement when implementing projects; and the flip side of that: organizations are under pressure to get lots of things done

14:00 — Jordan enjoys his job and the challenges it presents, especially developing people (he is measured(!) on his success in helping his employees develop new skills that allow them to move into other positions in the organization)

19:30 — the biggest challenge for a middle manager is managing executive expectations about project timelines — and navigating the desires of the executive versus employee engagement (Jordan recently had a conversation with a hospital president where the individual made it clear they think managers and directors are the most important people in the organization)

26:10 — the importance of spending time as a middle manager in becoming a visionary leader involved in organization strategy; middle management, though under appreciated, is a great platform for career development

30:56 — one last brilliant insight from Jordan

Central Management is made possible by Status:Go

Dinnertime: Henry Mintzberg

Today for dinner, the genius of Henry Mintzberg.

Mintzberg in his 1994 HBR article titled “The Fall and Rise of Strategic Planning” (there’s a book by a similar title) (the article is basically an examination on the fallacies of “strategic” planning) describes two types of planners in the planning department: the extremely analytic, order focused, right-handed planner and the more creative, quick and dirty, left-handed planner. He then writes:

Many organizations need both types, and it is top management’s job to ensure that it has them in appropriate proportions. Organizations need people to bring order to the messy world of mangement as well as challenge the conventions that managers and especially their organizations develop. Some organizations (those big, machine-like bureaucracies concerned with mass production) may favor the right-handed planners, while others (the loose, flexible “adhocracies,” or project organizations) may favor the left-handed ones. But both kinds of organization need both types of planners, if only to offset their natural tendencies. And, of course, some organizations, like those highly professionalized hospitals and educational systems that have been forced to waste so much time doing ill-conceived strategic planning, may prefer to have very few of either!

In 2008 he sat down with The Globe and Mail‘s Report on Business to discuss the financial collapse. The problem, as Mintzberg sees it, is too grand a focus on individualism and not enough on community building in organizations. Hallelujah:

We should focus on building institutions and we should focus on building strong institutions and focus on building those strong institutions through what I prefer to call community-ship. In the United States particularly, they just make such a huge fuss over leadership, it has become an absolute obsession. Everything is leadership, leadership, leadership. It is not coincidental that the more fuss that Americans make about leadership, the worse their leadership is whether it is corporate or political or anything else. Their leadership is dreadful in recent years and with all of this fuss on leadership. Leadership is about individuality, leadership is about me. Even if leadership is designed to encourage and to bring along other people and engage other people, it is still the individual driving it. So, show me a leader and I will show you all kinds of followers and that is not the kind of organizations that we want. That is not the way that we build things up. I think that we need to put more emphasis on what I prefer to call, there is no word for it but I use the word ‘community-ship’, which is the idea that corporations and other organizations, when they function well, are communities. People care for each other, they worry about each other, they work for each other and they work for the institution and they feel pride in the institution.

In: The Oracle

Warren Buffett:

To be a successful investor, you don’t need to understand higher math or law. It’s simple, but not easy. You do have to have an emotional stability that will take you through almost anything. If you have 150 IQ, sell 30 points to someone else. You need to be smart, but not a genius. What’s most important is inner peace; you have to be able to think for yourself. It’s not a complicated game.

Seems like a good management thought, too.