Most financial, human resource and management concepts eventually became second-hand. With mentoring and experience, I became comfortable with most aspects of my job.

But there were several duties that I struggled with through much of my career. They remained my greatest shortcomings. But I developed strategies to overcome them. 

Root Cause of My Weaknesses

When I think about it, most of my management shortcomings relate to employee relations. I have concluded that my personality traits naturally contribute to these deficiencies.

Through various personality inventories and introspection, I know that I am an introvert and more a logical thinker than an emotional one. I am good with details, but not the best at seeing the big picture.

Your personality traits may be different, so you may have different deficiencies. But I found specific challenges in the following areas as a result of these tendencies.

My Greatest Shortcomings

Number 3. Conceptualizing a New Organizational Structure

As a novice execute 17 years ago, I was very happy to simply accept the area assigned and try to achieve the best performance. This was generally simple to do, since I had excellent directors working with me.

I was comfortable delegating tasks to them and letting them do their jobs. It was just a matter of encouraging them and serving as an advocate and supporter when they needed resources to complete an important project or task.

But the CEO and COO were very good at looking at the “org structure,” and seeing opportunities for synergies. They might shift a director to a different VP to align certain skill sets; or combine Quality Improvement with Case Management to achieve synergies; or move Infection Control under QI to take advantage of expertise in the department.

In all of the management and leadership courses I have attended, I have never seen this topic addressed.

It took me a long time to begin to see those kinds of opportunities within my division. That kind of vision seems an important yet elusive skill to acquire.

Number 2. Succession Planning

This was a very foreign concept to me. The continued success of any organization is dependent on the smooth transition of leadership and management. Anyone can, and eventually will, be replaced.

Every director and VP should have a working document, subject to regular revision, that describes how the work will be completed in their absence.

This is something that's very easy to put off. I commonly used the excuse that it would be difficult to describe a succession plan for myself that did not just consist of hiring a new CMO. After all, my team of directors led pharmacy, quality, laboratory, and medical staff relations. And none of them were physicians with my background.

But an effective leader must be able to design a plan that shifts current managers and directors into positions to take on important functions of the CMO, until another physician executive can be hired or the various duties can be transferred to other senior executives.

[embed_popupally_pro popup_id=”3″]

And Now, Shortcoming Number 1. Hesitating to Intervene With a Failing Employee

I once had a director for a small department who demonstrated a number of his own weaknesses as a manager. He performed some of his duties at a mediocre level, and occasionally demonstrated some potential to improve.

But there were issues that he really struggled with. His interpersonal skills were often lacking. He was not always accountable and would make excuses when he failed to follow through on certain assignments.

He could be very passionate about his pet projects, but somewhat passive aggressive when working on projects he didn't see as important. This was fairly obvious to everyone on the senior executive team, especially those whose directors and managers who had to pick up the slack when this employee faltered.

I knew it as well. He was definitely a C player at best. And as we encouraged and coached employees to move from C to B, or B to A players, he never seemed to budge.

Yet, I found it difficult to find concrete and specific measures of his performance to hold him to. I always wanted to give him another chance to improve. My coaching clearly failed in getting him to “up his game.”

This director was managing an important area and had a sizeable budget. He was expected to perform at the level of the other 50-plus directors in the organization. The success of the organization depended on it.

But I avoided confrontation. So I tended to let things slide longer than I should have.

The Hammer is Dropped

Through a series of staff departures and changing roles, he was made responsible for an area that typically reported to the CFO, a very seasoned executive who ran a very tight ship. So, he was moved from my division and began reporting directly to the CFO shortly after assuming those duties.

The CFO identified his performance gaps and began to coach him. He penned written warnings for the director several times, attempting to clarify his concerns regarding the director's missteps. He involved the VP for human resources, the three of them meeting to discuss this ongoing problem.

The director then committed a serious violation of one of our policies and was eventually terminated. This all happened within six months of moving to the Finance Division.

I often wondered whether the CEO and CFO had orchestrated the transfer of this director in order to bring him under a more experienced and capable senior executive. Had the director still been my direct report I doubt that he would have been moved out of the organization so quickly.

Coming Clean

So, that's probably my biggest shortcoming. Over the years I have gotten better at addressing these situations. I try to be more proactive, and provide ongoing feedback to direct reports about their performance, both good and bad. And I'm better now at setting boundaries.

Stop Right There!

I've made a commitment not to allow that to happen again; to be clear with my expectations; to provide regular feedback and to take action for the benefit of the team when action is needed.

I've also learned that “writing somebody up” should not be looked at as punishment of a poorly performing employee. Instead it serves as an unambiguous warning that the current performance will not be tolerated. And it forces all involved parties to define clearly what good performance looks like. Some managers need that wake up call to motivate them to make meaningful changes.

Minimizing the Effects of My Shortcomings

Those are some of the biggest weaknesses I've identified so far. I thought that by sharing some of the more glaring aspects of my failings, it might serve as a trigger to examine your own shortcomings and address them.

We all have them. And we shouldn't dwell on them for too long. In fact, in the long-term, we grow more by enhancing our strengths than by trying to eliminate our weaknesses.

But once you've identified your weaknesses, you can try to minimize their effects by:

1. Hiring direct reports with strengths that can offset your weaknesses;

2. Enlisting your colleagues as mentors to help identify your weaknesses and remind you when they are interfering with your effectiveness;

3. Tap into the skills of the Human Resources Department when you're facing particularly challenging employees; and,

4. Consider formal business coaching to address your blind spots.

Have you identified any professional shortcomings that have hindered your success?

Do any of my shortcomings resonate with you?

Next Steps

Please add you're thoughts and questions in the Comments. I will respond to them all.

Don't forget to SUBSCRIBE Here and complete a SURVEY .

Thanks.

Until next time.

The post My Greatest Shortcoming as a Senior Hospital Leader appeared first on NonClinical Physicians.

After considering the purchase, we decided to proceed. We signed a loan agreement and purchased the device. It would take 5 years to pay back the loan. We were convinced the device would generate procedures that would easily cover the loan payments.

Eighteen months later, we had only used the device about a dozen times, and we were stuck making that monthly payment with little revenue to offset the cost.

We had been overly optimistic in our assessment of the need for the device. And we had not considered what we would do if it failed to match the salesperson's inflated return on investment.

As a former small business owner, I have been guilty of the sin of failing to perform a basic financial analysis prior to purchasing new equipment. Furthermore, my partner and I never took the time to budget appropriately or formally plan for each coming year.

Later in my career, as I studied hospital finances and participated in regular strategic and management planning meetings, I came to appreciate their importance. In hospital management, it is expected that annual goals and budgets will be developed. And executives and their direct reports will be held accountable to them.

The earlier in its development that a healthcare organization adopts a formal budgeting and management planning process, the more likely it is to meet and exceed its goals. The old adage is true: you cannot manage what you don't measure.

The Annual Management Plan

Many hospital systems, including ours, went though a major strategic planning process every 3 to 5 years. But we found that such a plan became outdated very quickly. So we began to focus our efforts on creating an annual management plan that was strategic in nature.

This process dovetailed with the annual budget process. We could therefore push the organization to identify and pursue big goals on a regular basis.

For this post, I would like to outline a fairly straightforward, though somewhat time-consuming, process that any business can follow. This process can be adopted to medical groups, hospice organizations, nursing homes and hospitals.

When applied appropriately, it will help such organizations to optimize their performance, and drive growth and improvements in satisfaction, quality and financial performance.

I'll start by providing an outline of the process that you can follow. The goal of this planning process is to review what has happened in the recent past, analyze the current situation, and then plan for the coming year.

It’s been demonstrated many times that those with a plan are much more likely to make progress toward important goals.

So, here are the general steps to follow when creating a new management plan for the upcoming year.

Assumptions

In creating this plan, I'm starting with two assumptions. You may need to pause the management planning process and address these foundational steps first, if these assumptions are not true.

Assumption #1 – Mission, Values and Vision

Your organization has a mission, values and vision that have been articulated clearly and are understood by everyone. The goals that will be chosen for the coming year must be aligned with these fundamental concepts.

Keep the vision in mind.

The one item that could be rolled into the planning process could be updating the vision. The vision is not as fixed as the mission, so it can change from time to time. It is therefore possible to start the management planning process by updating the vision.

Then the new management goals can be selected to start to achieve the new vision. It is rare that a one year is enough to completely achieve the vision.

Here's why.

The definition of vision is as follows (from businessdictionary.com): “An aspirational description of what an organization would like to achieve or accomplish in the mid-term or long-term future.”

So, a statement such as “improve sales by 10%,” or “increase revenues and earnings by 5% next year,” are not what I consider meaningful vision statements.

A vision statement is more profound and long-term: “Our organization will become the premier provider of in-home care in our county,” or “We will be the number one orthopedic group in the state, as measured by surgical volume.”

These are big audacious goals that qualify to be part of a vision statement.

Our annual management goals are going to help us move toward the fulfilment of the vision.

Assumption #2 – Pillars

At my hospital, we identified major domains or pillars that serve as the foundation for the success of the organization. These were fairly stable, but occasionally changed. For us, they generally included the following domains:

1. Financial
2. Growth
3. People
4. Customer satisfaction
5. Quality
6. Physicians

Pillars serve as the foundation.

Some organizations include employees and physicians under the People pillar. Academic organizations might have a pillar for Research or Technology.

A Word About the Budget

Sometimes the question comes up: should we complete the budget first or the management plan first?

To some extent the processes are done in tandem. However, it is impossible to complete the budget without knowing what new initiatives, service lines or technologies are going to be developed. If a new unit is to be opened or a management firm consulted, there will be new expenses generated.

And new revenues must be added to the budget if these new services are designed to generate additional income.

The final budget can, therefore, only be completed after the management goals have been approved for the new year.

Creating the Annual Management Plan

I divide the process into six phases, each of which will be described in more detail:

1. Preparation
2. Review of previous budget, previous management plan, prior results and market analysis.
3. Analyze and discuss, including a SWOT Analysis
4. Brainstorm preliminary goals
5. Draft the list of general goals
6. Finalize plan by creating SMART goals with assigned accountability and milestones to achieve

The Annual Management Planning Process

1. Preparation

The team will need to have a basis from which to make recommendations and select meaningful goals. That will require information to set the stage for analysis and brainstorming.

A set of documents will need to be prepared prior to the first meeting. The reports that will need to be reviewed prior to, and discussed during, first planning meeting will include the following:

• Financial Statements. The Profit and Loss Statement (also called an Income and Expense Statement). You probably want to look at 3 to 5 years of annual reports, if possible, and 12 months of monthly data. These will also include a comparison of the budget created last year to the actual financial performance.
• Volumes. Is the number of clients, patients, residents, etc. increasing or decreasing? What are the trends? Depending on the business, it could be the number of widgets sold, tests completed, or treatments delivered.
• Market Analysis. To the extent possible, bring in an analysis of what has happened over the past year or so with respect to the market. How many competitors are there? What is the market share of each? Is your share going up or down (you may be growing but still losing market share if others are growing faster).

Other Considerations

The Preparation Phase also includes determining the following:

• Who will be attending? Just the executive team (CEO, COO, etc.), or directors or managers? Who will be presenting the reports and leading the sessions? Who will take notes?
• Where will the review, brainstorming and selection of goals take place? Will some sessions be held at an offsite location (at a so-called retreat)? This tends to help avoid interruptions and distractions more than holding all of the meetings at the main office location.
• Will an outside speaker be needed to help set the stage with a broad market overview, or a review of the regulatory environment for your business? Perhaps a speaker with a legal or risk management perspective is needed. Or you might ask someone from one of your professional associations to provide a summary of recent trends in the field (like the American Hospital Association, the American Medical Group Association or the Ambulatory Surgery Center Association, or similar national or state associations).

Someone will need to be assigned to make the arrangements (reserve meeting space, hotel, meals, etc.).

Conference room for discussing and debating new goals.

2. Review and Market Update

This phase will take from one-half to one full day to complete.

At the beginning of this review, there should be an effort made to do some team building. This is something that should be done all year long, but at this meeting it will be helpful if the participants feel comfortable openly discussing issues with one another.

Team Building

You might simply have each person describe their background and their families. Or you can go further by sharing little known facts, and getting into hobbies and interests outside of work.

You can use specific techniques to break the ice and generate rapport among the participants, such as:

• Two Truths and a Lie. This is one of my favorites. In groups of 4 to 10, each member identifies three “facts” about themselves, two of which are true and one of which is completely made up. The others attempt to guess which item is false. Then the speaker explains which is false and expounds on the others. Each takes a turn doing the same.
• The Observation Game. Everyone is paired up with a partner. Then you both stand facing each other for about a minute, observing the appearance of their partner. The moderator has everyone turn away from their partners. One partner changes something about their appearance, such as removing eyeglasses or a bracelet, placing a pen in their shirt pocket, etc. Then the partners are asked to turn towards each other and the observer is given 30 seconds to determine what is different. Then the partners switch roles.

These games tend to help participants loosen up and feel comfortable with the group. When appropriate, more sophisticated team building methods can be employed.

Review of Reports with Discussion

Once the team building is done, a review of the prior year updates on financial, HR and satisfaction data are completed. This should be sufficient to prime a smaller organization and might take 2 to 4 hours to complete.

For a large organization, this might be an all day retreat with the hospital board, CEO, CFO, CMO and other senior executives, that includes a review of all of the above issues. It might include other presentations, such as:

• an overview of national trends in your business by a professional society representative as noted above,
• a lecture by a futurist about innovations in healthcare that might impact your organization,
• new healthcare delivery models, and
• changes coming to Medicare and Medicaid reimbursement.

This time is spent learning, digesting and internalizing new information in preparation for the next stage of the process. Discussion should be encouraged, but it is a bit early to start talking about specific goals or new initiatives.

Be sure that these reports are distributed PRIOR to the meeting so participants can come prepared to discuss them.

3. Analysis and Discussion

Components of the SWOT Analysis

At this point, the information reviewed needs to be put into context and analyzed. Probably the best way to accomplish this is to do a SWOT analysis. I have described this process in some detail at From SWOT Analysis to Inspired Goal Setting.

Briefly, a moderator is going to lead a discussion encouraging participants to identify the Strengths, Weaknesses, Opportunities and Threats that exist for the organization. These observations need to be captured in written form during an unbridled brainstorming session without regard to the relative importance or magnitude of the strength, weakness, opportunity or threat.

During a break, someone will then combine and categorize the results of the SWOT Analysis. The break for this can be as brief as a lunch or overnight break, or over a period of days back at the office.

4. Brainstorming Preliminary Goals

Following the collation and categorization of the items identified during the SWOT analysis, a separate meeting will be held to write out goals based on the analysis.

This SWOT analysis can drive the process by creating goals that:

• Capitalize on the Strengths of the organization,
• Address the Weaknesses of the organization,
• Take advantage of Opportunities open to the organization,
• Minimize Threats to the organization, and,
• Address combinations of the above factors.

When the team is together again, everyone takes turns articulating goals that follow the above outline. At this point, the goals do not need to be written in final form – just a form that is easy to understand and categorize under a given pillar.

Each goal is assigned to one of the Pillars. To facilitate the prioritization process, each goal can be listed on a document under the appropriate pillar. Then each team member assigns a number to the goal indicating the relative importance of each, and the name of a team member that should have accountability for the goal if it is adopted.

Ranking the proposed goals.

It is probably best to use three levels of importance:

1. Most critical and important – to be addressed quickly
2. Secondary importance – address if resources allow after goals rated #1 have been addressed
3. Least important – possibly to be considered at next year’s planning process, if ever

Someone must then calculate the average ranking of each goal. The list of goals and rankings must be distributed and discussed at a subsequent planning meeting.

5. Goal Selection

The CEO or other leader presents the list of draft goals and rankings at a subsequent meeting.

The team will look at the importance and balance of each of the goals. It will also consider the budgetary implications of the proposed goals. If not presented previously, estimated expenses and/or potential income associated with each goal will be listed parenthetically.

The team will select goals with the highest rankings, and confirm that the “owner” of each goal is appropriate and that it is assigned to the correct Pillar.

By the end of the meeting, each team member will have a list of goals which he/she will be responsible for during the coming year.

6. Write Finalized Goals and Management Plan

Each leader is asked to rework his or her goals offline such that the statement of the goal includes ALL of the following components (as discussed in How I'm Using Smart Goals). Each goal will be:

• Specific. It states a change that is clear to anyone reading the goal. It is not general in nature like “improve safety” or “reduce employee issues.”
• Measurable. The goal itself states or implies the change in the measure, such as “increase revenues by 10%,” or “reduce nursing turnover in the ICU from 10% to 6%.” Or it will describe a clear endpoint, such as “opening of the new unit.”
• Attainable. The goal should be a stretch to accomplish, but still possible.
• Relevant. It addresses an important issue that will support the previously described vision and make a significant contribution to the organization's finances, quality, community standing or similar aspect.
• Time-specific with a deadline. You should at least define the quarter when it will be completed. In addition, separate from the deadline, a series of milestones should be included as a footnote, or separately in another document, in order to support the next step of the process.

Following some “wordsmithing,” the team and/or the board or CEO finalizes and approves the plan.

Using the information within the document, a dashboard is created for each of the accountable parties that lists each goal, the milestones for the goal, and a place to write final grade for the goal.

Dashboard for the new goals.

The management team will review this document quarterly in order to maintain accountability AND to identify when assistance or resources are needed.

Conclusion

I've tried to provide a brief overview of a management planning process that any organization can follow. It can be adapted based on the resources available to organize the planning process.

Once the goals have been selected, budget aspects applied and accountable parties assigned, the hard work of implementation follows. However, following this process on an annual basis will greatly improve an organization's chances of continuing to grow and succeed.

Next Steps

If you're part of an executive team, pull out your annual management plan and see if it follows the guidelines presented here. Is there a dashboard that can be used to track implementation of the goals for each VP or Director?

If you are just getting into management, ask the CEO or Executive Director if a Management Plan exists, and look it over.

Check to see if SMART Goals are being used and if there is a single accountable owner of each goal.

If you're the leader of a small to medium-sized medical group or similar organization and you don't have an annual management plan process, start to develop one using these suggestions.

Don't forget to Subscribe.

Take my Survey.

The post Create a Wildly Effective Annual Management Plan appeared first on NonClinical Physicians.

How to Unlock Leadership Through Coaching

My thinking about coaching has been evolving.

The Death of Socrates – by Jacques-Louis David

As I described in my post comparing coaching and mentoring, coaching can be defined as the process of helping someone improve a skill by offering feedback as an impartial but knowledgeable observer.

In that model, a coach is focused on improving an individual's skill in a certain area. This follows the old sports model of coaching.

Batting and pitching coaches in baseball, or swing coaches in golf are common examples. As experts in those areas, coaches closely observe an athlete and offer advice and feedback to help fine tune the athlete's performance. These coaches focus on seeing what the coachee cannot see, and providing insight to them.

Such a coach can be contrasted with a mentor. Generally, mentors are persons who help to guide the mentee over a much longer time frame to achieve personal or professional maturation. A mentor may offer resources, like books or courses, and will point out career options to consider and pursue.

A More Nuanced Understanding of Coaching

I came to appreciate a more meaningful and effective definition of coaching during the American Association for Physician Leadership Spring Institute in New York City. In a previous post (Pursuing Resilient Physician Leadership), I described my experiences attending the conference.

Coaching was the topic of the second course that I attended. In it, Ed Walker provided an introduction to coaching as it relates to physician performance.

According to Walker, the updated definition of coaching is a process of inquiry used to “unlock potential and maximize performance.” The coach does not require expertise in the field of the coachee (baseball, golf, management, leadership).

Instead, the coach must know how to use appropriate questioning, much like the Socratic Method, to foster insights in the coachee that lead to self-awareness, motivation and growth.

The course included a didactic portion and group discussions. But it also provided several opportunities for the participants to practice and observe coaching in three-member teams involving a coach, a coachee and an observer.

Walker distinguished mentoring from coaching by noting that mentorship is a “personal developmental relationship in which a more experienced or more knowledgeable person (the mentor) assists a less experienced or less knowledgeable person (the apprentice, protégé, mentee) in the acquisition of advanced knowledge and skills.”

I found this experience to be very instructive.

Following my participation in the course, I read several books about coaching, including the classic text by John Whitmore, Coaching for Performance that was recommended by Walker.

In this post, I'll try to summarize my take on the topic, based on my integration of these learning experiences.

Comprehensive View

The term “coaching” can be applied to a wide array of interactions between a coach and those being coached: teaching, mentoring, influencing, leading, tutoring, advising, counselling, consulting, supervising, and managing, to name a few.

Walker noted that, in his model, coaching is similar in some respects to psychotherapy. They are both non-directive and involve talking with, and listening to, another person. And both are carried out in a trusting, non-judgmental, confidential manner.

But coaching is NOT therapy.

There is no illness to be cured. And the focus is on the participant succeeding at organizational goals and professional growth, rather than addressing personal issues or mental illness.

Further Distinctions

He points out that a mentor guides. A supervisor checks your work. A counsellor listens and supports.

But a coach asks questions, similar to the Socratic Method, and helps the coachee discover and clarify for themselves what needs to be done to achieve a desired goal.

Coaching for Performance

The role of the coach is to ask questions, listen, reflect, and encourage the coachee to do the following:

1. Reframe a problem as a goal. For example, to transform the issue of “being unhappy in my job,” to the goal of “finding or creating a job that I am passionate about.”
2. Review the current circumstances, and what has worked and what has not worked in the past.
3. Identify the “universe” of potential actions that might be taken to move closer to the goal.
4. Decide on a course of action and report back at the next coaching session.

In his book, Whitmore describes how coaching can be used in many settings, both formal and informal. He spends a significant amount of time extolling the virtues of coaching as an effective approach to managing.

He emphasised the benefits of coaching over directing and writes that coaching…

• empowers managers,
• promotes growth,
• reduces the need to micromanage, and
• produces happier, more independent employees.

By learning coaching principles, the leader will be better positioned to enhance listening, fuel engagement, and increase accountability.

Whitmore believes that coaching is an ideal way to approach interactions with direct reports.

“The coach is not a problem solver, a teacher, an advisor, an instructor, or even an expert; he or she is a sounding board, a facilitator, a counsellor, an awareness raiser.”

In a previous post, I described a meeting of me, my COO and the laboratory director. The purpose of the meeting was to discuss the challenges my director was having with one of her employees. It is a good example of the use of coaching to help her arrive at a plan for addressing this challenge.

Professional Coaches

At the extreme of this continuum are the paid professional business coaches. Such coaches use the same approach, and are unlikely to offer advice. They do not serve as consultants. They do not require deep knowledge of the content area.

Their primary role is to question the “student” in a way that encourages him/her to identify solutions themselves.

They follow a strict code of conduct, such as those promulgated by the International Coach Federation. They usually use contracts to describe their relationships.

Mastermind Groups

Finally, as part of this discussion of coaches, I want to address mastermind groups. Although mastermind groups were written about over 70 years ago, they are seen as a new phenomenon and have become very popular recently.

A mastermind group may resemble group coaching, but they typically also include sharing of advice, mentoring and networking that deviate from the definition of coaching that I'm using here.

Conclusions

In summary, coaching is a process in which the coach, through the Socratic Method, attempts to foster awareness, insight and accountability. He or she assists in the professional development of the person being coached resulting in greater:

• Independence
• Accountability
• Leadership
• Motivation
• Clarity
• Self Reliance
• Self Determination

Coaching also enhances the coachee's ability to listen, ask questions, reframe objectives, and support and encourage others.

Next Steps

For physician leaders, I encourage you to do the following:

1. Read John Whitmore's book, Coaching for Performance.
2. If you're a member of the AAPL, consider attending the next presentation on Coaching and Mentoring.
3. Begin to apply coaching principles to your interactions with colleagues and managers.

Sign up for my newsletter here.

Take a short survey here..

The post Unlock Leadership Through Coaching appeared first on NonClinical Physicians.

It was early August, and Julie and Pat had already received the most recent update on Julie’s balanced scorecard. The scorecard listed four key responsibilities as well as the three goals she and Janice had agreed upon at the beginning of the year. The scorecard contained data through the second quarter, ending June 30.

After some small talk, and briefly discussing a new manager on one of Julie’s units, they shifted their conversation to Julie’s scorecard. During the previous year the entire organization had implement this formal, objective evaluation process as a pilot. It had worked well, so it had been officially implemented in January.

Reviewing The Scorecard

Pat commented, “I’ve had a chance to look over your scorecard. It looks like almost everything is on track. The performance of your department in the financial, growth and patient satisfaction areas is at the above average level. The second quarter performance in quality was better than the first quarter. So, I want to commend you for that.”

“I notice that you had an uptick in turnover of your staff in the second quarter. It looks like that will push your overall score for Employee Engagement below the minimum threshold. We should probably talk about that one. Is there something I can do to help support you in this area?”

Julie responded. “Yes, I saw the spike in turnover. So, I worked with HR and reviewed the turnover for the past five years. This issue seems to be related specifically to CNA turnover. Nursing turnover actually looks very good. Looking back, there always seems to be a peak in turnover in the second quarter.”

“I worked with my managers to identify any employee concerns. But the increase this quarter is actually smaller than the average second quarter increase for the past five years. I'm confident that the third quarter numbers will be quite low and our performance for the year will be very good.”

Pat responded, “That's good to hear. I think it was great that you took the time to look into this before our meeting today. Your explanation makes sense. Now let's look at where you stand on your three goals for this year…”

How to Evaluate Direct Reports

As a physician executive, you will be blessed with the opportunity to work with some great directors and managers. They are called your “direct reports.” You will be held responsible for their performance as well as your own.

In your executive role, you will use your management skills to identify goals and ongoing performance measures to demonstrate the success of your division. The performance of your directors’ departments and their employees will be key to your division performance.

As a wise administrator, you will have neither the interest nor the time to micro-manage your direct reports. However, you will tools that allow you to monitor their performance and alignment with the rest of your division and with the organization as a whole.

You will have limited time each month in which to do this. Frequently, you will spend significant amounts of time meeting with other senior executives, including the CEO. You will be presenting updates on your division's performance, writing proposals, negotiating contracts and providing coaching and mentoring to other team members.

Competing Responsibilities

If you are a hospital chief medical officer, you will be preparing presentations about quality, patient safety, infection control, length of stay, and performance by contracted specialty groups, as outlined in the Eight Essentials Abilities.

Therefore, you need a system for motivating and supporting your direct reports. You’ll require a tool that lists their core responsibilities, and monitors their success in achieving them.

If your organization still uses an annual evaluation based on each director’s job description, the evaluation will be subjective and not very useful. It won't do much to align your direct reports’ daily and weekly efforts with your division goals.

An annual evaluation is basically useless with respect to day-to-day management. What you really need is a tool that will provide clarity for your direct reports and enable them to focus on important goals, and maintain accountability throughout the year.

The best way to do so is to use a balanced scorecard and key performance indicators (KPIs). By agreeing on a set of ongoing performance expectations and tracking them over time, you will be able to encourage and support your team. This tool will also enable them to make course corrections during the year.

Backbone of the Scorecard: KPIs

For each director you will need to identify the primary performance measures. These are often called the Key Performance Indicators (KPIs). I will provide an outline of a general scorecard below, and then a specific example of a scorecard for one hospital department.

Many large organizations, including hospitals and health systems, design their strategic plans and management goals around so-called Pillars. These pillars represent fundamental areas that must be addressed by any organization to be successful.

Generally, these pillars will include domains such as:

• Growth
• Financial Stability
• Customer Service
• Excellence or Quality
• Employee Satisfaction

The organizational pillars can be spun off into individual department pillars that parallel them. For hospital-based departments, they should align with the pillars above:

• Growth
• Financial Performance
• Patient Satisfaction
• Quality and Patient Safety
• Employee Engagement
• Physician Engagement

To implement this process, at the beginning of each year we create a balanced scorecard that identifies KPIs that align with each pillar and then determine levels of performance for each metric. Some departments may not create a KPI for every pillar. For example, if a department does not interact with physicians, then it will not have a KPI for Physician Engagement.

Some pillars might have more than one important KPI. A department that produces revenues and has expenses (e.g., outpatient laboratory) might need a KPI related to both increasing revenues and reducing expenses. A non-revenue producing/support department such as human resources, quality improvement or risk management may have one KPI related to reducing expenses.

Some of the measures remain the same from year to year, but the threshold goals for each may change over time. The goal for each metric may be dichotomous (pass/fail) or tiered to three or more levels.

Avoid Subjective Measures

My preference is that the measures be completely objective and easily measurable. I prefer not to use subjective evaluations.

For example, I would rather not use an evaluation with measures such as these:

Instead, I prefer evaluations based on achieving measurable agreed-upon thresholds that have been discussed and clearly articulated by the supervisor. This means that staff are assessed based on results, or what they accomplish, and not on how it is accomplished.

A criticism of such a process is that if the focus is on one or two parameters, short-term gains will be sought rather than long-term success. For example, financial performance could be improved by terminating highly compensated employees and replacing them with lower paid inexperienced staff.

Balance is Critical

But that is avoided by using a balanced scorecard in which all of the important measures are addressed simultaneously, thereby avoiding the short-sighted focus on only one or two measures.

A decent balanced scorecard for the evaluation of a director over an imaginary hospital department based on the pillars above might include KPIs that look like this:

[Note that more detail would need to be provided – this is for illustration only. – VPE]

For the director of such an imaginary department, these measures would be measured, reported and discussed monthly by the VP or CMO and the director. The director would be encouraged to perform at the above average or superior range.

The VP would provide support and encouragement to achieve better results in any area in which acceptable or less than acceptable performance was being achieved. The support of the VP might be to intervene with other departments, or deploy resources (staff or budget dollars) from another department to help meet important goals.

Incentives

There are two primary incentives working to improve performance. The first is simply the recognition that comes from achieving the proposed goals. This recognition can be enhanced when the results for all of the directors and executives are shared across the organization.

This scorecard will be even more powerful if annual salary bonuses are tied to the outcomes. In such a scenario, the KPIs are reviewed and discussed with the director monthly or quarterly. Estimated bonuses, based on the most recent scores, are discussed at least quarterly. Then later, the bonus amounts (or lack thereof) will not come as a shock to the director.

The CEO and CFO will generally determine the amount of financial incentive that is potentially available, because it needs to be budgeted. The board may also need to approve the plan.

The total available for bonuses  may be a set dollar figure, or it may be set as a percentage of salary (e.g, 20% maximum potential bonus). The bonus payments may be canceled if the organization experiences a major financial decline in any given year.

Once a potential bonus is determined, you must create a formula for a partial payout because it is likely that KPI thresholds will only be partially met. The formula is based on the number performance measures and the importance of each.

Pharmacy Director

Let’s create a balanced scorecard for the (inpatient) Pharmacy Director, using the rules we set above.

Based on the CEO’s recommendation and board approval, all directors will be eligible for a bonus of 20% of gross salary if all KPIs are met at the Superior level (maximum threshold). The total potential bonus is being split equally among each director's five KPIs (possible $6,000 for each).

If the performance falls between Above Average and Superior, 80% of the bonus will be paid. When it falls between the Average and the Above Average, then 50% of the potential bonus is added. If a KPI ends the year below the lowest (Average) threshold, then the director is not eligible for a bonus on that item.

If the Pharmacy Director receives a salary of $150,000 per year, she is eligible for a maximum bonus of $30,000 at the end of the year, to be paid in March following the calendar year. The reason for the delay in payment is the processing time required to collect, tabulate, and review the data being used to calculate the measures.

Here is how the year-end analysis might look, assuming the performance listed in the 6th column:

Under this scenario, with a potential $30,000 bonus, the Pharmacy Director would receive $21,600 in March, based on relatively good performance compared to the annual goals.

In this example, just the basic outline is provided. In a real implementation, each goal and threshold would be clearly defined, and a determination made that the measure could be reported in a timely fashion.

Carefully Select KPIs

For the HCAHPS metric (patient satisfaction that is based on a mailed survey, collected and reported by a third-party), there is a significant time delay. So, the organization might need to use internally tracked measures that mirror the publicly reported measures.

It is best to use a monthly or quarterly scorecard that looks like this at each meeting with the Pharmacy Director:

Each month or quarter, you and the director will look over the current trends and develop plans together to improve performance for those areas not meeting the stretch goals.

The design of the KPIs and specific goals will need to be carefully considered. Looking over historical averages and trends can help to determine appropriate thresholds. It is also helpful to consider the variability of the measures. If there are wide swings in annual expenses in a given department, setting a goal may be more difficult than setting one for a department that performs within a tight range.

Wrap Up

The performance of your direct reports will sky-rocket if they transition from old style subjective evaluations to a balanced scorecard using Key Performance Indicators. Whether through peer pressure or financial incentives, measurement and reporting are the keys to improved performance.

An optimal scorecard will include KPIs that represent the major pillars defining the performance of the department. The KPIs must be designed with care, however. The metrics must be measurable and timely and meet the same guidelines as a SMART Goal. And they must be balanced, so that one area does not dominate the focus of the director and department.

Next Steps

If you are not using a balanced scorecard to provide ongoing objective evaluation of your direct reports, then commit to the following process over the next month or two:

1. Choose a director with whom to explore the use of a balanced scorecard;
2. Identify the major pillars of the organization and of the department;
3. Select 4 or 5 Key Performance Indicators based on their importance and measurability;
4. Begin a pilot beginning next quarter in which you measure, report and discuss the KPIs with your direct report;
5. If the process results in improved performance, then expand to other departments;
6. Share with your COO and CEO and the rest of the organization.

Then watch as the organization's performance really blossoms!

For more ideas about leadership Subscribe here.

Please take a short survey:  Survey Page

Write me at john.jurica.md@gmail.com.

If you like this post, please share on your social media using the SHARE buttons below.

Thanks so much and see you soon!

The post How to Evaluate Direct Reports appeared first on NonClinical Physicians.

Pharmacy

Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.

The triad of professionals responsible for the selection and delivery of medications consists of the physician, nurse and pharmacist. These highly educated professionals each contributes critical expertise to medication delivery. The integration of the physician/nurse/pharmacist triad is the secret to safe medication delivery.

Those three professionals each work in domains with unique challenges and cultures. Thus, when they bring to bear their particular skills and tools, they optimize the patient's outcome.

Value of the Physician Executive

The physician is an expert in selecting the medication needed to treat a given patient. The nurse is the expert in safely administering the medication and monitoring the patient for intended benefits and adverse effects. The pharmacist is the expert at monitoring the process, delivering the medication to the bedside and providing needed support and advice, especially when polypharmacy is involved.

The Physician Executive is in the best position to understand the process and facilitate coordination of the stakeholders. Some of the critical aspects that must be led are:

• Developing guidelines and protocols that drive medication selection.
• Facilitating discussions needed to create a formulary that is appropriate, yet manageable in size, cost and complexity.
• Mediating between physicians and pharmacists when constraints are placed on the use of high cost medications.
• Advising about which functions can be delegated to technicians and which require direct doctorate-level pharmacists.
• Promoting the collaboration between the pharmacy and quality improvement departments.
• Balancing the costs and benefits of new pharmacy-led initiatives such as:
  • Deployment of clinical pharmacists to the emergency department and other units such as intensive care;
  • Diabetes management services to adjust insulin doses for inpatients; and
  • Anticoagulation clinics to adjust warfarin dosing.

Practical Considerations

How can the VPMA or CMO best help the pharmacy to deliver on its mission? Here are a few suggestions to consider.

1. Promote a culture of accountability, teamwork and safety within the department. This will require the selection and nurturing of a very skilled pharmacy director.
2. Lead your physician and nursing colleagues by example. Commit time and resources to measuring outcomes, participating in teams, and presenting pharmacy concerns to medical staff and executive leadership.
3. Remain current with important medication safety issues by monitoring publications from:
   • Institute for Safe Medication Practices
   • American Society of Hospital Pharmacists
   • American Hospital Association (see Quality Advisory on Medication Safety)

One-on-Ones

Finally, as with all of your direct reports, you will meet with your pharmacy director on a weekly or biweekly basis. During those meetings, the following topics should be addressed (not necessarily at every meeting):

1. Review of goals for the year. Are milestones being met? How can you facilitate them?
2. Review staffing. Is the pharmacy fully staffed? Are there open positions? How are those being addressed?
3. Budget updates. How are expenses running compared to budget, especially staffing and drug costs?
4. Medication safety reporting. What are the number and nature of medication errors for the past reporting period? Were they preventable?
5. Formulary requests. Are any pending? Review the agenda for the next Pharmacy and Therapeutics meeting. Do physicians need to be contacted prior to the next meeting?
6. Summary of cost reductions resulting from clinical pharmacy interventions.
7. Director’s performance review (at least quarterly).

Conclusion

The physician executive can have a positive impact on patient care. This will be achieved by enabling the pharmacists to fully apply their expertise and by promoting the physician/nurse/pharmacist triad.

Next Steps

If you are a VPMA or CMO and do not currently oversee the pharmacy functions, become more involved in the department.

• Attend P and T Committee meetings.
• Support the efforts of the Pharmacy Department to engage physicians.
• Promote new clinical pharmacy initiatives that will enhance medication safety.

Subscribe here to get regular updates.

What topics would you like to read about:  Survey Page

Email me at john.jurica.md@gmail.com. I am here to help you excel as a leader.

If you like this post, please share on your social media using the SHARE buttons below.

Thanks so much and see you in the next post!

The post Why the Hospital Pharmacy Director Should Report to the Senior Physician Executive appeared first on NonClinical Physicians.

Then my daughter started working as a social worker at a large medical center in the Chicago area. One day, she was providing services to a young injured gang member treated while under police custody. One of his constant companions was his 16-year-old girlfriend.

When the patient was out of the room for testing one day, the girlfriend asked my daughter if she could help her get away from her boyfriend. She felt threatened and abused. My daughter provided information needed to seek assistance, including the name and location of a shelter. And, the victim could readily report her concerns to the police who were guarding her “boyfriend” while he was hospitalized.

The next day, the girlfriend was still at the boyfriend's side. One of the nurses cautioned my daughter, because the patient was making threatening remarks about the “social worker” and what she had said to his girlfriend.

My daughter was able to avoid further contact with the patient, and he was sent back to jail shortly thereafter. But that story worried me and reminded me of the concerns expressed by staff at our hospital when caring for similar patients.

I recall several occasions when injured patients were brought to our ER and treated in our ICU for gunshot wounds. Our policy was that we would not lock down our hospital without good reason, since we had never had any serious consequence of a liberal visitation policy. Therefore, it was quite easy for “family members” to visit our gunshot victims at all hours.

The families could be quite large and would quickly become agitated if any restrictions were placed on their ability to visit their “loved ones.” We had no process for checking for weapons and certainly no metal detectors at our entrances. Our security department consisted of 5 to 6 staff covering the 200-bed facility 24 hours a day, 7 days a week.

Healthcare Has the Highest Rate of  Workplace Violence of Any Private Industry

According to OSHA, (Occupational Safety and Health Administration), the healthcare industry has a rate of injuries from workplace violence that is about 4 times that of private industries. Eighty percent of those injuries are caused by patients. And these incidents are consistently under-reported.

Even less likely to be reported are verbal threats to staff. When surveyed, 50% of nurses state they have been verbally abused within the prior 12 months. The highest risk of injuries is experienced by psychiatric aides, followed by nursing assistants.

Such injuries add significantly to health care costs. These costs include workers compensation costs, direct care and treatment, and replacement staff for injured workers. There is also evidence that such injuries result in medication errors, other patient safety issues and reduced patient satisfaction (presumably because of anxious or preoccupied care givers).

I understand how psychiatric aides can find themselves in these high risk situations. I recall several complaints investigated at our facilities by the Joint Commission because of alleged overuse of restraints, or injuries to psychiatric patients caused by overzealous security guards when called to restrain an agitated patient. But relaxing security measures can result in increased employee injuries.

The alternative to aggressively protecting staff on our psychiatric units might be more injuries such as those at Western State Hospital in Lakewood, Washington, or the attack caught on tape at Erie County Medical Center in Buffalo, New York. Staff members were seriously injured in both incidents.

And physicians are not exempt from the violence. Last year, in Boston, a physician was shot and killed by the son of a husband and wife he had treated.

Prevention

Some of these incidents can be prevented. According to OSHA, an effective workplace violence prevention program consists of the following components:

1. Commitment by management, and involvement of care givers in the program
2. Completion of a work site assessment and identification of hazards
3. Formal hazard control and prevention measures
4. Training in workplace safety for employees
5. Record-keeping and regular program evaluation

And in the event that a healthcare worker is injured in spite of a rigorous violence prevention program, a root cause analysis should be done to identify breakdowns in the program.

Next Steps

As a hospital leader, you should inquire into the current status of workplace violence prevention at your facility. If a formal program does not exist, you should lobby for establishing one.

Be certain that the human resources department is keeping track of these injuries. The workers compensation carrier should be able to provide a summary of such injuries and their associated costs.

Look at trends over the previous 5 years. If rates are increasing or are already higher than expected, push to find out why. And institute a plan to reduce such injuries, following OSHA recommendations.

Share Your Knowledge

Please describe any cases of workplace violence you have seen in the Comments.

For more of my thoughts on healthcare and leadership Subscribe here.

Please help me out by telling my what you would like to read about by taking a short survey:  Survey Page

And feel free to email me directly at john.jurica.md@gmail.com with any questions about anything.

See you in the next post!

The post Why Hospital Leaders Need to Prepare for Workplace Violence appeared first on NonClinical Physicians.

A Mentor To Me

Don was the chair of the committee prior to my being appointed to it. So he had been involved in CME for many years. I later served as chair myself for five years. Now he is officially retired from his job as Chief Medical Officer for a large independent hospital. But he continues to volunteer his time doing CME surveys and teaching young educators about CME accreditation.

Long before I made the move into an administrative position, Don inspired me to consider such a move. He was clearly well-respected by his physician colleagues, and by the ISMS staff with whom he worked. He and I shared a commitment to the accreditation process so that physicians could have access to high quality CME.

As I began to contemplate my transition from clinical medicine to hospital management, I would contact Don and get his advice. He would listen, encourage me to consider the options and do what I thought made the most sense for me. Don would caution me about the response from the physicians at my primary hospital. He would encourage me and help me face my fears about making such a change.

After working as VPMA and then CMO at my hospital, we continued to work on different projects together for the ISMS and I would occasionally seek his advice. The relationship remained fluid and flexible.

My relationship with Bob was much different. He was hired by the CEO of our hospital to help all of us on the senior executive team learn new skills that would help us become better leaders and managers. He was a formal business coach. Bob was an entrepreneur and had started several businesses. He had been coaching groups of CEOs and business owners for many years.

A Leadership Coach

When we had one on one meetings, they were pretty open-ended. “What is the most important thing we need to talk about today, John?” he would ask. I would often bring up specific challenges I was facing, like the performance of a director that was declining.

“If you were opening a brand new hospital down the street, would this be one the leaders you'd bring with you?” I'd chew on that for a while. “No, I would definitely find an A player,” I'd say.

“OK, then, you know what you need to do.”

This was one of my weaknesses. I was not good at handling conflict. But Bob taught me and the other team members the importance of conflict in an executive team. He also taught me that the most important conversation to have, was the one I most dreaded. I needed to have a fierce conversation with my director.

Coaching Versus Mentoring

I believe that the developing physician leader will benefit from both coaching and mentoring. And it will be helpful to understand the differences between the two.

The Coach

Coaching generally focuses on specific skills that need to be learned. Think of the hitting coach in baseball or vocal coach in the field of music. Because it is skill focused, the relationship tends to be shorter. And your supervisor (e.g. the CEO) may be the one to decide if the coaching has been successful and can be stopped. Coaches are typically content experts.

If your organization provides a business or leadership coach, take advantage of it. Use the results of a 360 degree evaluation to identify some weaknesses. Then use the coaching to focus on addressing them. Or talk to your CEO about using a coach to improve your strengths so they become even more effective. Practice what the coach advises you to practice. Your skills will improve.

The Mentor

Mentoring is focused more on attitudes and self-confidence. The mentor often serves as a role model, rather than a content expert. The relationship is generally long-term. Sometimes there needs to be a plan to identify the ultimate goals of the relationship. The success is determined more by the person being mentored than his or her supervisor. The focus is often on promoting growth, maturity, career goals and even work/life balance, without a specific end point.

I'm a strong advocate of using a mentor. But it does not need to be a formal relationship with a lot of pressure. Sometimes you can develop a mentorship just by asking questions. Find someone you admire. Engage them in a conversation. Touch base from time to time.

Just discuss issues that are perplexing or challenging to you at the time. Ask how they have overcome similar issues. I'm not even sure that Don knows he has been a mentor to me. He probably feels that he one of many colleagues that helped answer some of  my questions over the years.

Don't Smother the Mentor

Don't waste their time or impose on them unnecessarily. This is not a friendship you are trying to develop (although it may happen, that is not the goal). Keep the interactions brief and to the point. Listen closely and reflect on what they've said. Follow-up later with clarifying questions if you need to.

One other important note: as a boss, you may occasionally do some coaching and mentoring. But your primary role is not to be your direct report's coach or mentor. Your role should be to encourage your employees to find their own mentor.

You might also identify internal staff or external experts to do some coaching in certain circumstances. On the other hand, you may be a coach or mentor to someone in a completely different area of the organization reporting to a different set of supervisors.

Other Sources of Mentoring and Coaching

It is helpful to remember that we do not always need specific formal coaches and mentors. Many of us can learn specific skills by reading books, watching videos and other “how-to” instructional materials, using virtual coaches.

Even mentoring can be somewhat “generic” rather than personal. I have considered many authors such as Peter Lencioni and Susan Scott to be informal mentors to me through their books, and Michael Hyatt and Skip Prichard through their leadership blogs. The blog writers are even closer to real mentors because you can sometimes interact with them via blog comments, Facebook or LinkedIn groups, and email.

Action Steps

If you are already doing some management, talk to your COO or CEO about finding a leadership coach to help develop certain business skills. Perhaps your CEO is already using a business coach and could arrange to have him or her spend a bit of time with you.

Look around and see if there is an accomplished person in your field that you  admire that you can spend a little time chatting with. Alternatively, you could simply ask one of the more impressive presenters at the next American Association for Physician Leadership conference for their email address. Just promise to send only the occasional brief question related to physician leadership and management.

A new entity with characteristics of coaching and mentoring is a mastermind group. They also have the features of a networking and accountability group, and have become very popular. Consider this as another way to accomplish some of the goals mentioned above.

That should help get you started.

Let me know how it goes in the Comments Section.

For more of my thoughts on healthcare and leadership Subscribe here.

Please help me out by taking a short survey:  Survey Page

And feel free to email me directly at john.jurica.md@gmail.com

See you in the next post!

The post Why Both a Coach and a Mentor Are Vital to Your Career appeared first on NonClinical Physicians.

Your directors will create their goals as well, as we discussed in SWOT Analysis and Goal Setting. You will then review their goals and help adjust them as needed.

Using the SMART acronym will help you to identify appropriate goals. And they will ensure that you continue to remain indispensable to your CEO and board.

SMART Goals

Various words have been used for each letter in the SMART Goals acronym. I prefer to use the following.

Specific

Each SMART goal should be written in a way that is not ambiguous or inexact. You must avoid any lack of clarity, for the reasons discussed in my post on Clarity. An example of a nonspecific goal might be: “Our unit will improve our patient safety scores this year.” A much more specific goal would be: “Our unit will achieve a central line-associated blood stream infection (CLABSI) rate below the national average rate for the coming calendar year.”

Rather than use an outcome measure, you could also define completion of a project, such as “Our unit will put in place a multidisciplinary team to reduce CLABSIs, which will achieve 100% compliance with completing the AHRQ central line maintenance checklist and audit form on each patient, and will achieve 100% compliance with placing the central line under ultrasound guidance.”

Measurable

It is easier to track goals that lend themselves to measurement. It is clear when they have been succcessfully completed. The preceding example demonstrates this principle well.

Attainable

This is usually not a major problem. Most of the time, our direct reports are going to think carefully about attempting to achieve a goal that is not within reach. This is especially true if there is some type of salary increase or bonus attached to achievement of the goal.

But there needs to be balance. I have had pharmacy directors who thought they could make remarkable improvements in inpatient drug utilization. Then they experienced the intense resistance to restrictions on the formulary that physicians demonstrated.

Relevant

Management goals should be REALLY relevant. You and your staff are going to spend significant amounts of time and energy trying to accomplish these goals. They therefore need to be the top priorities for your division or department for the coming year.

Try to weed out the peripheral, “nice to have” goals and focus on the “must have” goals. These are teh goals that will advance the mission and vision of the organization.

For example, consider a facility that is addressing the patient safety issue of CLABSIs as mentioned above. Accuracy of documentation and codingis very important, since there are very specific inclusion and exclusion criteria being applied. Your CLABSI measures may be calculated and published inaccurately if coding mistakes are made.

Therefore, a relevant goal for the Nurse Documentation Specialists might be: “Put in place a process to review all charts of patients with a discharge diagnosis that meets CLABSI ICD-10 codes prior to final coding.” A less relevant goal might be something like: “Achieve 100% pre-discharge chart review by Nursing Documentation Specialists for patients with catheter associated urinary tract infections.” The latter might be an important goal, but it is just not relevant to the more pressing issue of CLABSIs in this case.

Time-Limited

Every goal must have a deadline. After all, a goal without a deadline is just a dream. (Sorry, I have no original attribution for this quote. It has been quoted in various forms by many authors and speakers, including Robert Herjavec on an episode of the TV show Shark Tank!)

One Bonus Requirement

It is also very helpful to add milestones to each goal. These are the steps that must be completed or reached along the path to achieving the goal. Starting with the goal in mind, the milestones can be developed by working backward to the present state. It is helpful if the milestones generally follow the same SMART format, but it is not always necessary.

My Turn

Now, I am going to use these guidelines for smart goals to set some goals for this blog. That will allow me to use another tool to achieve accountability: publishing my goals to the world (or at least my blog readers!). Here are a few to begin the year…

1. Add a new blog feature – interviews with successful physician leaders – by the end of January, 2017.

The interviews will start out in written format. I will include answers to a series of questions about the path a leader or executive took in the journey from clinician to formal physician leader. The final question will address advice for the fledgling physician leader. These interviews will be posted once each week.

Milestones: create the interview template; identify the first five interviewees; contact those colleagues to enlist them to participate; send out the survey(s); collect responses; prepare them for publication; begin publishing the completed interviews.

2. Write an e-book about hospital patient safety, and make it available for free to my audience by the end of March 2017.

This is intended to be a practical guide for any hospital executive involved in understanding, supporting or improving patient safety. It will focus on the recognized components of patient safety that are currently being measured and reported. The e-book will include advice on how to improve patient safety in the hospital setting. I will also provide guidance on improving safety rankings published by HealthGrades and Truven (Top 100 Hospital).

Milestones: complete the background research for the book, create the outline, design the layout, write each chapter, compile the complete e-book, post the e-book, publicize the e-book on Facebook, LinkedIn, my email list and through guest post on other blogs.

3. Write a second e-book by the end of June 2017, topic to be determined.

Milestones: select topic, complete research, etc., etc.

4. Compile a list of physician-authored blogs and post on LinkedIn by the end of January, 2017.

I am personally fascinated by the blogs being written by my colleagues in medicine. I enjoy reading the breadth of blogs being produced. But I am surprised that some topics, such as physician leadership, are not well represented in the blogosphere. I believe other physicians might find this list of interest, so I have slowly been compiling the list in order to share it. I will do so on various social media sites and my own blog in the near future.

Milestones: search other physician-authored blogs for blogrolls; complete additional searches; compile and organize list; publish list.

Start Using SMART Goals

Go ahead and give it a try. Write down your goals for 2017 now. Use these guidelines to rewrite old goals.

Let me know what you think of my new goals for the beginning of 2017.

Don't forget to subscribe here.

As always, write me directly at john.jurica.md@gmail.com

The post How I’m Using SMART Goals for 2017 and You Can Too appeared first on NonClinical Physicians.

This was an annual ritual. But I wanted it to be more focused. I wanted the team to create really meaningful goals. Our goal setting charge was to create four or five management goals for each department that would be challenging, but attainable. These goals would help to advance the mission and the vision of the organization.

We had a construct that we followed. It consisted of “pillars” from the management plan overview that each department would try to address. Depending on the department, there might be more goals in a certain pillar. For example, the Director of Quality would have more goals under the Quality Pillar than under the Finance Pillar.

My job was to encourage discussion and help the directors select goals that would align with the strategic imperatives of the organization. I would also prod them to aim for targets beyond their comfort zones. Then, I would be incorporating their goals into the overall goals for my division. I would later present my goals to the CEO and the  rest of the senior management team for discussion and approval.

All of the goal setting that we did served two primary purposes. The goals would help us focus on important strategic objectives during the coming year. They would also be used to develop the budget, assisting in estimating the expected capital expenditures and any new revenues and expenses.

From SWOT Analysis to Goal Setting

Here is what we did. We created goals that represented the intersection of the Strengths and Weaknesses with the Opportunities and Threats from the SWOT analysis as depicted in the following table:

We started by answering the following questions derived from the grid, using what we learned from the SWOT Analysis:

1. For my department, how can we utilize our strength(s) in ____________ to take advantage of the opportunity to _____________ ?
2. How can we utilize our strength(s) in _____________ to minimize the threat of ______________ ?
3. How can we take advantage of the opportunity to _______________ to minimize our weakness in _____________ ?
4. What additional steps can we take to reduce our weakness in ______________ ?

For each department, the director was charged with working through each of the SWOT components with their teams and generate multiple answers to each of these question.

Example Using the Medical Group

Imagine that one of the directors is responsible for the medical group, and that a SWOT analysis was done regarding expansion into a new geographic area with primary care or urgent care services. Here are some of the findings from the imaginary SWOT analysis described previously in When to Use a SWOT Analysis.

Strengths

1. Strong brand recognition of the hospital system
2. Financial strength – good reserves and cash flow
3. Strong interest by medical group primary care department to staff the clinic
4. Strong management team with expertise in opening new clinics in retail settings

Weaknesses

1. No expertise in urgent care
2. Multiple competing strategic initiatives already in place
3. Recent difficulty in recruiting support staff

Opportunities

1. Under-served population – there is a demonstrated need for primary care services
2. There is vacant rental space available at low-cost
3. The community is supportive of a new clinic and job creation

Threats

1. Large percentage of uninsured in the market
2. Competitor may be looking to establish a clinic in the same market
3. Some of the hospital medical staff (not employed) may be threatened by opening a hospital based clinic in their backyard

Now let's complete some of the questions to prepare for goal setting:

1. For my department, how can we utilize our financial strength and strong interest by medical group to staff the clinic to take advantage of the (opportunities of) a demonstrated need for primary care services and vacant rental space?
2. How can we utilize our strong management team to minimize (the threat of) the large percentage of uninsured in the market?
3. How can we take advantage of (the opportunity of) community support to minimize our (weakness in) difficulty in recruiting support staff?
4. What additional steps can we take to reduce our weakness in expertise in urgent care?

Based on the answers to these questions, the team completing this process might come up with the following goals for the next year. Note that many more goals could be developed just using this partial list of questions.

Goal #1:

Work with the CFO to create a pro forma for the opening of a new clinic with one physician – to be completed by the end of the first quarter.

Goal #2:

Meet with the medical group by the end of the first quarter and discuss a plan for staffing a new clinic by the end of the year. Present the staffing plan for the new clinic to the senior executive team by the end of the second quarter.

Goal #3:

Meet with staff from the billing department to discuss opening a new clinic. Have them create a checklist and timeline of items to complete before opening the new clinic. Focus on having all available commercial, Medicare and Medicaid contracts in place prior to going live. Have the checklist ready to present with the other reports at the end of the second quarter.

Goal #4:

In planning the office space, complete the following tasks by the end of the second quarter:

1. Contact the owner of the vacant clinic space and obtain information about possible lease terms;
2. Create a proposed floor plan and work with the hospital Facilities Department to estimate the build-out costs;
3. Develop a list of initial supplies and equipment needed for the new clinic.

Each of these proposed goals would then be discussed further. I would encourage my directors to expand the scope of each one a little, while pushing for a more aggressive timeline. The goals would then be presented to the executive team, where their impact on other departments would be assessed.

Areas for collaboration would be identified. The CEO would present the final document with all of the divisional management goals to the board of directors for approval. The CFO would probably present the budget to the board at the same meeting, if time allowed.

With that accomplished, we would shortly begin the process of implementing our plans and achieving our goals.

Is it clear as mud? Any Questions?

Don't forget to Subscribe to Future Posts.

And feel free to contact me directly at john.jurica.md@gmail.com

The post From SWOT Analysis to Inspired Goal Setting appeared first on NonClinical Physicians.

I am no HR guru, and no expert on the use of screening programs for hiring. But I have been involved in interviewing and recruiting many new employees for my practice and the hospital where I worked as CMO.

Based on discussion with administrators at other hospitals, it seems no one has a system that effectively identifies new team members who will be both effective and a good cultural fit.

But there is a tool that seems to help. With it, you can screen out those without the necessary skills and those that exaggerate their experience and expertise. I call it the Root Cause Analysis Approach to interviewing.

Interview Tactic for the Job Interview

Most of the information gleaned during an interview is not that useful. It's not that people lie, but it's human nature to present the best version of themselves. They may try to answer honestly. But they leave out certain facts and emphasize others.

Ther is a tactic that has been shown to help weed out unqualified or dishonest applicants. It involves digging very deeply into one of their stated skills during the job interview. This requires someone in the organization that knows a technical area well, in order to honestly assess their expertise. The interviewer asks about a particular skill, and digs into the specifics.

How did they use the skill, and under what circumstances? Were there specific tools used? Can they explain the details of the tool and its strengths and weaknesses? This process is stikingly similar to a root cause analysis.

A root cause analysis (RCA) is designed to find the root causes of an adverse outcome, error or broken process. It was originally used in manufacturing to determine how to fix mistakes and improve production. Once root causes are identified and corrected, the production of faulty products will be prevented.

This process has been effectively applied to analyzing errors in medical care. The Joint Commission has formalized the process for hospitals to identify the factors causing sentinel events and other adverse outcomes.

One feature of the RCA is to ask the question “Why” at least five times to get to the root cause(s) of an error.

Brief Example

Consider a case in which a patient has an allergic reaction to a medication. On investigation, it is determined that the patient was known to have an allergy to the medication. But nursing staff administered the medication in spite of that fact. Let's follow the progression of questions and answers:

A patient experienced a medication error…

1. Why was the patient injured?

Answer: His nurse gave him an overdose of medication.

2. Why was an overdose administered?

Answer: Because it was mis-labelled as a lower concentration than it actually was (proximate cause).

3. Why was it mis-labelled?

Answer: The concentration was manually entered into the bar-coding system improperly.

4.Why was it entered improperly?

Answer: The process was manual and therefore open to operator error.

5. What were the root causes of the operator error?

Answer: There were several root causes that may have contributed:

– the technician was new and not fully trained,

– he was working back to back shifts (probable fatigue),

– he was inadequately supervised during the training period, and,

– the staffing at the time was less than recommended (probable overwhelm).

Use the Root Cause Analysis Technique

Now let's apply this approach to a job interview. The idea is to NOT ask superficial questions, but to focus in on one or two areas in a manner similar to an RCA.

Consider an example in which I am interviewing a potential chief quality officer for a mid-sized hospital. One of the requirements of the job involves oversight of length of stay initiatives.

During the job interview, the conversation may go something like this:

Thanks for spending the day with us, Susan. I'm very pleased to meet you and discuss this position with you. According to your CV, you were administratively responsible for quality improvement and inpatient length of stay at your previous job. You probably noticed that our LOS has been going up in recent years. Do you believe you would be able to help us improve our LOS?

Absolutely. I was responsible for the oversight of our program for five years. I am fairly proficient at analysing and addressing LOS issues in the hospital setting.

Excellent. What were the main components of your LOS program?

We addressed it at several levels. We developed and followed evidence-based protocols for all of our high volume diagnoses. We had an aggressive case management program. We aggressively used observation care. And we implemented a post acute care process that enabled us to move patient to the nursing home quickly. We had an LOS oversight committee. We measured our LOS regularly and reviewed reports on a monthly basis.

(So far, so good).

That sounds great. Measurement of LOS is very important. That is one area where we will need to focus. What system did you use to track your LOS?

The reports were provided by our Decision Support team. I'm not sure which system we used for that.

Do you know if the data for LOS were risk adjusted, and if so, what method of risk adjustment was used?

I'm not sure about that. We used standard methods.

Do you recall the types of risk adjustment that might be applied in similar situations here?

I'm not really an expert on risk adjustment. I would need to get some help on that.

(Starting to see some knowledge gaps here).

OK. Earlier, I didn't hear you mention anything about involvement of documentation and coding staff on the LOS team. Were they involved at all? And if so, how?

I'm not sure what you're asking. Those services reported to the billing department and didn't have much to do with the LOS committee.

(Here is another knowledge deficit).

Review of Interview

The conversation starts out well. But as we get into the details of this specific topic, the applicant demonstrates a lack of understanding of the topic.

Susan should know the importance of coding and documentation in managing length of stay (if coded inaccurately, the expected LOS may appear to be much shorter than expected). It appears that she may not possess the specific experience required. The candidate's candor in describing her level of expertise is also starting to be questioned.

Ideally, the candidate will answer each deeper level of questioning appropriately. Alternatively, if the applicant were to honestly admit to her knowledge gaps early, it would have been more reassuring about her integrity. Then she might still be hired, but with efforts to provide her the necessary training over time.

Summary

Using the Root Cause Analysis Approach to performing a job interview is one of the most useful ways to discern whether new candidates have the  necessary knowledge and attitudes for the job. You can assess both their honesty and their expertise by digging deep, rather than asking a broad set of superficial questions.

If the applicant fails the RCA approach, think very carefully about whether to proceed with an offer. But be certain to discuss your concerns thoroughly with your HR professionals before making any final recommendations.

Following this interview method will not guarantee hiring success. But it will greatly increase the odds of identifying unqualified candidates.

Have you tried this method? Has it helped?

Don't forget to Subscribe to Future Posts.

And feel free to contact me directly at john.jurica.md@gmail.com

The post Use Root Cause Analysis Approach to Fine-Tune the Job Interview appeared first on NonClinical Physicians.