A Field of Dreams for Healthcare Innovation 

Recently, I have learned about a new community that is being constructed in Nevada called Union Village. It is more than a plan, but soon to become a model for innovation in community-based healthcare delivery.  It is an inspiration of what is possible when thought leaders representing all corners of the healthcare market space and care continuum, land/community development, architecture, politics and unions come together with all their respective paints and techniques to create a new picture for the future.

Union Village is being built in Henderson Nevada. It is an Integrated Health Village that will be a model of state-of-the art technology and environmental sustainability featuring a world-class healthcare center integrated into retail, entertainment and cultural centers as well as “smart” senior and residential communities to produce 17,000 (direct, indirect and construction) jobs and a dynamic economic engine generating nearly $10 billion in tax revenues over 25 years.  It will create new sources of revenue and margin improvement for healthcare providers, while providing union retires and their families with a community setting focused around living life to its fullest. Does this sound too good to be true?  Maybe, but believe me, it is real.  As I write this, dirt is being moved on 170 acres of land where the Village will be created.

Like automobiles that are designed to reflect certain performance and efficiency standards, the US healthcare system has been designed, or maybe allowed to evolve, to produce what it produces and cost what it costs. Imagine what your car would be like if it were designed in a similar manner. It would be unsafe, terribly expensive, have no gauges to monitor speed or fuel consumption, get two miles to the gallon, emit large amounts of CO2 and break down every week.

From the silos of their individual interests and bias, stakeholders ranging from politicians to physicians have sought solutions. On the healthcare delivery front, there continues to be deeply embedded barriers to innovation among healthcare administrators, clinicians and insurers. Consider this contrast–while healthcare reform has become an embarrassing example of political dysfunction that some are looking for our Supreme Court to resolve, the conservative Republican Governor of Nevada and the Democratic Senate Majority Leader stand should to shoulder in their support for Union Village.

How could this be possible? Simple. Build it and they will come. And best in class strategic partners have indeed signed on to make this a reality.

Rather than seeking to fix the dysfunctional economic, cultural and clinical systems that have been created through years of cobbled fixes, Union Village will succeed as it has been designed and engineered to a distinctly different set of specifications, all centered around building a community where the health, wellness, learning, entertainment of its residents paramount.  The possibilities of achieving this, while realizing a vibrant economic engine in a depressed geography will be realized.  Why? Because thought leaders were invited into an environment where they could not only be heard, but were expected to learn together.

I invite you to consider the possibilities for the development similar affiliated communities, as they are many.

While many contributed, and others will to the realization of vision of Union Village, every team has a natural leader. David Baker is an exceptional person who brings diverse development experiences, personal vision and passion, combined with inclusive and humble leadership to this project.

I encourage you to visit Union Village to learn more.  Do not expect a slick and elegant marketing-oriented website. It just tells a story. And of course, contact me to learn more at email hidden; JavaScript is required.

It has been several years since I had the pleasure of working with colleagues to produce the High Performance Measurement Model. Since that time I have applied this framework in my consulting, and while doing so have continued to add to it.

During this past year I found myself doing more in the area of leadership assessment and development and have renamed and updated the original measurement model to reflect particular focus on 10 attributes of leaders who cast positive and lasting shadows across their organization.

These attributes include the following.

1. Are self-aware and seek to understanding the gifts and potential of others.
2. Consistently hire and retain great talent.
3. Demonstrate passion about leaving their companies better than they found them.
4. Ensure possibilities and opinions are explored before moving to decisions.
5. Demand that discussions focus on what would it take to achieve high performance.
6. Build deep internal and external relationships through 2-way communication.
7. Model work life balance and hold members of their team to a similar high standard.
8. Create a climate where coaching to optimize performance and potential (not only to correct performance issues).
9. Build and use information systems (business intelligence) as “radar” to learn and adapt.
10. Ensure that when they move on that succession occurs without much of a blip.

You are invited to view the entire document in the Library Section of my website, http://www.aligns.net/library/

Here are Dave’s Top 10 reasons why Leaders Do Dumb Things.

1. Lack self-awareness; really do not have a clue about the person they see in the mirror.
2. Are worried about their personal cash flow. Yea, cars, houses, boats, etc., etc. All trying to make up for their lack of #1.
3. Have forgotten that they were given 2 ears and 1 mouth for a reason.
4. Wake up every morning and hear a voice asking them “what can I do today to make sure I don’t lose my job”?
5. Are incapable and unwilling to be vulnerable. They can’t say admit what they don’t know and ask for help.
6. Are distracted with personal interference. You know the stuff they just have not dealt with most likely because they lack work-life balance.
7. Really do not like people who are not just like them. This one is harsh, they use words that would lead you to believe they are about diversity and inclusion, but…you know the rest.
8. Just need to always be the smartest person in the room. Need to have the last and best word. And, their people know when to just shut up.
9. Either can’t get enough information to decide or make decisions without adequate information. Wait a day and their appetite for information will change.
10. Forget to take their medications. Yes, there is usually more than one!

Do you agree?

“Action Learning” (learning by doing) is something we have all experienced, but don’t always consider as a foundation to leadership development. As CEOs, you are being sold on the benefits of leadership development programs, and remain skeptical about ROI. Yet, you are facing increased pressure from your Board regarding preparing the next generation of leaders to succeed those in key strategic roles. You were sold on the value of the “corporate learning institute or university” and invested appropriately. You now might be hearing rumblings about the effectiveness of this program.

Action Learning is not a program, but rather an intentional methodology that requires business leaders to acquire new knowledge and skill in the context of addressing real issues and opportunities that face their organization. The concept isn’t new at all. It goes back to the coal mines in England when the owners of the mines were increasingly concerned about accidents that impacted profits and employee safety. One night they were sitting together around the pub table. They decided to asked the best and brightest from each of their companies to come together to address the issue. They did. And the immediate issue was solved for the cost of some food and a few pints.

Most leadership development initiatives in organizations focus on the individual. Yet, leadership in organizations is not an individual act, but rather a team sport focused around specific issues or opportunities. Leadership is not about one person at the top of an organization. It’s about many individuals distributed across geography, as well as functions and business units, that are required to work together to forge interdependencies required to sustain market advantage.

In spite of compelling evidence to support Action Learning, many executives, academics and learning leaders continue to focus on leadership competencies rather that the actual leadership issues facing an organization. Companies spend a lot of time and money on creating leadership competency models, with little regard for the core business knowledge that must be applied along with different behaviors to ensure strategic success. In many organizations there is a huge disconnect between staff work that produces competency models and the reality of the business.

In 1990 I joined Aetna Life and Casualty, the large lumbering multi-line insurance company. I was hired to build an internal consulting capability, staffed with the company’s high performing/high potential executives. The intent was to solve the company’s real problems and address strategic opportunities. We built a model based on the principals of action learning. Over three years, we addressed real issues/opportunities and helped totally reshape the strategy and sources of shareholder value for that company. Yes, we even used the action learning model to access the performance and potential of all businesses in the company against capital markets value criteria.

It was real. It was fun. And whoa, people who contributed to these projects landed in great places. At the end of the day, it’s all about getting s&^t done. We all learn by doing, not be reading or by being taught. Certainly not by sitting in a corporate classroom having knowledge poured into our heads.

The healthcare space in the US is changing. Solutions to complex problems are illusive. Exploring possibilities requires teams of people from all corners of the healthcare market to come together to learn, build a shared understanding of reality and apply new knowledge and skills to explore options. What an application for Action Learning. Wonder what would happen if our legislators had such a learning experience?

Today, I read a blog post by Josh Linkner in Fast Company where he reflects on “Life Lessons Learned from Steve Jobs”. While Steve continues to be a monumental force in driving innovation that changes people’s lives, there are additional attributes of leadership that I have experienced in most of my truly great clients.

1.Most important, great leaders are self aware. They know who they are as are comfortable in their own skin. As a result they are humble, vulnerable, and sincere in their appreciation for the gifts of others.

2.Great leaders are great at hiring. As good as their gut might be, they do not rely solely on it to make hiring decisions. They use external assessments and processes that create an accurate profile of candidate’s potential for success, as well as a map to accelerate their integration into the organization that is owned by the new executive and supported in a transparent manner by their colleagues.

3.They are passionate about leaving their companies (and the world) better than they found them. Success is not about their own success, but rather that of others. A good day is when they help someone discover something that makes a different in the company; an even better day is when they experience that person “paying forward” this gift. A fantastic day is when they thank the leader.

4.These leaders manage themselves to avoid premature decisions. As the boss, people look to you to decide. The best leaders ensure extremes in possibilities and opinions are explored before moving to detailed options analyses and decision. They encourage appropriate disagreement and debate.

5.They are positive in their thinking and words. Naysayers are not allowed, nor are those who dream without grounding in reality. They demand discussions that focus on what would it take, vs. what could go wrong if we do this. Having said this, there is always a focus on risk analysis as decisions come to closure.

6.These gifted leaders see people for who they are and what they bring to the party, not solely for the expected technical/functional knowledge that is inherent in their role and job title. For example, they expect all on the team to contribute as leaders of the organization first and leaders of their business units or functions second. In other words, there is one “A” team.

7.They model work life balance hold members of their team to a similar high standard knowing that in order for individuals and teams to perform at the highest level that renewal is critical.

8.When they move on, succession occurs without much of a blip. The stock price does not drop, the board is totally supportive of the new leader and the organization celebrates the contributions of the departing leader and the potential for her/his successor.

So, take a look in the mirror. On a scale of 1 (low) and 5 (high) and rate yourself in each of these dimensions and set a plan to improve your professional and personal effectiveness. You really have everything to gain!

1. Boards of Directors are increasingly holding CEOs accountable to serve as development coaches to their successors. It is no longer acceptable for the CEO to hire an outsider to do her/his work. Chances are that if the CEO does not have the motivation and skill to coach potential successors, they either have, or will have, limited credibility with their Boards. And their executive teams will not perform to their potential. This issue is placing CEOs at risk if they do not step up.
2. Executive Development Coaching is about optimizing the thinking of leaders. Even if you are not a product of the 60’s or 70’s, most of us respond to someone telling us what to do with a question such as, “Why”. Like Socrates, if the coach uses the power of asking the right question, in the right manner, at the right time, possibilities are explored, options are thoughtfully discussed and decisions regarding next steps are understood.  Coaching should produce a shared view of goals, reality, options, actions and measures of success exist.
3. Executive Development Coaching is not appropriate in every situation. Coaching works best when someone is motivated and has the potential to discover and own their judgment, while welcoming the challenge of the coach to help in the discovery process. Coaching for correcting performance or behavioral issues is very different than executive business coaching, and at times requires a much more directive response.
4. Regardless of past success, we can all benefit from Executive Development Coaching. Leadership demands continued learning and improvement. Board chairs and most executive leaders are not really good at development coaching, as they learned the old model of either positive or corrective coaching-feedback. Having said that, it is a skill that is highly amenable to development. The closer one gets to the top, the lonelier it can be.
5. Beware external Executive Development Coaches. There is a tremendous variation of capability in the market. If you are interested but do not know exactly what you or your organization needs, engage someone to help to pinpoint the need and help you to select the best coaching resources.

To summarize what I have experienced in some great organizations, building a culture of collaboration is not for the ego-centric or impatient. It is about setting a business grounded rationale that aligns strategy, leadership, culture, value and brand.  As a result, an organization develops sustainable competitive advantage.

I offer the following five essential elements as foundational to a culture of collaboration. I invite your comments.

1. Leaders who are self-aware: It takes leaders who know their distinct strengths, weaknesses (and we all have them) and those who demonstrate accountability and lifelong commitment to learning.  The leader who knows it all, needs to control it and those who lack the ability to give and receive feedback are not ready.
2. An expectation that coaching is everyone’s job: Providing colleagues, team members, and yes, even the boss with the opportunity to uncork their true potential is foundational. As Alan Fine describes in his book, You Already Know How To Be Great, this is driven through the power of the question.  While is easier and more efficient to just tell somewhat what to do and how to do it, this strategy does little to build the thinking capability and value of the human asset across the organization.
3. Apply understanding of the value of variety (a better word than diversity!): Differences in thinking and personality preferences, life-work experiences, cultures and education make for noisier and more productive teams. Yes, these are more challenging to lead.  Yet when leveraged appropriately, they can be a great source of collaboration and learning. This is not the work of the corporate diversity officer.
4. Thriving in the “white space”: We all know that the real work in most organizations happens in the white space between boxes on the formal organization chart; the place where vibrant and ever changing interdependencies work to produce breakthrough results. Where hierarchy rules, innovation and accountability are most difficult to nurture.
5. 5. An unwavering commitment to building professional trust: Trust is an often misused and misunderstood term at work. Trust is the degree to which people can rely on one another to deliver what they promise, and if they cannot, declare it and ask for help. Unhealthy competition, lack of self-awareness, inability to give and receive feedback and lack of true accountability all serve as barriers to the development professional trust.

Think about an organization that you have been part of that demonstrates these attributes. Compare the results to those of a different organization without these attributes for which you worked. Also, consider how you felt going to work in the morning.  Look in the mirror and make a difference.

“Obvious to you. Amazing to others. Any creator of anything knows this feeling: You experience someone else’s innovative work. It’s beautiful, brilliant, breath-taking. You’re stunned. Their ideas are unexpected and surprising, but perfect. You think, “I never would have thought of that. How do they even come up with that? It’s genius!”

Afterwards, you think, “My ideas are so obvious. I’ll never be as inventive as that.” I get this feeling often. Amazing books, music, movies, or even amazing conversations. I’m in awe at how the creator thinks like that. I’m humbled. But I continue to do my work. I tell my little tales. I share my point of view. Nothing spectacular. Just my ordinary thoughts. One day someone emailed me and said, “I never would have thought of that. How did you even come up with that? It’s genius!” Of course I disagreed, and explained why it was nothing special.

But afterwards, I realized something surprisingly profound: Everybody’s ideas seem obvious to them. I’ll bet even John Coltrane or Richard Feynman felt that everything they were playing or saying was pretty obvious. So maybe what’s obvious to me is amazing to someone else? Hit songwriters, in interviews, often admit that their most successful hit song was one they thought was just stupid, even not worth recording. We’re clearly a bad judge of our own creations. We should just put it out and let the world decide.

Are you holding back something that seems too obvious to share?

E=MC²?”

From the hospital perspective, it starts with the making the numbers work. There are typically assumptions about the P&L that illustrate how the acquisition will result in additional volume from physician referrals, as well as expense reductions through the consolidation of back room functions. Fairly straightforward, right? Not necessarily so.

Over and over, those with Blue Suits and White Coats fall in love too quickly. While they talk about differences in their vision, how their respective business have been run, how success has been measured and rewarded, the cultures that exist in their organizations, most of this is forgotten or put in the parking lot to deal with after the integration process. It is all about securing one’s financial future. Yes, but…

The transaction is now closed. The hospital acquirer has sold this deal to their Board based on a set financial assumptions. Someone is put in charge of integration and charged to ensure the integration produces the financial results. Now, the fun begins! Leaders on both sides begin to argue about how they interpreted discussions about integration priorities, timelines, metrics and results. This continues for several months and those financial benefits are not realized. Finally, whether from fatigue or Board pressure, integration actually begins. Physician leaders feel they were bullied and loyalties are questioned. Health system leaders question the integrity and loyalties of physician leadership.

Sound familiar? If not, I bet that you added a couple of critical steps before closing the deal.

First, your due diligence process included an objective and rigorous assessment of the practice’s culture. In all likelihood, you engaged an outside resources to help with this; a different resource than the one leading the financial due diligence. This, as well as a description of the hospital culture, was all shared with leadership of both organizations in a very transparent manner. As a result, differences were understood and identified in the beginning and served as the basis to pinpoint readiness to come together. Secondly, a small work group of leaders from both organizations were charged with developing a 12-18 month integration plan. This was also vetted with key stakeholders and modified prior to closing.

On day one, expectations were understood. That is not to say all was rosy. There were certainly challenges of change management. However, these were anticipated and managed appropriately.

Twice this week, I was brought into conversations where if these two steps were included, physician and hospital leadership would be sleeping better. No matter how obvious, people still miss the point and fall in love too quickly!

I’ll leave you with this:  Always remember, falling in love is whole a lot cheaper than getting a divorce…and for some hospital CEOs this might be the second divorce!

As a very smart former colleague and friend of mine (Thanks Mark!) notes, “ACOs are simply one example of value-based care delivery models, whether ACOs will succeed or not remains to be seen.  In the meantime, I’d be hesitant to hitch my buggy to the ACO craze“. Certainly there are many questions that remain to be answered, don’t get hung up on those. Just know that the sun is about to rise on the day when organizations, caregivers and leaders will be HELD ACCOUNTABLE FOR HEALTHCARE OUTCOMES.

Are you up for this? So, of you are thinking about an ACO, look in the mirror. If you see much of the following, then step up. If not, get out of the way and make room for the next generation of leaders.

1. Understanding of self and organization: The ability to recognize one’s strengths, weaknesses and opportunities for development, as well as those of the organization as a whole.  An appreciation of the importance of how others experience behavior may indeed be different from one’s intent.
2. Judgement: The ability to integrate information in a systemic manner to understand a problem or opportunity from the inside out, vertically, laterally, at the detail level, and the aerial view. A deep appreciation for the complex dependencies associated with financial, clinical and cultural drivers of value creation.
3. Motivation and ability to learn: The ability to develop and play with ideas and viewpoints to stretch them, bend them, reconstruct them into solutions that fit and work perfectly in specific situations and connect with those whose support is essential. As a leader, one must model this capability as the entire value-based health organization must have learning DNA embedded in all corners.
4. Fluency and clarity with ideas: The ability to describe many versions of one answer and many solutions to one problem set and to explain the impact or outcome of each both orally and in writing in ways that others can understand.
5. Vision: The ability to create and communicate a clear and compelling vision of accountable care inclusive of the destination, the strategy to get there, the measure of incremental success and the behavior that must be the foundation for change. This must be sufficiently detailed and supported to bring key stakeholders along.
6. Situational leadership: The ability to quickly and accurately assess the organizational and individual readiness and meet individual and parts of the organization where they are as the starting place for dialogue.
7. Authenticity of contributions: The ability to offer a value-added difference that would not be there were another person in the same role and have this be experienced as for the good of the organization over one’s personal interests.
8. A bias toward opportunity and action: The ability to estimate and verbalize the loss to be taken by standing still and missed opportunities that occur by choosing one avenue over another, in spite of the fact that there is incomplete information available.
9. Passion, enthusiasm, and positivity about decision making:The ability to bring the appropriate mindset to the decision-making process in order to lead oneself or a team to a positive decision-making experience; one more likely to result in commitment to action.
10. Coaching and organizational development: Supporting the development of others to see and act in a manner that leverages strengths, manages weaknesses before they become organizational or personal derailers, as well as initiates opportunities for professional and and organizational learning and continuous collaborative improvement

Some would suggest these thoughts represent leadership attributes that are critical to any major change. Yes, they certainly do, however in the past these capabilities were not always evident in initiatives intended to create more accountability for value creation in healthcare.