Category: Leadership

Great Governance, Great Decisions

Effective GovernancePeople know great governance, even when they don’t have words to describe it.  Great decisions pass our sniff test.  But, organizations get into big trouble when governance stinks.  Glen Tecker, governance consultant, has helped over 2000 companies put words to corporate frustration and find better ways of working.  I wrote about a presentation he gave before.  Here are some highlights from a recent one.

Good Governance: Difference between Oversight, Supervision, and ‘Snoopervision’

Oversight concerns itself with what and whether we accomplish what we wanted.

Supervision concerns itself with what and how work is accomplished.

Snoopervision concerns itself with what, how, and who does what, which leads to ‘administrivia’.

Corporations need to ask:

What do we want to accomplish?

What sort of organization is required?

What resources do we need?

Governance Requires Clarity of purpose:

Consider a curling team.  What happens if everyone thinks the stone should land somewhere different?  Desired outcomes are impossible without clarity on what we need to do, what’s required to do it, and how we will get the job done.  The parts of a rocket must all pull together.  What happens if pieces decided on their own where they wanted to go?

Organizations need to decide whether they will fund:

A group

An activity

An outcome

If we fund groups, we need organizational charts.

If we fund activities, we need series of business lines.  We need to know about programs and business lines within the organization.

If we want outcomes, we need clarity on outcomes, first.  We must have clear, measurable goals, and a definite picture of what we don’t like about the current state before we can work at achieving an outcome.

Stakeholder needs, wants and preferences determine what we hope to accomplish.

We make decisions using available information, not timely, accurate, or relevant information.

Available information comes from experience, reading, and conversations.

Assumption becomes surrogate for truth; assumption based on available information.

Where does your mental model, for what a governance unit, or person, should be doing, come from?  Does your mental model fit with the current issue?

Form follows function and Function follows purpose.

How do you define Fairness:  everyone gets the same vs. everyone gets what they need?

Culture + process + structure feeds into governance.  Governance itself is authority, process, and capacity

Levels of engagement in decision-making:

  • A – decision
  • B – involved
  • C – consulted
  • D – informed
  • E – no involved

From Building Better Boards, by David Nadler, 2004 HBR

 

Enough Engagement, Healthcare Needs Partnership

handshake-partnershipEngagement is over-used; we don’t need more of it. We need partnership, not engagement.  Leaders want supportive followers, but do not want to give up command and control for partnership.

Engagement

Leaders talk about people being engaged, how to engage, lack of engagement, and otherwise use engagement to explain all kinds of operational failure and success.

Engagement, for leaders, means interested, positive followers.  Interested, negative people are labeled irritants, not engaged.  Leaders love engagement, but change requires more.

Partnership

Peter Block writes that partnership is

    1. Exchange of purpose
    2. Absolute honesty
    3. The right to say No
    4. Joint accountability
    5. No abdication of responsibility

Engagement means support for a pre-defined purpose.  Partnership exchanges and builds purpose together.

Staff engage, but hold back criticism or gossip, whereas partnership demands absolute honesty.

Partnership gives others the right to say No.  It requires vulnerability, humility, and willingness to give up command and control.

Followers enjoy complaining about leaders’ decisions no matter how much they engaged.  True partnership eliminates complaint through joint accountability.

Engagement fizzles when parties walk away.  Partnership means parties keep their commitments.

Medicare needs partnership

Government needs to embrace partnership, and providers must follow through in all it demands.  True partnership would lessen the turmoil of election driven change, allow us to build on success, and create meaningful change for patients.

 

(photo credit: smallbusinessbc.ca)

Myth: Physicians Lead Medicare

doctor administrator

Bureaucrats and nurses lead Medicare. Aside from a few CEOs, and a smattering of administrators, physicians do not lead Medicare.  Most of the MDs in hospital admin positions do not have signing authority, cannot hire and fire, and have no budget.

If we include all paid leadership positions, non-physicians out-number physicians by at least 15:1, if not much more.

Physicians bear final responsibility for medical care. Until we figure out how to give other providers final responsibility, physicians should represent at least 30-50% of paid, senior leadership positions.

We need to train physician leaders and attract them to take leadership positions.   Physicians won’t apply for leadership roles for a fraction of clinical earnings.

40 years ago, Medicare bureaucrats assumed leadership and fought physicians for control when necessary.  This must change.  Medicare will not run well without physicians holding many of the top positions.  I said ‘many’, not ‘all’.

Once we create opportunity, physicians must not abrogate their responsibility to help run the system.  Physicians need to value system involvement and not see it as ‘going to the dark side’.

Patients assume physicians run hospitals.  They stare in disbelief when they hear physicians have almost no role in administrative hospital function.

Without a majority, or substantial portion, of physician members, leadership teams avoid decisions that might anger medical staff, or they make poor decisions for lack of physician leadership input.

Physicians do not lead Medicare; the myth has to change.

 

(photo credit: net.acpe.org)