leadership Archives - Page 2 of 4

Enough Engagement, Healthcare Needs Partnership

Engagement 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

Exchange of purpose
Absolute honesty
The right to say No
Joint accountability
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

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)

Medicare Dilemma: Equality or Excellence, But Not Both

Who wants average healthcare? We want the best for our children and loved ones, not average. Canadian Medicare can never deliver excellence, because it’s made to deliver equality.

Excellence does not occur by chance. We design systems to produce and reward excellence. But, Medicare hates reward based on performance.

Medicare delivers equal pay and equal performance, but not excellence.

Most big healthcare organizations are unionized in Canada. Unions discriminate on seniority; the longer you work, the more you make. Volume or quality of work does not change unionized income or job status.

But, we DO discriminate by punishing the very lowest performers. Gross negligence will get you fired, or sent for remedial training.

So, more accurately, Medicare just refuses to reward excellence. In fact, Medicare finds distasteful the idea that some perform better than average.

Every Olympic race has a few speedy people out in front, a pack in the middle, and a few of the slowest at the end. Medicare denies that bell curves exist; that there’s any race at all.

Excellence requires effort, exposure, and risk. Why reach for excellence to earn weak kudos from your boss and disdain from colleagues for making them look bad? Inspiring leaders can squeeze out extra effort, but always backed by the promise of rewards: better pay, better positions, or better intangible benefits.

When we remove the concept of excellence, all measures of excellence, and refuse to reward excellence, we leave nothing for management to lever. All that’s left is process and structure. Management defines work that needs to be done and relies on punishment if it’s not done. Punishment invites union scrutiny. Performance management gets tried, found difficult, and left undone.

Refusal to reward excellence drives revision to the mean. Everyone clusters around the average; the bell curve becomes narrow and steep…equal and safe.

When everyone’s performance is average, patients get average care. Unless we have unlimited budgets, excellence can never show up, except by chance or revolution.

Do we care about excellent patient care, or provider equality? In times of fiscal restraint, ideologic commitment to equality cheats patients of excellence by offering only average healthcare.

(photo credit: blog.ubc.ca)