A former Gundersen Health System CEO says the best leaders make hard choices for long-term greater good rather than quick fixes for the short term.
Some of our most difficult and persistent problems include cultural expectations between senior leaders and the subsequent generations. We struggle with recruitment and retention of workers in high-impact and, occasionally, high-maintenance positions. Burnout of previously inspired and diligent staff members has a deep emotional cost on leaders, not to mention the staggering financial cost to the organization. Finger pointing, generation bashing and firm emails are unlikely to make any progress toward an organization’s goals.
Solutions will have a lot to do with us, not them. It is going to take longer-term thinking, the courage to state your values, and the discipline to follow through. As physician leaders, we need to understand that what is most important to our key staff and recruits is an environment that inspires them rather than controls them.
To imagine that you can retain them with clever payment schemes or window-dressing benefits will solve only superficial problems. In the words of William D. Henderson, a professor at Indiana University’s Maurer School of Law: “Money by itself is a weak glue.”
Are you and your organization clear about where you are going and how you will get there? In his book, It's Not What You Sell, It's What You Stand For (2011, Portfolio), advertising executive Roy M. Spence Jr. says you must clearly state your purpose — what your organization is about, why it exists and what your priorities are. Is your purpose statement at the top of your website, on every recruitment flyer, on every strategic plan, on every communication? You are more likely to recruit people who believe the same way you do and retain the people you want and need if you are clear about your purpose.
Are your goals clear and inspirational? If you want the highest-performing medical staff, your people are not going to be inspired by goals set on mediocrity. Being 2 percent better than your mediocre past or 2 percent better than your mediocre peers is not inspirational and is unlikely to inspire the people who will help you build a competitive organization. You need to aim for excellence regardless of your current status.
The strategic plan we created (see Figure 1) is for a $1 billion organization with 500 physicians and 300 other providers serving hundreds of thousands of patients and dozens of communities. It is not complex, but it is hard.
Look at your strategic plan. Does it talk about service while declaring aims and measures that focus on financial success and growth? The tone of this strategic plan is outwardly focused. It does not talk about 200 percent growth, or making an enormous amount of money, or out-competing the competition (although it accomplished all of those). It focuses on improving the health and well-being of patients and the community. It talks about quality and service that includes the opinion of patients and those we serve.
The strategy of “great place to work” doesn't say “easy place.” In fact, an organization that sets high ideals, establishes high standards, and demands that all live by a set of values is going to be a hard place to work. Similarly, the financial portion of the strategy says to make care more affordable, not make a certain margin or extract a certain amount of money from the community. Most staff members are more willing to spend time and effort and help lead a team to make care more affordable for their patients and communities than they are to make the margin go from 2.8 percent to 3.2 percent. Who are you serving — the bond raters, or those highlighted in your mission and vision?
The purpose clearly explains why we exist, and the mission and vision tell us where we're going. But we need clear values to tell us how we're going to behave along the way.
Do you have a known set of values lived by everyone, especially the senior staff? Without that element, people come up with their own ideas of how they're going to get where they think they need to go, and it gets very messy and inefficient. Clarity on the values is not just writing them on the wall or posting them on the website; rather, it is living them consistently across all parts and all personnel, especially the medical staff and administrative executives. This consistency develops an environment that is more predictable, more secure and more likely to let the creative next generation help us accomplish the prime mission.
To give staff every chance to understand the plan and to choose wisely, we set down our values in the form of a compact (see Figure 2) and distributed it across application, orientation and evaluation activities.
Keeping It Real
What does it look like and feel like to live our values every day? Again, it’s not complicated. But often, it’s inconvenient and hard.
Here’s an example. A young surgeon with outstanding patient outcomes and broad skills called me one morning. “Jeff, I think I'm in trouble,” he said. “I parked up by the building, and when I came out, a security person was putting a ticket on my car. I complained loudly and told him he should get a job that is worth something and that I make more money in a week than he does in months.”
I reminded the surgeon that the ticket cost him nothing and that it was just a reminder to keep the fire lanes clear. He pointed out that he puts millions on the books and could get first starts in many other places. I was quiet, and he asked if I was going to fire him over this little incident.
What would you say? What effect does it have on the rest of the staff to allow this? If your values matter and you agree with the idea that “what you tolerate, you support,” then you are compelled to take action.
I told him that if he apologized to the security guard, wrote a letter to the guard’s supervisor, and committed to changing how he treated all staff members, I thought he could have a long and outstanding career at our organization. But, on the other hand, if he could not commit to treating everyone with respect, this wasn’t the place for him.
This is the difficult part of having a value statement and living by it. You will have people who are quite capable and quite important to your service but behave quite badly. You will need courage to make that statement, discipline to follow through, and a great deal of durability to manage the short-term negative consequences of this long-term plan.
This young surgeon chose to not live within our values. The department was not happy, his patients were not happy, and there were a lot of people at work who weren’t happy in the short term. But in the long term, it was the right thing to do.
No one’s ego should be more important than the well-being of staff or patients.
Official and Consistent
Establishing how we will live is so important it cannot be left to guesswork. This guidance — in our case, a compact — needs to be a part of the application, orientation, training and evaluation processes.
But shouldn't medical staff members get some special treatment in return for enduring arduous training, taking brutal call and making countless critical decisions? The truth is that we get paid well, have outstanding benefits, have better job security than most people, and enjoy more respect than most other occupations. But even as you lead the medical staff, you are inextricably tied to the rest of the organization. The tone you set affects everyone.
The more special and protected we treat the executives or the medical staff, the less special and more afraid other staff members feel.
Again, living by these values is not easy. It takes courage to stare our friends and colleagues in the face and declare how high our standards are. It takes discipline to follow through when it's not convenient, and it takes a tremendous amount of durability to put up with all the complaints, criticism and angst of being consistent for everyone at all times. If we don’t implement these values, they are just words.
The undermanaged ripple effect of leaders’ poor performance is enormous — far greater than that of the frontline employee or new medical staff member. All leaders, regardless of their title, have an influence outside of the normal lines and boxes of an organizational chart.
Members of the medical staff are prime examples of having a great deal of influence regardless of their organizational administrative titles. If medical staff members also have a major leadership role, their influence magnifies. If they live the values, strive for goals bigger than themselves, and commit to improving the health and well-being of patients in the communities, they can be a bright light across a wide path in the organization.
On the other hand, if they focus on short-term personal gain and ignore the compact and the values of the organization, the shadow of their influence can be remarkably destructive. Not easy to intervene, but a clear call for action. Silence to distance yourself from a critical situation is still a statement. Silence is still a choice, just one made in fear.
As leaders, our responsibility is to have the courage to intervene and make sure that those we are training to be leaders, those who are partners in leadership, and even those who are ahead of us on the organizational chart, live the values and stay focused on the greater mission.
YOUR TURN: What was the most difficult professional decision you ever had to make as a leader, because it was the right thing to do? What went well? What didn’t? Share your story and your ideas with fellow physician leaders. Send your thoughts to firstname.lastname@example.org to be considered for publication.
Jeff Thompson, MD, is executive adviser and CEO emeritus for Gundersen Health System, based in Wisconsin. He is the author of Lead True, a collection of insights from leaders throughout the United States. This commentary was written for the Physician Leadership Journal.