LEDI 68 | Leadership Development Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. The Baldrige Foundation and ABOUT Healthcare welcome you to LeaderDialogue Radio where leaders glean valuable insights and practical takeaways to help navigate effectively through these challenging times.  The show airs on the 1st and 3rd Tuesdays of every month at 1:00 pm (ET) on Business RadioX. Today’s LeaderDialogue podcast (2/1/22) titled,  Operating as One: Leadership Development includes author Russ Hill, who is a Senior Partner and one of the founders of Lone Rock Consulting. Russ has written 3 books on leadership including the latest one titled The Great Resignation: Why Millions Are Leaving Their Jobs and also a previous book titled Who Will Win the Battle for Talent? Russ coaches and consults executives of some of the world’s largest companies including Amazon, Lockheed Martin, Johnson & Johnson, Cigna, and others. He has spent considerable time with hospital clients including HCA, Inova, Sutter, and OSF Healthcare.  Charles (Chuck) Peck, MD co-hosts this podcast along with Dr. Darin Vercillo, MD, and Ben Sawyer MBA, LBB of ABOUT Healthcare.  Listen in to gain keen insights on how to Operate as One in an environment of workforce disruption, including practical takeaways that can be applied immediately!

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Operating As One: Leadership Development With Russ Hill

I’m honored to be joined by some friends of mine, Ben Sawyer and Darin Vercillo. They are Executives at About Healthcare. Guys, it’s great to be back with you. I’m excited about this episode. We are going to be talking about operating as one and, in particular, leadership development. I’m excited to have a special guest here to talk with us. Russ Hill is a Senior Partner and one of the Founders of Lone Rock Consulting. He has written three books on leadership, including the latest one titled, The Great Resignation: Why Millions Are Leaving Their Jobs, and also a previous book titled, Who Will Win The Battle For Talent? He coaches and consults executives of some of the world’s largest companies, including Amazon, Lockheed Martin, Johnson and Johnson, Cigna, and others. He has spent considerable time with hospital clients, including HCA, Inova, Sutter, and OSF Healthcare. On a personal note, I got to know Russ closely when I was putting the chair of a hospital and health system that had six days of cash-on-hand. We brought Russ and several of his colleagues to help the organization get stabilized and focus on leadership, culture, and accountability. I can tell you from my personal experience after about six months with Russ that, he doesn’t talk the talk. He walked the walk. We had incredible results from his leadership coaching and the work he and his colleagues did with all of the folks involved at the hospital where I was at. I can tell you that this is going to be a great opportunity for folks to learn what all leaders in all industries need to understand about the environment we’re in.

Russ, it’s great to have you here. It’s great to be on, Chuck, and with all of you. I appreciate the invitation. What are some of the critical leadership attributes you think a leader in healthcare has to have now in these incredibly challenging times? We could do hours on this. It’s such an issue. You mentioned some of the different companies and industries that we coach and consult. I might be on the phone, in a virtual meeting, or in person with a defense contractor, a manufacturing company, an insurance company, a retail, or a hospital system. Everybody, I don’t care what industry you’re in, you’re exhausted. Everybody is dealing with it. How could you not, after the last several years of this pandemic and all of the changes that we’ve had to deal with in our personal and professional lives. With that said, the most exhausted in our experience as a firm is hospitals and healthcare. These folks are on the front lines. We were on with a hospital system and the executive team, and they said, “You’ve got to help us re-engage the leaders in our hospital.” That was the term they used. It’s almost like they want to go out and recruit them again, rehire them and remind them of why they work here. The moment isn’t probably the best right now. Hopefully, as these variants fade, if, in fact, that happens and we switch from a pandemic to an endemic or whatever that looks like, you all are the healthcare professionals, not me.
LEDI 68 | Leadership Development
The Great Resignation: Why Millions Are Leaving Their Jobs
Hopefully, if there is some easing in the healthcare industry, in the hospital industry, in the coming months, there’s a massive opportunity and need to dig in. To your specific question, what I would say is it goes back to when I was first hired. It wasn’t in the healthcare space. When I was first hired and put into leadership, they told me, “Go get things done.” I was young, inexperienced, and thought I knew what to do. They said, “Now we’re going to do this thing called an Employee Engagement Survey.” I went, “What?” They surveyed my employees and what the results revealed. I don’t brag about this, but it can help your audience know where I came from. What happened is I was working for a national company at that time. My employee engagement scores on my team were the worst in the entire company. Nobody had a more toxic culture than I did, and I was ticked when I got the results. My new people set me up for this. You hired me of nurses that I’ve rounded within hospitals, “You were a great reliable nurse, so we’re going to elevate you to the nursing supervisor. By the way, your people aren’t engaged. Why aren’t they?” “It’s because you never taught me. I know how to take care of a patient. That doesn’t mean I know how to take care of this team. It doesn’t mean I know how to keep teams engaged, how to deliver, get HCAHPS scores up, get patient safety, and do all of these things.” Chuck, the short answer to your question is we aren’t training leaders well enough. What are some things that some of the folks can take away from this? I’m sure there are folks that have been in this position. All of us, at some time or another, have been put in a position where we’re told, “We think you’re a good fit. You’ll get the skills later. Go get the skills, and take a leadership course.” Folks barely have enough time to get their work done, as you were saying. What are some of the things that folks can do to try to acquire some of the skills they need? There are two ways I would respond to that. I’d be interested in your experience as a collective group on this. I’m not the only “expert” on this. You all are too. You’ve lived in this space, so react to what I say here. My opinion is there are two aspects to that answer. One is what health care executives are doing? We have a responsibility as leaders. I’m talking about a mid-level manager to you’re the CEO of the system, or you’re in the administration of a hospital, a clinic, or whatever it is. Wherever you’re at on that spectrum, we, as leaders, have a responsibility to develop our people. That could mean lots of different things, but we’ve got to be investing time and energy. It doesn’t mean a fourteen-day offsite where we go to some island. Who has time for that to get that training? It does mean that we’re talking about our culture, and we’re having some discussions that aren’t about the patient, nurse, financials, or whatever. We’re talking about us, what’s working, what’s not working, what obstacles we’re up against, the beliefs that I hold about your unit and your team, the beliefs that you hold about mine, and what results matter because you have a balanced scorecard that has 87,000 metrics I’m accountable for. I don’t know what the 3 or 4 most are. You keep giving me new policies, procedures, checklists, and corporate sending down all these things. I’m supposed to deliver on all these results, but I need the ability to talk about that. As a leader, we need to create space where we’re talking about leadership. The other aspect of it is when I got that packet of papers in my early twenties that said, “You are the worst leader on planet Earth, or at least in this company, you have the worst culture.” The response in me was first anger, frustration, exhaustion, all that, and it was, “I better figure this crap out. I got to figure out how to lead.” I went to the bookstore. We used to have them back, or you go to Amazon. I started reading and investing in my ability to lead. The leadership team of our hospital, healthcare clinic, or whatever has the responsibility to develop leaders. I, as a leader, have got to take accountability for what am I doing to develop myself? There are lots of different ways that could look there. There’s never been more available online or on Amazon with lots of different companies for those who are interested in developing themselves as a leader. Russ, let’s say that I, as a young leader, go out and do those things, and I work at it. I’ve got this other situation that you’ve written extensively about. I have all these people leaving. They’re leaving because they have a toxic person that they’re reporting to, or they’ve lost faith in the organization that they’re working for. They’ve got a phone call that’s offering them $40,000, $50,000, $60,000, or $100,000 more to come over. The grass always seems greener. As leaders, we have a responsibility to develop our people. Share on X How do you suggest leaders motivate their teams during these incredible times, whether it’s COVID or whatever else comes down the road. What I’ve been trying to talk about with the organizations I work with is going back to the way things used to be after COVID is not going to be the answer because so much has changed. I can’t do this by myself. I also can’t have my top performers continue to leave the organization. If I’m in that chair again, how do I motivate folks on my teams and in my leadership group during these incredibly stressful times? Two things come to my mind. Number one is I’m going to quit the leader who’s not listening. If I don’t feel heard, I’m gone, especially in an environment where there’s all of this pressure. We hire people because of their ideas, wisdom, experience, and skills. Many of us, as leaders, in our intense efforts to deliver results. We tell them, “Please shut up. Put your head down and do what I ask.” You hire me for my ideas, experience, and wisdom. Now, you don’t want any of it. You want me to go execute. Sorry, that’s not why I came to work here. I came to work here because I have ideas. I’m passionate about what I do. If you want a robot, go find one, but I’m not it. We have more options as employees in every industry than ever in our lifetime. You’ve never led at a time in history if you’re alive now, where an employee has had more options. That’s what we wrote about in The Great Resignation, the book. That’s the reality of it. It’s the rise of the individuals. In chapters 2 or 3 of that book, the individual employee has more power than ever. It’s interesting because it’s happened at the same time that company has gotten bigger, the employee has gotten bigger because they’ve got options, and they also have a lot of money in the bank. Unless Wall Street keeps doing what it’s doing right now, but that’s another episode. Number one, make sure you’re listening to your own people. We always go to leaders in times when it gets tough, which is tough now in healthcare. It’s transparency and empathy. Nothing matters more. Don’t give me the spin. Don’t beat around the bush. Don’t hide the facts from me. Tell me what’s going on and give me transparency and empathy. You need to take twenty seconds and ask me how my kids do it. You need to take 30 seconds and ask me how my spouse or my partner, whoever is doing it. That’s one thing, transparency and empathy. The second end of that spectrum as it comes to exhausted employees, which is critically important, is that in addition to listening to them, we’re also making sure that we understand that they have these options out there. If we’re not engaging them in tapping into their ideas, they’re going to go somewhere else. Ben and Darin, I’m sure you must have some questions for us. I have a couple of observations that reinforce what you’re saying, Russ. When I was a new leader, I joined a large healthcare organization that had gone through a merger and acquisition. Two cultures were put together, and they were added on. They used to be competitors. In the particular division that I was responsible for, there was a lot of expression of anger, frustration, and so forth that I was a new leader like you were talking about. I didn’t know what to do. I went in there and heard it. I was like, “This is going to be a challenge. I reached out to an executive coach I’d been using and she suggested that I schedule meetings with them and ask them, “What will it take to make you feel safe?” I’m like, “That’s the question?” She said, “Trust me, try this.” I scheduled meetings with them, I introduced myself, and I got a sense of who they were.
LEDI 68 | Leadership Development
Leadership Development: Leadership is about being at the bottom of the triangle, not at the top.
I said, “What is it going to take you to make you feel safe in this?” It was like a watershed moment. It was unbelievable the stuff that came out because nobody had ever asked them. They felt threatened by the environment. They weren’t aligned on what they were trying to accomplish. Some of them had real personal conflicts. That was an eye-opening experience for me. Another interview I listened to was of Frank Blake, who took over as a CEO at Home Depot back in 2008. I don’t know if you guys are familiar with this story, but he had never been in a CEO role before. He had been general counsel in the EP and stuff like that. Suddenly, he was trusted for the CEO role. He didn’t quite know what to do, and The Home Depot was struggling. That was right at the time of the economic crisis in 2008 and ultimately was successful. He brought them from a $40 billion market cap to a $100 billion in his term, but he said, “Bluff thing that made a difference.” What he realized is that leadership is about being at the bottom of the triangle, not at the top. That’s the moment of truth. That’s the frontline, and whatever he could do to support them so that they had a clear sense of vision that could be replicated in that moment of truth interaction. He spent a lot of time at Home Depot walking the aisles and supporting effects. One customer said to a customer service rep who was joking with them, “Do they have a new program of staff with the ARRP at Home Depot?” He was the old white-haired guy. His point was, “The best time I spent was being on the frontline.” To your point, understanding, listening, no spin transparency, and empathy with what these people are doing on the frontline. He said, “We had to acknowledge and reward behavior that was consistent with what we were trying to accomplish, but it wasn’t done from the boardroom. I had to realize that I’m at the bottom of this inverted pyramid.” Ben, I want to react to that if you don’t mind because those are good points, especially in healthcare. Before I get to the healthcare, the hospital, and the clinic side of this, I want to share an experience. I started my leadership career in the media business. I was working in television and radio properties. In our national broadcast company, the most successful property we had from a revenue standpoint was WTOP Radio in Washington, DC. It’s an all-new radio station, but those who live in the Washington, DC area know this radio station. Joel Oxley was the general manager at that time. I flew out as a young leader to Washington, DC to spend a couple of days at this media property. I remember having lunch with Joel and saying, “Joel, what’s your secret? How did you turn this place into the media powerhouse, the highest revenue generator in the radio business in North America?” He said, “Russ, I do it by walking around.” I remember thinking, “You’re not that smart.” I was looking for this wisdom, and that was it. I was disappointed, like, “That’s your secret. You walk around. That can’t be what’s responsible for it.” I can tell you countless stories of hospitals where we’ve been hired to come in, work on the culture, fix the culture, and try to help impact results from patient satisfaction to financials, employee engagement, and retention. We’ll start that project by interviewing 40 employees, whether they’re EBS employees, clinicians, or wherever they’re at. Frontline to leadership. One of the first questions we ask is about the leadership team. When’s the last time you saw them? I can tell you stories about manufacturing plants, where the challenges that we uncovered digging into a culture project. The biggest obstacle was the plant management team sitting in their office. There are tons. We could do a whole episode on what you were saying, Ben, which is visibility. Why is that critically important? It’s because my job is to manage the culture of this hospital, clinic, unit, and department. I can’t know what my people think unless I’m out. That’s why I’m rounding back when the emphasis was made on it. We overburdened rounding by putting way too many barriers on it and checklists. I’ve rounded with hospital administrators. What it comes down to is, “Lisa, what’s on your mind? What are you struggling with? Bob, what are the biggest challenges you’re dealing with and trying to deliver patient safety or doing this, that, or the other?” It’s in listening to the person who is closest to the customer, the patient, or the member who is going to be able to have the biggest impact on results. The more distance we create as leaders between us, the customer, and the patient, the worse off our culture is going to be. The more distance that we create as leaders between us and the customer, the worse off our culture's going to be. Share on X If you want a great example of this outside of the healthcare space, go follow on LinkedIn Doug McMillon. He is the CEO of Walmart. Do you know what he posted on his LinkedIn account day after day? Pictures of him what at some Walmart in the US. Guess who he’s talking with? Associates and customers. He’s got a few meetings to be in. He’s busy. There’s a lot going on with the supply chain and all this other stuff. If he can find time to visit with customers and associates, he’s got a private jet to get to various Walmart, a pandemic, no pandemic, or whatever is going on. We can find time to be closer to the patient, the member, and the employee. Russ, I want to touch on that. This is Darin. You’ve mentioned culture and it’s important in healthcare systems. This is something we deal with a lot when we come in. We work, especially with physician culture, interestingly enough. Chuck and I, being physicians, feel this when we talk about sometimes physician culture can be a barrier when you’re a nonclinical administrator. You’re trying to work through that hierarchical system that exists in healthcare systems. My question to you is what counsel do you give to the developing leader or the leader developing program to be able to cast a vision to overcome the barriers of physician culture, where physicians don’t like to change. They know things fit like an old shoe. When you’re asking them to maybe speed up, be the easy button, or allow patient flow to move through a lot faster, these are some of the things that we deal with. What’s your wisdom there for that leader that wants to deal with the physician culture and push back? Similar work to what you all are doing, there’s plenty of work to be done. Some of my most challenging groups to be in front of are union employees at nuclear power plants and physicians. I always tell people it’s two groups. This is from decades of doing this. I’m not casting judgment on either group, but I’ve had large hospital systems. They’ll put me in front of hundreds of physicians in one of their systems, and the arrows flying at me. I’m sure all who have had this experience are pretty sharp and plentiful. In those experiences, I thought, “Why is that? Why is this?” You all would probably know better than I would be in a position, but I’ll tell you my belief. My belief is that, as a physician, there have been many changes that have been made, and I don’t feel like my voice has been heard. I’ve got this expertise and the patient’s well-being. I feel the weight of that. This is what I see in the eyes and what I hear in the position. You all told me if I’m wrong. I’m responsible, life or death. Whether they’re going to heal or not is up to me. All the rest of you, I appreciate you were helping out and supporting me, but it’s on me. I feel that, and yet, you’re making all of these changes, and you’re not asking us. In the hospital system, somebody pays us, hires us, or whoever, you probably had the same experience, put you in the front of the room, you’re talking to these positions, and they’re like, “Somebody is now going to ask my opinion.” I’ve been holding onto this for several years here. It all comes to you. Am I right on that? What do you think? I’m glad you brought that up because the idea of hearing the voice of the physician and getting their input not only engages them in the process and makes them feel that they’re part of it and it’s somewhat their own. To your point, you stave off all the things that could fly at you later because you made decisions in a vacuum. Put them in the same room. I don’t understand why many times we don’t want the positions in the same room as the nurses, the texts, or the different. When we’re getting the leadership team together, many hospital administrators I’ve worked with over the years seemed scared of positions. There’s this fear in like, “We’re going to schedule this meeting two weeks from now when everyone else is busy. We’re going to have the physicians in this room.” I’m like, “What are you doing?”
LEDI 68 | Leadership Development
Leadership Development: Your team can’t work on 150 things. You need them to deliver specific results, and they need clarity on what they are.
They all have to work together on the floor anyway, and most of the culture problems I’ve seen in hospitals are because these groups don’t feel heard by one another. Going back to where Chuck started our conversation years ago in one of the hospitals he oversaw that he brought us in to help him out with, that’s what he did. Chuck, that’s what you did. You put us in the room with them and got these folks together. I think about some of our sessions with surgical services where in those areas, the pressure is intense. If you want to find the most toxic culture in most organizations, it’s in surgical services. For lots of different reasons, those folks don’t feel heard, and the pandemics created all kinds of challenges. It’s like, “When are we going to schedule that meeting, Russ?” In the middle of what we’ve been going through over the last couple of years, those conversations are needed. I’m hopeful that in 2022, in the weeks and months ahead, a lot of those reading are going to put effort, time, and energy investment into having those conversations they’re sorely needed. You talked about something I’d like to follow up on. You mentioned that the fear related to some administrators and physicians, but you coach an awful lot of high-level executives in Fortune 500 companies, hospitals, etc. What are some of the other things that stand in these leaders reaching their people? Aside from being afraid sometimes, what do you coach people about the top 2 or 3 obstacles that you found in coaching? It’s these three things, Chuck, clarity, alignment, and movement. We call it The Third Leader. We work with all kinds of different types of leaders. Each of you had experience working with thousands of different leaders, and we started to segment them into the 1st, the 2nd, and the 3rd leader. We run out of time in this episode to dig into those definitions. We’re aiming to be the third leader. The third leader is somebody who has the ability to create clarity. Your team can’t work on 150 things. You need them to deliver specific results, and they need clarity on what they are. There can’t be more than 3 or 4. On that balanced scorecard, what are the 3 or 4 metrics that matter most? We go into a senior team that leads 30,000 people and say, “What are they?” You can’t pick 7 or 12. There are lots of metrics that matter, but it’s got to be these three. Clarity, you’ve got to create clarity as a leader. The second area is Alignment. Alignment is different than awareness. Almost all of us are good at leaders as leaders creating awareness, new policies, projects, and priorities. Awareness is different than alignment. A team that’s aware of something doesn’t deliver the same results than a team that’s aligned to it. That’s why I’ve dug deep into this conversation about making sure people feel heard. That’s what happens with alignment. Alignment is messy. Alignment needs to happen out loud. I need to think, ask questions, and raise observations and challenges. A leader who knows how to create alignment and leans into it is critical, Chuck. The last area is Movement. You saw this, Chuck, with the work we’ve been involved in over the years. What are the 3 or 4 beliefs that need to shift in this clinic, hospital, or unit? What are the 3 or 4 aspects of the mindset on this team that is slowing us down? A leader that’s skilled and being able to manage culture and shift that mindset is effective and has a different level of engagement. It’s creating clarity, building alignment, and generating movement. Thanks a million, Russ. This has been a great episode. I want to remind our readers that we’ll be talking more about systemness. We’ll have some additional episodes on leadership. We have a webinar coming up also. Please stay tuned, and we’ll be discussing some of these important topics as we go forward. Ben, any last words? Russ, thanks so much for joining us. I thought that was a great conversation and lots of considerations and takeaways for the audience. We appreciate it. My pleasure.

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