Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic.
Dr. Roger Spoelman of the Baldrige Foundation and Ben Sawyer from ABOUT Healthcare facilitate a very insightful discussion regarding how the Loyola University Health System team achieved a $100 million turnaround by applying the principles of the 12-week year in a robust team-oriented effort. That overcame the trap of annualized thinking and the many hurdles within a commonly experienced people-process-technology operation to achieve breakthrough results. The model applies to any strategy execution challenge an organization faces.
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“Driving Clarity & Focus: The 12-week Year” With Guests Dan Isacksen, Trinity’s CFO, And Brian Moran, Author Of The Book “The 12 Week Year”
I am joined by my friend and colleague, Ben Sawyer. Ben, how are you doing?
I’m doing fine.
Ben, our audiences are in for a real treat. They will be tuning in to our conversation with two amazing leaders who are going to share some practical advice and a great story of problem-solving. This was a persistent problem that was addressed by a book that I ended up reading. I’m not exactly sure where I first heard about this book. It was timely and very providential that I picked this book up exactly when I did. We’ll get into that story in a little bit. Our guests are Brian Moran, the author and Founder of The 12 Week Year, the book and the organization with the same title. I love the subtitle, It’s Get More Done in 12 Weeks Than Others Do in 12 Months.
Anybody who worked with me or knew me back when I was deep into this business, I was always looking for hacks. It sounded like a Tim Ferriss book, The 4-Hour Workweek or something like that. I loved the concept. I got it immediately within the first few pages. It was cool. Brian is with us as well as Dan Isacksen, who is the Chief Financial Officer and the VP of Finance for all of Trinity Health, which is one of the largest health systems in the country. I had the privilege of working with Dan when I was the CEO at Loyola Healthcare in Chicago. He was a wonderful trusted colleague and friend. We had some difficult problems. In addition, to going into some Cubs games together, we did some amazing work. Brian and Dan, welcome to the show.
Thanks for having me.
Thanks. It’s great to be here.
There’s so much here. I don’t know if we can pack it all in the short time that we have available. I want to start out with you, Brian. The 12 Week Year is not a brand-new book. It was published in 2013. I’m sure this idea was with you for quite a while before that. I love the concept of compressing the timeframe and getting more done. I don’t want to throw you a curve and have you talk about private stuff you don’t want to, but you mentioned in the book that you and your wife, Judy, are both cancer survivors. I wonder if that gave you a different perspective, not only on business but on life as well so that getting more done in a shorter period of time seems rather appealing. Talk a little bit about that. Would you, Brian?
I’m happy to. That experience definitely changed our mindset around how we look at time. I would tell you that the two of us walk in gratitude way more than we did before. That was one of the significant changes, but appreciating what you have and trying to make the most of it. The 12 Week Year came about because we were working with clients and trying to figure out how we were going to best help them. They all had great ideas. They all had great resources.
Michael Lennington, the coauthor and I realized early on that the number one thing holding organizations and individuals back, for that matter, was not a knowing issue. It was a knowing-doing gap. People weren’t executing. I would argue if you did more of what you know consistently, you’d be healthier and happy to make a lot more money without learning anything new. Everything we do is with that bet. How do we help our clients execute more effectively and get more of the critical stuff done in less time? It drives profound results.
In doing that, one of the things we bumped into is working in the annual environment, which is what everybody did. We did the same. We set these annual goals and built these annual plans, and broke them down quarterly, monthly and weekly. Although we were getting good results, we didn’t feel like we were getting more people capable of it. We realized it was that annual cycle. There’s too much time to put things off.
I can guarantee that everybody started 2022 all fired up, “2022 is going to be my best year ever,” but when we get to the end of this month, most of them are going to be behind goals and plans. Not one of them was going to be worried because the mindset was “I got plenty of time to catch up.” That is the bugaboo. That’s the thing that we saw. We had to somehow shift that mindset and thinking in order to change behavior and results. The 12 Week Year was born out of an athletic training process called periodization, where they use short cycles to focus on particular disciplines and build capacity. We saw that and said, “Let’s apply that to what we’re doing in our business and personal life. That was the accelerant for what we were doing.
It sure works. You call it in your book, the trap of annualized thinking. It’s in a minor way. It’s the whole notion of when you got a vacation planned, the most productive days are always those couple days before you go on vacation.
You crank stuff and it’s all the important stuff. You’re good at prioritizing what matters and doesn’t right before vacation.
Another thing that you talked about in the book is that every day counts. December is a long way off. We have this casual attitude about this, but when you refocus your efforts in the organization on what I am going to do today, every day has to count toward accomplishing the goal. We get toward the end. You’re talking about scoring, which I don’t know if you want to talk about that now, but we’ll certainly talk to you about it in the example. Dan may have a chance to share about this and how you score yourselves better. You said, “Every day counts and this gives you clarity and urgency together,” which I love.
Some people hear that and think, “That sounds stressful.” It’s the opposite because when you’re focused on what matters most each day and you’re doing what needs to be done, that lowers the stress. The results come online so much quicker. Oftentimes, stress is created when we’re not doing things that we feel like we should be doing. When we’re clear on what those are, and we’re being consistent with them but not perfect, but consistent with them day in and day out, all of a sudden, that starts to respond like compound interest. A few days of that is no big deal or a few weeks, but day after day after day, week after week after week. As you found, in twelve short weeks, you could be in a very different position.
Tell us a little bit about the kind of clients you’re working with so our audience gets a sense of who the target audience is. Who’s the ideal candidate to read this book and apply its principles?
We’ve been fortunate to work in every industry because execution isn’t a problem in one industry. We’ve got soccer moms. I did a workshop for a hospital group in Saudi Arabia. We’ve worked in about every industry. We have two avatars. One is the individual who wants to perform better, whether it’s in their business, career or personal life. The other is leaders that are trying to get their organizations to achieve what they’re capable of. The 12 Week Year works phenomenally well in either of those walks of life and sense.
Let’s talk to Dan. I’m eager to have you talk about the problem that we encountered now. Loyola Healthcare is part of Trinity Health. I had been asked to a stint at the tail end of my career with Trinity before I retired and served as the interim CEO of the health system. Dan, you weren’t the CFO when I started.When you're focused on what matters most each day, and you're doing what needs to be done, it lowers the stress, and the results come much quicker. Click To Tweet
No. I was Vice President of Finance.
We made a change there at one point because what we were doing wasn’t working. We want to give a nod to Ben Carter, who’s now the Chief Operating Officer of Trinity Health. Ben and I were colleagues. When he asked me to go and spend some time there, Ben said, “Our CEO left. He went to another health system. Will you go? There’s a problem there that no one has been able to figure out, but as long as you’re there, why don’t you give it a shot?” Ben and I talked a little bit about this, and we immediately brought Dan in as a co-conspirator. I had read this book. I gave it to Dan. Why don’t you talk about what our challenge was at Loyola?
Right before you arrived, Roger, Ben did give us a call and said, “We’ve got a problem here. We had a significant issue with our revenue cycle function, everything from the front end to the back end, billing, customer service, authorizations, you name it.” There was a series of surprise write-offs towards the year-end for several years in a row that was a real problem. A lot of our other metrics were all going in the right direction. Our volumes were growing. Our strategies were working. Our clinical programs were enhancing, but we continued to have financial problems.
I’m sure, Dan, that Trinity and Loyola were the only people who have ever experienced this.
It’s us and everyone else. We knew there was a problem. At the time, Revenue Cycle didn’t report to me. I was a part of some groups. We were trying to influence, but I was asked to help lead the Revenue Cycle and take a different approach. Right as you were arriving, we had decided to set up a modified FEMA Command Center for Revenue Cycle to declare an emergency. What we were looking for was what a FEMA Command Center for Healthcare Revenue Cycle looks like. We were trying to figure out what the structure is and what the cadence is. Roger comes and not too long after, he was like, “Take a look at this book?”
I took it just like you did. I said, “Another business book.” A couple of chapters in, I’m like, “This is it.” I remember going and talking to you and saying, “We’re going to do this and incorporate this together. This is what we’re looking for.” For years, they had consultants, complicated data, PowerPoints, and all of these things, and nothing was fixing this. We set this team up and we meant for it to conceptually be exactly as I was reading The 12 Week Year. I was like, “This is what we’re trying to do.” We use these principles in our work there.
Brian, you have not heard the full story. I’ve teased you when I try to contact you and talk you into being part of this show. I teased you with this. Does this sound at all familiar? Have others had the same problem?
They have. Every organization is a little unique in terms of specific dynamics. Often, it comes to the point where an executive group or somebody on the team says, “Enough is enough. We’ve got to do something different.” The 12 Week Year certainly facilitates something different.
When we first rolled it out, I pulled out the old kickoff materials. We went through it and provided every team member with a copy of the book and said, “Read this and be ready.” Most of them did. A couple of them thought, “It’s just another gimmick,” but the majority of the team took it seriously. We started to think differently. I have to tell you, that first period was rough. This was a monumental change in thinking. I think expeditiously in my style. When we started to roll this out and talk about daily metrics and assignments that were due the following day or the next day, someone said, “I can’t get this done tomorrow. How about Wednesday? How about Thursday?”
We started on this cadence of shortening everything down. What Roger brought to it is we celebrate it. As soon as anything happened that was in the direction of good, we celebrate it, whether it was a week, a day, two weeks or after the first month. It started to catch on and people started to get in the cadence of the whole thinking, planning, and seeing those results. What’s amazing to me looking back is it kept getting faster and faster. It started off slow, but it kept getting faster and faster.
Dan, we warmed down. When you say who’s the team, we made a decision, didn’t we? Who were the people around the table?
One of the problems was that Finance was trying to fix a financial problem for years and years. What the real answer was is that we had to get people from operations and from all over, not only from Revenue Cycle, but we needed physicians and front end. People who are pushing the buttons on the front end needed to be there. We had marketing, HR, and a representative from every functional area. One of the concepts is sharing your vision and your results with others. We did that well.
The reason we had the marketing leader there was that she would take these, and we would say on a weekly basis or every two weeks, we were going to report out to the entire organization. We were going to be that transparent. Once everybody realized, “These results are going out there to everyone. By the way, I’m going to share them with our executive team and the board” When we started talking, Roger, you remember those first days. It’s like, “Okay, this is real.”
We met every single day, and it wasn’t a long meeting. What time did we meet? I can’t remember.
We met from 11:30 to 12:00. We reserved 12:00 to 12:30 in an emergency, but it was a FEMA-like conversation. You knew when you were going to go and you knew what your report out was going to be. We assigned it in advance. The folks took ownership, and that accountability was given. In those first few weeks, you remember, people came and they weren’t ready. What ended up happening is in the beginning, Roger and I were holding them accountable. By the time we were done, the team was holding each other accountable. I would even say towards the end, individually, each person was holding themselves accountable. It has completely changed the dynamic.
It was beautiful, Brian, because it was like you talked about. It’s daily goals. Very few people have the discipline to do this. As Dan says, you make the group accountable for the activities and the things that go well and don’t go well because there’s no place to hide. All the decision-makers are in the room.
That’s one of the keys. There is nowhere to hide. The people that refuse to execute won’t last. They’re called out and sometimes they’re asked to move on to someplace else, which is not a bad thing. You said a number of keys there. You celebrated the small wins and the successes along the way. Sometimes it’s the shift in how we’re thinking. Lots of times, you’re going to see that shift in the actions before we ever see it in the outcomes. We don’t control the outcomes. What you’re focused on daily and weekly are the actions. What do we control? What actions are we taking? What’s the impact they’re having?
You said it started to get faster and faster. That’s the momentum building. You never get that in an annual cycle because it’s too long a timeframe to build that momentum because it’s palpable. You need to feel it and see it, and having people brought along in the wake of that is powerful. I love the fact that you shared the results, good or bad, with everybody.We don't start with the organization. We start with people's personal lives because their careers are part of that. Click To Tweet
Brian, in Chapter 6, confronts the truth. It was ugly. That’s part of the problem, wasn’t it, Dan? We were hiding the truth or we were not taking responsibility for the results. It was always like, “That’s some other department.”
I want to ask a question on behalf of the audience. Without airing dirty laundry, what exactly was the problem? How did this focus go right to the root cause? I know it was Rev Cycle. Everybody on the show is in this space, Dan, and probably has experienced similar things. Where can they derive hope from this? What were the kinds of problems, practically speaking, that you were addressing and knocking away at root causal factors?
That’s a great question. Everything was broken, and I’m not exaggerating. The general answer is it was people, processes, and systems. Little things like denials and getting paid for the work we’re doing, not involving the clinicians or operational-minded folks in the processes, and trying to back off as well. This is what I think connects the dots, but from a system perspective, we had a system that had the ability to do a lot of functions, prioritization, and work queues. Someone could come in and work the most important. Those weren’t even turned on, and the ones that were hadn’t been reviewed.
We had a defining moment in the first couple of weeks, and Roger will remember that we looked at each other and realized how bad it was. We realized that for some of these functions, these people who were supposedly working together all the time, the tool they had in the system to even do it wasn’t on. I’ll give you a specific example. We were having some patients pay and get a bill saying that they didn’t pay it. It turned out that the module for the front-end desk clerk to say, “Here’s a payment and post it to the right place.” They only had one place to post it. It didn’t connect back to where the actual claim was.
You could pay your bill, and they would post it. You then get another bill saying you didn’t pay it. You get a refund of that payment. It was a mess. I don’t want this to go without saying that there’s a part of the book about emotional connection. We did this for the patients. The mandate for change wasn’t about money. It ended up turning the organization around from a money perspective, but this was about our patients, even our colleagues.
On the first day when we started the command center, I brought a picture of my sisters who had passed away within about six months of each other back in 2000. They were my inspiration for a lot of things. I shared my story and put their picture up on the board. I said, “I want each of you to bring a picture of a loved one, tell us the story, and put them up on the board.” It was just an idea I had. I thought, “Everyone is going to think that this is ridiculous.” It would be in the way, but what happened was people not only had the emotional connection to the work we were doing, they had an emotional connection to each other and what we were doing.
We would get to points where as the leader I would pause and say, “I’m stopping the conversation.” We would turn to the wall. Most of these people had pictures of loved ones who had passed or were dealing with something. I said, “Would we send them an incorrect bill? Do we want to increase their stress? Would we do this to them? How should we handle this?”
It would only take about 3 or 4 minutes. Roger was there. It was very powerful. I get emotional thinking about it almost, but everybody was on point, “This is what we should do. This is what we have to do. We have to figure this out. We have to do this for grandma, my mom, and my sister. We have to do this.” I don’t know if you remember that.
It was brilliant, Dan. It was a great centering and focusing event. I still think about your sisters and how you were vulnerable. You brought that into the conversation. My wife has had breast cancer four times. I brought her pictures. Dan and I were there every single day.
That is so powerful, Dan. Thanks for the vulnerability on that. That’s very moving. Brian, is that something that happens this 12 Week Year with other groups that you’re working with? Is that a moment? Is that a motivational threshold that has hit in these kinds of activities?
With the 12 Week Year, it all starts with the emotional connection. It has to be personal. If it’s not, then we’re just going through the motions. We do a lot of vision work with organizations. We don’t start with the department or the organization. We start with people’s personal lives because their career is part of that. It’s how we connect the career and ultimately, what we’re asking them to do Monday through Friday with the life they want to live.
Dan brought it all together in a powerful way for people. They’re trying to solve a problem, “Here’s why it matters to us in the room. Not just our patients, but let’s put names and faces of those family members that have been patients.” There’s always an emotional connection. Otherwise, what happens is we continue to do what we’ve done and the marketplace moves on. We’re left behind and struggling to embrace change. The big bugaboo with change is the discomfort of doing something different. That’s the enemy of great. We find what works and stick with it for way too long, and the world moves on. I can give you names of companies that are out of business now that were paragons in their industry because of that very thing.
Change is never easy, but when you have an emotional connection to the future and the future is more compelling than the present, that’s how we move into it. Dan did a fantastic job setting that up for the team and not just one time, but keeping people connected to it. That’s the key. There’s that vision, but if it’s sitting in a drawer somewhere or it gets themed on a wall on a poster, it means nothing. It’s making that emotional connection on a daily or weekly basis with people that causes them to behave differently to enter into the change, the uncertainty, and the discomfort of taking new action.
I can’t believe that we are about out of time. Dan, in two minutes, can you summarize what the results were? What happened? This is a Cinderella story. You’re now the CFO of the whole company, but tell us what happened quickly.
We were on a journey. Loyola Medicine was losing. We lost about $30 million when we started. We had about $100 million in turnarounds, and almost half of that was from the Revenue Cycle. More importantly, what happened was that everyone started to rethink how they did everything else. We brought that into today, and it’s not as defined as it was in that command center. Some of the actions that we’ve had to take in getting everybody in a room and working on emergence from COVID or working on how we are going to handle electives, and how we are going to keep people safe. It’s getting all these people in a room. What were ones crazy to get marketing, everybody is representative and now, it’s common.
We have these ROA groups throughout Trinity for all of the ministries, which is helping to improve their revenue cycle optimization. It was an amazing turn, and our billing got more accurate. We were getting hundreds of complaints a week on billing. When we were humming there, it got down to 1 or 2, and some weeks had none. It was a huge difference on behalf of our patients and the stress that it relieved.
The stress that I had was all these physicians in the medical group. I had to meet with the chairs once a month. They were working as hard as they could in high volume. We could not get an accurate bill out for their services. We had to fix this. Dan, you and your team did it. Congratulations to you. Thanks for your great vulnerable leadership. It has paid off.
Roger, can I ask you this question to close? We would be remiss if we didn’t recognize the power of this during the pandemic and all that disruption and the change and how difficult it is for leadership teams to overcome these mounting workforce challenges and so forth. What is your key takeaway, Roger, that you would recommend to executives like yourself and those who are tuning in?
Get the book and get to the point where everyone sees the scoreboard that not only tells you how you’re doing relative to the goal but also has the time clock. That’s Chapter 6. Read the book and start tracking behaviors because behaviors will turn into results just like Dan did. We’re unfortunately out of time. I would love to pick this up later. Maybe do some more about this. Thank you so much. Congratulations to both of you. I know our readers are hungry for this practical advice.
For any of you that have thorny problems, this is a great way. You ought to consider this. Get ahold of Brian. The 12WeekYear.com is where you can get ahold of Brian and his organization. Dan, congratulations to you and your fairly new role. You still have a lot to do, but you are crushing it, my friends. Thanks to our readers. Tune in again next time to another episode. Thanks, everyone.
About Daniel P. Isacksen
Daniel P. Isacksen, Jr., executive vice president and chief financial officer (CFO), leads all financial functions including financial enterprise development, treasury, financial reporting, payer strategies and revenue excellence, for the system and across the national organization’s Health Ministries (HMs). A strategic-minded and results-driven financial leader with a successful track record, Isacksen has spent the last 25 years serving in Catholic health care, including financial executive positions in other Catholic health systems, academic providers and community health care systems.
Previously, Isacksen served as executive vice president and regional CFO of Loyola Medicine in Maywood, Illinois, one of Trinity Health’s regional HMs. There his efforts contributed to operational improvements and a significant financial turnaround and stabilization of the regional ministry.
Prior to joining Loyola Medicine, Isacksen served as CFO for Alexian Brothers Health System – Physician Enterprise (Ascension Health), in Hoffmann Estates, Illinois, where he was responsible for all finance-related functions including accounting/financial reporting, budgeting and strategic planning, revenue cycle management, specialty practice administration and physician contracting, accounts payable, payroll, and development of policies and procedures.
Other past positions include controller for St. Alexius Medical Center in Hoffman Estates, Illinois, as well as several financial leadership positions at Loyola University Health System and Medical Center. He began his career at Deloitte & Touche, LLP.
Isacksen holds both a Master of Business Administration in Executive Leadership and a Bachelor of Science in Accounting from Bradley University. He serves on several boards for health care joint ventures and is a member of the Illinois Hospital Association CFO Advisory Council, the Vizient AMC CFO Council and the Healthcare Financial Management Association.
About Brian Moran
One of the biggest challenges leadership faces when bringing their people together for large scale corporate events is the investment in speaker talent without a clear ROI. Whether it is the keynote or breakout, measuring the success of the session is not based on the meeting itself, but what happens when they all go back to work.