Category Archives: Mentorship

What is a blind reference?

Some people naively think that the only reference checking that is done is with the references given by a candidate or a head hunter.   Executives recruiting for talent will peruse your CV looking for places where you might have common acquaintances.  They will also look for places that some of their friends and professional contacts might have insights.  When these links are found which is most of the time for an experienced recruiter or hiring executive, you are about to become the victim of a blind reference.

A ‘blind reference’ is an investigation into your past by a hiring executive that you know nothing about.

I do not put a lot of faith in  references provided by a candidate although I have had candidates give me references that were not very complimentary of them.  If you are going to give a reference, at least have an idea about what they are likely to say about you.  No one that has any sense is going to intentionally give a bad reference on a candidate to a stranger.  I also disregard reference letters.  No one is going to write a letter that states the candidate is bad.  On occasion, I will write a reference letter for someone as a personal favor but I aways counsel them that reference letters in my opinion are a total waste of time.  The only time I pay any attention to a reference letter is if I know the author.

Because of political correctness and the cold legal realities associated with references these days, the best you are going to get from formal references in most cases is that the candidate was hired on one date and departed on another date.  The most you are likely to learn is that the candidate actually did work for the firm you are contacting for the stated period of time.  They will rarely tell you anything more because references are subjective by nature in most cases.  Subjective references that cause a candidate to be ruled out of a search can become a liability for the person that gave the reference.  This is one of the reasons that blind reference checking has grown in my opinion.

If I get a reference call on a candidate being evaluated by someone I do not know, I refer the call to HR where I know what they are going to be told.  Even if the reference call comes from a friend,  I know the candidate and I know them to be bad, usually instead of giving a bad reference, I will refer my friend to HR where they will get the standard, canned response.  The hiring manager gets the message.  If a friend encounters me refusing to give a reference, they always get the message.

The more frequent call that I get is from a decision maker that is checking references that are not on the candidate’s list.  These are the calls that are dangerous for candidates because they are blind to the candidate; hence a blind reference call.  The candidate will never know in most cases they were vetted through a blind source.  This is one of the many reasons why it is so important to keep up your networking and to not burn bridges unnecessarily.  If you left a place under questionable circumstances, you need to have a good explanatory story and you need to be forthcoming and transparent.  Of course a blind reference is not necessarily a bad thing.  Under the right conditions, it can propel you to the front of the line.  I received a blind reference call on a candidate I happened to be considering at the same time.  I told the blind reference caller that they could dispense with their questions because my reference will be very simple, “If you do not hire her, I will.”  I had worked with this candidate before and she is outstanding.  She was going to end up with a gig regardless of how the reference checking worked out in this case.

When I get a blind call from someone I know and trust, they are going to learn the whole story.  The reason is that I know I can call them to have the favor returned at some point in the future.  If the candidate departed under less than ideal circumstances or told a story that I know to not be true, I will give the reference to HR as stated above.  This usually surprises the decision maker that hoped to get something from me.  The fact that I refuse to provide a reference for someone that the decision maker knows I know well usually tells them enough, especially when I put off multiple requests for help.   About the third time I refuse to provide any information, the recruiting executive gets the message.  If you are going to engage in this activity, you have to be absolutely certain that your confidence will be protected.  This is the main reason that I resist giving references to head hunters unless I know them personally because it is hard to be certain your confidentiality will be protected.

When you are looking for a job, who will the hiring decision maker call?  What will they be told by people you used to work around?  Time after time, I have received blind reference calls.  Often, these calls are about someone that has done little if anything to endear themselves to me or to even keep in touch.  People like this generally do not return calls, ask of an acquaintance while offering nothing of value to i.e., they do not engage in networking, they do not accept meetings or referrals, they do not attend or participate in industry related networking or continuing education activities such as ACHE or HFMA.  I wonder what these people expect I am going to say about them?  And of course, all of this is above and beyond anything I might know about their acumen, experience or capabilities.   I would rather not receive these calls in the first place but I do not control who calls me.

I do not know what it is about some people.  In one case, I reached out to an executive that I thought might benefit from my insight about handling executive turnover in his organization.  He humored me then never called me back in spite of the fact that I specifically requested a call regarding a wealth of information that I volunteered.  I never heard from him and I do not expect to hear from him because his failure to take my advice was at least partially responsible for his own firing a couple of months later.  A few weeks ago, I got a blind reference call.  The guy was seeking employment with a consulting firm and I knew the hiring executive very well.  What do you think happened?

This kind of thing does not have to happen to you.  If you are smart, you will get serious about networking and building as many positive relationships as you can.  Many of these relationships come from active participation in associations, alliances and industry peer groups.  You should volunteer your time to give yourself exposure to people that you might need for a job some day and in the process help them develop a positive impression of  you.

There is a saying that there are three kinds of people;  Those that make things happen, those that watch things happen and those that wonder what happened.  You never know when someone is going to make a call to someone that you might not even know; about you – a blind reference.  When that occurs, what will the results of that call be?  If you or someone you know is having difficulty getting a job and their qualifications appear competitive, they may be the victim of blind reference checking which puts them in the category of wondering what happened.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.

The easiest way to keep abreast of this blog is to become a follower.  You will be notified of all updates as they occur.  To become a follower, just click the “Following” link that usually appears as a bubble near the bottom this web page.

There is a comment section at the bottom of each blog page.  Please provide input and feedback that will help me to improve the quality of this work.

This is original work.  This material is copyrighted by me with reproduction prohibited without prior permission.  I note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

What is the value proposition of an Interim Executive?

Interim Executive Services as defined in my ‘About‘ page is not as common in the US as it is in Europe.  On the continent, in order to practice as an interim executive, a person needs to have a certification similar to a CPA in the US.  In the US, it is still the wild west when it comes to interim executives.  A few years back, a private enterprise in NC attempted to establish a credential for interim executives but the effort failed so now it is a buyer beware market.  There are firms providing interim services but in my experience these firms do very little in terms of either training or providing oversight for their interims.  The interims are placed and they are usually on their own from that point.  This raises the question of the value proposition of an interim executive because the proposed pricing is usually higher than the hourly rate for the employee being replaced.

In my experience dealing with buyers of interim services, the first and often most heavily weighed consideration is the cost of the interim resource.  The less sophisticated the decision maker, the more likely that they will be motivated primarily if not exclusively by cost.  This is because they do not get or choose to ignore the value proposition.  This has happened to me time after time.  Each time, I held my ground and demanded a fair premium for my services.  In each case, I told my client that if they did not find value in my services, they could terminate me without cause or notice.  Once they had a chance to experience what a sophisticated interim executive could provide, the cost issue was not raised again.  A decision maker that seizes an opportunity to buy interim services at a small or no premium should be worried about what they will be getting for their money.

I am aware of interim firms that prey on executives in transition that are desperate for income.  Some of these interims will take any job at any price.  The interim firm then sells their services based on price alone and is successful getting a markup of 30% to 50% while providing a price sensitive decision maker just what they paid for.

What would rationalize a premium for a sophisticated interim executive?  There are many considerations that a decision maker should contemplate in addition or in lieu of rate.  I am making repetitive use of the adjective ‘sophisticated’ when referring to interim executives.  There are differences in the sophistication of interim executives and the decision makers that engage them.  These differences are discussed in an earlier article.

The criteria below while useful in understanding the value proposition of a sophisticated interim executive may be equally if not more valuable in evaluating potential interim resources for fit in your organization.

I would advise against hiring the first interim you see unless you have a recommendation from a source that you highly trust.  When I worked with Tatum, they made it a habit to present at least two resources on each project so that the decision maker would have the ability to see more than one alternative and make their own choice instead of letting the interim firm sell them on whoever happened to be currently sitting on their bench with nothing better to be doing at the time.

Experience – One thing worth paying a premium for is experience.  The typical interim executive is a late career individual with a lot of experience, usually in a number of organizations.  The depth and breadth of this experience allows them to assimilate quickly an organization and to begin creating value almost immediately.  This is particularly true if the interim has on-point experience, something you should always look for.

In addition to career experience, it is worth paying a premium for an interim executive with multiple interim engagements on their CV.  The approach to a position as an interim is radically different from what one would take as an employee.  It is worth paying a premium for an experienced interim unless you already have another interim in the organization that can serve as a mentor.

Credentials – In addition to being highly experienced, sophisticated interims tend to carry above average credentials.  Things like advanced degrees, CPA certifications, ACHE, HFMA  and/or fellowships.  These credentials may or may not specifically make one person better than another but the probability that a credentialed executive is going to have a higher level of cognitive capability and an innate drive toward personal excellence is a pretty safe bet.  Another consideration is that no one requires executives to seek advanced education and professional credentialing.  In a situation where everything else is equal, I will always favor a credentialed individual because the very fact that they have obtained a credential is proof of their drive to go beyond the minimum required to get by.  In my experience, credentialed executives are always superior for this reason alone.  As most of us that are credentialed know, you do actually learn something in the credentialing process that might come in handy once in a while.

Expertise – Knowing what you are doing should count for something.  I have seen more than one decision maker hire the first resource they could find that had a heart beat only to make the situation infinitely worse when the interim executive failed.  Most decision makers I have met do not know how to supervise or manage an interim executive.  For example, I would argue that most CEOs do not have the ability to manage a CFO from a technical or risk management standpoint.  I discuss this phenomenon in an earlier article.  The risk for the decision maker is that if the interim fails, the decision maker will usually be held accountable.  The interim will go on to the next gig while the decision maker that may not have been considering relocating finds himself hanging paper from home.

MentorshipSophisticated interims are invaluable in the potential they present to mentor rising executives in an organization.  A sophisticated interim executive that knows how to mentor properly can help turn younger leaders into rising stars.  In addition, interim engagements  frequently lead to demand for additional interim resources that were not anticipated at the beginning of an engagement.  In this situation, an interim that has the capability to manage and/or mentor other interims can bring a very high value to an organization.  I have engaged a number of interims while serving as an interim myself.  I can say from experience that I believe I have delivered substantial value by making sure that the other interims were doing what they are supposed to be doing.

Judgment – You have probably heard the one liner that says, “Good judgment comes from experience that we get by exercising bad judgment.”  I would argue that having the ability to bring above average experience and judgment to bear on a problem is worth paying for.  Experienced executives, especially interim executives can be expected to have better judgment than a decision maker might be accustomed to.

Stability – A transition situation is unstable by definition.  My practice has shown me that the only thing you can be certain of in a transitory situation is that you cannot be certain of anything.  Some people have difficulty dealing with unstable, unpredictable situations.  After or arguably before a decision maker initiates a transition, they should be thinking ahead about their next steps and high among them should be an effort to stabilize the situation so that a business interruption or a bad outcome may be avoided.

Morphing deals – Some people need predictability and stability in order to function effectively.  They are unnerved by constantly changing circumstances and seize up.  An experienced interim executive knows that as a project progresses, things will happen and changes will become necessary that were not initially expected.  The project morphs from one set of circumstances to another.  It is worth paying for experience that can not only help stabilize a situation but experience that can adapt to unforeseen challenges.

Easy to sever – I have seen interim engagements fail.  There is no way that I know of  to accurately predict in advance if the interim executive will be what was expected or whether or not they will be effective in your organization.  In the event that the engagement is not working, you should have the ability to have the interim replaced immediately without cause or reason.  I discuss this in my article about contracting.  If the interim deal is not working, it is highly unlikely that it will improve.  I have had to terminate an interim before the end of their second week in an organization.  In the event that something like this occurs, the sooner you act, the less the potential for damage.  The other side of this is that the issue may not be anything worse than a bad fit.  I am happy to be the easiest person in the organization to get rid of but if I am expected to bear this risk, part the premium I receive justifies me taking this risk.

Interim services firms will endeavor to mitigate this risk by asking for minimum engagement time periods.  My advice would be to pay the premium and refuse to accept a minimum term as explained in my contracting article.

Velocity – In my article about contracting, I talk about the importance of velocity as it relates to interim engagements.  Frequently, decision makers procrastinate about making a decision but once they make up their minds, they want the resource TOMORROW.  Providing this kind of flexibility is worth paying a premium for especially if the resource you want has been waiting for you to make a decision.  If you want a resource to sit around waiting for you make a decision and be at you beck and call at any time, you need to be prepared to pay a premium for this luxury.

Rapid acclimation – When I was at Tatum, the firm’s mantra was ‘Velocity.’  The connotation is that the firm focused on rapid response.  What I have learned from the stages of an interim engagement is that once a decision maker decides to bring an interim executive in, they want them tomorrow.  Part of the premium a decision maker pays is to get  an interim executive  to get to their site quickly,   Sophisticated interim executives also know how to assess a situation quickly.  This skill and experience allows them to become productive much faster than would be expected of an employee.  Decision makers tend to vacillate and procrastinate about a decision to bring in interim resources.  They should not be unhappy about paying a premium for a resource that can help them compensate for the time it took to get the interim on their site.

No benefits – An interim deal is simple from the perspective that it usually only involves the professional fee and out of pocket expenses.  Unsophisticated decision makers will compare the salary rate of the departed employee with the billing rate of the interim and conclude that the interim is expensive without taking into consideration that the employee had benefit cost somewhere in the range of 25% of their compensation.  Not having an interim executive on the organization’s benefit plan is clean and can be a cost saving aspect of the engagement.

Living and travel burden – If you don’t think an interim executive deserves a premium, try living in a hotel and traveling every week.  Not only does this create an expense that substantially adds to the cost of an interim engagement, it is very hard on the interim executive.  The longer the engagement lasts, the harder this becomes on the interim.  It is too easy for decision makers to forget the interim executive as they are going home a warm meal and the privilege of going to bed with their spouse while the interim is separated from their family, eating out and going to sleep in a cold bed.  This aspect of interim executive consulting by itself warrants a premium.  I accept that the burden of travel goes with Interim work but I wonder if the price my family and marriage have paid for me to do this work has been worth any amount of money.  I have lost my sensitively about what I ask for my services primarily be causes of the burden that the interim lifestyle places on the consultant.  I discuss this in detail in my article about becoming a an interim executive.

While I could take the position that it is not a problem of mine, I deeply resent the cost associated with being an interim executive.  Travel, food, temporary lodging and other costs associated with an interim executive is a significant proportion of the total cost of an interim resource.  It drives me crazy to pay these costs or incur them on behalf of a client.  This is one of the strongest reasons for making sure that you are getting your money’s worth from any interim you engage.

Hired independently or via a firm – My experience is showing me that there is a growing population of ‘free agent’ interim executives.  Firms that place interims will take somewhere in the range of 30% – 50% of the total professional fee for their overhead and profit.  In addition, because of what I would describe as oppressive government overreach, most if not all firms now require their interims to work on a W-2 instead of a 1099 or K-1.  This can result in the interim losing tax benefit in the best case and paying tax on out-of-pocket expenses in the worst case.  While free agent interims can be harder to find because you have to know how to network to find them, they can be less expensive because they are not taking a hair cut in a direct deal.  In my experience, a free-lance interim is likely to be much better than interims that come from firms for a variety of reasons that are beyond the scope of this article.

Summary – I could go on but I trust that as a decision maker or an interim for that matter, you can see that there is plenty of justification for a premium for interim executive services.  The premiums I have seen run 50% or more over the base salary of the executive being replaced.  If you are a decision maker, you should not be afraid of paying a premium to get superior skills and resources brought to bear quickly on complex or dangerous business problems and or transitions.  Quibbling over rate can slow down the process of getting the right resource and can prevent you from getting the best possible skill in place.  One of the most profound value propositions of an interim executive is their ability to raise the probability that the decision maker that hired them will not also become a victim of the transitions that created the need for the interim in the first place.  In my experience, decision makers routinely discount this aspect of an interim engagement’s value that is in  my opinion one of the strongest reasons for paying a premium for the right interim.

If you are an interim executive, you should not ever sell yourself short.  I took a haircut on a deal that was only supposed to last 3 months to mitigate on behalf of the firm something that I had nothing to do with.  After three months, the firm would not get my rate corrected and the engagement ended up lasting thirteen months.  I will not work with that firm again because they have demonstrated in more than one case involving me that they cannot be trusted.  As an aside, from my perspective in this case, the firm detracted significantly from its value to me while adding insignificantly to the client’s value.  If you have experience as an interim, you know that one certainty is that you are probably going into a situation that will turn out to be significantly different from what was described and invariably more challenging.  You also know that there is a very high probability that you are going to be in the organization much longer than the decision maker assumes at the onset.  In my  experience once you have proven your value, decision makers will take considerably more time getting you out than they took getting you in.  I have helped decision makers over the cost hump by reminding them that hiring me is a no risk proposition.  They can send me packing the day that they decide that the engagement is not working or that I am failing to produce more value than they expected.  I am happy to take this risk as long as I am being appropriately compensated.  I have yet to be sent packing.  In every case, I have remained much longer than initially expected or planned.  Some interim firms prey on unsophisticated executives in transition by buying them at or below what they were receiving as an employee and reselling them at a market consulting rate.  If you allow yourself to be prostituted in this manner it is your own fault.

In closing, I believe there is substantial justification for paying a premium for interim executive services.  I postulate that the time usually lost by decision makers that struggle with the decision to bring an interim in can quickly create costs and/or losses that far exceed any premium.  As I said in an earlier article, if you are a decision maker, make a decision.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.

The easiest way to keep abreast of this blog is to become a follower.  You will be notified of all updates as they occur.  To become a follower, just click the “Following” link that usually appears as a bubble near the bottom this web page.

This is original work.  This material is copyrighted by me with reproduction prohibited without prior permission.  I note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

 

 

An old epiphany AKA my Barbara Mandrell story

A few years ago, my wife and I had the opportunity to spend the better part of a week in Nashville, TN.  While there, we decided to check out the Fontanel Mansion.  Fontanel was Barbara Mandrell’s ‘cabin in the woods.’  As of this writing, Fontanel is number 4 of 209 things to do in Nashville according to Tripadvisor.  Barbara named Fontanel after her youngest child.  I will leave it to you to look up the meaning of the word and to see if you can see the inspiration.

I highly recommend visiting Fontanel if you are in the area.  It will leave a lasting impression.  Barbara’s ‘cabin’ is some 27,500 square feet in size.  At the time of its construction, it was the largest log structure on earth.  It is still in the top five.  The magnitude and scale of the mansion defy description.  As I said, you need to see it for yourself.  The mansion is so large, the Mandrell family regularly lost their children in the house so everyone had to carry walkie-talkies to stay in touch.  A huge indoor swimming pool, indoor shooting range, 5,500 square foot ‘great room’, arcade, commercial kitchen, lavish finishes and irreplaceable casework and finishes overwhelm the visitor.

At the time I visited Fontanel, I was struggling personally with what I perceived to be a lack of ability to have the degree of favorable transformational influence in the organizations I served as an interim executive.  I knew what needed to happen.  I knew what it looked like when it is right and what it looks like when it is not right.  I was frustrated by  the fact that the organizations just did not seem to be as interested in changing as I expected.  Many of my recommendations either fell on deaf ears or were humored then subsequently ignored.

You can easily spend an entire day at Fontanel.  There is a lot to see and do.  It takes a while to begin to comprehend the magnitude of the mansion.  To me it was as impressive if not more impressive in its own way than the Biltmore house.  Late in the day we had an opportunity to hear Barbara’s daughter Jamie speak.  She stayed with the new owners of Fontanel as an interpreter and her comments brought the place to life.  I was standing with a group of people listening to Jamie talk about her childhood experience at Fontanel.  She was explaining that she had to reach high school age where she started getting out into friends’ homes before she realized that her childhood experience was any different than that of any other child.  She and her brothers assumed that their childhood experience characterized by wealth, maids, butlers, chauffeurs and the like was no different than the childhood experience of other children.

It was at this second that I could have been knocked over with a feather.  I was overwhelmed by a wave of dawning realization that nearly overcame me.  In one second, I got it!  In the blink of an eye, I finally understood the problem I was experiencing.  The reason that I could not get people in the organizations to see my vision for what they and their organization could be was that the environment they were in as dysfunctional as it might be is their sense of normalcy.  They cannot see the possibility of something so much better because their view of the world is characterized by their role in their environment.  They frequently see little if anything that needs to be fixed.  It is normal for me to hear, “Everything here was fine until you showed up and starting changing everything.”

In one organization I served, the Vice President of Finance told me one day that she was there when I came and that she would be there after I was gone.  She went on to explain that she had ‘broken-in and trained’ five CFOs and had survived them all as she would survive me.  We managed to co-exist for a few months primarily because as an interim, I resist  taking personnel actions that will alter someone’s career unless I am forced into a situation where my options have been reduced to one.  In this case, the first thing my successor did was rid himself and the organization of this caustic cancer of an employee.  I have seen multiple examples in organizations that I have served of shock and awe when the degree of dysfunction, sub-optimization and loss were revealed.

The only thing worse than a dysfunctional culture is a toxic culture.  A dysfunctional culture fails to meet the needs of the organization while a toxic culture is more detrimental to the organization because it characterized by active degradation.  There are a number of characterizations of dysfunctional or toxic culture many of which are obvious to independent, disinterested observers while being transparent to the people that are a part of the toxic culture.   These phenomena are more easily recognized to the degree the observer is viewing the situation academically or clinically without personalization of the circumstances or any of the people involved in the issue.  The problem with this is that people rarely change.  In fact, most of us are extremely resistant to change.  The observation of this phenomena over a long time spent in a variety of organizations has led me to the conclusion that achieving a change in culture without changing the cast of characters is generally a fool’s errand.  Ascension Health is the largest not-for-profit healthcare systems in the US.  Ascension is also the largest US Catholic healthcare organization.  Ascension places high value on the worth of individuals and in my experience errs on the side of doing the right thing by people in its employ.  I have seen the focus inspired by this culture in Ascension hospitals lead them to make substantial investments trying to salvage leaders that should have been long gone.  Sadly, more often than not, these efforts fail and the person ends up leaving the organization anyway.

How does this apply to leadership?  Every time an organization is presented with the opportunity to fill a leadership position, it needs to think about the role and function that now needs new leadership.  In the case of senior executive positions, I strongly recommend that an assessment be conducted to document the degree to which the previous incumbent and the function was meeting the needs of the organization.  Some organizations have a stronger bias than others to promote from within.  While I support this organizational value, it can be problematic.  There is no substitute or alternative that I know of for the enriching experience of working in different organizations, cultures and climates.  This experience provides insight and perspective that is un-achievable for persons that have grown up in the organization with most or all of their experience being in that organization.  They have no capacity to see things differently than how they currently exist.  In some cases I have seen, internal candidates have been victimized by poor or weak mentorship or leadership in the organization.

This is not to say that an internal candidate should not be considered.  The internal candidate does have the experience and insight to know the history of the organization and the location of every closet where a skeleton is hung and the site of every grave.  They can be up to speed immediately while it can take an outsider months to come up to their full potential.

The moral of this story is to be cognizant of your culture and the degree to which it might be impeding your ability as a leader to move your area of responsibility forward.  You need to ask yourself the very hard question of the degree to which you might be part of the problem.  This is one reason that continuing professional education is so valuable.  You need to be concentrating on improving your education and skills continuously.  In this process, you will begin to gain clarity as to how you may have been sub-optimizing.  This is also an example of how consultants can be very valuable to your personal survival probability.  Use them for their subject matter expertise but ask them questions and listen to them very carefully.  You have experience in a few organizations.  They have experience in many organizations and are uniquely qualified to help you understand where your organization might be missing opportunities to improve.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.

The easiest way to keep abreast of this blog is to become a follower.  You will be notified of all updates as they occur.  To become a follower, just click the “Following” link in the menu bar at the top of this web page.
This is original work.  This material is copyrighted by me with reproduction prohibited without prior permission.  I note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

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More sadistics

In my last blog post, I made a grievous, amateur error.  I will be lucky if UAB does not repossess my degree.  I made the most common mistake know in the world of statistics.  I said, “and does the thing I think is causing what I am seeing really have anything to do with it?”

If you ever learn anything about statistics, it must be that no amount of statistical analysis can prove a cause and effect relationship between anything.  All you can prove with statistics is that things are ASSOCIATED with each other.  The best example of this I can think of is the debate around smoking and disease.  As far as I know, no one has proved a direct link or causal effect between smoking and disease.  No scientist can explain why some smokers get disease and others do not.  No one can explain why one smoker gets cancer while another gets heart disease.  No one knows exactly what about tobacco is unhealthy.  No one can explain how George Burns lived to be 100 years old smoking a cigar every day.  Of course smoke has bad chemicals in it but so does the air we breathe and almost everything we consume, especially since the government approved drugging livestock and feeding them (and us) genetically altered food.  We do know with a very high degree of certainty that there is a strong ASSOCIATION between smoking and disease.  We just cannot explain the causal factor(s).  If we could, we would do something about it.  I never did believe the attacks on the tobacco industry were justified because no one can prove cause.  The attacks are about money and not much else.  The tort liability vested upon tobacco manufactures served only to raise the price of the product while creating a windfall for States that as far as I know have not spent much if anything of the appropriated funds they received on smoking prevention.  If the government is really serious about smoking, it would not give Medicaid cards out to smokers.  For that matter, it would use EBT to incentivize people to engage in more healthy lifestyles in order to reduce Medicaid expenditures down the road but that is the topic for another blog.

If you are now boiling mad at me for making these assertions, I have you where I want you to make a point about statistics that you might remember.  To cite just one example, there is similar controversy about diet drinks.  There have been a number of studies that show that diet drinks may be as bad or worse for your health than cigarettes.  “Researchers from the University of Texas found that over the course of about a decade, diet soda drinkers had a 70% greater increase in waist circumference compared with non-drinkers. (1)”.  “Drinking one diet soda a day was associated with a 36% increased risk of metabolic syndrome and diabetes in a University of Minnesota study.  Metabolic syndrome describes a cluster of conditions (including high blood pressure, elevated glucose levels, raised cholesterol, and large waist circumference) that put people at high risk for heart disease, stroke, and diabetes (2).  “Using diet soda as a low-calorie cocktail mixer has the dangerous effect of getting you drunk faster than sugar-sweetened beverages, according to research from Northern Kentucky University.  The study revealed that participants who consumed cocktails mixed with diet drinks had a higher breath alcohol concentration than those who drank alcohol blended with sugared beverages.  The researchers believe this is because our bloodstream is able to absorb artificial sweetener more quickly than sugar (3).  “Just one diet soft drink a day could boost your risk of having a vascular event such as stroke, heart attack, or vascular death, according to researchers from the University of Miami and Columbia University.  Their study found that diet soda devotees were 43% more likely to have experienced a vascular event than those who drank none. Regular soda drinkers did not appear to have an increased risk of vascular events.(4)”  All of these citations were from just one article.  If you do not believe me, do your own internet search.  This makes me wonder why the government and the tort lawyers are not after the soft drink industry if its products CAUSE all of these maladies?

Now I am going to bring back nightmares from your college statistics course by reminding you about something you forgot long ago.  Remember regression?  For those of you that have not been initiated, regression is a procedure utilized to determine the degree of ASSOCIATION between things.  In a simple regression, you are looking at two things (an independent and a dependent variable).  In a multiple regression, you are looking at multiple things (one dependent and multiple independent variables).  I know some of you are thinking that the only kind of regression you understand is what happens when people are appointed to C-Suite roles in healthcare organizations but bear with me for a minute.  Among the various statistics produced as a result of a regression analysis is the effect size measurement of R Squared.  The R Squared statistic is alternatively described as the coefficient of determination or correlation coefficient.  Start dropping these terms at a cocktail party and watch how fast people start treating you like you have the plague.  What this statistic describes is the degree of association among the variables.  Its values range from 0 to 1 or 0% to 100%.  If there is no association between the variables, the correlation coefficient will be low.  If there is a perfect ‘fit’ (in other words when one variable zigs, the other zigs by the same magnitude. They also zag together) between the variables, the correlation coefficient will be 100%

People that fall into the trap of believing that statistics prove cause and effect would draw the incorrect conclusions from the following examples of extremely high statistical associations.  These associations are described as spurious correlations where the statistics say that things that cannot be related are associated with each other.  Uninformed analysts or liars would infer or imply that there is a causal effect.  What do you think about these examples?

US spending on space, science and technology correlates with suicides by hanging.  The correlation coefficient is 99.79%  Maybe people are actually killing themselves when they come to the full realization about how much money the government is blowing.

Per capita cheese consumption is very strongly associated with the number of deaths occurring when people became entangled in their bed sheets.  R Squared = 94.71%

There is an association between the per-capita consumption of margarine and the divorce rate in Maine.  The coefficient of determination is 99.26%.  Some would conclude that in order to eliminate divorce in Maine, all we have to do is outlaw the consumption of margarine.

Drownings resulting from falling out of a fishing boat can be explained by the marriage rate in Kentucky (R Squared = 95.2%)  In other words, in order to eliminate drownings in fishing accidents, we need to outlaw marriage in Kentucky.  I guess the Supreme Court recently took care of that.  I would recommend that fishermen start wearing life vests.

There are a number of examples of spurious correlations on the internet.  The point of these examples is to sensitize you to the fact that statistics do not and can not PROVE cause and effect.  Sometimes associations found in statistical analyses are spurious.  This is why you are paid the big bucks – to understand what you are looking for, to not fall into this trap and to apply cognitive analysis to anything you see to prevent you from drawing the wrong conclusion(s).

As I have said before, as leaders we are not paid for what we do.  We are paid for what we know and more than anything, we are paid for our decision making capability.  My point in writing this is to argue for the use of more analysis and evidence in executive decision making in healthcare administration.  They even have a Doctorate of Science Program at The University of Alabama at Birmingham that focuses on this very concept.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.
The easiest way to keep abreast of this blog is to become a follower.  You will be notified of all updates as they occur.  To become a follower, just click the “Following” link in the menu bar at the top of this web page.
This is original work.  This material is copyrighted by me with reproduction prohibited without prior permission.  I note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

A new epiphany

I tell people that I am not all that smart.  I tell them that mostly I am not much more than a collection of experiences and epiphanies. I see profound wisdom in the simplest of things.  These epiphanies often have a profound effect on me and galvanize my thinking about leadership in ways that help me inspire others.  I tell a lot of stories and use self deprecating humor to make points.  At times, my antics will shock people which is the effect I am looking for.  In order to teach, you must have attention and recall.  If there is no recall, teaching has not occurred.  If my reaction to something, one of my stories or one liners burns an image into someone’s mind that they never forget, I have been successful in teaching them an important point about leadership or in my case finance.  The affirmation of this is when I hear myself quoted or see someone retelling one of my stories. If my experience helps them to improve what they are responsible for or to avoid a similar calamity in the future, it has been worth while.

While I am on this point, I will digress briefly.  Much is made of titles.  Some people obsess over whether their office meets the standards of their peers.  They engage in petty antics to cause others to have to succumb to their mind games.  Part of this is to make sure that everyone recognizes how important they (think they) are.  In some cases, this is a cover for insecurity.  Things like having to make an appointment to see your leader or being put off for no good reason.  How about the office where the level of the guest’s chair is lower than the host’s?  Or the executive that has their assistant make all of their calls.  When this happens to me, I hang up.  If someone wants to talk to me, they can dial the phone just like I do.  I am convinced that most people, even uneducated people can discern quickly whether a leader is genuine and whether or not they know what they are doing.  No title or number of degrees hanging on a wall or other trappings will convince them otherwise.  This is the reason I do not hang degrees on my wall.  If someone wants to know if I have a degree, they usually know where to find the answer.  People indulging themselves in the trappings of their role are frequently not respected.  They will be followed because of pecking order diktats but respect has to be earned.  It is not bestowed.  You will be respected if you respect others and they believe you are honorable, genuine and that you know what you are doing.  I poke fun at myself or at a situation to diffuse tension and put people at ease.  I will never poke fun at another person.  When I am poking fun, the people involved in the situation get the point.  Some people earn the title of Executive Vice President, Senior Vice President, CFO, CEO or who knows what.  When people ask me what I do, I tell them I head up the bookkeeping department.  They might not know what a CFO or an EVP is or what they do but they understand what bookkeeping is.  I do not feel a need to lay a title on someone to impress them.  People that do this often get a result that is the exact opposite of what they intended.

I had an experience recently that is haunting me as I write this.  I was on my way to a dinner.  The purpose of the dinner was to interview a Job candidate.  I was driving out of town on a four lane road.  Ahead of me, I saw what I initially believed to be a black plastic shopping bag drifting lazily across the road from right to left.  It looked strange and out of place.  As I drew closer, I realized that what I was actually seeing was a mother mallard duck with a gaggle of ducklings crossing the road.   They were about half way across the first lane of the four lane street, the lane my car was in bearing down on them at forty plus miles per hour.  The ducklings were so small they could not have been more than a few days old.  There must have been eight or ten of them.  Seeing my car approaching, the mother sensed danger and reversed course.  As I got to where they were, the mother had jumped up on the curb and was moving away from the street.  All of her brood were in a bunch bouncing off of the concrete as they attempted jump up on the curb to catch up with their mother.  They were jumping into the curb and falling back time after time.  Not one of them was big enough to get over the curb.  They had to be horrified.  It was a heart rending sight.  This scene has affected me deeply.  I pray that this family found a way to safety.  As I was watching this drama unfold over just a few seconds, it struck me that this is a perfect analogy to one of the biggest challenges we face as leaders.

How often have you seen this scenario?  The brood follows their leader from safety into uncharted deep water or a new situation.  Something occurs in the environment that introduces a problem they have not experienced before or unexpected danger.  The leader changes or reverses course.  The brood gets to a curb and runs into the wall.  The leader knows or has a sense of what they need to do.  Unfortunately, the brood cannot muster what it takes to follow and they are trapped.  The brood cannot keep up with the leader.  The leader and the brood ultimately fail together because the brood does not get the support they need or they are incapable of performing at the level the new situation demands.

Sound familiar?  Remember the old adage that the time to drain the swamp is before you are up to your ass in alligators?  As leaders, we have to appreciate that we are supposed to have insight, experience and expertise that our brood does not have.  They are willing to follow us due to faith they have that we will keep them safe and help them grow.  Sometimes, we inadvertently lead them into a situation where everyone’s ability to survive becomes an issue.

This is one of the reasons why leadership is hard.  We are called to be leaders because someone thinks we have what it takes to make a part of the organization successful however that is measured.  We cannot succeed without the full support and cooperation of our brood.  We manage the risk that our brood is up to the task by investing in them every day.

What are you doing to develop your brood?

Are you demonstrating the proper example of leadership to them?  Do they have faith in you or they just tolerating you?

Are you leading from the front?  Are you leading by example?

Are you encouraging and supporting training and continuing education?

Do you see to it that your brood has the resources they need to accomplish their objectives?

Do you take time for mentorship?  Would you advise one of your best to move on if you saw how they could better develop their skills and talents in different situation?  I recently counseled one of the sharpest young people in my charge to quit and go back to graduate school.  He has so much potential, it is a shame to see it not developed.  This person could easily grow themselves to take my job.  He was incredulous when I made this suggestion.  He did not believe that he had ‘what it takes’ to become a senior executive in a healthcare organization.  He does and he will if he will make the investment in himself.

Do you give people in your charge assignments that challenge their capacity and stretch their analytical capabilities as a means of helping them see their own potential?  Do you create an environment where it is safe for young people to make mistakes so that they can learn?  I would rather have someone more afraid that they would fail to meet my expectations for them than to have them paralyzed by fear of what might happen if they make a mistake.

Are you approachable?  Do you take time for mentorship?  This is why I engage in self deprecating humor.  I do not want anyone to fear dealing with me because they think I am too important to spend time on them or that there is nothing they can offer that will be of much interest to me.  I do not want anyone uncomfortable about approaching me about anything.  I want them to feel empowered to act within their authority and to know when to come to me for affirmation or assistance.

These are but a few of many examples of what we should be doing every day but all too often forget in the midst of the dung storm dejour.

Do not be afraid to lead your brood off the curb into danger.  Just make sure before you do that if you have to reverse course or the going gets tough you have prepared them to keep up with you because it is at this time that you will need them more than ever.  Like the mother duck, you may not be able to help them as much as is necessary at the most critical time.

My hope is that is as a result of reading this, you never forget the galvanizing image of a mother separated from her young brood and the collective fear they all experienced.  I hope that you will view your staff and your responsibilities as a leader differently as a result of my epiphany.  If you resolve to never allow yourself to get into a situation like this because of this simple story, you will become a better leader, teaching and retention have occurred and my objective in this commentary is accomplished.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two you would find value in.  I can also help with career transitions or career planning.
The easiest way to keep abreast of this blog is to become a follower.  You will be notified of all updates as they occur.  To become a follower, just click the “Following” link in the menu bar at the top of this web page.
This is original work.  I have not seen content of this nature in my extensive dissertation research.  This material is copyrighted by me with reproduction prohibited without prior permission.  I always note and  provide links to supporting documentation for non-original material.

If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com. I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.