Tag Archives: leadership

Examples of what not to do – simple mistakes you have seen that others could avoid.  AKA – How many ways can you get yourself into trouble?

One of the items of constructive feedback I have received is that some of my articles are too long.  The subject of this article resulted in an article over 2,000 words long.  I have reminisced with friends in the consulting business that have suggested that we collaborate on a book on this topic based on the experiences we have had.  As a result, this article will be posted in multiple editions.

A very highly regarded friend of mine recommended that I address mistakes that might be beneficial to others.  Nasreddin said something to the effect that, ‘good judgment comes from the experience we get from exercising bad judgment.’  Given the benefit of this insight, I will address some of the things that I have seen as the cause of extreme angst in one healthcare organization after another.  An exhaustive listing is beyond the scope of any article.  However, I welcome tips and stories from my readers addressing vivid memories of things that would be beneficial for others to know, especially those that do not have the experience of some of us.

Blind trust of systems

This is one of the most basic managerial errors and it is seen over and over.  People ‘assume’ that a system will or will not do something without proving the assumption only to be surprised when their blind faith is proven wrong in a spectacular faux-pas.  Rather than assuming that people understand the meaning of the word ‘assume’, I will define it by dissection.  All to often, people engage in assumptions leading to flawed decisions that make an ASS/out of U/and ME.  I wish I could remember how many times I have witnessed flawed assumptions wreaking havoc around me.  Sometimes, these errors result in terminations of the people involved.  Mark Twain and Ronald Regan said that, “It is not what you know that will get you, it is what you are absolutely certain of that is just not right.”

Once upon a time when I had reason to doubt the controls in the hospital’s accounts payable system right after a new state of the art, super whiz-bang application had been implemented, I was assured by my Controller that there were safeguards in the system that he said would guarantee that there was no scenario under which an automated check for more than $25,000 could be produced and signed with my facsimile.  I had set this limit to insure that I had the chance to personally review large disbursements and sign them manually.  About a week later, it came to my attention that instead of keying a construction draw request of less than $25K, the A/P clerk keyed the remaining balance of over $275K to a contractor that the hospital was engaged in an active dispute with.  What do you think happened when this transaction went through the system without interruption and out to the contractor?  If you ass/u/me that he brought the check back, you would be sorely mistaken.  I am sure others can provide similar nightmare stories.

There are thousands of ways to be trapped by our own systems. The more complex the systems, the greater the number of interfaces with other systems and the higher the volume of transactions, the greater the potential for error and the larger the error will have to become before it is discovered by normal control and balancing processes.

Hiring mistakes

Another HUGE area of learning in the school of hard knocks is hiring decisions.  Jack Welsh said something to the effect of, “Getting the right people into the right jobs is a lot more important than developing a strategy.”  As an interim executive I have observed that one of the more common areas that gets organizations into trouble is hiring decisions that result in people being put into roles where they cannot succeed.  Some organizations and hiring decision makers are highly motivated to put the next person in line into a role whether they are qualified or not.  I have been criticized for bringing people from outside of town into the organization to fill crucial roles.  My response is that if  properly qualified local applicants were available, I would hire locally to save travel money if for no other reason.  I have counseled Boards and written on the subject of organizational performance being nothing more complicated than the collective caliber of the team on the field.  One of my mentors taught me by example the potential and value of getting the right people into the right places in an organization and the difference they can make.

Getting the right people is as important if not more important than avoiding hiring the wrong people by making mistakes in the vetting process.

AR valuation

I have seen so many executives brought down by incorrect valuations of their accounts receivable that I have lost count.  So many in fact, that I was inspired to address one of my blog articles to CEOs that all too often become one of the first victims of this error.  The article asks the question, ‘have you been caught looking?’  One of the biggest risks on a hospital’s financial statements is the valuation of revenue and accounts receivable and for every understatement, there are multiples of over-statements of receivable and revenue value.  In fact, I have not seen an undervaluation recorded although I have been in arguments with outside auditors about under and over valuations of revenue and A/R.  It is a lot easier to convince an audit partner to not book an undervaluation than it is an over valuation.   The executive that wishes to avoid becoming a victim of this trap needs to take the advice of my article on the topic to heart.

AR reclassifications

A reclassification of AR is potentially more dangerous and harder to catch than a simple error in calculating realizable value.  For example, consider an organization that holds self pay balances after insurance in the same bucket as the insurance.  This is considerably more common than many managers appreciate.  Suppose a commercial receivable is valued at 70% of the underlying charges and self pay receivables are valued at 5%.  When an amount like $5 million is reclassified from insurance to self pay to clean up a backlog after the insurance balances have been satisfied, the adjustment to the value of receivables will be 65% (70% – 5%) or $3.25 million.  There are other reasons for balances to accumulate in the wrong buckets on the receivable system leading to reclassification adjustments.  The receivables are not wrong, they are just valued incorrectly.  This kind of error is enough to knock an enormous dent into or potentially wipe out the operating income of any enterprise.  There are rarely adequate cushions or reserves in realizable value calculations to absorb a shock like this.

Summary

As can be seen, a text-book could easily be written on the topic of what not to do.  There are plenty of texts that are written on what to do, they are just all too regularly ignored.  Some leaders seem to not have the ability to connect academic learning and practice. These are but a few examples of things that I have seen go wrong in healthcare organization’s business operations.  This discussion is a good example of the value of experience.  Experienced executives operating on evidence based practice have a far better potential to avoid these pitfalls and others.  Sometimes the value of an executive in an organization is more related to what they know than what they do.  Once a patient in an outage accosted a surgeon  over his fee.  The patient took the position that the fee bore no relationship to the time spent on the procedure.  The surgeon replied that 5% of his fee was for the cutting and the other 95% was for knowing where to cut and what not to cut.

My plan is to publish another article on this topic with more examples of what not to do. If you have any stories to contribute, I would love to hear them.

I would like to thank Dr. Christy Lemak, Dean of the Health Administration program at the University of Alabama at Birmingham for inspiring this article.  I am looking forward to seeing my grade.

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.

Just a nurse?

Merry Christmas.  This article is my Christmas gift to my readers, especially nurses whether they read my blog or not.  I thank you for your support and wish all of you the very best for this Christmas season and a safe and prosperous new year.

My wife sent me an article that ran in Fox news about an Australian nurse that fought back on Facebook after having her fill of hearing, “just a nurse.”

One of the saddest aspects of our society in my opinion is the general lack of regard that people have for hospitals.  It is especially demoralizing when community leaders are actively engaged in destroying their community hospital and in the process disrespecting the doctors, nurses, volunteers, leadership and hard-working employees who would do anything for them at any time, no questions asked.  It makes you wonder whether the people who engage in this destruction even care about the capability of the hospital should they or one of their loved ones be stricken with an accident or illness.  I tell audiences regularly that it is not hard to see that  people do not care about the hospital . . . . until they need it.  The same people who persecute voluntary trustees and administrative representatives of their community hospital  expect nothing but the best that medicine has to offer when they or one of their loved ones needs the hospital’s services.  Some of these hypocrites will quietly seek healthcare elsewhere while doing nothing constructive to help their community hosptial.  Sometimes I wonder if the people in the towns where these activities occur realistically believe that they can escape an involuntary visit to their community hospital when they are the victim of an accident, a heart attack or some other unanticipated serious illness?

When the people who engage in activities of this ilk intentionally denigrate their hospital, they are disrespecting all of the employees, physicians and volunteers of the hospital by inference regardless of what they say.  Just like the disgusting, duplicative politicians that commit the young people in the military to life endangering missions then withhold resources and/or engage in open criticism of the military.  This disingenuous behavior is too routine in our society when we witness the spectacle of politicians holding hands and praying together before they send the military overseas only to then undermine and denigrate military leadership and increase the number of body bags coming home by their subsequent lack of support.

I view a hospital like an aircraft carrier.  On a carrier, EVERY person aboard the ship has a job that can be directly traced to the support of a relatively small number of airplanes and their pilots.   The ratio is over 6,000 to about 100.  In a hospital, the primary  reason for every person in the organization is to support the nursing function, more specifically, bedside nurses.  The services delivered in hospitals are for the most part ordered by physicians but they are delivered by nurses.  It is the nurse that is in the building with the patient 24/7/365.  It is the nurse that will place themselves between a patient and any source of danger or threat.  It is the nurse that is the first responder to the patient’s every need.  It is the nurse that carries our their responsibilities with dignity and pride even when they are disparaged or abused by physicians and other authority figures in a hospital.  It is the nurse that is the voice of assurance when a patient is afraid.  It is the nurse that is left to pick up the pieces when a tragedy occurs.  It is the nurse that carries out the final preparations following death.

Nurses control resource utilization and therefore the cost of providing healthcare.  It would seem that executives that are interested in getting more out of nursing would see to it that nurses have what they need to do their job.  In my experience, most of the time, no one has to tell nurses what to do.  They know what to do and they will do it gladly if we will facilitate their efforts and get out of their way.   Those of us in healthcare administration should be ever vigilant to remove barriers, policies and procedures that frustrate the efforts of our nurses to give their patients our collective best.  Nurses influence patient satisfaction and patient outcomes.  One of the greatest sins in society in my opinion is activities of any kind in a hospital that undermine nursing, particularity when these activities are carried out by authority figures.

You do not have to teach or train a nurse to be compassionate or focused on error free work.  In fact nurses operate at far higher levels of performance than the rest of us usually appreciate.  Most of us would not make it very long if we had to perform at the level of our nurses.  Nurses understand the grave consequences of errors in their work.  All too frequently, a nurse that is involved in an all too common human error becomes the second victim of a bad outcome.  That these people can function at all under this stress tells the rest of us how incredible our nurses are.

I have thoroughly enjoyed my relationships with nurses over the years.  The type of people who gravitate to nursing are special.  Most of them are motivated to be in a position to do things to help other people in their time of need.  They do not allow those of us that are ‘bad patients’ to detract from their focus to give us their best.  Their attitude is always positive and uplifting even when we are in the mist of having our worst day(s) and showing it liberally.

Most hospitals recognize their nurses by providing badging that clearly indicates that they are nurses.  One of my personal crusades is to make sure that EVERY nurse in the organization whether they are a bedside nurse or not PROUDLY display their RN identification so that no one will mistake these giants of humanity for any one of the rest of us regardless of their role.

What would our world be without nurses?  What would our world be without the type of people that gravitate to nursing?  What are we doing as leaders that is making life more difficult for our nurses?  Are we creating environments more or less conducive to patient safety?

The next time an opportunity presents itself, do not miss taking the time to thank every nurse you meet for their service to the hospital, its patients and your community.

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.

CFO Radio Interview

On October 17, 2011,  I was interviewed by Lorraine Chilvers on CFO Radio on the topic of Interim Executive Services.  The interview that lasted around 45 minutes is proceeded by some industry news.  During the course of the interview, I am asked about a variety of aspects of Interim Executive Services.  Since Lorraine has insight into the Interim Executive Consulting business, her questions were deeply probing and she did a very good job of engaging me on many of the more important aspects of Interim Engagements and the Interim Executive lifestyle.

Lorraine and I previously served together at Tatum.  Eventually, we went our separate ways.  I went on with my Interim Executive Services career and Lorraine went on to found Delaney Consulting and CFO Radio.

At the time of the interview, I was serving as the Interim Chief Financial Officer of The Central Florida Health Alliance serving Leesburg and The Villages in central Florida.  I recently listened to the interview again and it struck me that the material in the interview is just as current now as it was then.

The interview may be found here.

The people in the lobby

It was winter in the north country.  The temperature was in the low teens, the wind was blowing 20 MPH and the heavy snow was flying horizontally.  When I walked into the lobby of the hospital it was full of Mennonites.  They had come from their milking barns to the hospital and they were waiting for the business office to open so they could pay on their bills.  You see, Mennonites pay their bills – in full – in cash.  They will spend the rest of their lives paying their obligations.  I went on to the administrative suite where ridiculous debate was occurring that made me furious.  The administration was discussing sub-optimizing for the private benefit of Dr. Huff-and-Puff while the Mennonites were lining up to pay the hospital not from their excess but from their necessity.  I am very lucky I did not get fired for suggesting that Catholics in a Catholic hospital were engaging in decision making somewhere between magic eight ball and Ouija board.  I had no idea that Catholics did not like Ouija boards and I had no idea what it meant to get reamed out by a nun but I soon found out.

A couple of years later, I was invited to South Georgia Medical Center to be interviewed for the purpose of a potential interim engagement.  As I walked through the lobby, I was nearly overcome.  South Georgia has a large lobby and little space elsewhere for waiting.  The lobby almost always has people.  They are south Georgia people.  They are easy to identify by their dress and their speech.  They sit and sit in the lobby keeping vigil for their loved ones.  They wait and they pray.  They pray that their loved ones will be healed and that those of us that are responsible for their care will get it right for their family.

These people do not know who we are or what we do.  Many of them would not understand what we did if we explained it.  Shucks, some of us don’t know what we are doing most of the time.  ‘Still and yet’ (as the girl from WVA used to say), the people in the lobby wait, pray and hold vigil.  I have told my family that if I am in a hospital, I do not want anyone holding vigil over me, there is nothing they can do.

Has this ever occurred to you?  When you are making decisions that are going to impact care and allocation of resources to provide care do you think about the people in the lobby?  Do you see to it that to the best of your ability to exercise control or influence that not one cent of the hospital’s resources are wasted?  Do you demonstrate this ethic by your living?  Are people around you inspired to be better by the example of leadership you are setting?

One of my favorite one-liners is the euphoria we get from drinking at our own still.  How often are we wasting time in an administrative suite waxing eloquently about how great we are while simple people are sitting a few yards away from us praying as hard as they can that somehow we will get it right for them and their loved ones in spite of ourselves?  Anyone that does not labor daily under the stress of this burden or awaken in the middle of the night worried about this does not deserve to serve in a hospital.

Just this week, I told some voluntary hospital trustees how much respect I have for them and their service to insure to the best of their ability that the hospitals they represent meet the needs of the communities they serve.  Talk about an awesome, bone chilling responsibility.  When you are in the presence of these people, you have the incredible experience of being in the same room with the giants of humanity among us.

I have at times in the past experienced fear for my job.  I meet regularly with people who have fear for their job.  One of the benefits of being in interim services and a late career executive is that I no longer have fear for a job.  I am a lot more afraid of the people in the lobby and the Board of Trustees.  Will I reach my potential to deliver what the sick, wounded and downtrodden need?  Will the blessing of intelligence and understanding of numbers and complicated governance and leadership concepts I have be enough to meet the needs of so many that are so utterly dependent upon me?  Will my ability to  get an organization functioning as efficiently as possible be sufficient to meet the needs of the people that depend upon the hospital?

One of the many unique features of a hospital is that not one of its customers (patients) with the possible exception of healthy women bearing healthy children want to be there.  Virtually every other patient would just as soon be anywhere else doing anything other than subjecting themselves voluntarily or involuntarily to medical interventions that in many cases only prolong their agony.   I have yet to meet the person that was glad they were diagnosed with cancer so they could spend days in an infusion room.  I have yet to have the marketing department introduce me to a patient that saw a billboard and woke up the next morning saying that they should spend the day in the emergency room.  Where is the first patent that drank their morning coffee from a hospital logo cup and decided as a result to come in for a MRI?  The people that we serve know very little about disease process or clinical process.  Even those among us who work around hospitals are rendered impudent when we find ourselves on our backs at the mercy of people we do not know doing things to us we never envisioned or understand.  The last time I faced surgery, the day before I had no idea that before a day had passed that I would be in an operating room as a patient.  Actually, I had some other plans that were more important in my mind.  A sharp ache and the next thing I knew, my life was turned totally upside down and out of my control.

I heard the Chairman of a Board that had undergone heart surgery say that he literally watched the seconds of his life ticking away on a wall clock in the cath lab as he was told he was going straight to a heart room.  The question that was in the front of his mind was whether or not the hosptial had what it needed to provide the care he was going to require?  He mused to himself about whether or not as a Board Chairman had he done enough because if he had not, it was a little late to start focusing on the need.

This is what we do and why it is important.  We do not know who will need our services, when or why.  The reason we are leaders in healthcare organizations or organizations providing service and support to healthcare providers is to be there for EVERYONE that needs our services in their hour of need.  The better we do our jobs, the better enabled our organizations will be to meet the vision of their missions.  If we fall short of our potential or what the organization needs, the friends and family of the people in the lobby will suffer.  Sleep with that a few nights.  Sometimes, I wonder if I should have stuck with my original career aspiration; wrecker operator.

And so I come back to familiar questions.  Are you up to the challenge?  Are you leading from the front by example?  Are you an example of what the organization aspires to become or what it needs to rid itself of?  Are you spending time, money and energy in ongoing education to improve your potential to meet the increasingly complex challenges of running a complicated healthcare organization these days?  Is your area of responsibility meeting the needs of the organization?  Have you made it better or is it impeding the ability of the organization to move forward?  Are you and your area of responsibility rising to your full potential or is new leadership needed to reach the next level?

Get off your ass, take a walk.  Go into the waiting rooms.  Look at the people there.  Speak to them.  Engage them.  Shake their hands.  Introduce yourself.  Tell them what you do.  Tell them that you are seeing to it that they or their loved ones are getting the best the organization is capable of delivering.  Give them a card and tell them to call you ON YOUR CELL PHONE if they have a problem, question or concern about how things are going.  Demonstrate interest and compassion.  Engage your patients and family you would like to be engaged if you tomorrow found yourself sitting in the lobby of a strange hospital in a strange town with no idea of what is happening.

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.  Copyright is claimed 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.

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.

The stages of an interim executive engagement

I have come to realize in my practice that an interim engagement follows a predictable pattern.  I have seen this happen time and again.  I understand the process that a decision maker goes through during the course of an interim engagement.  A majority of decision makers dealing with transitional situations have little or no experience with interim executives.  I asked about this as a part of my dissertation research.  A small proportion of my respondents (35.7%) reported having experience engaging and managing interim executives.  Another 33.6% of my respondents said they were knowledgeable about interim executive services but had not engaged an interim executive.  Similar to Elisabeth Kübler-Ross‘ five stages of grief, I have observed one organization after another going through a similar process during an executive transition.  The primary difference between organizations and decision makers is their exit point from this process. Some never get around to making a decision or decide to avoid the use of an interim.  In order of their occurrence, here are the stages of an interim engagement that I have experienced.

We do not need an interim – When faced with a transition situation, organizations employ a variety of strategies.  Some use internal resources, some leave the position open and others resort to consultants.  In a future blog, I will address the difference between an interim executive and a consultant.  Organizations will frequently initially resist the fees associated with engaging an interim executive.  They will search for any possible alternative to engaging the interim.  They will spend weeks or months struggling with the interim decision.  I have seen the passage of over six months between the time first contact was made with a decision maker regarding an interim position and the time the engagement actually started.

Acceptance of an interim – All too often, once the decision is made to employ an interim, the client wants the interim TOMORROW!.  Generally, the client communicates their desire to accelerate the interim engagement as a means of managing the cost of the interim engagement.  Sometimes, too much time passes between the time the decision maker meets an acceptable interim and the time they make a decision.  Then they are frustrated when they call to find that the interim they wanted is now engaged.  I once had a potential client get upset with me for ‘putting pressure’ on them to hire me.  All I had done was to tell them that I was being proposed by the firm I represented on multiple jobs and if they wanted me, they needed to make a decision.  In this case, one of the reasons they wanted me was perceived cultural fit.  They wanted someone that would fit into a rural eastern North Carolina culture and I had been a hospital CFO in that area.  Two weeks later, I received a desperate call.  They wanted to know how fast I could get to their site to address what had become a big problem.  I told them that I was literally on my way to Milwaukee.  I had been engaged a few days earlier by one of the other clients that had seen me.  The potential client that had let me ‘get away’ was not happy.  Ultimately, the firm lost the gig because they did not have any other resources that this client liked and I got to spend the winter in Milwaukee instead of eastern NC.  If you are a decision maker, MAKE A DECISION.

 
Recognition of the value proposition – I start my engagements with an assessment.  The purpose of the assessment is to determine the degree to which the function I am filling is or is not meeting the needs of the organization.  During the assessment, it is common to find a number of significant opportunities for improvement.  My experience has been that when a client sees the difference between the interim and what they had before or when they see the magnitude of opportunity revealed by the assessment, the value proposition ‘clicks.’  There is no easy way that I have found to tell a prospective client before an engagement that my experience might be valuable to their organization .  It comes across as self serving.  Once they understand the potential of working with a professional interim that is capable of being transformational in their organization, they want to get as much as possible out of the the engagement as fast as they can because they understand that the potential value is multiples of the cost.  This frequently reduces the client’s focus on getting the engagement over as fast as possible.

 
Employment overtures – Somewhere along the line, usually in the six to nine month period of an engagement, the client decides that the interim is highly desirable and recruitment overtures start.  Sometimes, they come to doubt that a recruitment would result in an equal or better permanent solution. According to my dissertation research, 25% – 40% of the time, the overtures result in employment even if it was not the initial intent of either party.  Tatum called this a ‘conversion.’  The respondents to my dissertation research survey stated that they had converted their interim 35.9% of the time.  If the interim is sophisticated, they will generally resist converting as they see consulting preferable to employment.  The challenge to this part of the process is to get through it without the client becoming concerned that they or their organization are not good enough for the interim.

Diminishing returns – If the interim does not convert, they ultimately begin to experience difficulty in achieving transformational gain in the organization.  Initially, they were a novelty full of energy and fresh ideas.  They are generally very impressive compared to their predecessors.  They are humored by the bureaucracy in the organization and their harvest of low hanging fruit is impressive.  Sooner or later, the resistance of the organization to engage in increasingly difficult change and increasing resistance on the part of the bureaucracy reduces the ability of the interim to produce transformational change.  One day the leadership is evaluating their situation and they conclude that the consultants are not earning their keep and the transition(s) start.  I will discuss the topic of culture and change in organizations in a future blog entry.

Recruitment – During this stage of the process, the interim participates in the recruitment by performing a number of key tasks.  They spearhead the development of a revised job description, they develop a specification for the recruiter, they participate in the interviewing and vetting and ultimately in the selection of the permanent candidate.  I have cast the deciding vote on my replacement more than once.

 
Transition – The transition occurs when the interim is replaced by a full time employee which can be the interim.  If it is not to be the interim, the interim generally assists the organization with the recruitment and on-boarding process.  When the on-boarding process is complete, the interim moves on to their next challenge usually leaving their client organization in much better shape and thankful for their service.

I have personally experienced this progression of an interim engagement time after time. I have also seen every one of my engagements run longer than initially discussed.  Before a client appreciates the value proposition, they are very highly motivated to get the engagement over as fast as possible.  I have been told time and again to not expect more than ninety days, 120 days at the most.   My average engagement is nine months and I am currently twenty months into an engagement  was initially mutually understood to be limited to an assessment only.

The other interesting phenomena that I have seen is that the process can be exited at any stage given circumstances unforeseen initially.  This is one reason that I go the extra mile by making it very easy for my clients to exit an engagement should it become necessary.

One of the factors that lead to engagements dragging on is that the client becomes comfortable with the interim and they allow distractions to degrade their focus on moving the organization beyond the interim engagement.  The next thing they know, the engagement is approaching its first anniversary.

If you are a decision maker considering an interim, my hope is that this material will enable you to better manage the engagement and get the most from it for you and your organization.  If you are considering interim services, and if you are any good, you should expect that your engagements will nearly always run longer than initially discussed with the clients.  Therefore, as an interim, you need to be careful making forward commitments that assume the engagement will be over by a time certain.

This is original work.  I have not seen content of this nature in my extensive dissertation research.  This material is copywrited by me with reproduction prohibited without prior permission.  I always note and  provide links to supporting documentation for non-original material.

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.
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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.