ZachEvans

Believer. Husband. Dad. Coach. Healthcare Thought-Leader. All-Around Good Guy.

Thoughts

Life Is Expensive

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I never like to admit to anyone (especially myself) that I am getting older and I certainly do not want to fall in to the cliche of constantly talking with my kids about how much more difficult my life growing up was than theirs is, but is it just me or is it insanely expensive to raise kids today? Forget the cost of clothes and food (you know, the basics) but when you consider the growth of entertainment and media devices and services that our kids have to choose from today the accumulated cost can be overwhelming.

My Childhood (Family of 4)

Cable TV: $0 (We had an antenna)
Internet: $0 (What’s that?)
Movie Rentals: $5.00 each (Blockbuster)
Streaming Movies: $0
Movie Ticket: $3.55 (1985)
Cell Phone: $0
Number of electronic devices in the home: 3 (TV, VCR, PC)

My Kids Childhood (Family of 6)

TV: $100 (Comcast)
Internet: $50 (Comcast)
Movie Rentals: $1.50 each (Redbox)
Streaming Movies: $20 per month (Netflix)
Movie Ticket: $8.13 (2013)
Cell Phone: $85 (None of my kids have one…yet)
Number of electronic devices in the home: 19 (3 TVs, 2 DVD players, 3 cable boxes, 2 cell phones, 3 iPods, 2 iPads, 2 laptops, Xbox, Wii)

Inflation certainly has a lot to do with how much more expensive it is to raise children today but the sheer volume of devices and services that we choose to offer our children has caused a greater portion of the growth. Not that I am ready to cut any of this out–I enjoy using these devices and services to the same extent the kids do–but, oh my, it is certainly expensive and I am sure I have forgotten some things from my list. Share your list with me and I will update mine.

Urgent, Not Emergent

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A statement in a recent article from The Motley Fool attributes the rapid rise of urgent care clinics to failures by hospitals.

Long waits in emergency rooms for breaks, sprains, and the flu coupled with triple digit out-of-pocket invoices are making hospitals the care-of-last-resort.

The issue I take with this statement is that it leaves out the fact that the emergency room may not be the best place to treat breaks, sprains, and the flu in the first place. There is often a wide gap between a healthcare need that is urgent and one that is emergent.

Over the past several decades–driven in large part but the rise in the uninsured–emergency rooms became the primary treatment provider for all kinds of healthcare needs that were not, in fact, an emergency. Emergency rooms, by law, are required to treat almost any patient that presents at their door regardless of their ability to pay (this is a good thing) but have limited say in what patients actually show up requesting care.

Is the patient with the sprained wrist or suffering from flu-like symptoms experiencing a healthcare emergency? Most likely not, but many of them came to the emergency room anyway–often driving up the wait times mentioned in the article.

Urgent care centers, walk-in clinics, work-site clinics and the like are excellent avenues for patients with urgent–but not emergent–healthcare needs. Their rise in popularity (and the financial success that is following) should not be viewed as a failure of hospitals, but rather as a success of patients selecting the right provider for their current healthcare needs.

Motivating the Right Party

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Patient engagement is a popular buzz word in healthcare circles right now. Motivation to increase the engagement of a healthcare provider’s patients vary  but most–if not all–center on the idea that an engaged patient will be a healthier patient. Employers want engaged patients because employers want to speed-up the role out of consumer driven health plans. Insurance companies want engaged patients because they want to keep down medical expenses (so do employers and the patients themselves). Doctors and hospitals want engaged patients because engaged patients can be marketed to directly regarding one doctor’s or hospital’s strengths compared to another.

CMS has even expanded its focus on the engaged patient with the requirements to meet Meaningful Use Stage 2. As part of MU/S2, patients are required to be given expanded electronic access to their medical records, access I strongly support as this data is owned by the patient, not by the doctor or hospital that provided the care.

The Core Measure relating to Patient Electronic Access has as its objective to “provide patients the ability to view online, download, and transmit information about a hospital admission” and is broken down in to two parts:

  1. More than 50 percent of all unique patients discharged from the inpatient or emergency departments during the EHR reporting period have their information available online withing 36 hours of discharge.
  2. More than 5 percent of all patients (or their authorized representatives) who are discharged from the inpatient or emergency department during the EHR reporting period view, download or transmit to a third party their information.

I appreciate and agree with the first requirement. Given the technology of today and the general acceptance of consumer portals, hospitals should be required to give patients access to their healthcare data and it should be available in a timely fashion. The first incarnation of HIPAA provided a common framework for patients to request copies of their data, but the process was sorely outdated and expensive to both parties involved.

It is the second requirement that I take issue with. I am proud to work in healthcare and for a hospital company. I firmly believe that we have a near-sacred responsibility to provide the highest quality of care to the greatest number of patients. We see patients at their weakest and most vulnerable moments. We have a responsibility to give them the necessary care to help them get better. We do not, however, have a responsibility to ensure that they are engaged in their care.

Yes, we have a responsibility to educate them about all of the care options and resources available to them. Yes, we have a responsibility to remove as many barriers as possible when it comes to accessing those care options and resources (see the first part of the requirement above). I fail to see, however, why a hospital should be held accountable for a patient that refuses to actively engaged in their own healthcare.

Where is the personal accountability for ones on health? Why are we not motivating the right party to become more engaged in their own health?

Why Vulnerability Matters

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There has been no shortage of articles written on the value of transparency in business. Drivers behind transparency include increased trust, higher employee engagement and buy-in, realized brand authenticity, and improved loyalty. As a leader, I am a big believer in being as transparent with my team, customers, business partners, and stakeholders as possible. I believe in transparency for all of the reasons mentioned previously and for one additional simple fact: It is the right thing to do. When I am asked to lead a new team or my existing team adds a new teammate, there are four promises I make to them:

  1. I promise to give you a truthful answer when asked a question (aka: transparency). I may not always be able to give you all of the details at the present time but I will not lie to you.
  2. I promise to wear the black hat and tell people “no” on your behalf so that you can maintain as positive of a relationship as possible.
  3. I promise to remove as many barriers as possible that are keeping you from being as productive and as happy as you can be.
  4. I promise to help you find a healthy balance between your responsibilities both inside and outside the office.

I am considering adding a fifth question to my list: I promise to be vulnerable to you when appropriate.

Vulnerability is different than transparency in that, while transparency allows those around you to look inside your operations, vulnerability allows those around you to look inside you. It allows co-workers, team members, and stakeholders to see the less-than-perfect you. The you that, if you only make three mistakes before lunch, considers the day a success. The human you. The personal you.

Leaders understand the need for both transparency and vulnerability. Both engender loyalty from your team and can lead to greater passion and productivity. With transparency comes buy-in but with vulnerability comes connection.

I have, on more than one occasion, been given the opportunity to admit mistakes I have made in my career and I have never regretted doing just that. When a leader admits a mistake, it frees their team to try their hardest, safe in the knowledge that calculated risks–and the inevitable mistakes that come about because of taking them–are acceptable to the organization.

Note: For a more detailed discussion on vulnerability and its power, please view this excellent TEDxHouston talk by Brene Brown.

David or Goliath: Start-Up or Big Company

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I have had the good fortune to work with both start-ups and Fortune 100 companies (#79 in 2014, to be exact) in my career. Working with David or Goliath carries with it both positives and negatives and when you are considering going to work for a company you need to ensure that these characteristics match up with your own personality and needs.

David (The Start-Up)

Pros

Flexibility and agility
Wide individual scope of work
Palatable energy
Passion fueled
Newness
Undefined culture
Define your own career path
Broader individual impact

Cons

Instability and risk
Constrained resources
Passion fueled (yes, it goes both ways)
Unproven business model
High stress / long hours
Identifying the next big thing is tough
Risk of being crushed by larger, more financially stable companies

Goliath (The Big Company)

Pros

Resources (people, money, technology, etc.)
Established business model
Stability (or at least the sense of stability)
Organizational history
Defined culture
Learn the art of politics
Broader corporate impact
Time to reflect on lessons learned

Cons

Bureaucracy
Limited individual scope of work
Risk of being undercut by smaller, more nimble companies
Organizational history (this goes both ways, too)
Frustration of company politics
Slow career growth
Being pigeon holed as a specialist

Most of these pros and cons are based on potential for good or bad but as you think of the type of company you want to work for it is important to decide if you are willing to accept the risks associated with any given size of company.

As I think of additional items to add to my lists I will do so but please feel free to contact me with anything you think needs to be added to either David’s or Goliath’s score card.

The Question To Ask

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I have been a part of a few start-up companies and have learned quite a bit along the way. One question that many early employee candidates of start-ups struggle with is how to ask for equity in the company they are being asked to help build (assuming there is not a formal program in place). I have helped frame this question in a few different ways but a friend of mine, Gary Peat, put it as concisely as I have heard it said:

What do I need to do to earn an equity position in this company?

I like the way this particular question is framed because 1) it puts the onus on the company to stake out what performance level it requires to grant equity and 2) it allows the candidate to put forth he question in an humble manner because he or she wants to earn that which will be granted. In the era of 140-character abbreviated rants, it is nice to see how a well-phrased question can make all the difference in the world as to how it will be received.

Contrasting Practices

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I recently completed a short training course produced by a colleague of mine, Dr. Mark Radlauer, who is both an emergency room physician in Colorado as well as an early-stage tech investor. The topic of the training course was improving IT-Provider communication. Dr. Radlauer is a voice I listen to because he understands the clinician’s point of view and workflow and he is a firm believer in leveraging technology to deliver the best patient care and experience possible.

Dr. Radlauer pointed out, correctly, that one of the leading causes of communication challenges between IT professionals and providers is that contrasting practices exist in terms of how each individual approaches their work.

Contrasting Practices

(The one point where I slightly disagree with Dr. Radlauer is in his assertion that IT is organization-driven rather than data-driven but my experience shows that this is sometimes the case. IT–and most all businesses / departments / teams–should be more data-driven than they currently are.)

I believe that seeing a construct such as this helps both IT professionals and clinicians understand the points of view of the other party and, therefore, improve overall communication between the two groups. When communicating across disciplines, it is always helpful to understand how the receiver of your messages (regardless of how they are sent) works and thinks. This understanding will allow you to tailor your message to be as effective as possible.

 

Being Visible

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Management by wandering around is not a new concept for most leaders. This type of unplanned, ad-hoc process has been proven overtime to engender transparency and trust while facilitating informal conversations that can be wildly productive but may otherwise never happen. At TriStar Centennial Medical Center, this takes place during rounding sessions where leaders take the time to visit with staff on the floors–to be visible–to get a sense for how the organization is functioning on the front lines of patient care. This kind of information gathering (and dissemination), however, is only part of the battle.

Generally speaking, individual contributors want to hear from their organization’s leaders on a regular basis. They want updates on the state of the organization, how the team is tracking to plan, what strategic initiatives are going to be starting up, and how are we responding to the ever-changing business and regulatory environment in which we operate. For large organizations (TriStar Centennial has over 3,000 employees that work in shifts around the clock), these updates happen in a multitude of forums:

  1. Leadership Team Meetings. Targeted to Directors and above, these meetings are the foundation of top-down communication where the organization’s leadership team is brought up to speed on the state of operations as well as educated on strategic communications and themes that need to be passed on to the larger staff.
  2. Departmental All-Hands Meetings. Often held monthly (I “bribe” my team with breakfast to make the thought of yet another meeting more palatable), these sessions allow for department leaders to communicate both the broader messages from the senior leadership team as well as discuss department-specific ideas, themes and strategies.
  3. Facility Town Hall Meetings. Held quarterly, these sessions are open to anyone that can attend and include discussion segments led by various members of the senior leadership team. Because of the size of our campus, we break them down by facility to keep the group size manageable.
  4. Night Meals. Operating in a 24 x 7 x 365 organization creates communication challenges that need to be creatively addressed. One way that we do this is by hosting quarterly “night meals” where our 7P/7A employees can a) get a free meal and b) interact with and hear from their leadership team. For some of these employees it may be the only times throughout the year that they get to see certain leaders.
  5. Weekly Emails from the CEO. Our CEO does a great job of sending out a quick note via email every Monday communicating a key, strategic message for the week. Often based on personal observations and experience, they serve as a touch-point regarding what we believe in as an organization and how we strive to serve our customer. HCA’s CIO, Marty Paslick, produces a similar weekly communication via podcast.
  6. Monthly Newsletters. Long a part of many an organization’s communication strategy, we produce both printed and electronic copies of a monthly newsletter that reaches a large section of our employee population.

Taken individually, each tactic may leave out certain portions of our employee population. When building upon one another, however, we are able to communicate the desired and necessary messages while also providing forums for feedback and questions. The design of each of these communication opportunities is to increase the visibility of the leadership teams with the staff so that ALL members of the team feel valued, respected, and communicated with.

These are just six of the more formal strategies that my organization employs to increase visibility to, and communication with, our talented team of employees. What other strategies have you seen successfully employed by organizations you have been a part of?