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Management consultant and author Roger A. Gerard discusses his article, “10 ways health care leaders sabotage their own success—and how to stop.” He identifies common, often unintentional, ways health care leaders undermine their credibility and effectiveness, frequently due to a lack of formal leadership training. Roger outlines ten key pitfalls, including failing to clarify priorities, attempting to motivate rather than listen to already dedicated staff, treating professionals as liabilities, leading remotely instead of observing frontline work, permitting blame, breaking promises, and ignoring the wisdom of those doing the daily tasks. To counter these tendencies, Roger proposes five promises every leader should make and keep—focused on listening, support, growth, compensation, and backing staff—along with two crucial actions: “Go and see” the work being done and “Go and do” what’s needed to remove barriers and improve processes, ultimately fostering trust and a high-performing culture.
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Transcript
Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Roger A. Gerard. He is a management consultant and he is the author of the book Lead With Purpose. The KevinMD article that we are going to talk about today is “10 ways health care leaders sabotaged your own success and how to stop.” Roger, welcome to the show.
Roger A. Gerard: Thank you. I appreciate being here, Kevin, and let’s have some fun.
Kevin Pho: Just briefly share your story and then talk about the KevinMD article that you shared with us today.
Roger A. Gerard: My story is 50-plus years in both administrative and executive roles in the health care industry. About a five-year detour into manufacturing back into health care. And I have been on the executive team of two health care systems: one based in Michigan, one based in Wisconsin. In addition to that, I have been a consultant for the last 10-plus years to three different large health care systems, and I have been out and about quite a bit with other kinds of smaller organizations as well.
I theoretically retired—my wife wonders what all of the party was about. I theoretically retired in 2014 and I have been a full-time consultant since then.
Kevin Pho: Today we are going to talk about health care leadership, which is very salient in terms of what we do, and certainly what I do as a physician—tumultuous health care times to say the least. So talk about the article that you shared with us today on KevinMD.
Roger A. Gerard: What I focused on are the mistakes that leaders tend to make as they attempt to bring about engagement and the passion of the people who come to work. We have to understand that when professionals, particularly in health care—as I have worked in other industries as well, but particularly in health care—professionals come to their work with very limited intentions, one of which is to help people. That is a huge, grandiose intention. A second intention is the science. A lot of people in health care really appreciate and love the science. You as an internal medicine practitioner would probably appreciate that more than I would.
And so as you work with people in this industry, you have to appreciate as a leader why they are there, what they are coming to accomplish for themselves, and whether you can orchestrate the dynamics of your organization so that those needs are met. Leaders make mistakes. And the article I sent to you summarized a lot of those mistakes that leaders tend to make, and those mistakes sabotage your leadership. People want to trust their leaders. They want to help their leaders, and they come to the party with great intentions.
Unless they have been burned or damaged somewhere else. And because of that willingness to listen and learn and meet the needs of your organization, they are raw material for high levels of engagement, high levels of impact in the work that is being done on a daily basis in your organization.
What mistakes do we make? We fail to treat people with respect. Treat them as if we are not willing to have our position influenced. We set policy, we create procedures, we set standards, we set expectations, and then expect them to accommodate all of that without having any co-authorship, without having any input into the dynamics that affect their daily life. I worked in one organization where the mantra of the CEO was: “You get paid, don’t you? Go do your job.” That is not respectful. That is totally disrespectful, especially with high-level professionals.
Second: Blame and shame. Things are going to go wrong, mistakes are going to be made. People are going to do things that they probably should not have done. And instead of looking at the dynamics, looking at the factors that led to those mistakes, led to those errors, we want to blame people. We either discipline them or send them off to some kind of training program, or do everything but get at the heart of why that mistake was made in the first place. And very often it is because of the way work has been set up, the way the workplace has been designed. I learned a ton in my experiments with Lean Enterprise work that came out of manufacturing where many of the problems we find in health care are problems that are generated by poor organization. And that is a leadership issue. That is not a staff issue.
Expecting loyalty without giving loyalty. This is a huge disincentive for professionals. Professionals can go just about anywhere today and practice their professions and do a great job. We talk in administrative circles about employees being our most important asset. The moment things get tough, we start laying people off. You do not lay off assets. That is wrong. That is not loyalty. And yet we expect loyalty in return. That is nonsense.
Another mistake: Over-standardization. When you over-standardize the work and compel people to follow scripts—and we are seeing this in medicine, we are seeing this in nursing, we are seeing this in teaching professions, we are seeing this in emergency rescue professions—a certain amount of standardization allows us to measure quality and allows us to measure productivity. When you over-standardize, you take away discretion. Professionals expect discretion. They expect to be able to use judgment. They have been trained to exercise judgment, and when you over-standardize, you take that away from the professional and they become cogs in a wheel. I call it commoditization of the professional. You become a commodity.
I do not want the doctor treating me to behave like a commodity. When I had a major pulmonary embolism shutting down both of my lungs, that doctor had to move fast and had to use judgment. I do not want standard work in that case. I want him to be able to do what he needs to do. So those are some of the major ways, as leaders, we fail to address the real needs of the professionals doing the daily work.
Kevin Pho: I want to come back to one of the things that you said: that health care leaders who fail sometimes are disrespectful of the staff. You gave that example, the CEO, who said, “You get paid for this, don’t you?” Now, for those leaders who act like that—and I have heard multiple stories of such instances—what are some of the root causes that they become that way? Because it sounds like treating people with respect, that sounds like a common sense thing to do, but that does not always happen. Why is that?
Roger A. Gerard: The people in the administrative suite—and I have been there, I lived in that executive suite for 15 years of my career—the people in the administrative suite are accountable to boards. Very often these boards are made up of business leaders. They are made up of people with expectations and the desire to advocate for special interests. And I can give you a couple of great examples of that, but when you bring business into your board—and health care is a business, we have to have that feature—but when you bring it in, in a way that supersedes the clinical needs of the patient in the moment, that is not good practice.
The people in administration are constantly under pressure to meet the business requirements of the business. There is no business if you do not declare a bottom line. What I have attempted to teach leaders in my work is that there are four dynamics that every executive needs to pay attention to.
The first is the quality of the work being done. It better be quality because if it is not quality, they are not going to keep coming to your shop, period. You better pay attention to the money because if you do not pay attention to the money, the business is going to go away. It has to be able to sustain its costs and health care is expensive. The third is the engagement of the professionals that are doing the work. If they are not engaged, they are going to go somewhere else. They are not going to care in their daily work. And the last piece is the community or the customer you are serving. And in health care, that is the patient, and sometimes the family members, and you have to be very careful that their needs and requirements are met.
This is a tricky balance and it is very stressful for people in the administrative suites. I hear from employees all the time: ‘Those guys, they get paid the big bucks and they are in the administrative suite.’ And my response is: That CEO probably makes three decisions a year. But you need to understand that they are doozies; they are big decisions and they affect thousands of people, so they better get it right. They are under a great deal of stress.
I think that is what leads to cynicism. It leads to people burning out in the job and they do not realize they have burned out. You end up with people who slowly lose hope that there is a better way.
Kevin Pho: Let us talk a little bit about that tension: the tension between business and what is best for clinical care. I think some of the things that you mentioned in terms of commoditization of health care, that, I think, leads directly from some of those business pressures, right? They want to standardize everything because they want to maximize efficiency. As a management consultant who has been familiar with multiple hospital boards, how is that tension discussed behind the scenes? Because as a physician, obviously I am going to lean towards one side, but give me a sense of what those discussions are behind the scenes that we often do not hear about.
Roger A. Gerard: Typically I am brought into an organization when there is distress. And that distress is usually felt by the CEO or somebody else on the executive team. And I will come and sit with them and do a bit of a quick assessment with them. But one of the first things I am going to want to do is meet with them and some of their board leadership.
I walked into one client where the board was—we met offsite in Chicago—and the board was a group of about 40 people and about a third of them were physicians. A third of them were business people, and a third of them were just random people from the community. And it was a big board. A lot of people, very too many. And we did not have a lot of room in the group, but I am looking at that, and literally everyone around the table had their arms crossed, daring me to teach them anything. My first move was to get them all on their feet around flip charts, and I asked them to define their future as an organization. I also asked them to define all of the ways that that future was imperiled.
So we had two lists going in the room, and you would have thought I created an explosion in the room because all hell broke loose. It was very loud, it was very noisy, it was very robust. People were excited about putting these things on the flip chart. That told me a ton about what had gone before. This was bottled up. This was—so nobody had ever asked them about those two questions.
What I find in leadership is that we are not having the conversations behind the scenes that you are talking about. It is for several reasons. First of all, it is threatening to the people in leadership. They may not really want to hear what they are going to hear. Second, they do not know how to have the conversation. They do not know how to release that tension. And I am a trained facilitator. I have—my doctorate is in organizational behavior and I know how to bring people together and cause these kinds of conversations. Most leaders are not trained for that. There is no training program for this. It is about being able to conduct dialogue. So all this stuff goes under the surface and it gets bottled up. So people are more protective than they are open to ideas.
That is at the heart of what I see. But once you unleash it, change can start to happen. I do not know if that gets specifically to your question or not, but behind the scenes, there is a lot of, in many organizations, pent-up conversations. They are not having the conversations they really need to have.
Kevin Pho: Let us talk about physicians who aspire to be leaders within their health care system. A lot of times, as you know, physicians do not have any formal training unless they go and get an MBA degree into some of these leadership principles. What are some paths to success for physicians to become better leaders? Do they need formal training like an MBA? Can most physicians be trained on the job to be a health care leader? Tell us about some paths forward for doctors.
Roger A. Gerard: In the world of leadership development, there are three ways to gain knowledge and skill. One is through formal education: you can go and get a master’s degree, and many of the folks that I have worked with as chief medical officers or department directors, they have gone back and they have gotten their master’s, and that is great. But it is academic. It is not pragmatic; it is not practical leadership. Leadership is a practice. You must do it in order to learn it.
And so the second way you get there is through mentorship. You need to find somebody to hook your wagon to, and you need to allow them to influence you, and you must be very careful about who you pick as a mentor. The third thing is practical experience.
What I find among a lot of physicians who move into leadership is they believe that their medical training has prepared them for leadership. It has not. It has made them great scientists. It has made them great practitioners, but it has not made them great leaders. The decisional processes in leadership are much different than they are in medicine. When you are seeing a patient, you might have 15, 20, maybe even 30 minutes of diagnostic time. Then you have to draw some diagnosis and conclusions, and then you have to prescribe a decision, and then you move on to the next patient. And if you are in a practitioner that is doing surgical procedures or whatever, it is time-bound.
Leadership is not that way. What I see more than anything else among physicians moving into leadership is an impatience with the process for how long decisions take. A good leader, a good CEO is going to make sure that before they make good big decisions, they involve lots of players. And that is when the impatience of the physician leaders starts playing out and saying, “I know what the right answer is. Let us just go do it. We have already done the assessment, we have already talked to the—we do not need all of this.” Yes you do, because there are a lot of stakeholders in health care. So decisions take more time in the management arena than they do in the medical arena. That is a big difference.
Helping the physician leaders understand that they are in a different world now is part of the orientation to leadership. And I can tell you when I conduct orientations for new physicians coming into leadership, they hear the message. They humor me and they say, “We understand.” And then within the first six months they have come back frustrated saying, “You told us, we did not believe you. We believe you now.” This is frustrating. That is how the learning process takes place. I think there is going to be a certain amount of frustration for any new physician leader coming into the dynamic.
Kevin Pho: We are talking to Roger Gerard. He is a management consultant. He is the author of the book Lead With Purpose. Today’s KevinMD article is “10 ways health care leaders sabotage your own success and how to stop.” Roger, let us end with some of your take-home messages that you want to leave with the KevinMD audience.
Roger A. Gerard: A couple of big ones. I tend to want to make sure that the people who are moving into leadership understand that their basic job is very simple. It is not hard but it… I call it the five promises and the two steps.
The five promises are simple. If you are coming into leadership:
The first thing I want you to do is listen to people. The promise you are making is: I will listen to you with respect and I will take your input seriously. And if I disagree with it, I will tell you why. But I want the leader to listen. If you come into a new role and you do not spend the first six weeks just walking around and listening to people, you do not understand your job.
The second promise: I will help you learn and grow as a professional. Professionals want to know that their leaders are helping them. They want to grow in their profession. They want to do new things. They want to stay current in their profession. The leader who helps that wins a friend every time.
The third promise: I will help you be wildly successful in your profession. Too often the leaders are obstacles: “We cannot do this because of the budget. We cannot do this because of the time constraints. We cannot do this because of something. Politics.” Help your people be successful, find out what they need and want to be successful in their jobs and make sure they have it.
Fourth promise: I will make sure you are compensated competitively. This is a big deal among professionals. And competitive means 60 percent comp ratio or higher. It does not mean 50 percent. It does not—the surveys out there lag. The surveys are old. So if you are going to treat people competitively so that they do not get tempted to go somewhere else, you are going to pay them a little more than what the data tells you. And with high professionals like the physicians out there—there is this myth that we ought to be incenting physicians to do more. Incentives are manipulation, because the reason you have to use incentives to get them to do something is because they do not want to do it. Now you are using manipulation to get them to do it. And once you put people on strings, that is all you are going to get is what you want when you pull the string.
The fifth promise, the last one: I will have your back. When things go wrong—things are going to go wrong—people want to know they are working in a safe environment. They want to know that when they make a mistake they are not going to be shamed for it and blamed for it; they want to learn from those mistakes. That is what a professional does. If you make those five promises and keep them, you are going to have a great team and you are going to have a great ride as a leader.
Then there are two steps. Step one: Take the time to go into the environment and see what people are doing. Go and see. Too many leaders think their job is in the executive suite. Their job is in their office. Their job is somewhere in the conference room, but not out where the work is being done. When I was in an administrative role, I was spending a day a month shadowing somebody for almost 25 years, a day a month. And I knew what was going on in the different departments and they knew who I was. We had first-name relationships throughout the organizations.
The second step: Go and do something about what you see. If you can find a way when you are wandering around talking with people, if you can find a way to help make their jobs easier and better, do it. And do it now. It is cheap. Do it before they ask for it. And what happens is you will become a leader who they want to see and who they know will help them. Five promises, two steps. Go and see, go and do. That is my takeaway.
Kevin Pho: Roger, thank you so much for sharing your perspective and insight and thanks again for coming on the show.