Uberization of Nursing

“Uberization" is a catchphrase that has quickly become part of common parlance in discussions about the pandemic-induced economy. Uberization is the movement by organizations to “replace fixed wage contracts with ‘dynamic pricing’ for labor” (Davis, & Sinha, 2021).  It is transforming many elements of the economy and replacing employees employed by the organization with a type of self-employed or contract employee. In essence, it allows businesses to “recruit labour at a large scale in new ways” (Davis, & Sinha, 2021). 

The global business community has had a range of responses to the trend of uberization (Babali, 2019), as has the healthcare industry in particular.  Yet as health systems emerge from the pandemic, Bloomberg reports that “the ongoing elevated costs of [healthcare] workers are causing profit warnings” (KHN, 2022; Court, & Coleman-Lochner, 2022). Regardless of one’s resistance or acceptance of uberization, healthcare employment is in crisis. Change must occur to keep health systems from financial disaster.

It seems that the tide of uberization in the healthcare industry is already rising. An increasing number of employees are contracting with hospitals and health systems via a staffing agency. This trend is likely to evolve, with a portion of staff employed directly by the hospital, and the remaining employees self-contracting with hospitals or health systems with short-term or even daily contracts. In fact, hospitals are reporting that rather than temporary “travel nurses” coming from other states to work on a contract basis, nurses are taking short-term contract work at hospitals a short drive from their own homes rather than pursue permanent employment with these organizations.  We are witnessing the uberization of nursing, which will eventually extend to other healthcare occupations.

Why uberization?

The healthcare workforce shouldered the heavy burden of fighting the COVID-19 pandemic. Yet a collaborative study from Indiana University, the nonprofit Rand Corp., and the University of Michigan that analyzed the changes in the U.S. healthcare workforce during the COVID-19 pandemic found that “the average wages for U.S. healthcare workers rose less than wages in other industries during 2020 and the first six months of 2021” (Toler, 2022; Cantor, Whaley, Kosali, & Nguyen, 2022). According to a February 2022 report by the U.S. Bureau of Labor Statistics, only about 35 percent of healthcare and social assistance organizations “increased wages and salaries, paid wage premiums, or provided bonuses because of the COVID-19 pandemic” (U.S. Bureau of Labor Statistics, 2022).

Due to the media attention the “Great Resignation” has received, it is common knowledge that workers across industries have been leaving their jobs at higher rates than before the pandemic (Parker, & Horowitz, 2022).  Yet by October 2021, when the “quit rates” were at their highest recorded levels, healthcare and social assistance job resignations had increased to 35% higher than they had been before the pandemic, slightly higher than the increase of resignations among all workers in the same period (29%) (Wager, Amin, Cox, & Hughes-Cromwick, 2021).  

Over the last ten years, “the salary of registered nurses increased by 1.67 percent in the United States” (Michas, 2021). Whereas healthcare executives make on average eight times more than their hourly employees (Saini, Garber, & Brownlee, 2022). The pandemic has rebalanced the scales in favor of those underpaid for many years. The salary landscape has changed, and in response many hospital systems blindly grasp to the pre-pandemic state of agency staffing. This, combined with near flat salary increases, contribute to the uberization of healthcare.

For many healthcare professionals, the combination of work-related stress and incommensurate compensation was the final straw. However, in addition to fair salary, flexibility has become a top demand of employees—even in healthcare. “Gone are the days when job security or pay was everything. Workers now are giving more thought to how their jobs fit into their lives. Ambition for ambition’s sake is being reassessed” (Buckingham, & Richardson, 2022).

A recent survey articulated “higher pay and dissatisfaction with management were also key drivers of nurses changing work settings in 2020 or 2021,” with 28% of respondents saying they've changed work settings (Lagasse, 2022). The percentage of nurses considering changing employers increased by 6% from 2020 to 2021, with 17% saying they are contemplating making an employment change. The percentage of nurses who are “passive job seekers – not actively looking for a new job but open to new opportunities – also increased, from 38% in 2020 to 47% in the current survey” (Lagasse, 2022).

The moment: contractor or non-contractor

As the trend of uberization continues to spread beyond the transportation industry, the global business community should be watchful of challenges that the trendsetter Uber is facing to understand future implications of this movement in their own industry. For example, recent legal battles regarding the employment status of Uber drivers will likely impact the cost-benefit analysis of those considering traditional employment or independent contracting. While an independent contractor is free to offer services to anyone and doesn’t have the limits on their freedom that comes with being an employee of a single organization, the U.S. National Labor Relations Board decision that Uber drivers are independent contractors means that drivers have no federal right to unionize (HyreCar, 2021; Fishman, 2020). In Europe, however, Uber drivers are considered employees and not independent, which could mean that unionization could occur en masse.

The future

The future of healthcare employment could be via an app on smart phones. Imagine: daily staffing supplemented by workers employed and credentialed through the app. The healthcare worker could choose their rate and shifts, and the hospital could determine the desired experience, quality, and patient experience reviews for the open position. It could shift the future of employment healthcare significantly.

The rate of change in today’s workplace is accelerating whether it is through the uberization of healthcare workers or advancements in workers’ rights. A recent New York Times article entitled “The Revolt of the College-Educated Working Class” states: “The support for labor unions among college graduates has increased from 55 percent in the late 1990s to around 70 percent in the last few years, and is even higher among younger college graduates” (Scheiber, 2022).  

This may have a ripple effect on the healthcare workforce. Years of stagnating salaries and organizations’ undefined workforce vision has primed the industry for action with record job-quits within healthcare. This has proven especially true in rural markets where recruitment of permanent and agency staff has posed numerous challenges. Our current climate potentially opens the door for workers to leverage themselves via the advocacy of a union.   

Summary

The labor supply and demand are out of balance. The long-term effects on the health sector labor market from the pandemic are unknown, but changes in healthcare delivery (such as the growth of telehealth) may lead to lasting shifts in the healthcare industry. Fierce competition for healthcare workers means that employers must go beyond good pay and benefits to attract the best candidates. Healthcare recruitment is a zero-sum game. There isn’t a pool of healthcare workers lying idle, and so recruitment is often at the cost of a competitor. The employee knows that this demand exists, and this could further drive the uberization of healthcare workers. However, there is potential for this new movement to benefit both parties. As limited number of employees equates to skill scarcity which drives salaries, hospitals could utilize their skilled workforce based on need and demand. 

Resources

Babali, B. (2019). What is Uberization? The Business Year.

Buckingham, M., & Richardson, N. (2022). What’s Really Driving the ‘Great Resignation’. Barron’s.

Cantor, J., Whaley, C., Kosali, S., & Nguyen, T. (2022). US Health Care Workforce Changes During the First and Second Years of the COVID-19 Pandemic. JAMA Health Forum. 2022;3(2):e215217.

Court, E., & Coleman-Lochner, L. (2022). ‘Unsustainable’ Squeeze Grips U.S. Hospitals on Covid Labor Cost. Bloomberg.

Davis, G., & Sinha, A. (2021). Varieties of Uberization: How technology and institutions change the organization(s) of late capitalism. Sage Journals, 2(1).

Fishman, S. (2020). Uber Drivers are Contractors Not Employees According to the NLRB. NOLO.

HyreCar (2021). Are Uber Drivers Employees or Independent Contractors: Explained. HyreCar

KHN (2022). Hospitals Losing Money, Thanks To Covid-Driven Cost Increases. KHN Morning Briefing, April 28, 2022.

Lagasse, J. (2022). Almost 30% of nurses are considering leaving the profession. Healthcare Finance News.

Michas, F. (2021). Average annual salary of registered nurses in the United States from 2011 to 2020. Statista.

Parker, K., & Horowitz, J. (2022). Majority of workers who quit a job in 2021 cite low pay, no opportunities for advancement, feeling disrespected. Pew Research Center.

Saini, V., Garber, J., & Brownlee, S. (2022). Nonprofit Hospital CEO Compensation: How Much Is Enough? Health Affairs.

Scheiber, N. (2022). The Revolt of the College-Educated Working Class. The New York Times.

Toler, A. (2022). Health care wage growth has lagged behind other industries, despite pandemic burden. Indiana University.

U.S. Bureau of Labor Statistics (2022). 24 percent of establishments increased pay or paid bonuses because of COVID-19 pandemic. U.S. Bureau of Labor Statistics.

Wager, E., Amin, K., Cox, C., & Hughes-Cromwick, P. (2021). What impact has the coronavirus pandemic had on health employment? Peterson-KFF Health System Tracker.

Google’s Alphabet, Facebook’s Meta, and now Anthem’s Elevance

By Clive Riddle, March 10, 2022

In 2015 Google unveiled Alphabet, a new name to brand the parent holding company separate from the Google identity. Last year, Facebook announced Meta in a similar fashion.  And now, 2,306 miles from Silicon Valley, an announcement emerges from Indianapolis that the separate parent name above the Anthem brand will become Elevance Health. Their announcement states that “the new name underscores the company’s commitment to elevating whole health and advancing health beyond healthcare.”

Anthem President and CEO Gail Boudreaux says the new name reflects “our transformation from a health benefits organization to a lifetime, trusted health partner.” Aetna in 2018 also shed the parent branding identity of a health benefits organization out of necessity, being acquired by CVS Health. While Cigna’s parent identity is still a health benefits organization - Cigna, their PBM Express Scripts acquisition in 2020 rolled up into Evernorth branding with new and existing applicable sister health service solution businesses. Last year Humana – like Cigna still sticking to parent health benefits organization branding – introduced CenterWell as the new brand for a range of its payer-agnostic health care services offerings. Not that this is a brand new concept in the health benefits organization world – UnitedHealth Group announced its "Optum" master brand for its health services businesses in 2011.

In their announcement, Anthem states its “family of companies has evolved to offer products and services beyond traditional health insurance. Through its digital capabilities, pharmacy, behavioral, clinical and complex care assets the company is able to address consumers’ full range of needs with an integrated, whole-person approach. It’s through these diverse assets that the company will deliver on its strategy, drive growth and exceed expectations for consumers.”

And their branding makeover won’t stop there. Anthem tells us that “the corporate rebranding is a first step in the company’s effort to optimize its brand portfolio. While Anthem Blue Cross Blue Shield health plans’ names will not change, the company does expect to streamline the number of other brands in the market to reduce complexities and improve consumer experiences.”

The company does more details in the form of FAQs in their new one-page website: https://www.elevancehealth.com/

What’s Next for Medicare Advantage: Part II - Next Up: Time To Get Real

by Lindsay Resnick, March 2, 2022

The is Part II of What’s Next for Medicare Advantage, offering a few observations and insights from the 2021-22 Annual Enrollment Period. The previous post, Part I - Frontline: Lessons Learned is available here.

Whether called ‘keys to success’ or ‘make it or break it time’ the following five challenges and opportunities are real. To be competitive in tomorrow’s Medicare Advantage marketplace plans need strategies for each.

Catch First-timers

On average 10,000 Americans turn 65 every day – THIS is Medicare Advantage’s new customer growth opportunity. While AEP will continue to be an important customer acquisition time of the year, fighting over fewer and fewer AEP switchers becomes a long, tough game to win. Individuals turning 65 choosing a Medicare plan for the first time and late market entrants (generally between ages 66 and 70) coming off an employer plan are the future of MA. For consumers, making the wrong Medicare insurance choice when they first enroll can not only be costly, but may mean they can’t get the best plan for them later. Plans with commercial Group and Individual business units have the extra advantage of capturing this ‘same brand’ existing customer cohort with an internal cross- over or cross-selling transition approach moving existing members to their Medicare products. Overall, the industry isn’t doing well here: only one-third of Medicare enrollees went to a plan with same group or individual carrier.

Grab consumers at their first Medicare enrollment decision, serve them well and plans can enjoy strong annual retention and profitable MA ROI. This is a year-round, always-on effort with significant LifeTime Value.

Leverage Retirement

The emotional charge around ‘retirement’ can be a persuasive response driver, supported by this eye-opening stat: A retired 65-year-old couple will need $300,000 for medical expenses…in addition to their Medicare coverage. Eighty percent of Americans age 65+ have a chronic condition and 68% have two or more. The link between retirement’s financial and healthcare concerns is extremely strong. In fact, one of the biggest post- retirement surprises cited by seniors is financial load of their Medicare coverage… I thought I planned for everything! Leveraging retirement planning into Medicare decision lead generation can be an effective direct response QOPC hook (Qualify, Offer, Product, Call-to-action). For example, ‘Take the Mystery Out of Retirement Planning‘ or ‘Financial Health in Retirement Depends on Your Medicare Choices‘ make compelling offers. Healthcare, long-term care and unexpected medical costs tops the list of retirement planning financial concerns...with both pre-retirees and retirees. It’s right up there with credit card debt, mortgage payments, savings, and Social Security.

Take the opportunity to speak with prospects at their “full” Social Security retirement: from 1943- 1954 it’s age 66, those between 1956-1959 its 66.4, and after 1960 full retirement age is 67.

Remove Friction

Again? Yes again…it’s time to deliver on high- performance customer experience/CX. Superior customer service goes a long, long way toward not only a top-level Star Rating, but it’s an essential part of customer retention and loyalty. Simply put: make sure the AEP switchers aren’t yours! Why pay the high price of acquiring new members just to see them walk out the back door? Investments in fixing and removing ‘points of friction’ throughout your MA plan, particularly inside your customer service organization, translate into improved profitability. And today, the bar is high. Even ‘satisfied’ customers walk out the door; ‘satisfactory’ performance is no longer enough to retain members---excellent, superior, first class and ‘the best’ need to be the plan’s goal. Once a plan has a ‘retention problem’ retroactively trying to keep members from leaving isn’t the answer. Rather, proactively delivering meaningful value and experiences that make members want to stay in the first place is a winning CX strategy.

CX represents an MA plan’s brand, it’s a marketable attribute that gets attention, and with recent adjustments to the new Star Rating guidance, having happy customers goes a long way.

Cultivate Partners

All the big retailers are in the Medicare game, either directly underwriting MA plans, selling plans through in-house agencies, or engaging MA customers through a branded primary care clinic or low-cost, convenience driven pharmacy service. During AEP these partnerships meant stores with high traffic area pop-up MA sales kiosks with agents and/or lead cards, co- branded Website tools and advertising, and pharmacist or clinic staff with “Ask Me About Medicare” buttons. For MA plans, it’s an if you can’t beat ‘em join ‘em moment to explore similar collaborative partnerships or joint ventures with national, regional, or local retailers. Collaboration is also being leveraged with providers. Either hospital systems or primary care physician networks sponsoring or affiliating with MA plans. Outside the strategic alignment that comes with this payer/provider relationship (aka Payvider), provider brand equity and trust can be a significant lead generation asset. Partnerships bring scale, which translates into financial and operating efficiencies, expanded market reach, and a better ability to address consumer demands for convenience, continuity, and consistency.

Teamwork makes the dreamwork. MA partnerships can yield big rewards: open new markets, extend product or service offering reach, and for consumers, better managed and more affordable health care.

Final Takeaway: Gut Check

The Medicare Payment Advisory Commission (MedPAC), a panel that makes recommendations to Congress on Medicare policy, expects beneficiaries in Parts A and B enrolled in MA plans to stretch past 50% in 2023.

Staying competitive in an increasingly benefit- rich, fast-paced growth market challenges even the best in the business. As Medicare Advantage plans strategize around their 2022 market moves, meaningful brand and product differentiation matter more than ever. On the marketing and sales frontlines, deploying the full power of distinction quickly separates winners from losers…those plans headed toward growth and profitability rather than a slow decline into obsolescence.

There’s no better time than the start of a new year to do a MA marketing ‘gut check’, an assessment to validate MA marketing assumptions, resource adequacy and comparative industry best-practice “gap analysis” to identify important areas of improvement. Here’s a 10-point checklist to guide your assessment:

Get Ready for (Healthcare) Microgrids

By Kim Bellard, February 24, 2022

We depend on it.  Indeed, our daily lives are unimaginable without it.  The trouble is, it’s become unreliable.  Lives have been lost because it wasn’t performing when it needed to be.  It’s built around large facilities that are often decades old.  Parts of it don’t communicate/coordinate well with others.  Its workforce is aging and burnt out.  There is no person or agency charged with ensuring its resiliency. It badly needs to be rethought for the 21st century. 

Oh, you thought I was talking about our nation’s power grid?  I was talking about our healthcare system. 

The parallels are striking, and concerning.  The power outages in Texas last year caught everyone’s attention.  People went for days or even weeks without power.  Oh, that’s Texas, people elsewhere might say, so the failures were not really surprising. Maybe, but it’s not just Texas.  

Large, sustained outages have occurred with increasing frequency in the U.S. over the past two decades, according to a Wall Street Journal review of federal data. In 2000, there were fewer than two dozen major disruptions, the data shows. In 2020, the number surpassed 180.

That’s where microgrids come in.

According to Microgrid Knowledge, a microgrid is a self-sufficient energy system that serves a discrete geographic footprint, such as a college campus, factory, hospital complex, business center, military installation or neighborhood. Microgrids can operate independently from the grid using power generated on-site; they can also be used for backup power. Microgrids are designed to operate consistently in both “blue sky” and emergency situations supported by a range of energy resources, such as renewable energy, energy storage, combined heat and power or generators.

Healthcare needs to literally join in.  If there’s a hospital, nursing home, pharmacy, dialysis center, or other health care facility that hasn’t already become part of a microgrid, it’s time.  Those 1960’s-era backup generators are not going to cut it.

Healthcare needs to figuratively join the microgrid movement.  Think of hospitals as the traditional power plants, the loci of the healthcare system.  Everything revolves around them, especially as they’ve bought physician practices, developed more outpatient facilities, and consolidated.  They control how healthcare is practiced and at what cost in their community/region. They power the system.

That’s worked for us, in our dysfunctional U.S. healthcare way, but the cracks are showing. We’re effectively seeing healthcare’s versions of brownouts, or even blackouts.  If there is one thing our healthcare system is not, it is resilient.

A healthcare microgrid would more effectively keep people out of hospitals.  It would rely less on physicians, especially specialists.  It would be community-based.  It would be available 24/7, and be able to flex capacity as needed.  It would be “smart,” and incorporate as many 21^st century technologies as possible, such as home monitoring.  Unlike actual microgrids (but more like most power grids) and unlike current medical practice, it would freely cross city/state/regional lines.

Telemedicine is an example of what should be included in microgrids.  Some hospitals are bold enough to impose facility fees for telehealth visits. Those are all signs that telehealth is not part of a microgrid; it’s being coopted by the power plants – er, hospitals.

Similarly, are we really taking advantage of nurse practitioners or physician assistants can do?  Why do we even think of nurse practitioners as “nurses” or PAs just as assisting physicians?  Do we give pharmacists as much authority as their training would allow for? 

And, of course, when are we going to get AI that can be our first line of medical advice, and perhaps more?

These are microgrid questions. They’re not questions we should only be considering during times of extreme crisis, like the current pandemic; they are questions we should be answering for the next crisis.   

The analogy is not perfect. I don’t know exactly what a healthcare microgrid would look like.  But, just as I know traditional power grids are not going to be enough for our energy needs, our traditional healthcare system is not going to be enough for our healthcare needs. We need something more resilient and more localized.  We need healthcare microgrids.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)  

The Big Picture: Healthcare 2022 - Trends, Predictions Challenges & Opportunities

by Lindsay Resnick, January 20, 2022 

Health brands are jumping on the transformation bandwagon. We need to change. We need to modernize. The health sector needs to reimagine itself. And needs to do it around the customer.

This collection of curated factoids can help health brands not only contend with market realities, but anticipate change. Think of it as context for the futurity of today’s decisions. An opportunity to step back to assess ‘big picture’ healthcare trends to inform core enterprise planning from vision to strategy to in-market tactics.

 

The first six factoids are provided below. To download the full set of 24 factoids from Wunderman Thompson Health, go here: https://www.wundermanthompson.com/expertise/health

 

 

Five Healthcare Prognosticators That Resonated for 2022

By Clive Riddle, January 13, 2022

We recently provided our own view into 2022, Scrolling Through the Roadmap of 2022 Healthcare Trends, With Sixteen Selected Stops.  Now we’ve scrolled even further to see what others are saying about the coming year in healthcareland. We found five recent prognosticators from different perspectives that resonated, to share with you.

Doctor Marc Harrison, the CEO of Utah’s Intermountain Healthcare provides an excellent outline of 5 Critical Priorities for the U.S. Health Care System in Harvard Business Review. His national agenda includes:

1. Focus on Improving Health (“One of the most striking aspects of Covid-19 is that it often exploits underlying chronic conditions such as diabetes, heart disease, and obesity. With these chronic conditions already at epidemic levels in America, the U.S. population has been ripe to be ravaged by Covid-19.”

2. Tackle Racial Disparities (“The Covid-19 pandemic has starkly illuminated the profound racial disparities in health care, and these must be rapidly addressed to achieve health equity.”)

3. Expand Telehealth and In-Home Hospital Services (“In health care, we’ve long asked people to come to us for help. We need to change that thinking entirely and become more consumer-centric. We need to care for people closer to their home.”

4. Build Integrated Systems (“Another important confirmation from the pandemic is that integrated health care delivery systems — those that offer their own health insurance plan or do so via a partnership with an external insurer — are better suited to adapt and align incentives to rapidly changing circumstances.”)

5. Adopt Value-Based Care (“The widespread acceptance of value-based care — under which providers, including hospitals and physicians, are paid on the basis of capitation and patient health outcomes — would accelerate the adoption of the above priorities.”

Cigna shared The 4 Biggest Health Care Trends of 2022 and How They Impact America’s Employers:

1. Behavioral Health Care: More Need, More Availability, and More of a Focus for U.S. Employers (Cigna saw a 27% increase in outpatient behavioral health visits in 2020 over 2019, and the trend has continued throughout 2021)

2. Working Toward Health Equity: The Role Employers Play ("Health disparities don’t stay at home when we go to work." say Cigna's Kimberly Funderburk, VP and GM for government & education)

3. Drug Costs Continue to Spark Concern for Employers (Cigna reminds us that specialty medications accounted for more than half of pharmacy spend in 2020, although only 2% of the population utilizes these drugs)

4. Virtual Care Provides Ease, Flexibility, and Can Help Foster a Healthy Workforce (Cigna notes that Pre-pandemic, less than 2% of outpatient behavioral health and medical claims were for virtual visits. Today they make up nearly 25%)

Silicon Velley’s Bessemer Venture Partners offers these 2022 Healthcare Predictions, telling us “opportunities are emerging for leaders to build the connective tissue between the physical and digital worlds in healthcare”:

1. 2022 is the year where IaaS meets digital health

2. An increased focus on hybrid care

3. As the digital health field becomes more crowded, clinical outcomes will become a key competitive differentiator

4. The great resignation poses a breaking point for the supply of clinicians

5. A tech-enabled renaissance for the independent clinician (“Emerging new platforms and tools are helping clinicians become more independent and run successful businesses by enabling flexible hours, additional revenue streams, or owning their audience.”)

6. Value on investment alongside return on investment (“Increasingly, benefit managers are now looking at social factors as well when making purchasing decisions. They are beginning to place a premium on benefits that support diversity, equity and inclusion, as well as employee satisfaction and productivity.”)

7. Teenage years for digital health

In Forbes, Dr. Anita Gupta is a C-Suite Leader from Johns Hopkins School of Medicine penned The Future Of Health: Three Healthcare Trends For 2022:

1. ESG Strategy Focused On Innovation (“The life science industry is moving toward a model of social impact focused on ESG (environment, sustainability, governance) and customized therapies for specific patient populations.”)

2. Data Analytics To Accelerate Biotechnology Innovation (“As our understanding of genetics and disease continues to evolve, the life sciences industry relies on data analytics more than ever before”)

3. Consumer-Facing Telemedicine And Digital Care Solutions (“Finding more consumer-facing solutions that are hybrid models, including both face-to-face and telemedicine, could be the future, while making telemedicine more mainstream and improving consumer access”)

And finally, GE Healthcare published this tech perspective on The Future of the Healthcare Workforce: 5 Predictions For 2022:

1: Innovation to Reduce Burnout Will Continue

2: Clinicians Will Separate the Wheat From the Chaff When It Comes to AI (“the healthcare industry will become increasingly selective about its AI. Clinicians will seek out tools that limit their time in front of a screen and reduce the number of clicks required to input data. Tools that don’t reduce the workload will be ignored.”)

3: Technology Will Help the Workforce To Reduce Healthcare Inequities

4: Telemedicine Will Become Even More Integral to Healthcare Delivery

5: Precision Health Will Revolutionize Healthcare Delivery

A mission statement must be more than a PR tactic

By Dr. Seleem R. Choudhury, December 2, 2021

Each one of us has deeply held beliefs that motivate us to action.  This is part of what it is to be human.  It is embedded in our humanity to pursue virtue, or a habitual and firm disposition to do good. Our character is inextricably linked with virtue, because good character is built through the practice and habituation of virtues (Newstead, Dawkins, & Martin, 2019).  

It is no wonder, then, that mission-driven organizations have become so desirable to today’s workforce. Working for a mission-driven organization offers a powerful avenue for the exercise of virtues through the expression and implementation of positive contributions to society (Maciariell, 2006).

I recently transitioned from NYC Health and Hospitals to Adventist HealthCare. During this transition process, it became abundantly clear that the organization’s mission is a determining factor before working in any organization. Both organizations have mission statements that align with my personal values and virtues. NYC Health and Hospitals, the largest public health care system has the mission “to extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity, and respect,” and Adventist HealthCare, is a faith-based health system providing Christ-centered care to meet the need of quality and accessible healthcare for the local community by “extending God’s care through the ministry of physical, mental and spiritual healing” (NYC Health and Hospitals, 2021; Adventist HealthCare, 2021).

The importance of a compelling mission statement

At its best, an organization’s mission “defines and upholds” what an organization stands for (Craig, 2018). Several studies suggest that there is a positive correlation between mission statements and organizational performance. In fact, the highest performing organizations are often the ones with more comprehensive mission statements—speaking to corporate philosophy, self-concept, public image, and financial performance (Kadhium, Betteg, Sharma, & Nalliah, 2021; Bartkus, Glassman, & McAfee, 2006; Rarick & Vitton, 1995; Desmidt, Prinzie, & Decramer, 2011; Ranasinghe, 2010).

The mission statement of a healthcare organization is an essential strategic tool that captures an organization’s “enduring purpose, practices, and core values” (Trybou, Gemmel, Desmidt, & Annemans, 2017; Bart & Hupfer, 2004). Individuals are attracted to an organization as their personal motivation aligns with the mission and intrinsic factors meet individual interests. A compelling shared mission keeps everyone’s focus on the greater primary purpose and goal of the work they are doing. It also provides guardrails and direction for decision-making in times of unpredictability or conflict (Ansary, 2019). Collaborating between leadership and staff on how to unite and put into practice the organization’s mission is a sign of a truly mission-driven, successful and healthy organization (Trybou, Gemmel, Desmidt, & Annemans, 2017).

Finding the “why”

Simon Sinek, leadership guru and founder of SinekPartners, states: “The value of our lives is not determined by what we do for ourselves. The value of our lives is determined by what we do for others” (Sinek, 2014).

A mission statement should articulate why you are doing what you are doing.  For example, NYC Health and Hospitals is “committed to the health and well-being of all New Yorkers” (NYC Health and Hospitals, 2021). This statement expresses the importance of community and how being part of a community can make us feel as though we are a part of something greater than ourselves. NYC Health and Hospitals’ why is to create a healthy community.  By starting there, the how of building a healthy community—social-connectedness, overall well-being, satisfaction in life, work, and play—all become clearer (Caulfield, 2015). 

Adventist HealthCare’s mission focuses upon faith, desiring to “extend God’s care through the ministry of physical, mental and spiritual healing” (Adventist HealthCare, 2021). It is faith that “gives people a sense of meaning and purpose in life,” or as discussed above, their why (Moll, 2019). A faith-based care approach understands the wholeness and health of a person through the ministry of physical, mental, and spiritual healing. 

Relationships are important to humans and a mission that supports connectedness speaks to the why. Close connection to the people, activities, etc., that we love yields feelings of happiness, contentment, and personal satisfaction with our lives (Sharry, 2018). There is more than sufficient scientific evidence to show that involvement in social relationships have a benefit upon health (Umberson & Montez, 2010). In healthcare, a mission statement’s emphasis on relationships, whether through community or faith, creates a connection and gives the organization a strong why.

The benefit to organizations

A clear, inspiring mission statement is essential to the health of an organization. Without it, strategic planning of any kind is impossible (Alegre, Berbegal-Mirabent, & Guerrero, 2019).  Mission statements also show the intent and purpose of an organization, providing a roadmap and an element of predictability concerning whether opportunities should be pursued or services offered, and making expectations clear for executives and staff within the organization (Salehi-Kordabadi, Karimi, & Qorbani-Azar, 2020). It also determines what criteria would be most effective to measure achievement (Bryson & Alston, 2005).

Furthermore, the mission imbues the work of every single employee with meaning and purpose. It helps them see how their job fits into the bigger picture and gives them a why that will inspire them (Sinek, 2009). This inspiration is a core component of organizational performance. Data shows that the design of mission statements are crucial for organizations’ growth, profitability, and shareholder equity.

However, studies also indicate that “almost 40 percent of employees do not know or understand their company’s mission” (McMillan). This suggests that leaders must embrace the task of helping employees view their work in light of the mission and understand how it contributes to the organization’s larger efforts.

A mission statement is essential to communicate the purpose and goals of an organization, and is crucial to success in effective strategic management (Hieu & Vu, 2021; Bart, Bontis, & Taggar, 2001). To be effective and inspiring, it should define the basic question of why the organization exists and what it hopes to achieve. A strong mission statement is a guiding light for the strategy and operations of the organization, attracting individuals whose virtues and motivation aligns with the organization, and paving the way for organizational success.

Reference

Alegre, I., Berbegal-Mirabent, J., & Guerrero, A. (2019). Mission statements: what university research parks tell us about timing. Journal of Business Strategy.

Bartkus, B., Glassman, M., & McAfee, B. (2006). Mission statement quality and financial performance. European Management Journal, 24(1), 86-94.

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Breaking Up Is Good to Do

By Kim Bellard, November 16, 2021

Last week General Electric announced it was breaking itself up. GE is an American icon, part of America’s industrial landscape for the last 129 years, but the 21st century has not been kind to it. The breakup didn’t come as a complete surprise. Then later in the week Johnson and Johnson, another longtime American icon, also announced it would split itself up, and I thought, well, that’s interesting. When on the same day Toshiba said it was splitting itself up, I thought, hmm, I may have to write about this.

Healthcare is still in the consolidation phase, but there may be some lessons here for it.

As unique as each of their stories is, the thing that each breakup has in common is that the hope is that investors will see greater value as a result. It’s not about the products or the customers; it’s about the returns.

Healthcare knows about that.

Healthcare has been a hotbed of acquisition and consolidation. Hospitals buy hospitals; health insurers buy health insurers, pharmaceutical companies buy pharmaceutical companies, digital health companies buy digital health companies, private equity firms buy physician practices. But we’re also seeing things like CVS buying Aetna or UnitedHealth Group buying DaVita Medical Group (and trying to buy Change Healthcare).

Still, though, when I see conglomerates like GE, J&J, or Toshiba breaking up, what I think about most are not those kinds of healthcare conglomerates, but, rather, hospitals.

Hospital systems are big. It probably won’t come as much surprise that a for-profit chain like HCA has annual revenues of $59b, but it might that “non-profit” UPMC has annual revenues of $23b. Mayo Clinic and Cleveland Clinic also report double digit billion dollar revenues. We’re talking about big businesses.

But are hospitals anything other than healthcare conglomerates? They fix your heart over here, they implant a new hip over there, they deliver your babies, they attack a variety of your cancers in a variety of ways, they put various kinds of scopes inside you, they take detailed images of you, and, Lord knows, they do all sorts of lab tests, all while running the meter on you to ensure they can charge you as much as they are allowed.

I can see the argument that you’ll need imaging and lab tests whether you are getting a bypass or having a baby, but it is not at all clear that doing bypasses makes a hospital a better place to deliver babies. Being the best cancer hospital, or even just a good cancer hospital, doesn’t mean it is good at doing a cholecystectomy. Service lines are businesses; it’s hard enough to ensure quality within a service line, much less across them. More isn’t necessarily better.

Michael Farr, head of Farr, Miller & Washington, told WaPo: “More effective CEOs said, ‘Wait a minute, I need to make sure this is strategically and logically integrated with everything our core business is doing.’” He was speaking of the GE divestiture, but how many hospital CEOs are having that same examination? How many of them could truly define their “core business,” other than offering a bland “patient care”? Which patients, which care, in what places using what services?

Increasingly, hospitals want to be all things to all patients in all places, just as industrial conglomerates wanted to serve all customers in all industries. That worked well for a long time, but no longer. That time is coming in healthcare too. Hospitals, and all healthcare companies, need to truly define, and focus on, their core business.

Healthcare has too many conglomerates. Time for them to break up.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)  

Developing Excellence in Primary Care

By Dr. Seleem R. Choudhury, October 13, 2021

Nearly half of all Americans suffer from at least one chronic disease, and that number is growing (American Association of Retired Persons; Fried, 2017; Tinker, 2017).  Chronic diseases—including cancer, diabetes, hypertension, stroke, heart disease, respiratory diseases, arthritis, obesity, and oral diseases—can lead to hospitalization, long-term disability, reduced quality of life, and death.  Additionally, chronic diseases often require a long period of supervision, observation, or care (Rothman, & Wagner, 2003). To make matters more complicated, many patients have multiple morbidities, creating particular challenges for healthcare providers (Braillard, Slama-Chaudhry, Joly, Perone, & Beran, 2018).

As Reynolds, et al, explain in their 2018 article, “the defining features of primary care (including continuity, coordination, and comprehensiveness) makes this setting suitable for managing chronic conditions” (Reynolds, Dennis, Hasan, Slewa, Chen, et al., 2018).  High-performing primary care teams keep the “quadruple aim” of primary care—enhancing the care experience, improving the health of the population, reducing costs, and improving the work-life of the team—at the forefront of their work (Haverfield, Tierney, Schwartz, Bass, Brown-Johnson, et al, 2020). Studies repeatedly bear this out, demonstrating that an integrated approach with an aim to improve the quality of life of patients—as well as those caring for them—can enhance chronic disease outcomes and management.  As the healthcare industry continues to evolve, it cannot afford not to invest in primary care.

Bodenheimer’s Building Blocks

Current literature discussing characteristics of best primary care practices supports three well-proven methods:

1. Patient-Centered Medical Home (PCMH) standards from the National Committee on Quality Assurance (Hahn, Gonzalez, Etz, & Crabtree, 2014),
2. the Peterson Center on Health Care’s “America’s Most Valuable Care: Primary Care” (Peterson Center on Health Care, & Stanford Medicine Clinical Excellence Research Center, 2014), and
3. the Building Blocks framework commonly known as Bodenheimer’s Building Blocks. (Bodenheimer, Ghorob, Willard-Grace, & Kevin Grumbach, 2014).

Each of these models is similar, often reinforcing one another yet each with its unique benefits.  Inspired by a conversation with Tanya Kapka, MD, MPH, FAAFP, a leader in healthcare transformation, this article will focus on four specific areas within Bodenheimer’s Building Blocks: Engaged Leadership, Data-Driven Improvement, Empanelment, and Team-Based Care (see graphic). These four blocks are foundational in the quest for clinical excellence in primary care.

 

Block 1: Engaged leadership

One of the most commonly cited reasons for failed PCMH change efforts is a lack of leadership support (Qureshi, Quigley, & Hays, 2020).  Active, engaged, supportive leadership is not a new necessity, nor is its importance limited to healthcare. The role is critical in Comprehensive Primary Care transformation (Altman Dautoff, Philips, & Manning, 2013). Leaders are the ones who drive and inspire change.  Without a leader to champion the change and navigate teams through its complexities, then the aspiration for developing excellence will never be attained.

Block 2: Data-Driven Improvement

 Evidence of what constitutes quality care is always evolving; this is a good thing for patients and the health of our communities. This necessitates that providers regularly re-evaluate and change their practices in order to stay current (Agency for Healthcare Research and Quality, 2018).  This, of course, assumes that this evidence will lead to improved patient care and outcomes.  The challenge is typically about finding a balance regarding data. When making choices about care practices, too much data becomes daunting, too little leads to uncertainty. The goal is to hit a sweet spot where all members of the team feel like they have enough data to make informed decisions to enhance clinical excellence (Coppersmith, Sarkar, & Chen, 2019).

Block 3: Empanelment

Empanelment is a foundational strategy for building or improving primary health care systems by linking patients to a primary care provider. This strategy is a “critical pathway” for achieving optimal outcomes, effective universal health coverage, and population health management (Bearden, Ratcliffe, Sugarman, Bitton, & Anaman, 2019). To effectively promote patient engagement or, in some circumstances, patient re-engagement, the care team must remain coordinated, data must be up to date, and patient coordination and communication consistent. These elements are essential for excellence in primary care (McGough, Chaudhari, El-Attar, & Yung, 2018).

Block 4: Team-Based Care

The concept of a team approach in primary care is not new. However, it is often assumed that it is occurring. And though team-based care may occur, few organizations effectively and regularly evaluate its success and consider how their care teams might become even higher-performing.  Namely, organizations should assess whether the required knowledge, skills, and abilities are present on the team (Larson, 2009), the team members are in their optimal roles (Luig, Asselin, Sharma, & Campbell-Schererand, 2018), and the team is striving for improvement together (Shukor, Edelman, Brown, & Rivard, 2018).

The identity of High-Quality, Comprehensive Primary Care, mid- and post-COVID

The past year and a half of providing care in a pandemic has starkly highlighted the importance of primary care. “During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care” (Krist, DeVoe, Cheng, Ehrlich, & Jones, 2020).

At the onset of the pandemic, primary care was forced to transform from a person-visiting-a-clinic modality to a telemedicine program (Jaklevic, 2020). Interestingly, healthcare systems and primary care practices had tried to coax this change prior to the pandemic, but many experienced resistance.  The reasons for this resistance were complex and varied, yet literally overnight these changes occurred (Nittari, Khuman, Baldoni, Pallotta, Battineni, et al, 2020; Kaplan, 2020). Some would say the change occurred too quickly.

Initially, these programs demonstrated success with continuity of care, improved or plateaued outcomes, and reimbursement from payers (Rosen, Joffe, & Kelz, 2020). However, cracks present within team cohesion before the pandemic combined with overnight forced change highlighted vulnerabilities and tension in teams that were inadequately lead, staffed, managed, and skilled. It is evident that while teams with the aforementioned gaps struggled or continue to struggle today, high-performing teams pre-pandemic continued to transition successfully (Contreras, Baykal, & Abid, 2020).

The characteristics of high-quality primary care in the midst of COVID and post-COVID requires providers to get back to basics. Providers need to set their sights on the quadruple aim of enhancing the care experience, improving the health of the population, reducing costs, and improving the work-life of the team, as well as ensuring that the foundational building blocks of the Bodenheimer model are firmly in place.  

Health systems must invest in the primary care infrastructure. This begins with team leadership that endorses engagement and satisfaction, sufficient and easily-accessible data, the appropriate application of a patient panel that promotes appropriate ratio of patient acuity that leads to population health management in and out of the clinic, and a fully staffed team that fosters cohesion, camaraderie, and continual desire to improve.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com

Reference

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Braillard, O., Slama-Chaudhry, A., Joly, C., Perone, N., & Beran, D. (2018). The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC family practice, 19(1), 159. https://doi.org/10.1186/s12875-018-0833-3

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Not Your Father's Job Market

By Kim Bellard, September 24, 2021

If you, like me, continue to think that TikTok is mostly about dumb stunts, or, more charitably, as an unexpected platform for social activism, you probably also missed that TikTok thinks it could take on LinkedIn. 

Welcome to #TikTokresumes.  Welcome to the Gen Z workplace.  If healthcare is having a hard time adapting to Gen Z patients – and it is -- then dealing with Gen Z workers is even harder. 

TikTok actually announced the program in early July, but, as a baby boomer, I did not get the memo.  It was a pilot program, only active from July 7 to July 31, and only for a select number of employers, which included Chipotle and Target.  The announcement stated:

TikTok believes there's an opportunity to bring more value to people's experience with TikTok by enhancing the utility of the platform as a channel for recruitment. Short, creative videos, combined with TikTok's easy-to-use, built-in creation tools have organically created new ways to discover talented candidates and career opportunities.

The Wall Street Journal is also watching the trend: “Video résumés are fast becoming the new cover letter for a certain breed of young creatives…For some brands, soliciting video résumés on social media is a way to meet more young, diverse job candidates.” 

As it turns out, even Gen Zers have misgivings about the idea.  A survey by Tallo found them fairly evenly split. A bigger concern, though, was the possibility of bias: Nagaraj Nadendla, SVP of development at Oracle Cloud HCM, raised the same concerns in TechCrunch: The very element that gives video resumes their potential also presents the biggest problems. Video inescapably highlights the person behind the skills and achievements. As recruiters form their first opinions about a candidate, they will be confronted with information they do not usually see until much later in the process, including whether they belong to protected classes because of their race, disability or gender.

Lest you think this is not important to your organization, that Gen Z’s needs don’t really matter, Morten Peterson, CEO of Worksome, writing in Fast Company, calls Gen Z the “new disruptors,” pointing out: “The overwhelming majority of today’s graduate pool come from Generation Z and will do so for the next decade at least.”  

And they vote with their feet.  Research from Amdocs found they, along with Millennials, are much more likely than Baby Boomers or even Gen X to have considered leaving their job within the last year:

Every industry is having a hard time recruiting, and keeping, workers these days, and healthcare is no exception.  Between normal burnout, pandemic-related burnout, vaccine mandates, and the lure of jobs that offer more opportunity for remote work, most healthcare organizations are struggling to have enough staff.  When the current Baby Boomer doctors, nurses, technicians, and aides retire, there better be Gen Z replacements ready to step in.

Some healthcare organizations are already starting to use TikTok for marketing,  others are trying to combat misinformation, but most healthcare organizations are probably not just behind the curve when it comes to recruiting workers using TikTok; they may not have yet realized there is a curve.  If, as NYT said, one page resumes are gong the way of the fax machine, well, in healthcare those fax machines haven’t gone very far. 

RecTech Media’s Mr. Russell said it: “video is eating the world.”  Healthcare’s world too. 

TikTok resumes may not take off.  Tallo’s survey found it low on the list of sites Gen Zers felt comfortable posting a resume on (perhaps not coincidentally, Tallo’s site was rated the highest, followed by LinkedIn).  Video resumes more generally may not become the norm.  Those bias concerns with video resume are real and must be appropriately considered. 

But Gen Zers are different, and healthcare organizations, like other organizations, better be thinking about how to best recruit them.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

The Most Important Thing

by Kim Bellard, July 26, 2021

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  Digital health has never been hotter. We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it.

These, and other initiatives, are all important and I sure hope people are working on them.  However, I think about some other things that Mr. Dorsey discussed in the webinar.

We have all these monopolies off balance and the individual doesn’t have power and the amount of cost and distraction that comes from our monetary system today is real and it takes away attention from the bigger problems…You fix that foundational level and everything above it improves in such a dramatic way.

So, for me, the most interesting future for healthcare has to be synthetic biology, including biohacking.

Synthetic biology, in case, you didn’t know, is “redesigning organisms for useful purposes by engineering them to have new abilities,” and biohacking is doing that to your own body, usually to optimize or improve its functioning. 

Observers seem to think that synthetic biology seems to draw an edgy, counter-cultural crowd.  It’s on the cutting edge, and it, too, is getting record funding.  Former Google CEO Eric Schmidt said, at a 2019 synthetic biology conference: “What is changing the fastest right now? Because whatever that is determining the history of next year. There’s lot of evidence that biology is in that golden period right now.” 

When we start talking about “programming biology,” well, if that isn’t “weird as hell,” I don’t know what is.  That’s fun, and that’s the future.

The theme for me is to solve health issues at the source code level.  Fix things, as Mr. Dorsey said about bitcoin, “at the foundational level.”

Mike Brock, who will head up Square’s DeFi business, tweeted: “Technology has always been a story of decentralization. From the printing press, to the internet to bitcoin – technology has the power to distribute power to the masses and unleash human potential for good, and I’m convinced this is the next step.” 

I want the same for our health – use technology to decentralize, and to distribute power to the masses.  That offers the promise of taking control from the traditional healthcare structures – not relying on hospitals, health insurance companies, or even medical professionals. 

As Mr. Dorsey thinks about bitcoin, “I don’t think there is anything more enabling for people around the world.”

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

The Necessary Insecurity of Healthcare Leadership

By Dr. Seleem R. Choudhury, July 8, 2021 

Years ago, I accepted a job even though I was told that the team I was to lead didn’t want me as their leader. During my tenure, I received anonymous threats to leave, as well as episodes of sabotage and unhelpful behavior. Despite this, I was convinced that I could win them over with my leadership skills. Instead of improved conditions, however, things got worse. It became clear that the team was just waiting for me to make a mistake. Like all leaders (and indeed all humans), I eventually did. 

Rather than having a supportive team, I instead experienced attempts to oust me from the position. It was an untenable position, and eventually I left. Afterward, many others in the organization voiced concerns that I was a victim of racism.  While it is possible that my colour may have been one strand of motivation, I believe that the deeper issue was the unmanaged insecurity of the organization’s leaders that may have driven the negative behaviors from the start.

Motivation and theory

Most professionals have their own stories of working for organizations with difficult or unhealthy leadership. In fact, being on the receiving end of negative leadership behaviors rooted in insecurity is especially likely if you are competent (Davey, 2017).

Studies have found that conflicts with leadership are a “critical driver of loss of high-performing talent” (Kutty, 2020).  Often, when faced with insecurity, individuals can become more rigid and show reduced creativity, resulting in products, solutions, or work habits that are less than innovative (Probst, Stewart, Gruys, & Tierney, 2007). The irony of these behaviors and methods intended to “re-secure” often go unchecked, which reinforces the leader’s thinking that this leadership method works (Lubans, 2007).

There are many reasons why behaviors like this continue to present themselves in top leaders across organizations and industries. I believe the main reason we continue to see insecure behavior in leadership is that we are all insecure leaders. We all demonstrate that insecurity differently through various characteristics; however, it’s how we manage that insecurity and even our awareness of that insecurity that determine whether subsequent leadership behaviors will be positive or negative.

As a leader, I often feel insecure in my abilities and position, and over the years I have learned that I am not alone in this. Firstly, insecurity is simply fear. As Arash Javanbakht and Linda Saab explain in their 2017 Smithsonian Magazine article:

“Fear starts in the part of the brain called the amygdala. When our ‘thinking’ brain gives feedback to our ‘emotional’ brain and we perceive ourselves as being in a safe space, we can then quickly shift the way we experience that high arousal state, going from one of fear to one of enjoyment or excitement” (Javanbakht, & Saab, 2017).

So, if fear leads to insecurity, then being insecure is a normal reaction. But if it is natural—even expected—to experience insecurity, then why doesn’t our culture embrace leaders who are insecure? We live in a world where we are surrounded by fear-inducing stimuli, propagated by media and our experience, to name just a couple sources. Though these fears are nearly always unsubstantiated, a fear response is tolerated because fear is part of the human experience (Holtz, 2015).  Our expectations of our leaders should be no different.

Being a secure leader is a myth. Instead, strong leaders are adept at managing their insecurities (Weber, & Petriglieri, 2018). When insecurities interfere with your leadership skills and methodology, they can become a danger to your team and your organization (Coveney, 2018).  But insecurities are not inherently threatening. Insecurity allows leaders to self-reflect by reviewing situations, rethinking a process, and shapes leaders into someone with the capacity to evolve and grow, and act in ways that are conscientious of other people’s feelings (Leonard, 2018).

If being insecure is a normal human trait that improves our thinking, makes us more empathetic, and helps us to grow, it seems one could even call it an asset, not a hindrance.  Being insecure as a leader can improve leaders by enhancing their opportunity to lead, making them more mindful of their team, understanding what needs to be done, and ultimately delivering thoughtful, high-performance results. Perhaps the realization of these assets is less commonly seen in leadership because leaders don’t acknowledge that they are insecure. Rather, they deal with their insecurities by over-managing situations or teams, or over-compensating as they try to come across as secure to their employees. 

Managing insecurity

I believe that an insecure leader is a good leader. Behaviors resulting from insecurity are a spectrum, with one side making you more aware and emphatic, and the other side making you angry, controlling, and difficult to work with.

The bottom line is that it’s okay to be insecure as a leader. It is easy to look at other leaders and think everyone else is confident, secure, transformational, and amazing, and feel that lack in ourselves, which perpetuates the insecurity. This is often because among leaders it is rare to find anyone who discusses their own insecurities openly. In many circles it is mistakenly portrayed as a negative leadership trait. Rather, acknowledging one’s own insecurity will help both seasoned and developing leaders to see insecurity as a natural part of leadership and something that must be named and managed.

At every level, good leadership hinges upon emotional health. Our integrity and our ability to be honest about our insecurities and leverage them effectively is especially important in times of crisis (Sager, 2020).  The main driver of insecurity is fear, which typically manifests in feelings of inadequacy, failure, uncertainty, resistance to change, and being judged (Morin, 2020). This list is not comprehensive, but these often appear in leaders with low emotional health and unaddressed insecurities.

The first step in using your natural insecurity as a tool to grow as a leader is to acknowledge the insecurity, and to get comfortable with feeling that way often (Coveney, 2018). The second step is understanding the source of why you feel insecure (Ball, van Dijk, & Mecozzi, 2016). The better you understand the reason, the easier it can be to overcome and leverage for the good of your organization and those you lead (Schawbel, 2013). Thirdly, get feedback from people you trust.

 The majority of management literature is focused on helping to recognize or coach the insecure leader, rather than how to harness insecurity to become a better leader.  Leadership literature negatively portrays insecurity as an all-encompassing term—either you are an insecure leader or a secure one—rather than viewing insecurity from a more humanistic perspective that permits us to experience and often times demonstrate insecurity.  If we can experience insecurity in our personal and professional lives through relationships, parenting, exams, job applications, job evaluations, or our daily work, yet learn and grow from those experiences as a “work in progress,” then we should embrace insecurity in leadership as well.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com 

Resources

Ball, R., van Dijk, M., & Mecozzi, V. (2016). Fear. Thnk.

Coveney, N. (2018). Don't Let Your Insecurities Dictate How You Lead. Forbes.

Davey, L. (2017). The scariest, most anxiety-provoking bosses to work for—and how to cope with them. Quartz.

Hendriksen, E. (2018). Why Everyone Is Insecure (and Why That's Okay). Scientific American.

Holtz, C. (2015). It Is Ok to Be Afraid. HuffPost.

Javanbakht, A., & Saab, L. (2017). What Happens in the Brain When We Feel Fear. Smithsonian Magazine.

Kutty, S. (2020). How To Mitigate The Destructive Force Of Insecure Leaders. Forbes.

Leonard, E. (2018). Beautifully Insecure. Psychology Today.

Lubans, J. (2007). “I’ll Ask the Questions:” The Insecure Boss. Library Administration and Management, 21(4). 

Morin, A. (2020). Almost everyone fears they're not good enough, according to a psychotherapist. Here's how to overcome that fear. Business Insider. 

Probst, T.M., Stewart, S.M., Gruys, M.L., & Tierney, B.W. (2007). Productivity, Counterproductivity and Creativity: The Ups and Downs of Job Insecurity. Journal of Occupational and Organizational Psychology, 80(3):479 – 497.

Sager, D. (2020). The Blight of Insecure Leaders. Word & Way.

Schawbel, D. (2013). Brene Brown: How Vulnerability Can Make Our Lives Better. Forbes.

Weber, S., & Petriglieri, G. (2018). To Overcome Your Insecurity, Recognize Where It Really Comes From. Harvard Business Review.

Organizational culture change as renovation, not demolition

by Dr. Seleem R. Choudhury, April 15, 2021

An organization’s “culture” is simply defined as the expected way to behave within an organization. Stated more simply, organizational culture is “the way things are done around here” (Deal & Kennedy, 2000).  Culture is not written rules or guidelines, but rather the way we act and how we get work done. The values of a particular organizational culture are engrained into the life of the organization.  When culture is found to be ineffective or, worse, toxic, leaders discover that it is extremely difficult to change.

Many organizations start in the wrong place by making sweeping changes to the staff or executive team or attempting to overhaul every aspect of the current culture. Changing culture is more than a matter of changing the players, and seeking to change everything about an organization’s culture will inadvertently remove elements of the organization that are working well.  Rather than taking a demolition approach, leaders would increase the possibility of successfully changing their organization’s culture by thinking of culture change as a renovation.

The importance of culture

A 2017 Harvard Business Review article compares organizational culture to the wind: “[Culture] is invisible, yet its effect can be seen and felt” (Walker & Soule, 2017).  Harnessing the power of organizational culture is one of the keys to getting good work done. A recent conversation with friend, colleague, and mentor Brian Dolan, OBE, RMN, RGN, highlighted that it is a leader’s responsibility to understand this power, and determine if the current organizational culture is effective or ineffective in helping the organization fulfill its mission. For better and worse, culture and leadership are intricately interconnected (Groysberg, Lee, Price, & Cheng, 2018).  Leaders, whether they do so intentionally or passively, are shaping the culture of their organizations. They should be capable of actively shaping culture to the benefit of everyone on the team and the realization of the organization’s goals (Craig, 2018).

Interestingly, though there is a plethora of articles, discussions, and research that focuses on cultural change, much controversy exists on whether it is possible to make these changes successfully. Undoubtedly, changing the culture of an organization is a steep challenge. It requires much more than recognizing a problem and leaders who are committed to making a change. It takes significant effort and investment at every level of the organization.

Still, despite the challenges to making a successful culture change, the outcomes regarding building the right culture are indisputable. Organizations that can turn the tide and maintain a “drive towards lasting improvement in performance and organizational health,” regularly outperform competitors (McKinsey, 2021).

“Culture renovation,” not “culture change”

Terms like “culture change” or “organizational transformation” tend to carry a negative connotation. These phrases often imply that nothing good exists in the organization, and so everything must change, bringing to mind the idiomatic expression, “throwing the baby out with the bathwater.” The danger of culture transformation efforts is making a change that impacts many elements of the organization, including things that are working for the organization or are core to its identity.  A goal of leaders in culture change processes is to ensure that the organization does not lose something important while trying to get rid of unwanted elements of its culture.  Changes to a company’s culture, then, should be carefully and thoughtfully engaged, not left to chance (Patel, 2017).

Kevin Oakes, CEO and Co-founder of i4CP and author of Culture Renovation, proposes a different strategy when exploring the need to transform your culture. In an interview with HR Executive, Oakes describes cultural change as restoring an old 100-year-old house by considering what exists, then deciding what to keep and what to change (Ramirez, 2021).

Oakes states:  

“With a historic house, there are elements that are timeless that you want to hang on to. You keep those elements, while upgrading for the future with new technology and new ways of doing things that increase the value of your house long-term. The same concept applies to companies. Successful companies don’t transform their organization. They renovate their culture, meaning they keep the values and traits that have made them successful, build upon them and recognize what they need to create to increase the value of the organization long-term” (Ramirez, 2021).

This metaphor resonates strongly with me.  When I was a child, my parents bought a Victorian house in London. The house was huge and beautiful. My parents wanted to preserve and honor the Victorian elements of the home, but also wanted to modernize elements within. This was not an easy feat, and the work required to renovate the house felt nearly endless. Yet, it never occurred to my parents to rip down the house and build it anew; rather, they wanted to keep what was good and focus their efforts on areas that needed changing or upgrading.

Organizational culture is quite similar. It is not a one-and-done process. Leaders must also know this and be willing to invest the time, money, and work necessary for the renovation, recognizing that it is a continuous improvement process. 

Perhaps that is why, according to a 2019 study from i4CP, only 15% of the companies studied said their culture change efforts had been successful (Goodridge, 2019). Oakes believes that those organizations that are successful know that no one can truly change their culture; rather, they “intentionally [renovate] their culture” (Fagan, & Prokopeak, 2021). Just like my parents’ Victorian House, organizations should keep what they want, understand what they need, and add what is required.

In his book Culture Renovation, Oakes guides organizations through this process, laying out an evidence-based, three-step process to effectively renovate a culture plan. However, he cautions organizations not to make any changes until they perform a full assessment to evaluate the “readiness and maturity level on the organization's culture change journey” (Oakes, 2021).

It was Peter Drucker who coined the phrase, “Culture eats strategy for breakfast.” While it is certainly true that a thriving culture is essential for organizational success, these sorts of maxims on culture change often drive leaders to feel that a wholesale, top-to-bottom culture overhaul is necessary. In my experience, this is rarely the case.

Before leaders decide if the culture needs to be changed, begin first with an assessment (Dooley, 2021).  Just as in the old house analogy, it is likely that much of the structure is contributing to the organization’s success and should be kept, renewed, or strengthened. Only elements that pose a danger to the structure should be replaced for the health of the organization.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com    

References

Brené Brown Education and Research Group (2021). Brené with Kevin Oakes on Cultural Renovation. Brené Brown.

Craig, W. (2018). 10 Ways Leaders Influence Organizational Culture. Forbes.

Deal, T. E., & Kennedy, A. A. (2008). The new corporate cultures: Revitalizing the workplace after downsizing, mergers, and reengineering. Basic Books.

Dooley, R. (2021). Episode 357: Culture Renovation with Kevin Oakes. Brainfluence Podcast with Roger Dooley. 

Fagan, S., & Prokopeak, M. (2021). Get Reworked Podcast: Why Now Is the Perfect Time for Culture Renovation. Get Reworked Podcast.

Goodridge, N. (2019). Only 15% of Organizations Succeed in Transforming Their Cultures. I4CP.

Groysberg, B., Lee, J., Price, J., & Cheng, J. Y. (2018). The Leader’s Guide to Corporate Culture. Harvard Business Review.

McKinsey (2021). Culture & Change. McKinsey.

McLaren, S. (2019). How Microsoft “Renovated” Its Culture by Following These 3 Steps. LinkedIn Talent Blog.

Oakes, K. (2021). Culture Renovation: 18 Leadership Actions to Build an Unshakeable Company.

Patel, S. (2017). The Importance of Building Culture in Your Organization. Inc.

Ramirez, J.C. (2021). Here’s how HR can lead a ‘culture renovation.’ Human Resources Executive.

Walker, B., & Soule, S.A. (2017). Changing Company Culture Requires a Movement, Not a Mandate. Harvard Business Review.

Nanoparticles On My Mind

By Kim Bellard, March 24, 2021

Nanoparticles are everywhere! By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare. But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants. They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier.

Professor Khizroev has been working on the technology for over a decade, and has received funding from Darpa as part of its Next Generation Non-surgical Neurotechnology (N3) program (also known as BrianSTORMs), the goal of which is “to develop high-performance, bi-directional brain-machine interfaces for able-bodied service members.” The team got Phase II funding last November in order to build working devices.

“Right now, we’re just scratching the surface,” Dr. Khizroev says. “We can only imagine how our everyday life will change with such technology.” Some of what he does imagine, though, is:

We will learn how to treat Parkinson’s, Alzheimer’s, and even depression. Not only could it revolutionize the field of neuroscience, but it could potentially change many other aspects of our health care system.

Lest anyone think this is either an easy or a solved problem, Darpa points out: “N3 researchers are working to develop solutions that address challenges such as the physics of scattering and weakening of signals as they pass through skin, skull, and brain tissue, as well as designing algorithms for decoding and encoding neural signals that are represented by other modalities such as light, acoustic, or electro-magnetic energy.”

But that’s not all the nanoparticle news from just this week. In no particular order:

· Researchers from Cleveland Clinic and Chungbuk National University tested a COVID-19 vaccine (on ferrets) using antigens attached to nanoparticles.

· Another research team, from Scripps and Temple, also tested using nanoparticles to deliver antigens for COVID-19, using three self-assembling protein nanoparticle (SApNP) platforms

· A research team at the University of Manchester used nanoparticles to discover previously unseen blood markers: This might allow earlier and more definitive diagnoses of Alzheimer’s.

· A research team at the University of Science and Technology China are testing “acid-responsive nanoparticles composed solely of membrane-disruptive macromolecules” to treat pancreatic cancer.

· Russian and Israeli researchers “have developed hybrid nanostructured particles that can be magnetically guided to the tumor, tracked by their fluorescence and pushed to release the drug on demand by ultrasound.

· Another Chinese research team is using nanoparticles to deliver antimicrobial peptides (AMPs) for the treatment of deep infections.

· An international team of researchers assert: “The potential of nanotechnology in fighting this deadly disease [COVID-19] has not only been realized in context of developing a nano-vaccine but by delivering the nano-based anti-viral agents.”

· Spanish researchers have been able to observe autonomous nanobots in vivo — inside the bladders of a living mouse — using Positron Emission Tomography (PET).

Again, that’s just this week, and only health-related nano news.

I’m no expert on nanoparticles, or any kind of nanotechnology. I understand that the technology has a long way to go yet. I realize that there are risks, included unintended health effects, to using nanotechnology. All that being said, too much of our health treatments are “shotgun” approaches that often cause as much collateral damage as beneficial impacts. Nanoparticles offer the promise of “rifle” approaches that offer precise targeting — like using smart bombs instead of carpet bombing.

Within my lifetime, and hopefully within the decade, we’ll have nano-delivered drugs that will greatly increase their efficacy. We’ll have nanobots swimming around in us, for a variety of therapeutic purposes. And we should have nanoparticle mediated brain-computer interfaces too.

Exciting stuff.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)

Need Care, Should Travel

By Kim Bellard, February 25, 2021

I find myself thinking once more about our inability to distinguish quality in our health care. I live in Cincinnati (OH).  The metro area has five hospital systems. Most Cincinnati residents go their entire lives getting all their medical care here. That’s the problem.

If, for example, someone in Cincinnati had a serious heart issue, he/she/they should really go to The Cleveland Clinic.  It is known worldwide for its cardiac care and is ranked #1 in the country for it by U.S. News & World Report.   No Cincinnati hospital is nationally ranked in this field. 

For that matter, The Cleveland Clinic is top 10 ranked in 11 other adult specialties as well, plus top 50 in two others.  It’s the #2 hospital in the nation overall (The Mayo Clinic is #1).  Frankly, if something is wrong with you, it would seem worthwhile to drive up to Cleveland to get care there.  But most don’t. 

If that drive is too far, you could go to Columbus, which is only about half as far, where The OSU Wexner Medical Center/The James Hospital is nationally ranked in 9 adult specialties, still higher than any Cincinnati hospital.  Again, though, most don’t.

Whatever state/city you live in, there’s probably a similar dynamic.  There may be many reasons why most care remains local.  For one thing, the ratings almost certainly aren’t as accurate as one would like; there is more subjectivity/ambiguity in them than anyone would like.  For another thing, a large chunk of hospital admissions come from emergency room visits, and driving two to three hours to a “better” hospital during an emergency is usually ill-advised.  Travel is a barrier generally.. 

Most importantly, though, most people don’t really understand that there might be differences in the quality of care they might expect from different hospitals.  They might be aware of The Cleveland Clinic’s reputation, or have heard of The Mayo Clinic, but the thought of travelling to either doesn’t occur to most.  People in Cincinnati, like people most places, think the care here is just fine, thank you very much.

For most care, that’s probably fine. But if you need a heart transplant or have a rare form of cancer, you should probably be thinking seriously about travelling. The trouble is that there’s no good way to help us distinguish these situations.  For which cases should I be seriously weighing going up to Cleveland for my care? I don’t know, you don’t know, and even “experts” are likely to disagree. 

What we need is what I’ll call a “quality matrix,” indicating when which type of condition needs what “quality” of care.   It might be based on the potential variation in outcomes patients might face based on using different hospitals/physicians. 

Using the USN&WR system, “low variability” conditions could be treated at any hospital (or outpatient by their physicians), but for “medium variability” conditions patients should consider hospitals that are rated at least “high performing,” and for “high variability” conditions, care should be directed to nationally ranked hospitals. 

I know: we don’t have the data.  We don’t have good data on outcomes for most conditions; we don’t quite understand the interplay between the institutions and the specific clinicians practicing within those institutions (e.g., it’s unlikely that every Cleveland Clinic heart surgeon is better than any Cincinnati heart surgeon).  No patients are the same, outcomes can’t be predicted, and so on. 

In other words, the same excuses we’ve been using for the past fifty years.   

Of course, there would be non-trivial financial implications to such a change.  Frankly, I believe our seeming indifference to actually measuring and acting on quality of care is an overarching problem in our healthcare system.  

I challenge hospitals and health plans to focus on getting patients to the right places for their condition, not just enabling patients’ desire to stay local.  And I challenge more patients to demand better. All politics, as they say, is local, but all health care shouldn’t be. 

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)

Setting yourself up for success in a new healthcare leadership role

By Dr. Seleem R. Choudhury, February 18, 2021

The uncertainty brought on by leadership transitions can be hard on employees and organizations (Keller & Meaney, 2017). Staff members wonder: Will the new leader understand the mission? What changes will they implement—and will that impact my ability to do my work and find fulfillment in this job? 

But leadership transitions are tough on the incoming new leaders too.  An IMD survey of 1350 HR professionals shows that transitions into new roles are the most difficult times in leaders’ professional lives (Watkins, Orlick, & Stehli, 2014).  They face pressure to make a good impression, instill confidence in their selection across the organization, and perform the balancing act of learning about the company while attempting to shape it (Watkins, Orlick, & Stehli, 2014).   

The first 30 days in a new role matter immensely, and can set the tone for a leader’s tenure in their organization. 

Four Principles for a Leader’s First 30 Days 

1. Focus on connection.  

In your first weeks in a new senior leadership role, you will likely be given many opportunities to speak to larger groups of people as you’re introduced at meetings with your team, staff, or board of directors. It is important to remember that while these opportunities to build face recognition are important, more is required. You must ensure you are taking the time to talk with each person in your organization individually (Knight, 2020). 

The importance of one-on-one connection cannot be overstated.  This allows you to build trust with your team, which will be essential to long-term success in your new role, and for the organization as a whole.  Start by making an effort to learn every person’s name. One of the best ways to make a great “second” impression with those we manage is by confidently recalling their name the next time we see them (Hedges, 2013). 

This can be a particular challenge for leaders who are more reserved or introverted (Isakson, 2015).  After getting to know your new team, continue to reach out to unfamiliar coworkers who you may not interact with as regularly (Rollag, 2015). It requires vulnerability, but the risk will not go unrewarded.

 2. Learn first, act second. 

Manage the urge to start making your mark on the organization in your first month on the job.  It is natural to be eager to prove your worth to your new colleagues and employees, but—in the wise words from the Harvard Business Review article, “Why New Leaders Should Make Decisions Slowly”—it is critical to “learn first, and act second” (Dierickx, 2019). 

Instead of taking every opportunity to share your opinion or plan of action, do the opposite in your first 30 days (Biro, 2013).  Ask questions about your team’s observations. Learn what has or hasn’t worked in the past, and why. Find out what they believe their strengths and weaknesses are (Rapid Start Leadership, 2020). As the old management adage goes, good leaders avoid being the smartest person in the room (Executive Forum, 2020).  Becoming infatuated with yourself and your own thoughts will cause your tenure to be dead on arrival (Dowling, 2019). 

As you ask questions of your team, listen actively. This is a crucial skill. It can be tempting to formulate a response or rebuttal as someone is speaking, but this prevents you from comprehending and responding to their entire message (Hersh, 2018).  Tuning out information from your co-workers deprives you of the opportunity to know and develop trust in your team, which will in turn stunt your and your team’s ability to engage in a rewarding and fulfilling workplace (Biro, 2013).

3. Create the kind of work environment you want to be part of. 

In a 2014 survey of 19,000 employees, only 25% of those surveyed believed their workplace’s leadership modeled “sustainable work practices” (Schwartz & Porath, 2014). The survey also found that the employees of leaders who engaged in sustainable work practices were “55% more engaged, 72% higher in health well-being, 77% more satisfied at work, and also reported more than twice the level of trust in their leaders” compared to other respondents (Wingard, 2020). 

The work practices of new leadership are an indicator to others of that leader’s expectations of them—whether they intend for it to be or not. Modeling a healthy work-life balance, even in your first 30 days in your new role, gives your employees permission to seek a sustainable lifestyle as well. The data on the impact this can have on employees’ quality of life, productivity, team dynamics, and overall wellness are well-documented. 

Additionally, the character you display in the early days as a senior leader sets the tone for your entire tenure.  You may have a misunderstanding with a new co-worker or make a mistake. To be human means to miss the mark once in a while, after all.  Yet your response should be carefully considered. The difference between “good leaders and great ones lies in how they handle those mistakes” (Daskal, 2018).  It’s important to know when to apologize, and when to remain firm (Kellerman, 2006). 

4. Internalize the mission. 

Use your first month on the new job to solidify your understanding of your new organization’s “why,” or their reason for being, as Simon Sinek says in his 2009 book, “Start with Why.”   

The heart of any company is its mission, vision, and values (Groscurth, 2014).  When you’re new on the job, it is easy to get wrapped up in the “what”—products or services, industry, or competitors—and the “how”—processes, methods, unique differentiators (Ranadive, 2017).  When you feel stuck in your new position, you don’t have to reinvent anything. Look to the mission as your guide. 

Even in your first weeks leading an organization, new leaders can actively be creating a culture conducive to success (Rihal, 2017; Shaffer, 2015).  Invest your time in forming genuine connections with your new colleagues and employees.  Listen well, and learn everything you can about the company and your team’s capabilities.  Even in the busyness of getting caught up to speed in a new position, model sustainable work practices and prioritize your overall well-being.  Take time to fully understand the mission, and allow it to propel you forward.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com 

Resources:

Biro, M.M. (2013). 5 Leadership Lessons: Listen, Learn, Lead. Forbes. 

Craig, W. (2018). The Importance Of Having A Mission-Driven Company. Forbes. 

Daskal, L. (2018). 4 Impressive Ways Great Leaders Handle Their Mistakes. Inc Magazine. 

Dierickx, C. (2019). Why New Leaders Should Make Decisions Slowly. Harvard Business Review. 

Dowling, M. (2019). What Not to Do as a Leader. Northwell Health. 

Executive Forum (2020). Never Be the Smartest Person in the Room. Executive Forum. 

Groscurth, C. (2014). Why Your Company Must Be Mission-Driven. Gallup. 

Hedges, K. (2013).  The Five Best Tricks To Remember Names. Forbes. 

Hersh, E. (2018). Using Effective Listening to Improve Leadership in Environmental Health and Safety. Harvard School of Public Health. 

Isakson, T. (2015). 5 Habits Of Effective Introverted Leaders. Fast Company. 

Keller, S., & Meaney, M. (2017). High-performing teams: A timeless leadership topic. McKinsey Quarterly. 

Kellerman, B. (2006). When Should a Leader Apologize—and When Not?. Harvard Business Review. 

Knight, R. (2020). How to Talk to Your Team When the Future Is Uncertain. Harvard Business Review. 

Marie, L. (2019). The Art of Taking People and Things at Face Value. Human Parts. 

O’Hara, C. (2014). What New Team Leaders Should Do First. Harvard Business Review. 

Patel, D. (2017). Big Brands and business Are Aligning their Missions with Millennial and Gen Z Consumers. Forbes.  

Ranadive, A. (2017). The Power of Starting with Why. Medium. 

Rapid Start Leadership (2020). New Leader Checklist: 4 Questions to Ask if You Want to Lead Effectively. Rapid Start Leadership. 

Rihal, C.S. (2017). The Importance of Leadership to Organizational Success. NEJM Catalyst. 

Rollag, K. (2015). 3 Things Every New Leader Should Do Their First Week On The Job. Fast Company. 

Schwartz, T., & Porath, C. (2014). Your Boss’s Work-Life Balance Matters as Much as Your Own. Harvard Business Review.

 Shaffer, J. (2015). A Leader’s First 30 Days Are Free. Jim Shaffer Group. 

Sinek, S. (2009). “Start with Why.” Portfolio. 

Watkins, M.D., Orlick, A.L., & Stehli, S. (2014). Hit the ground running: Transitioning to new leadership roles. IMD. 

Wingard, J. (2020). Want To Be A Good Leader? Go Home!. Forbes.

Influenza Joins The 1%ers – The One Bit of Good COVID News

By Clive Riddle, February 12, 2021

It’s been widely discussed that influenza spread this flu season is significantly lower, due in great part to COVID-19 induced mask wearing, hand washing, physical distancing and reduced travel by a good portion (but certainly not all) of our population.  

Now that we’re progressing through this influenza season, it’s interesting to do a side-by-side comparison for 2021 vs 2020 as of week five of the calendar year (40 cumulative weeks for the flu season).

Summing up the numbers from the CDC Weekly Surveillance Report totals through the 40^th week of the season for both years, here’s the jaw-dropping difference:

• 2019-2020 Positive Cases through Week 40: 129,997
• 2020-2021 Positive Cases through Week 40:    1,364
• 2019-2020 Flu Test Positivity Rate through Week 40: 17.6% (738,331 tests)
• 2020-2021 Flu Test Positivity Rate through Week 40:   0.2% (593,570 tests)

So this season’s positive cases of influenza are running at 1% of last season!

Comparing the CDC Weekly Surveillance Report charts for these two snapshots in time, stark as the difference appears, actually doesn’t do the comparison justice as the scale for the current season had to be changed for the graph to be readable (the y axis grid for number of positive specimens is in increments of 50 for the 2020-2021 season, vs increments of 2,000 for the 2019-2020 season.)

Four Important Takes on the Key Healthcare Trends and Issues for 2021

By Clive Riddle, January 22, 2021

With the promise and peril of each new year, healthcare prognosticators weigh in on what are the significant trends and issues that lay in wait. With the stakes in 2021 seemingly like no year in recent memory, here is a capsule of items put forward from four important perspectives as we move forward in the calendar:

PwC’s Health Research Institute (HRI) annually publishes their report on top issues for the new year, which will be featured next week in the 2021 Future Care Web Summit. This year’s report: Top health industry issues of 2021: Will a shocked system emerge stronger? “examines how the healthcare industry is expected to face the uncertainty of 2021, building resilience for long-term survival by developing its own forecasting systems, reshaping business portfolios post-pandemic for financial stability and growth, and creating a more nimble, modern supply chain.” 

They find the key issues will include:

• Virtual health reshapes healthcare delivery
• Clinical trials are changing—for good
• Digital relationships can help improve the clinician experience
• Enhanced Healthcare forecasting for an uncertain 2021
• Health portfolios reshaped for growth: increased investment in and by healthcare companies
• A resilient and responsive supply chain built for long-term health
• Interoperability 2021: potential foundation to power forward a more consumer-centric healthcare system after the pandemic

The employer perspective, from the Business Group on Health, is offered in their new report: Key Insights: Health Care Trends in 2021, which cities these five trends:

• The Proliferation of Virtual Care—  More attention will be given to the evaluation of the quality, outcomes, effectiveness, patient experience and cost of virtual care options and innovations, as well as the appropriateness of virtual vs. in-person care for specific services.
• A Reimagining of Health Care Delivery— Even though employers and plans may have momentarily slowed the expansion of alternative payment and delivery models because of the pandemic, a redoubling of efforts in 2021 will drive improvements in quality and value.
• A Spotlight on Mental Health and Emotional Well-being—In 2021, novel approaches such virtual counseling and the integration of Employee Assistance Programs and mental health benefits, will place mental health on par with other medical conditions.
• Adapting to the Well-being Needs of a Changing Workforce— In 2021, employers will continue to demonstrate flexibility and support employee needs through leave, remote work and other benefits.
• Addressing Gaps in Health Equity—In 2021, the health care ecosystem, including providers, suppliers and payers, will boost efforts to examine and address health equity, while mitigating the harmful effects of social determinants of health.

A hospital perspective is offered by the American Hospital Association in their AHA Trustee piece: Top 10 Emerging Trends in Health Care for 2021: The New Normal

1. More Strategic and Agile Supply Chains
2. Coopetition as a Viable Strategy
3. Patient Consumerization
4. Personalization of Care
5. Workforce Diversity and Safety
6. Virtual Care
7. Artificial Intelligence and Automation
8. Revenue Diversification
9. Mergers and integration
10. Payer Shifts

And finally, with the pandemic further bringing behavioral health issues to the forefront, the American Psychological Association offers their report on Emerging trends for 2021:

• Healing the political divide
• Social media is increasing impact
• The fight against racism must continue
• Psychology research is front and center
• Mental health apps are gaining traction
• Psychologists’ skills are in great demand
• The national mental health crisis
• The great distance learning experiment continues
• There’s a new push to reach underserved communities
• Psychology’s involvement in policing
• Psychologists are moving up in academia
• Online therapy is here to stay
• Advocacy will help secure expanded telehealth coverage
• Employers are increasing support for mental health

Streaming, Baby Yoda, and Healthcare

by Kim Bellard, December 15, 2020

I’ve never seen The Mandalorian. I don’t have Disney+. But I know who Baby Yoda is, and I’m pretty sure Disney is counting on that. Hollywood, in case you haven’t been paying attention, is going through some radical changes. There may be some lessons for healthcare in them.

Hollywood has made some startling announcements in the past few weeks that illustrate how swiftly changes are coming to the entertainment industry:

Disney: Disney expects to have 100 new titles — TV shows or movies — each year for the next few years. Disney chairman Bob Iger noted modestly: “The pipeline of original content we’re making is much more robust than originally anticipated.” Of particular note, though, CEO Bob Chapek said, “Of the 100 new titles announced today, 80 percent of them will go to Disney Plus.”

Warner Bros: Although Disney expects some of its movies to still have theatrical runs prior to streaming, Warner Bros announced in early December that all of its 2021 releases will be available for streaming on its HBO Max service upon release, rather than after the “traditional” 90+ day wait.

If you’re worried about the original streaming service — Netflix — don’t be. Although its growth has slowed, that’s partly because it already has close to 200m subscribers worldwide. Its stock is up over 50% YTD, and even the announcements from Disney and Warner didn’t seem to shake that. Similarly, Amazon Prime has over 150m video users, more than half of them in the U.S., and continues to invest heavily in new streaming content.

It’s a new world for Hollywood. Brooks Barnes, NYT entertainment reporter, wrote: “one Warner Bros. executive told me that “the town” felt like a dismantled movie set: The gleaming false fronts had been hauled away to reveal mere mortals wandering around in a mess.” Another Hollywood insider told him: “I see this as a time of opportunity. Sometimes you have to take it down to the studs and build something new.”

Healthcare’s “false fronts” have been torn down too. If ever there was a time to take healthcare “down to the studs and build something new,” this is it.

We brag about the increases in telemedicine, but we should note the CMS rules that have expanded its use are only temporary. We haven’t addressed the inter-state licensing issues. We’re not even doing telehealth visits all that well; the Press Ganey survey concluded: “The bad news is that patients clearly feel that the process of telemedicine (logistical things like ease of scheduling and making audio/video connections) falls short.”

We’ve seen dramatic declines not just in office visits but also in use of preventive services and screenings, elective surgeries, emergency room visits, even heart attacks. We just don’t know if these declines are good or bad. Researchers Allison H. Stokes, PhD, and Jodi B. Segal, MD, suggest in Health Affairs: “We see a unique methodological opportunity to evaluate the harms of low-value care.”

But will we take advantage of that opportunity, or will we just go back to our old ways once the vaccines work their magic?

E.g., will healthcare just expect patients to go back to the theater? Or will major healthcare companies bet big on the future: “streaming” (aka telehealth) as the main consumer point-of-contact, with patient convenience as a main driver? Where digital is the norm?

Disney’s physical locations — its theme parks — are hemorrhaging money, and Warner Bros has suffered dramatic declines from theater revenues, but both are betting big on their virtual strategies — and the markets are rewarding them. Warner says its announcement is only a strategy for 2021, but, as NYT put it:

It will be almost impossible to go back, and it may force other studios to abandon the old model.

We shouldn’t expect patients to go back to the “old” healthcare system either.

I’m not expecting healthcare to have a Baby Yoda caliber idea, but it can certainly do better than its current Jar Jar Binks strategies.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)

Overcoming barriers to provide patient-centered care

By Dr. Seleem R. Choudhury, December 10, 2020

The term "patient-centered care" is in vogue and utilized by health system administrators, marketing gurus, hospital staff, and clinicians alike. It's a catchy phrase that resonates with stakeholders, and it sounds like something every healthcare organization would heartily embrace. However, the heart of patient-centered care and its implications for how care is actually provided to patients is not well understood.

The Institute of Medicine defines patient-centered care as "providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions" (HealthLeads, 2018; Wolfe, 2001). The goal of patient-centered care is focused primarily on the health outcomes of the individual rather than the entire population (NEJM Catalyst, 2017). However, by prioritizing the individual's health, populations' health outcomes are improved as well (Cramm & Neiboer, 2016).  Additionally, patient-centered care presents possible economic advantages for both hospitals and patients (David, Saynisch, & Smith-McLallen, 2018).

However, there are many barriers that must be overcome to live up to the aspirational definition of patient-centered care and experience the benefits this approach offers. 

Barriers to patient-centered care

An article released last year by Academy Health outlines many of the barriers to patient-centered care (Sinaiko, Szumigalski, Eastman, & Chien, 2019). It highlights that these barriers are "pervasive" within the healthcare system.  The current lack of agility within healthcare as an industry has limited the customizability of care delivery, and there are many broad sections of the population that are paying the price.

Reimbursements

Erasmus spoke of "the talking power of money," and it is true that "money talks" centuries later in today's healthcare system. Many healthcare systems continue to utilize fee-for-service. While this approach is hotly debated amongst healthcare professionals and economists, many believe fee-for-service models create incentives for providers to encourage face-to-face or volume building visits, and are widely indicted for promoting care that is inefficient, uncoordinated, and too often fails to meet the needs of patients (Agency for Healthcare Research and Quality, 2002). 

The fee-for-service system serves to drive up volume and encourages hospital and community health organizations to make money and support their healthcare system rather than the needs of the patient.  This may lead providers to perform unnecessary surgeries, x-rays, or lab work, to name a few common examples, in order to increase revenue, rather than focus on the patient's desire to receive only the care they need at a cost they can afford.

It is recognized, however, that the fault does not just rest with the organization. Often, the regulatory burden on providers and hospitals is unrealistic and cumbersome, stifling innovation (Secretary of Health and Human Services, 2018). This can lead to the tail wagging the dog with organizations feeling pressure to meet regulatory needs before addressing patient needs in order to gain reimbursements.

Organizational culture

Unsurprisingly, the culture of the organization impacts patient outcomes and the practice of patient-centered care (Hahtela, McCormack, Doran, Paavilainen, Slater, Helminen, & Suominen, 2017). It is not enough to simply tout a patient-centered approach in annual reports, periodic training, glossy posters, mission statements, email signatures, or quick notes in a staff meeting. Everyone associated within the organization—from executives to clinicians to non-clinical support staff to volunteers—must hold attitudes and beliefs consistent with patient-centeredness (Gorli, Liberati, Galuppo, & Scaratti, 2016; Agha, Werner, Reddem, Huseman, Long, & Shea, 2018).

The organization must become transformational to make patient-centered care a reality, not just a nice sentiment.  This will require training for all employees and a mindset shift from the top down.

Inadequate trust

Patients often do not trust their clinician's management of their health. This is due in part to a lack of transparency combined with the steadily rising cost of care over decades. Healthcare is the only industry in the world where consumers have no idea how much money they will be required to spend on a service prior to receiving it.  Clinicians are unable to tell their patients how much their care is going to cost—how could there not be a lack of trust?

We see evidence of this lack of trust consistently in issues with medication compliance among patients with chronic medical conditions.  According to a recent article in Practical Pain Management, "approximately 125,000 people with treatable diseases die each year in the U.S. because they do not take their medication as prescribed, while 10% to 25% of hospital and nursing home admissions result from uninitiated or incomplete prescribed treatment plans" (Cosio & Demyan, 2020).  Data suggests that if a stronger, more respectful, and trusting relationship exists with the patient, then the patient is likely to be more compliant with their treatment (Sladdin, Ball, Bull, & Chaboyer, 2017).

Social determinants of health

Social determinants of health include the social factors that impact a patient's ability to achieve health and wellness.  We live in an electronic age, and it seems bizarre that this crucial information is missing from patients' medical history. But the fact is that data on social determinants of health is not consistently collected, thus stunting patient-centered care efforts.

A lack of understanding or reliable methods for collecting this information translates to a lack of understanding of the needs of the patient.  When providers do not have information on what patients have and what they need—whether poverty, educational issues, or homelessness, for example—it impacts their ability to achieve positive health outcomes for their patients (Heath, 2017). 

Pandemic

A barrier not mentioned in the Academy Health article is the current global pandemic.  COVID-19 has impacted patient-centered care, especially as care delivery is focused on the most acute cases (Carlos, Lowry, & Sadigh, 2020). Staff are stretched too thin to take into account patient preferences.

Non-COVID treatment often comes with a list of precautions to prevent spreading the virus and less flexibility in care and support options.  Many hospitals have suspended visitors, so the patient is left alone without their loved ones, who often act as a support system and a channel of communication with care providers.

Strategies and solutions

Despite the many substantial barriers to implementing patient-centered care in the healthcare industry, hospitals and healthcare professionals are finding ways to overcome these obstacles and put the needs of the patient first.  A 2018 report supported by the Robert Wood Johnson Foundation, titled Moving Patient-Centered Care Forward: How Do We Get There?, identifies several actionable strategies.

Improve diversity.

Improved diversity among the healthcare workforce will result in increased opportunities for patients to receive care from someone who shares the same racial or ethnic background.  This is essential for improved individual health outcomes, as data has repeatedly shown that compliance with physician recommendations is heightened when patients identify with the ethnicity of their provider and clinical team (Khullar, 2018).

In addition, a study found that patients were more likely to give the maximum patient rating score and were more compliant with the treatment regime when they identified with their provider's ethnicity (Takeshita, Wang, & Loren, 2020). In addition to hiring a more diverse workforce, hospitals must also collect information regarding patient ethnicity, and take steps to take ethnicity into account in a patient's care.

Embrace innovation.

The healthcare industry needs to think outside the box not only when it comes to improving care, but also reimbursement for care. Patient-centered care is increasingly delivered in teams, both within healthcare systems and through referral relationships with other organizations. A lot of work goes on behind the scenes that is often not reimbursable. Developing an innovative system that rewards collaboration will help undo a payment system that does not adequately compensate for this work. 

Collaborate with community organizations.

The African proverb, "It takes a village to raise a child," rings true for organizations that have embraced patient-centered care. Too often hospitals think they are the be-all-end-all of their patients' care, but in reality, there are many people and organizations, such as schools, food banks, and local agencies, to name a few, that contribute to a person's health.  Hospitals must change their focus from protecting their volume and growing their service line to embracing their role as a contributor to the health of their community for the sake of their patients.

Serve the "whole patient."

Transforming the culture of an organization to deliver care in a way that better serves the "whole" patient is a complex endeavor. To put a patient's needs first requires that the organization be willing to put its own needs second. A commitment within the organization to permit staff to address patient needs as they arise, even if the service is not in their job description, sounds good on a mission statement or strategic plan. However, it will require hospitals to invest in training their staff and creating a culture that focuses on customer service, respect, and patient empowerment.

Promote transparency.

A lack of transparency inevitably leads to a lack to trust, and we must listen to patients' and the government's demands for increased transparency in the healthcare industry. The 21st Century Cures Act, set to take effect in April 2021, will help all patients to have immediate electronic access to their detailed notes and records. The intent is to lower costs, create improved trust with transparent conversation between provider and the patient, and empower the patient to make more informed healthcare decisions. 

Transparency doesn't end there. There needs to be greater openness and ease in hospital billing practices, billing and cost understanding, and the ins and outs of the insurance reimbursement system. Hospitals' pay codes are indecipherable to patients trying to interpret their billing statements. Patients need to see actual costs if they are to be empowered to make wise decisions for their physical and financial health. 

Rethink compliance.

Regulations meant to ensure that all patients receive quality care have unwittingly turned the healthcare industry into a tick-box culture where hospitals are incentivized to provide care to the lowest common denominator to keep agencies off their back.

There is something for healthcare leaders to ponder in Amazon CEO Jeff Bezos's statement to shareholders in 2016: 

"Good process serves you so you can serve customers. But if you're not watchful, the process can become the 'thing.' This can happen very easily in large organizations. The process becomes the proxy for the result you want. You stop looking at outcomes and just make sure you're doing the process right."

In healthcare as well as in the tech sector, the process of ensuring regulatory compliance can too easily become the "thing," much to the chagrin of clinicians. As a result, care can become encumbered, slow, and legalistic, rather than dynamic, patient-focused, and friendly (Sims, Leamy, Levenson, Brearley, Ross, & Harris, 2020).

It is clear that to deliver patient-centered care organizations must not be held hostage to meeting regulatory requirements. Instead, they should look beyond the minimum and understand their patients when designing a patient-centric model that not only surpasses the minimum requirement for compliance, but also delivers clinical excellence.

Placing the patient in their rightful place at the center of all healthcare organizations do is an ongoing journey and not an endpoint.  Embracing patient-centered care is a paradigm shift that will require healthcare partnership, adoption and acceptance by every person in the healthcare organization, and openness to innovative approaches in an ever-evolving and complex healthcare system.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com 

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