When Changing the Culture: Speak Softly but Definitely Carry a Big Stick! | Pete Rivera | Healthcare Blogs Skip to content Skip to navigation

When Changing the Culture: Speak Softly but Definitely Carry a Big Stick!

March 9, 2017
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The rule is: treat everyone as an adult, until they prove otherwise.

Silos are alive and well in most organizations. These divides become readily apparent when you undertake large projects or your organization is merging with another recently acquired organization. Each silo and to a greater extent, each organization has its own culture. Good, bad, or indifferent disparate cultures will clash. Knowing when to nudge and went to hammer is key to resolving culture issues in order to move forward with your strategy.

Leadership is the art of influencing and directing. But keep in mind that the people that you’re trying to influence and direct are adults, and adults learn differently. The rule is: treat everyone as an adult, until they prove otherwise.

Being confrontational and overbearing are traits that are often counterproductive for teambuilding. However, you may have a dysfunctional member of your staff or an employee that feels empowered and irreplaceable to the point that they become a stumbling block to progress. In these cases you may be forced to create a significant emotional event with this person to change their behavior and begin to change the culture of that silo or organization.

I am a firm believer of the stages of team formation; forming, storming, norming, performing and adjourning. It’s actually sometimes fun to watch. But when you have a member that becomes obstructive and keeps the team in the storming mode, then that’s when you have to step in and do something radical.

  1. Callout the behavior: Sometimes it’s just enough to make the person aware that they are obstructing the efforts of the team and their behavior is no longer tolerated. Believe it or not, they may not even be aware of it. They may be so use to operating in this mode and having people enable their behavior to the point that it becomes acceptable around them.
  2. Do not engage in email battles: When you have someone dig their heels and want to make a stand, they resort to lengthy emails with multiple addressees. Don’t fall for the trap. Replying to all and attempting to address all of their concerns will only result in another reply with more lengthy information. Dysfunctional employees like to hide behind email and quickly change their tone when you’re with them face-to-face. The best way to avoid an email battle is to simply respond with a “thank you,” and then schedule a face-to-face (or virtual) meeting with them and their direct supervisor.
  3. Give them enough rope. As the team culture begins to change and the storming starts to die down this may be enough for the difficult team member to start changing. However if this is not the case, then you may have to resort to calling out their functional area on a status report or executive meeting as a risk factor for accomplishing milestones.

During a large implementation that involved over 1000 users across two states, efforts were consistently hampered by one interface analyst that kept challenging the application analysts. They always had a reason why it couldn’t be done, or how their current processes would not allow for whatever change that needed to be implemented. During a critical status call the interface analysts manipulated the entire time talking about all the problems that the project was creating. There were probably 15 people on the call and I allowed the analyst to get everything off their chest. Then I asked a simple question, “Are you done?” Then I went on to inform everyone on the call that as of that minute the project status was red, we would not be going live on the planned date because of the interface team. That the following day the executive steering committee will be getting a status report to that effect and we will have to regroup with the executive team to figure out the financial implications of the delay. There was a long period of silence until the interface analysts came back on and stated that before I placed the project in the red status, they might be able to resolve the issues by the next day.

I am not sure why this particular interface analyst felt empowered or enabled to get away with the behavior that they were used to. But I do know that once the line was drawn it was never crossed again, issues were resolved and the project was completed on schedule.

There is a hidden cost associated with people that want to avoid change and continue to keep their organizational culture alive. While facilitating the merge of two hospitals, I was asked to sit in a Compliance reorganization meeting. Apparently they were having a hard time moving forward and establishing joint policies and procedures. It was an early meeting so I had my coffee in hand. The introductions were lengthy in part because most were lawyers, some physicians and a few IT security people. We did not get past the first agenda item before an argument ensued between two of the members. As I sipped my coffee I looked at the meeting facilitator to see if they were going to do anything. The argument continued and got more heated. I started looking around the room and trying to figure out what each person earned an hour. As you can imagine with all the lawyers and physicians my mental estimate of the cost of the meeting was substantial. I guess 20 minutes is a good breakpoint, at least it was for me. Because I said, “Take it outside.” I then told them I was serious. That I would go to a separate office with them and facilitate whatever issues they had with one another and hopefully resolve them to the point that both of them can move forward. But that we could not continue to waste everyone’s time with a petty argument. I also told them what I estimated the cost of the meeting to be (including my cost) and that there was an expectation from the executive leadership that the group submit their recommendations on time. Once both members agreed that they really didn’t want to leave the conference room, we went on to establish meeting rules and an agreement on who was really facilitating the meeting.

“Culture eats strategy for breakfast”
---Peter Drucker.

Most people that create barriers for change are actually scared. They feel that somehow they will lose control or that it may jeopardize their job. These are significant stressful motivators to keep them angry and obstructing anything you may want to accomplish. Changing an existing culture, at any level, is difficult. Sometimes it is enough to just provide a gentle nudge to get everyone pointed in the same direction. But don’t overlook the other tools that you have available, because sometimes you do have to reach for that stick.

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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.

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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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