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What cultural attributes are holding healthcare systems back?


Today in health, it such a gene is added again. And we're going to take a look at. He's going to talk about the management culture and five things that we should change in healthcare management culture. My name is bill Russell. I'm a former CIO. For 16 hospital system and creator of this week health.

Set of channels dedicated to keeping health it staff current and engaged. We want to thank our show sponsors who are investigating, developing the next generation of health leaders, short tests and artists. I check them out at, oh wait, short test artist site. Parlance and service. Now we now have four sponsors for the today. Show, check them out at this week. Health.

Dot com slash today. Having a child with cancer, one of the most painful and difficult situations a family can face in 2023 to celebrate five years at this week health we are working to give back. We are partnering with Alex's lemonade stand all year long. We have a goal to raise $50,000 from our community, and we are so excited to be up over $40,000.

So far for this year, we asked you to join us, hit our website , top right-hand column. You're going to see the lemonade stand logo. Go ahead and click on that. And you can give today. We believe in the generosity of our community. And we thank you in advance. All right. I was out on LinkedIn, just perusing some things, seeing what was going on. And I came across such and Jane's posts and, , I.

Quite frankly, I read them off. You're not following him. I would highly recommend that you do at such and Jane. Dr. Jane is the president and CEO of skin group and health plan. He posts a lot on LinkedIn and is worth. Following. So I'm going to give you some of the things that he has to say so much of what we need to accelerate change in us. Healthcare is a new management culture.

The starting point for building a new management culture is acknowledging and limitations with our current culture, regardless of the sector, having worked across all sectors of healthcare, I reflect on some cultural impediments holding us back.

Number one. Slow pace of execution. We have convinced ourselves that change needs to be slow, deliberate, and measured. We let the perfect be the enemy of the good while the nature of operations that influence life and death requires measured action. We sometimes forget that inaction can sometimes be just as damaging to the lives of the people that we serve.

I'm going to go on number two, avoiding hard decisions. So many leaders and leadership teams know the right thing to do, but fail to do so. For fear of disruption of some kind. So dysfunction. Perpetuates ad infinitum.

As hard as making the hard decision sometimes is living with the consequences of not making these hard decisions. Often creates more pain in the longterm. As my friend likes to say, Problems do not get better with age.

Number three passive aggression. So many cultures perpetuate silence in decision-making meetings. Leaders engage in meetings after the meeting. To have further discussion and decisions that are made are really litigated opaquely in a private setting. When there's an implicit belief. That anyone can change or reverse a decision once it has been made people don't respect decisions.

When they happen, made an inaction, becomes the norm. We used to call this at St. Joe's. We call this the silent veto. It's when you, you could have even raised your hand in a set. I am for this. And then you walk out of the meeting and you either do not allocate the resources. You just pretend like the decision was never made or you continue to have discussions as if we're still making the decision.

And it is something that our leadership attacked. Significantly to make sure that that did not happen. We made decisions in groups. When we made those decision as a group, everyone agreed. Everyone was expected to walk out of that meeting and do what we had decided to do as a group. However, if you did not agree, you were.

, encouraged to speak up during those meetings, but at the end of the day, when the group made a decision we followed through on those number four. Committee lead disempowerment. So many cultures, disempower leaders by requiring decisions to be made by committees instead of individuals, great cultures instinctively understand that the quality of some decisions.

Is improved by committee work. While the quality of other kinds of decisions is significantly degraded. So committees aren't all bad. There are very good committees within health systems, and there are very, , dysfunctional committees within health system. That's not what we're talking about here. We're talking about decisions that are better left to committees and decisions that are better left to individual leaders.

Which gets to the last point. Number five leadership. The days of the player coach in healthcare have given way to excessive hierarchy. Where many leaders are unwilling to roll up their sleeves to see. What the real work of their team is like, They're more content to direct it from afar. As a result, we have lots of people overseeing work, they know little instinctively about, and they don't know basic details that they should. So there you go, leadership.

And then he asked what other things. , cultural attributes of the healthcare industry that you have seen that need reform. And there's 48 comments already in the last, see, this was posted eight hours ago. So let me give you those five again, slow pace of execution, avoiding hard decisions, passive aggression.

Committee lead disempowerment and leadership. And, , as I look at these, I've experienced all of those slow pace of execution. When I came into healthcare, we determined we needed to move to the cloud. And it took the executive team. I would say about nine months to agree that we needed to move to a more agile environment.

Keep in, in, in the backdrop, keep in mind that, , 80 to 90% of our equipment was end of life. Not old. And of life. The manufacturer has said we will no longer support this equipment. So we've made many bad decisions up until that point to allow that equipment to get that old in the data center. And when a solution was presented around that, we, we.

, went back and forth for months and months and months and months. I think the other thing, if I were to add something here is that. Allow the people to who understand things, to articulate it. And you have to trust people in their area of expertise. When the supply chain person comes in and starts talking about supply chain.

We heard that person. We vetted that person. We believe in that person. If they're not the right person, get rid of them. But, , don't act as if we are all supply chain experts and all of a sudden when they're saying, Hey, these are the five things we should do. We look at them and say, wow, I agree with one in five, but I don't really agree with two, three, and four.

When your expertise isn't supply chain. I mean, we force people and especially as an it leader. As somebody who understood technology. And I would say better than anybody in the 20,000 person organization, that I was a part of. Aye. I've been in it for my entire career. I'd done it for Anheuser-Busch. I'd done it for McDonald Douglas. I had done it for bank of America. I consulted at the highest levels in many organizations.

I literally had my hand sturdy. I was a programmer. I knew the technology inside out. I could actually get on the routers and fix them. I understood the technology. A case could be made. I didn't understand clinical technology. And, but I understood technology and their cloud computing had nothing to do with clinical technology. It was about what was the best model for moving forward. Now this was back in 2012.

And the argument we were getting on that was, Hey. This is too forward thinking healthcare isn't ready for this. And I, and I had to make the case that this is not forward-thinking. This was for thinking. A decade ago. In many other industries have already made their journey to the cloud. Healthcare is just now catching up so fast, forward 11 years, and now.

, , everything is moving to the cloud. So I would say the other thing is let the experts be the expert. In that field and allow them to speak into those decisions. Avoiding hard decisions. I said earlier, I think. It amazes me. How many health systems waited so long? To do the cuts that needed to be done within their health system.

The financials were apparent. Probably two years ago. If not a year ago. Definitely. And, , you fast forward. And when you wait nine months to make a decision based on data, you had nine months ago, you are well behind and that will impact your. It just means you'll be longer coming out of the downturn.

Because you waited too long to make those decisions. We avoid hard decisions in healthcare. I've seen that over and over again. Passive aggression. I already talked about the silent veto. You have to attack that even if it's at the department level, if you are a leader of a, an it operation, and there are people who really litigate the decisions that have been made, you have to, you have to nip that in the bud almost.

, as soon as you see it happening, , committees find the ones that are functional, continue to utilize them. , you can even form new committees. It's not the, it's not the, I'm not anti committee. But there are decisions that when they go through the committee, they just get lost. And there's some decisions that should just be quick decisions we make, we move and we do things so, , together, determine which things should go through committee, which ones should.

And then, , , leadership. , I'm not sure I understand this techno the terminology, the days of the player coach in healthcare have given way to excess hierarchy. I understand that idea of excess hierarchy. , it's it's I, I love this article. I love the stuff that he shares. I'm not sure what the practical application of it is. If I really broke it down, it's probably each one of these.

It is where you can move quickly. Don't avoid the hard decisions. Problems do not get better with age, make the hard decisions when you are aware of the data and you have the data. , you have to nip the passive aggression in the bud early, , committee use the committee correctly, use them for the right decisions.

And the right things, committees are great for gaining a broader perspective on a problem and to drive. , more consensus, , across an organization. And then the final thing, , , , in as much as it depends on you get rid of the hierarchy. My it organization. Let's see, we were a six and a half billion dollars.

My T organization at one time, I only had three direct reports and then they kept giving me areas and I ended up with six. Direct reports. I think that was about as many as I could handle. And I, I see it org charts all the time with like the CIO has 10 direct reports. I just look at him and go it's too many.

Because you want to invest in each one of those six, you want to invest in each of those people. , to, to develop them as leaders to help them to formulate strategy around their, their various areas. You can't invest in 10 people. It's just too many people. You have too many other people to invest in. You have your, , technology champions throughout the organization and whatnot. So, , again, hierarchy is bad and as much as it depends on us and it, we should limit it. Then the other thing is I would say, listen to your experts.

If you have an expert in architecture, listen to your expert in architecture. Do you have an expert in routing, listen to your expert and routing and security and so forth and so on. , if they give you bad advice over and over again, you have the wrong person and you either need to get them training or move them out.

And, , but if you have the right person. You're only doing damage by not listening to them when they give you their expert opinion. So that's all such and gene appreciate his insights worth following on LinkedIn, that's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week.

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