Great Leaders Are Thoughtful and Deliberate, Not Impulsive and Reactive

https://hbr.org/2019/04/great-leaders-are-thoughtful-and-deliberate-not-impulsive-and-reactive?utm_source=facebook&utm_medium=social&utm_campaign=hbr&fbclid=IwAR15xBzRuRJsKxkITe-z0wa1AwDMc_gwJmhM5r6ONnL7bw3s9zP8qRxYiEE

You set aside the first hour of your day to work on a strategy document that you’ve been putting off for a week. You haven’t been disciplined about getting to it, but you’ve had one crisis after another to deal with in the past week. Now, finally, you’ve carved out 90 early morning minutes to work on it.

First, however, you take a quick peek at the email that has piled up in your inbox overnight. Before you know it, you’ve used up the whole 90 minutes responding to emails, even though none of them were truly urgent.

By the time you walk into your next meeting, you’re feeling frustrated that you failed to stick by your plan. This meeting is a discussion with a direct report about the approach he’ll be taking in a negotiation with an important client. You have strong views about how best to deal with the situation, but you’ve promised yourself that you will be open and curious rather than directive and judgmental. You’re committed, after all, to becoming a more empowering manager.

Instead, you find yourself growing even more irritable as he describes an approach that doesn’t feel right to you. Impulsively, you jump in with a sharp comment. He reacts defensively. You worry for a moment — and rightly so — that you cut him off too quickly, but you tell yourself that you’ve worked with this client for years, the outcome is critical, and you don’t have time to hear your direct report’s whole explanation. He leaves your office looking hurt and defeated.

Welcome to the invisible drama that operates inside us all day long at work, mostly outside our consciousness. Most of us believe we have one self. In reality, we have two different selves, run by two separate operating systems, in different parts of our brain.

The self that we’re most aware of — the one that planned to work diligently on the strategy document and listen patiently to your direct report — is run by our pre-frontal cortex and mediated through our parasympathetic nervous system. This is the self we prefer to present to the world. It’s calm, measured, rational, and capable of making deliberate choices.

The second self is run by our amygdala, a small almond-shaped cluster of nuclei in our mid-brain and it is mediated by our sympathetic nervous system. Our second self seizes control any time we begin to perceive threat or danger. It’s reactive, impulsive, and operates largely outside our conscious control.

This second self serves us well if a lion is coming at us, but the threats we experience today are mostly to our sense of worth and value. They can feel nearly as terrifying as those to our survival, but the danger we experience isn’t truly life-threatening. Responding to them as if they are only make things worse.

It’s in these moments that we often use our highest cognitive capacities to justify our worst behaviors. When we feel we’ve fallen short, we instinctively summon up our “inner lawyer” — a term coined by author Jonathan Haidt — to defend us.

Our inner lawyer is expert at rationalizing, avoiding, deflecting, dissembling, denying, disparaging, attacking, and blaming others for our missteps and shortcomings. The inner lawyer works overtime to silence our own inner critic, and to counter criticism from others. All this inner turmoil narrows and consumes our attention and drains our energy.

The problem is that most organizations spend far more time focused on generating external value than they do attending to people’s internal sense of value. Doing so requires navigational skills that most leaders have never been taught, much less mastered. The irony is that ignoring people’s internal experience leads them to spend more energy defending their value, leaving them less energy to create value.

In our work with leaders, we’ve discovered that the antidote to reacting from the second self is to develop the capacity to observe our two selves in real time. You can’t change what you don’t notice, but noticing can be a powerful tool for shifting from defending our value to creating value.

A well-cultivated self-observer allows us to watch our dueling selves without reacting impulsively. It also makes it possible to ask our inner lawyer to stand down whenever it rises up to argue our case to our inner and outer critics. Finally, the self-observer can acknowledge, without judgment, that we are both our best and our worst selves, and then make deliberate rather than reactive choices about how to respond in challenging situations.

To improve your capacity to self-observe, begin with negative emotions such as impatience, frustration, and anger. When you feel them arising, it’s a strong signal that you’re sliding into the second self. Simply naming these emotions as they arise is a way to gain some distance from them.

Also, watch out for times when you feel you’re digging in your heels. The absolute conviction that you’re right and the compulsion to take action are both strong indicators that you‘re feeling a sense of threat and danger.

In our work, we provide leaders with small daily doses of support — reminders to pay attention to what they’re feeling and thinking.  We’ve also found it helpful to build small groups that meet at regular intervals so leaders can share their experiences. A blend of support, community, connection and accountability helps offset our shared impulse to stop noticing, push away discomfort, and revert to survival behaviors in the face of perceived threats to our value. A good starting place is to find a colleague you trust to be your accountability partner, and to seek regular feedback from one another.

Finally, it’s important to ask yourself two key questions in challenging moments: “What else could be true here?” and “What is my responsibility in this?” By regularly questioning your conclusions, you’re offsetting your confirmation bias — the instinct to look for evidence that supports what you already believe. By always looking for your own responsibility, you’re resisting the instinct to blame others and play victim and focusing instead on what you have the greatest ability to influence — your own behavior.

A deceptively simple premise lies at the heart of this deliberate set of practices: see more to be more. Rather than simply getting better at what they already do, transformational leaders balance courage and humility in order to grow and develop every day.

 

 

 

EVERY HOSPITAL BOARD NEEDS A CEO SUCCESSION PLAN. HALF ARE FAILING.

https://www.healthleadersmedia.com/strategy/every-hospital-board-needs-ceo-succession-plan-half-are-failing

The organization needs to have a strong sense for who will lead next. That’s ultimately the responsibility of the board, not the incumbent. This article appears in the July/August 2019 edition of HealthLeaders magazine.

The departure of a CEO can severely disrupt an organization’s progress, especially when the leader leaves suddenly without a clear successor. Despite the well-known need for succession planning, an alarming number of healthcare provider organizations are chugging along without a plan in place, just hoping that their top executives stick around for the foreseeable future.

Forty-nine percent of hospital and health system boards lack a formal CEO succession plan, according to the American Hospital Association Trustee Services 2019 national healthcare governance survey report. That leaves them vulnerable to the disruptive gusts of a CEO’s sudden departure, and it can inhibit their ability to pursue longer-term strategies by leaving them overly dependent on one leader’s vision.

The failure of these boards to formalize CEO succession plans is outrageous and unacceptable, says Jamie Orlikoff, president of the Chicago-based healthcare governance and leadership consulting firm Orlikoff & Associates Inc. and board member of St. Charles Health System in Bend, Oregon. “Whatever the reasons are, it’s just a fundamental and inexcusable abrogation of a basic governance responsibility, so I am nothing less than shocked that the figure is almost 50%,” Orlikoff says.

Why Plans Aren’t Made There are typically a few basic reasons why an organization may be slow to finalize a CEO succession plan. Perhaps the current CEO just doesn’t want to talk about it, Orlikoff says. Some executives are more comfortable talking to their families about their own life insurance plans than they are talking to the board about what to do in the event of their sudden departure, he says. Or perhaps it’s the board members who don’t want to talk about it. Orlikoff says at least four board chairpersons for various organizations have told him in the past seven years that they don’t want their current CEOs to leave and that they don’t want to think about succession planning because the recruitment process is too burdensome. Or there could be an unhealthy power dynamic between the CEO and the board, with the CEO asserting control over tasks that should be handled by the board members, Orlikoff says.

What makes the relationship between the CEO and the board so tricky is how it ties together two distinct relationships. On the one hand, the CEO and the board are strategic partners defining and executing a shared vision. On the other, they are an employee and an employer. “Those are two very, very different and very important functions,” Orlikoff says.

“Some boards have great difficulty envisioning the distinction between those two roles.” A board should lean on the CEO as a strategic partner because the CEO is likely to know more about the industry and more about the local market than the board members do, Orlikoff says. But when the board neglects to assert its proper place in the employer-employee relationship, the CEO may be given free rein over a broader scope of issues than is appropriate, and that can impede the CEO succession planning process, he adds.

In other words, while it’s perfectly appropriate for a CEO to groom a potential successor, the board should not defer to the CEO’s selection, and the CEO should not insist that the board do so. How to Fix This The existence or nonexistence of a formal CEO succession plan is often a symptom of whether the relationship between a CEO and the board is healthy, Orlikoff says.

Notably, the task of devising a succession plan is one exercise that can improve that relationship, he adds. While the detailed steps each organization should take will vary from one situation to another, there are two specific items that Orlikoff recommends: 1. Ask about the mundane threat of a bus.

Whether you’re a CEO or board member for an organization without a formal succession plan in place, there’s one straightforward question you can ask to kickstart productive dialogue on the topic: What do we do if our CEO gets hit by a bus tonight? The question is nonthreatening. It doesn’t signal a CEO’s possible intent to resign or retire. It doesn’t suggest the board members are thinking about giving him or her the boot.

It simply asks, as a matter of fact, how the organization will maintain continuity in the event of an unplanned CEO departure, just as parents would speak with their families about life insurance, Orlikoff says. The CEO should tell the board, without any other senior leaders present, whom the CEO would pick to step into the interim CEO role, Orlikoff says. That will inevitably prompt follow-up questions: Would the interim CEO be a good permanent replacement? Which of the requisite skills do they lack? How well do they align with our long-term needs and vision?

The conversations about an unplanned CEO departure will flow naturally into questions about a planned departure. Where are we in the current CEO’s contract cycle? When does the CEO want to retire? What skills and traits will our next CEO need to lead the organization into the future of healthcare?

Conversations about an unplanned departure should begin on the very first day of a new CEO’s contract, Orlikoff says. Conversations about a planned departure should begin at the end of the CEO’s first year, he says. For a CEO with a five-year contract, the board should start asking halfway through contract whether the CEO wishes to renew a contract or leave the organization, and the board should know three years into the five-year contract whether the CEO wants to stay, he says.

Hold executive sessions without the CEO present. An increasing number of hospital and health system boards are routinely listing executive sessions on their meeting agendas, and that’s a good thing, according to the AHA Trustee Services survey. A slight majority, 52%, of all respondents routinely included an executive session in the agenda of every board meeting, according to the survey report. But 26% of system boards, 59% of subsidiary boards, and 48% of freestanding boards still don’t.

Even if a board has an executive session, though, that doesn’t mean members are able to fully discuss the topics in their purview. The survey found that CEOs participate in the entire executive session for a majority, 54%, of all boards. That includes 41% of system boards and 57% for both subsidiary and freestanding boards. That deprives trustees of an opportunity to discuss the CEO in his or her absence and might impede the CEO succession planning process, Orlikoff says.

Related: 4 Steps for Planning CEO Succession Boards should think of their meetings in three stages, Orlikoff says. The first stage includes everyone in the room, including board members, the CEO, senior executives, and invited guests. The second stage is a modified executive session that includes the board members and CEO only, which is where the majority of the meeting should take place. The third stage should be an executive session with the board members only. “Confident, secure CEOs know that their boards need to go into executive session without them present occasionally in order to perform certain governance functions. They encourage it,” Orlikoff says. “Insecure CEOs or those who are attempting to control and manipulate the board are very uncomfortable with executive sessions and don’t want the board going into an executive session.”

It’s Mutually Beneficial While it may be difficult to prompt board members to think about a future under different leadership, CEOs who do so are not only investing in the organization’s long-term success but also signaling that they are the sort of leader willing to make investments in the organization’s long-term success. “When a CEO goes to the board and says, ‘You guys need to do this,’ … it demonstrates an incredibly high degree of confidence.

It also demonstrates an incredibly high degree of commitment to the organization,” Orlikoff says. “It shows that you’re thinking beyond yourself,” he adds. “You’re thinking about the best interests of the organization, that you’re willing to have difficult conversations for the good of the organization.”

“INSECURE CEOS OR THOSE WHO ARE ATTEMPTING TO CONTROL AND MANIPULATE THE BOARD ARE VERY UNCOMFORTABLE WITH EXECUTIVE SESSIONS AND DON’T WANT THE BOARD GOING INTO AN EXECUTIVE SESSION.”

KEY TAKEAWAYS

Not having a formal succession plan may be a symptom of an unhealthy relationship between the CEO and the board.

When CEOs prompt the board to think about who will lead next, it demonstrates self-confidence and commitment to the organization.

 

 

 

Financial updates from UnitedHealth, Anthem + 5 other for-profit payers

https://www.beckershospitalreview.com/payer-issues/financial-updates-from-unitedhealth-anthem-5-other-for-profit-payers.html?utm_medium=email

The following seven health insurers recently released their financial statements for the fourth quarter of fiscal year 2019:

1. Anthem saw its revenues and profits grow in the fourth quarter, but the insurer missed analysts’ earnings expectations.

2. Cigna continued to realize higher revenues and profits in the fourth quarter, thanks to its subsidiary Express Scripts.

3. Molina Healthcare ended the fourth quarter with lower net income than a year prior as premium revenues declined.

4. Humana saw total revenue and net income grow in the fourth quarter, thanks in part to growth in its Medicare Advantage business and health services segment.

5. Centene Corp. saw its revenues grow in the fourth quarter, but experienced higher-than-expected flu costs.

6. UnitedHealth Group saw its revenues just miss analysts’ expectations in the fourth quarter, but the health insurance giant’s Optum unit boosted profits.

7. Aetna‘s parent company, CVS Health, exceeded Wall Street’s expectations with its fourth-quarter results, boosted largely by its pharmacy benefit management business.

 

Half of insured adults are skipping primary care visits. Cost a major reason why

https://www.beckershospitalreview.com/finance/half-of-insured-adults-are-skipping-primary-care-visits-cost-a-major-reason-why.html?utm_medium=email

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In a given year by 2016, almost 50 percent of adults with commercial insurance hadn’t visited a primary care physician, according to a study published in the Annals of Internal Medicine.

For the study, researchers from Harvard Medical School in Boston, the Icahn School of Medicine at Mount Sinai in New York City and the University of Pittsburgh School of Medicine wanted to better characterize primary care declines among adults. To do so, the study authors analyzed deidentified claims data from a national private insurer that covers roughly 20 million members each year, according to NPR.

They found from 2008-16, adult visits to primary care physicians fell by nearly 25 percent. The decline was largest among younger adults. The proportion of adults with no visits to primary care physicians in a given year climbed from 38.1 percent to 46.4 percent within the same period.

While the number of preventive checkups rose — likely because the ACA made the appointments cost-free — problem-based visits, such as going to a primary care physician for sickness or injury, declined more than 30 percent, according to NPR.

Problem-based visits saw out-of-pocket costs increase 31.5 percent during the study period, which could have affected the decline, according to researchers. Additionally, visits to alternative sites like urgent care clinics grew by 46.9 percent in the study period.

“Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care,” the study authors concluded. 

 

 

 

Americans with coronavirus were flown home over CDC objections: report

https://thehill.com/policy/healthcare/483925-americans-with-coronavirus-flown-home-over-cdc-objections-report?utm_source=&utm_medium=email&utm_campaign=27749

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More than a dozen Americans who had tested positive for coronavirus and were flown home alongside others without the virus were transported despite objections from the Centers for Disease Control and Prevention (CDC), The Washington Post reported on Thursday.

The 14 Americans who tested positive were among more than 300 who arrived back in the United States earlier this week after being evacuated from the Diamond Princess cruise ship in Japan, which has been the center of scrutiny over a coronavirus outbreak on board.

When those individuals tested positive for the virus, U.S. officials had to make a choice as to whether to let them fly home alongside the other passengers.

The State Department and some Department of Health and Human Services (HHS) officials decided to allow it while the CDC objected, warning of the risk of the disease spreading on the plane, the Post reported.

The plane did have a plastic-lined enclosure that allowed the 14 people with the virus to be separated from the others, according to the newspaper.

The State Department and HHS explained the decision to allow the flights with sick passengers in a statement earlier this week, without mentioning the CDC objections.

The Post reported that the CDC asked to be taken off the press release.

“These individuals were moved in the most expeditious and safe manner to a specialized containment area on the evacuation aircraft to isolate them in accordance with standard protocols,” the departments said in the earlier statement.

“Every precaution to ensure proper isolation and community protection measures are being taken, driven by the most up-to-date risk assessments by U.S. health authorities,” they added.

All of the Americans evacuated from the cruise ship will be quarantined on military bases for 14 days to ensure they do not spread the disease to others.

 

 

 

House Democrats ask Trump to ensure affordability of future coronavirus vaccine

https://thehill.com/policy/healthcare/483888-house-democrats-ask-trump-to-ensure-affordability-of-future-coronavirus?utm_source=&utm_medium=email&utm_campaign=27749

House Democrats ask Trump to ensure affordability of future coronavirus vaccine

Dozens of House Democrats wrote to President Trump Thursday to ask that he ensure any future coronavirus vaccines and treatments be “accessible, available and affordable.” 

The Department of Health and Human Services (HHS) will help fund efforts by Janssen — a drug company owned by Johnson & Johnson — to create a coronavirus vaccine and treatment. HHS is also partnering with French drugmaker Sanofi to produce a potential coronavirus vaccine.

Rep. Jan Schakowsky (D-Ill.) led 45 House Democrats in warning that HHS should not give an exclusive license to any private manufacturer or risk making the vaccines or treatments unaffordable.

“Providing exclusive monopoly rights could result in an expensive medicine that is inaccessible, wasting public resources and putting public health at risk in the United States and around the globe,” the lawmakers wrote. 

“If HHS or any other federal agency moves forward with such a proposal, we urge you to instead issue a limited license and implement requirements that a vaccine or treatment be made available at an affordable price.”

The efforts are in the early stages, and it could take years for a vaccine to be available to the public. 

“Americans deserve to know that they will benefit from the fruits of their public investments,” the lawmakers wrote.

“That goal cannot be met if pharmaceutical corporations are given authority to set prices and determine distribution, putting profit-making interests ahead of public health priorities.”

But the concern from House Democrats comes as lawmakers increase their scrutiny of drugmakers over rising prescription costs.

“You have repeatedly called for action to lower drug prices and know that unjustifiably high drug prices are one of the most pressing public health concerns we face today,” the lawmakers wrote to Trump.

“We should not grant any manufacturer a blank check to monopolize a coronavirus vaccine or treatment developed with public, taxpayer support.”

 

 

 

Cartoon – Modern Health Insurance Coverage

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Cartoon – The Tin Plan

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Cartoon – Acme Health Insurance

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