A San Jose jury convicted Theranos founder Elizabeth Holmes on four counts of fraud, deciding that she lied to investors while raising more than $700M in funds for the company. Holmes was found not guilty on four other counts relating to defrauding patients, though Theranos ended up voiding tens of thousands of erroneous test results. Each conviction carries a maximum twenty-year sentence, although Holmes is widely expected to appeal.
The Gist: It’s rare that tech executives are convicted of fraud. Investors, including many health systems, have been flooding healthcare startups with large sums of cash in hopes of big returns. But the Theranos debacle is a reminder that Silicon Valley’s “fake it till you make it culture” is not always the best fit for healthcare. Providers must continue to hold new medical technologies to high standards, regardless of how much promise they hold to “revolutionize” aspects of patient care.
When COVID volumes waned in the spring and early summer, most health systems “de-escalated” dedicated COVID testing and triage facilities. But with the Delta variant surging across the country, consumers are now once again looking for services like drive-through testing, which is perceived as more convenient and safer.
One physician leader told us patients in the ED are asking why the hospital got rid of the “COVID tent”, which provided a separate pathway for patients with respiratory and other COVID symptoms—and a highly visible signal that the rest of the department was as COVID-free as possible.
Another system is now fielding questions from the media about whether they’ll bring back their dedicated COVID hospital: “We spent a lot of time last year convincing the community that the dedicated hospital was key to safely managing care during the pandemic. Now we’ve got almost as many COVID admissions spread across our hospitals.”
Over the past year, providers have learned how to safely manage COVID care and prevent spread in healthcare settings—but consumers may perceive the lack of dedicated facilities as a decline in safety.
Unlike last year, hospitals are full of non-COVID patients, as those who delayed care reemerge. And with the current surge likely to continue into flu season, emergency rooms will only get more crowded, necessitating a new round of communication describing how hospitals are keeping patients safe, and reassuring patients that healthcare settings remain one of the safest places to visit in the community.
A physician leader asked recently whether we saw many health system executive teams work remotely throughout the pandemic. At her system, nearly every non-clinical leader worked mostly from home. “It seemed like two of our executives spent most of last year at their vacation homes,” she shared. “I know that we were being socially distant, but when our CEO held a virtual town hall from his beach house, it felt really tone deaf to our doctors and nurses.” In our experience, we saw most leaders spending many days in the office, even if some meetings were on Zoom. One
CEO mentioned he felt compelled to come to his office, even if it meant working alone: “If the people working on the front lines came in, I felt I needed to come in. And in the rare case someone needed to connect in person, they knew I was there.” There is power in just being visible to caregivers.
One recently retired CEO shared that he knew colleagues who rarely stepped into a hospital during the pandemic, missing a critical leadership opportunity. “No one expects the CEO to be hanging out in the COVID unit,” he shared.
“But being in our facilities, not just in the office, to hear directly from frontline workers and express gratitude, was so important—and caregivers remember that.” Now fully vaccinated, most health system leadership teams are back in the office. To remain competitive, health systems will likely need to create models that allow some non-clinical associates to work virtually—which will require evolution of cultures long centered around in-person collaboration.
I went out on a social event with a hospital CFO. During the course of the day, it seemed that all I heard was griping about the CEO. Then I heard that the organization was ‘giving back’ most of the last year’s gains, how most of the leadership team were idiots, and on and on. Finally, I told my friend that I thought he was in burn-out and that if he did not do something to alleviate the stress he was bearing, things were not going to end well. A couple of weeks later, I received a call from my friend. The conversation started with, “You will not believe what just happened.” My answer was, “How many guesses do I get?”
In hindsight, it was easy to see this transition coming. I know. It has happened to me – more than once. The circumstances, emotions, and process leading up to a transition event are relatively consistent in my experience. People stop listening to you. You start feeling out of touch with the rest of the organization. Your relationships with peers begin to cool, especially the relationship with the boss. You learn that you are increasingly not invited to important meetings or summoned to participate in matters that are clearly within your scope. You begin to sense divergence of political and or philosophical views with the core leadership of the organization. Your boss and others start going around you to approach your staff directly.
These processes continue until you get invited to an unscheduled meeting where you learn that you are about to be freed up to seek other opportunities.
First, a disclaimer. I am assuming that the termination is not for cause, i.e., violation of policy, violation of the law, or behavior unbecoming. The majority of separations and terminations I am familiar with have little if anything to do with cause and occur primarily because of lack of fit or growing disagreement between the incumbent and their manager regarding the organization’s course. Sometimes, the incumbent’s area of responsibility is no longer meeting the needs of the organization. Too often, internal corporate politics are responsible for deals that started well souring. Sometimes, a transition follows an executive, usually but not always the CFO, digging in over their interpretation of the organization getting too close to crossing a compliance red line. Instead of greasing the squeaky wheel, the organization decides to address the problem by getting rid of the irritant. I have been in a situation more than once where I had to decide whether my integrity was for sale and what a fair price might be. In every case, I elected to avoid the disaster that has befallen executives that flew too close to the OIG’s flame, and in one case, it led to a separation from the organization.
One of my favorite Zig Ziglar quotes is, “Failure is an event; it is not a person.” Just because someone ends up in a transition does not mean by definition that they are a terrible person. Time and again, in these blogs, I have stipulated that for me to follow someone that was ‘bad’ in some way is extremely rare. In these articles, I address termination from the view of the ‘victim.’
I am speaking from experience writing this as I have been through an unplanned transition more than once. I know my problem; I get frustrated with politics, BS, sub-optimization, the toxicity of culture, and eventually lose my sense of humor or ability to eat crap without gagging. Not too long after I start telling people what I really think and, . . . . well, you know the rest of the story. What I believe is a growing risk of being an employee is why I decided to leave permanent employment and become a career Interim Executive Consultant. Regardless of the cause of a turnover event, it is gut-wrenching. Even if you sense it coming, it is no easier to bear. In a matter of a few minutes, you go from someone whose expertise and perspective are in high demand to someone that has no reason to get out of bed. The pain is increased exponentially by those that used to dote on you refusing to return phone calls or answer emails.
More than once, I have received a call from someone looking for help because their deal either has gone bad or is in the process of deterioriation. Invariably, a few weeks later, I get the call. Upon answering the phone, the conversation starts, “You aren’t going to believe what just happened to me!” My first thought is not again! It pains me almost as much to witness someone else go through a transition as it is to go through it yourself. As I said before, my response is, “How many guesses do I get?” I ask this question with a high degree of certainty that the answer is a forgone conclusion.
Sadly, people going through a transition process do not fully appreciate what they are facing, especially the first time. The first problem is the amount of time the executive is going to be unemployed. When this happened to me the first time in the ’80s, I was shocked when a mentor told me to expect a month for each $10,000 of pre-transition compensation. I could not believe this was possible, but I have seen it happen time after time. With the inflation that has occurred since then, a good rule of thumb is probably a month for each $20,000 of pre-transition compensation. Thinking back to my principle that the time to start planning for a transition is now, one of the things to be prepared for is up to a year of interruption in income unless you are fortunate enough to have a severance agreement.
Contact me to discuss any questions or observations you might have about these articles, leadership, transitions, or interim services. I might have an idea or two that might be valuable to you. An observation from my experience is that we need better leadership at every level in organizations. Some of my feedback comes from people who are demonstrating an interest in advancing their careers, and I am writing content to address those inquiries.
I encourage you to use the comment section at the bottom of each article to provide feedback and stimulate discussion. I welcome input and feedback that will help me to improve the quality and relevance of this work.
If you would like to discuss any of this content, provide private feedback or ask questions, you can reach me at email@example.com.
Hardly one month into 2021, the pressing priorities facing healthcare leaders are abundantly clear.
First, we will be living in a world preoccupied by COVID-19 and vaccination for many months to come. Remember: this is a marathon, not a sprint. And the stark reality is that the vaccination rollout will continue well into the summer, if not longer, while at the same time we continue to care for hundreds of thousands of Americans sickened by the virus. Despite the challenges we face now and in the coming months in treating the disease and vaccinating a U.S. population of 330 million, none of us should doubt that we will prevail. Despite the federal government’s missteps over the past year in managing and responding to this unprecedented public health crisis, historians will recognize the critical role of the nation’s healthcare community in enabling us to conquer this once-in-a-generation pandemic.
While there has been an overwhelming public demand for the vaccine during the past couple of weeks, there remains some skepticism within the communities we serve, including some of the most-vulnerable populations, so healthcare leaders will find themselves spending time and energy communicating the safety and efficacy of vaccines to those who may be hesitant. This is a good thing. It is our responsibility to share facts, further public education and influence public policy.COVID-19 has enhanced public trust in healthcare professionals, and we can maintain that trust if we keep our focus on the right things — namely, how we improve the health of our communities.
And as healthcare leaders diligently balance this work, we also have a great opportunity to reimagine what our hospitals and health systems can be as we emerge from the most trying year of our professional lifetimes. How do you want your hospital or system organized? What kind of structural changes are needed to achieve the desired results? What do you really want to focus on? Amid the pressing priorities and urgent decision-making needed to survive, it is easy to overlook the great reimagination period in front of us. The key is to forget what we were like before COVID-19 and reflect upon what we want to be after.
These changes won’t occur overnight. We’ll need patience, but here are my thoughts on five key questions we need to answer to get the right results.
1. How do you enhance productivity and become more efficient? Throughout 2021, most systems will be in recovery mode from COVID’s financial bruises. Hospitals saw double-digit declines in inpatient and outpatient volumes in 2020, and total losses for hospitals and health systems nationwide were estimated to total at least $323 billion. While federal relief offset some of our losses, most of us still took a major financial hit. As we move forward, we must reorganize to operate as efficiently as possible. Does reorganization sound daunting? If so, remember the amount of reorganization we mustered to work effectively in the early days of the pandemic. When faced with no alternative, healthcare moved heaven and earth to fulfill its mission. Crises bring with them great clarity. It’s up to leaders to keep that clarity as this tragic, exhausting and frustrating crisis gradually fades.
2. How do you accelerate digital care? COVID-19 changed our relationship with technology, personally and professionally. Look at what we accomplished and how connected we remain. We were reminded of how high-quality healthcare can go unhindered by distance, commutes and travel constraints with the right technology and telehealth programs in place. Health system leaders must decide how much of their business can be accommodated through virtual care so their organizations can best offer convenience while increasing access. Oftentimes, these conversations don’t get far before confronting doubts about reimbursement. Remember, policy change must happen before reimbursement catches up. If you wait for reimbursement before implementing progressive telehealth initiatives, you’ll fall behind.
3. How will your organization confront healthcare inequities? In 2020, I pledged that Northwell would redouble its efforts and remain a leader in diversity and inclusion. I am taking this commitment further this year and, with the strength of our diverse workforce, will address healthcare inequities in our surrounding communities head-on. This requires new partnerships, operational changes and renewed commitments from our workforce. We need to look upstream and strengthen our reach into communities that have disparate access to healthcare, education and resources. We must push harder to transcend language barriers, and we need our physicians and medical professionals of color reinforcing key healthcare messages to the diverse communities we serve. COVID-19’s devastating effect on communities of color laid bare long-standing healthcare inequalities. They are no longer an ugly backdrop of American healthcare, but the central plot point that we can change. If more equitable healthcare is not a top priority, you may want to reconsider your mission. We need leaders whose vision, commitment and courage match this moment and the unmistakable challenge in front of us.
4. How will you accommodate the growing portion of your workforce that will be remote?Ten to 15 percent of Northwell’s workforce will continue to work remotely this year. In the past, some managers may have correlated remote work and teams with a decline in productivity. The past year defied that assumption. Leaders now face decisions about what groups can function remotely, what groups must return on-site, and how those who continue to work from afar are overseen and managed. These decisions will affect your organizations’ culture, communications, real estate strategy and more.
5. How do you vigorously hold onto your cultural values amid all of this change? This will remain a test through 2021 and beyond. Culture is the personality of your organization. Like many health systems and hospitals, much of Northwell’s culture of connectedness, awareness, respect and empathy was built through face-to-face interaction and relationships where we continually reinforced the organization’s mission, vision and values. With so many employees now working remotely, how can we continue to bring out the best in all of our people? We will work to answer that question every day. The work you put in to restore, strengthen and revitalize your culture this year will go a long way toward cementing how your employees, patients and community come to see your organization for years to come. Don’t underestimate the power of these seemingly simple decisions.
While we’ve been through hell and back over the past year, I’m convinced that the healthcare community can continue to strengthen the public trust and admiration we’ve built during this pandemic. However, as we slowly round the corner on COVID-19, our future success will hinge on what we as healthcare organizations do now to confront the questions above and others head-on. It won’t be quick or easy and progress will be a jagged line. Let’s resist the temptation to return to what healthcare was and instead work toward building what healthcare can be. After the crisis of a lifetime, here’s our opportunity of a lifetime. We can all be part of it.