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7 Examples of Shallow Leadership

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http://www.leadershipdigital.com/edition/daily-finance-career-2018-10-17?open-article-id=9085494&article-title=7-examples-of-shallow-leadership&blog-domain=ronedmondson.com&blog-title=ron-edmondson

Growing in our leadership abilities, including growing in the knowledge of leadership and the relational aspect of leadership, should be a goal for every leader.

Sadly, in my experiencee, many leaders settle for a sort of status quo leadership rather than stretching themselves to continually improve. They settle for mediocre quality of leading, fathering than attempting the hard work of leadership excellence. They remain oblivious to the real health of their leadership and the organizations they lead. They may get by – people may say things are “okay” leaders, but no one would call them exceptional leaders.

I have often referred to this style of leadership as shallow leadership.

Perhaps you’ve seen this before or maybe you’ve been guilty of providing shallow leadership. For seasons, at least, I am not too proud to admit I certainly have.

If you’re still wondering what shallow leadership looks like, let me offer some suggestions.

7 characteristics of shallow leadership:

Thinking your idea will be everyone’s idea. You assume everyone is on the same page with you. You think everyone thinks like you. That’s because you’ve stopped asking questions of your team. You have stopped evaluating everything. You aren’t open to constructive evaluation – of you.

Believing your way is the only way. You’re the leader- you must be right, right? Maybe you’ve had some success and it went to your head just a little. Perhaps you’ve become – or you’ve always been – a little stubborn or head strong. You may even be controlling. You have to make or sign off on every decision. You may never delegate. Those are all signs of shallow leadership, because you’ve likely shut out some of the best ideas within the organization – which reside among the people you are trying to lead.

Assuming you already know the answer. You think you’ve done it long enough to see it all, so you quit learning. You have stopped reading. You never meet with other leaders anymore.

Pretending to care when really you don’t. This is so common among shallow leaders. Shallow leaders have grown cold in their passion. They may speak the vision, but they’re just words on a page or hung on a wall now. They may even go through all the motions. They are still drawing a paycheck, but if the truth be known, they’d rather be anywhere than where they are right now.

Giving the response, which makes you most popular. Shallow leaders like to be liked. They never make the hard decisions, refuse to challenge, avoid conflict, and run from complainers. They ignore the real problems in the organization so things never really get better.

Refusing to make a decision. Often a shallow leader had a setback at some point. Things didn’t go as planned, so they’ve grown scared or overwhelmed and so they refuse to walk by faith. The team won’t move forward because the leader won’t move forward.

Ignoring the warning signs of poor health. This can be poor health in the organization, the team, or in the leader. Things may not be “awesome” anymore. Momentum may be suffering. Shallow leaders look the other way. And, again, it could be the leader. Your soul may be empty. You may be the one unhealthy. Or the team may be unhealthy. Shallow leaders refuse to see it or do anything about it.

We never achieve our best with shallow leadership. And, the first step is always to admit.

 

Health Care in America – The Experience of People with Serious Illness

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http://features.commonwealthfund.org/health-care-in-america?_ga=2.69920404.568922675.1539785477-833267550.1532293701

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Listening to People with Serious Illness

These are just a few of the many voices of people with serious illness. They express the bewilderment and the loss of control. They convey fear that the system is indifferent to their needs and that the cost of care is beyond their reach. They reflect the joy of feeling well enough to get back to the familiar parts of life.

Most Americans expect the health care system will deliver effective treatment and support them through trying times when they get sick. But in reality, health care in America sometimes hurts even as it helps. Appointments can be difficult to get. Clinics and emergency rooms are often overcrowded. Doctors’ recommendations can be confusing and difficult to follow. And when the bills arrive, the costs can be unexpected and devastating. More than 40 million adults in the United States experienced serious illness in the past three years. More than 41 million provided unpaid care to elderly adults during the past year.

Health Care in America: The Experience of People with Serious Illness, a project of the Harvard T.H. Chan School of Public Health, the New York Times, and the Commonwealth Fund, is examining the experiences of Americans with serious illness — the sickest of the sick — and those who help care for them. Our goal is to understand whether our health care system is doing all it can do not just to treat illness but to help people cope with illness. Where is the system failing to meet people’s needs? How is it adding to already heavy burdens? Can the most seriously ill Americans afford the care our health system delivers?

To help answer these and other questions, we surveyed nearly 1,500 Americans with serious illness and the friends or family members caring for them. We considered someone to have serious illness if, within the past three years, they had two or more hospital stays and visits with three or more doctors. Below we discuss what we found. We then point to opportunities to help ensure that American health care not only saves people but also supports them in their time of need.

Serious Illness: A Life-Altering Journey

People going through serious illness often experience profound loss: loss of control, loss of independence, loss of time, and the loss of capabilities that most of us take for granted. The physical, emotional, and financial toll can be life-altering. It can mean an end to the activities that give life pleasure; growing isolation from friends, family, and familiar places; and an inability to work or support others. And there is the worry of being a burden on family and friends.

People with serious illness experience distress over and above the physical symptoms of their specific condition. And our new survey reveals that many are distressed. Sixty-two percent feel anxious, confused, or helpless at some point. Nearly half have emotional or psychological problems. Social isolation, a known risk factor for worse health outcomes, is common, with one-third of respondents reporting feeling left out, lacking in companionship, or isolated from others.

Many people with serious illness want to continue working or continue to provide care for family and friends who need their help, but they face high hurdles. Nearly three of four have had problems related to work or their ability to care for others (Appendix 1). Half reported being unable to do their job as well as they could before. Twenty-nine percent lost a job or had to change jobs. Half reported wanting to work but being unable to do so.

Our Health Care System Often Adds to the Burden of Illness

It’s fair to say that several consequences of serious illness — the distress, isolation, confusion, and lost earnings — are simply part of being sick. In some cases, they are probably inevitable. But being sick in America also means carrying some burdens that our health care system foists upon us.

Americans have high expectations for their health care. Most believe that when serious illness strikes, their health professionals will be fully prepared to make a diagnosis and provide appropriate treatment. This belief is not wholly unwarranted, of course. News stories brim with pioneering medical advances. For people with what were once fatal and untreatable diseases, there are now cures. Once harrowing chemotherapy regimens have been replaced by pills taken once a day. New technologies are improving the quality of life for many people with serious disabilities.

A health care system that promises so much would seem capable of minimizing the burdens of illness and care, of helping people cope. But for too many, American health care does the opposite: it places unexpected and unnecessary burdens on the sick. People struggle to obtain effective treatments and services. Pervasive fragmentation and lack of coordination across the health system make obtaining services heavy labor for people with advanced illnesses or frailty.

How common are such problems for this vulnerable group? In our survey, six of 10 people with serious illness reported at least one problem receiving care (Appendix 2). The difficulties people reported are symptomatic of the confusing patchwork that is health care in the United States. Nearly a third of those with serious illness spoke of trouble understanding what their health insurance covered. Twenty-nine percent reported being sent for duplicate tests or diagnostic procedures by different doctors, nurses, or other health care workers. Twenty-three percent of respondents said they experienced a problem with conflicting recommendations from the health professionals that saw them. One of five had difficulty understanding a doctor’s bill — a confusion not just about the costs of care but about what services were provided.

Unnecessary tests and procedures are not only redundant and costly. They carry their own risks to health. Safety in health care is, in fact, an ongoing challenge, especially for patients requiring complex care plans. Nearly one of four adults in our survey reported a serious medical error in their care. We know from other studies that people with serious illness are especially prone to diagnostic errors, prescribing errors, and communication mishaps. Every doctor and many patients can recall missed abnormal lab results, failure to account for allergies, and lost information that led to terrible side effects, or even death.

Paying for Care: Teetering on the Edge of Financial Ruin

Health care can be extraordinarily expensive for anyone, but especially so for people with serious illness. Millions of Americans are ruined financially by the costs of their treatment. Although most survey respondents reported having insurance coverage, nearly one in 10 were uninsured. Even with coverage, many are not adequately protected from health care costs. More than half of people with serious illness in our survey (representing more than 21 million people) experienced one or more dire financial consequences related to their care (Appendix 3).

Apart from its sometimes lasting health consequences, serious illness also appears to cause long-term financial problems for many. More than one-third of survey respondents used up most or all of their savings. Nearly one-quarter were unable to pay for basic necessities like food, heat, or housing. Nearly a third were contacted by a collection agency for unpaid bills. And the financial consequences are not felt by patients alone. More than one in four survey respondents reported that the costs of care placed a major burden on their family.

What Can Be Done to Improve the Experience of the Seriously Ill?

The burdens described above are not an inevitable companion to serious illness. They are a consequence — at times inadvertent, but no less real — of how our health system operates today. But things could be different. It is fully within our means as a nation to improve the experience of the millions of Americans living with serious illness and the millions more who help care for them.

In fact, strategies for delivering a better health care experience — one that ensures comprehensive, holistic care while always respecting the dignity of the individual — already exist. They just need to be adopted on a much wider scale.

  1. Build the capacity to identify and manage the behavioral health needs of patients and their caregivers. Integrating behavioral health services into medical care requires more than simply improving communication among siloed professionals. Multidisciplinary care teams that include behaviorists, social workers, and patients working together can ease the sense of helplessness, the loss, and the social isolation that seriously ill people commonly experience.
  2. Assess and address social service needs. Our findings illustrate that the impact of serious illness extends well beyond the medical realm. Many people cannot work while dealing with a life-threatening condition. This means fewer resources at a time when expenses can increase dramatically. Access to and support for reliable transportation, supportive housing, nutritious meals, and other services are critical to helping the seriously ill maintain a level of well-being.

  3. Make it easier for patients, caregivers, and professionals to work in close coordination with one another. Patients want their clinicians and other providers to talk to each other — and they want in on the conversation, too. Providers can improve communication with each other, with patients, and with caregiving family members and friends by taking full advantage of advances in consumer-friendly digital tools like secure texting, email, telehealth, and social media platforms. Coordination could be further enhanced by care managers or community health workers who check in on patients and caregivers between appointments and connect them to needed services.
  4. Make care more affordable. Universal health insurance coverage is a fundamental protection against the cost of unexpected illness. It not only guards against the threat of financial ruin but minimizes the costs incurred by everyone else when sick people who are uninsured (or underinsured) show up in emergency rooms or hospitals, which by law must treat everyone in need of care. Guaranteed coverage of preexisting conditions is especially important to those who have experienced serious illness and would otherwise be denied coverage by insurers. Keeping out-of-pocket costs like copayments and coinsurance reasonable not only prevents bills from going unpaid but makes it easier for patients to stick with their preventive care regimen, avoid repeated emergency room visits and hospitalizations, and maintain progress in their treatment.

Conclusion

Americans have high expectations for their health system. They spend more than the citizens of any other country with the hope that the right care will be there for them when serious illness strikes. But along with the treatments and services that can improve life for the seriously ill come an unwanted and unnecessary set of physical, emotional, and financial burdens. These burdens result from the choices made by policymakers, practitioners, payers, and others. Listening to the voices of people with serious illness, reckoning with the human costs of our current system, and lifting the burdens that health care places on us when we become sick may be the most important work health care can undertake.

 

Is Medicare for All the Answer to Sky-High Administrative Costs?

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Is Medicare for All the Answer to Sky-High Administrative Costs?

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Calls for a Medicare for All system are growing louder. Many Democrats have embraced it, while President Trump said last week that it would raise health care costs drastically.

Democrats say that giving people the option to partake in Medicare — no matter their age — will actually cut costs.

American administrative costs for health care are the highest in the world, and they argue that one advantage of Medicare for All is that it would save money because Medicare’s administrative costs are below those of private insurers.

Does that argument hold up?

Medicare’s administrative costs were $8.1 billion last year, or 1.1 percent of total spending, close to the proportion it has been in recent years.

But some have argued that the actual cost is higher because of services performed for Medicare by other parts of the government that aren’t accounted for: The Social Security Administration collects premiums, the Internal Revenue Service collects taxes for the program, the F.B.I. provides fraud prevention services, and at least seven other federal agencies and departments also do work that benefits Medicare.

The claim that these administrative costs are overlooked is false. As annual reporting of Medicare’s finances plainly states, they are accounted for.

But there is something missing from the $8.1 billion Medicare administrative cost figure, as Kip Sullivan explains in a 2013 paper published in the Journal of Health Politics, Policy and Law. Although it accurately accounts for the federal government’s administrative costs, it does not include those borne by private plans that also offer Medicare benefits.

In addition to the traditional (public) Medicare plan, Medicare is also available from private plans through the Medicare Advantage program. Today, one-third of people using Medicare are in such plans, up from about one-fifth a decade ago. Moreover, all Medicare drug benefits are administered through private plans.

National Health Expenditure data shows both the government’s administrative costs for Medicare and those of Medicare’s private plans. Putting them together for the most recent year available (2016), they reach $47 billion, or 7 percent of total Medicare spending — well above the administrative costs borne directly by the Medicare program.

Medicare’s private drug benefit plans incur administrative costs that are about 11 percent of their spending. All of this additional, private administrative cost is paid for by taxpayers and, through their premiums, people who use Medicare.

Medicare’s direct administrative costs are not only low, but they also have been falling over the years, as a percent of total program spending. Yet the program’s total administrative costs — including those of the private plans — have been rising.

“This reflects a shift toward more enrollment in private plans,” Mr. Sullivan said. “The growth of those plans has raised, not lowered, overall Medicare administrative costs.”

Making an accurate estimate of the administrative costs of Medicare for All would depend, in part, on whether it would be more like an expansion of traditional Medicare (with its 1.1 percent administrative cost rate) or of all of Medicare, including its private plans (with a combined 7 percent administrative cost rate).

Yet both figures are well below private insurers’ administrative costs, which run about 13 percent of spending (this also includes profit), according to America’s Health Insurance Plans, an advocacy organization for the industry.

Some critics have argued that Medicare’s administrative cost rate appears artificially low because Medicare enrollees’ health spending is so high. Average Medicare spending per beneficiary is just over $12,000 per year; for an average worker in a private plan, it’s about $6,000. If you simply divide administrative costs by total spending, you will get a lower number for Medicare for this reason alone.

This is true, but the government’s administrative costs for Medicare are still below those of private plans. The government’s administrative costs are about $132 per person compared with over $700 for private plans. One reason Medicare’s are so much lower is that it reaps economies of scale. It also benefits from not needing to do much marketing, and it doesn’t earn profits.

The Dose, Episode Two: A Menu of Medical Prices

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https://www.commonwealthfund.org/alert/22431?omnicid=EALERT1489433&mid=henrykotula@yahoo.com

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In this episode of The Dose  — the Commonwealth Fund’s new health policy podcast — host Shanoor Seervai speaks with Natacha Lemaire, a French citizen who spent a year in the U.S. for a fellowship and experienced surprise and frustration as she learned to navigate the U.S. health system.

Coming from France, where everyone has coverage, Natacha was struck by the high costs of care in the U.S., the lack of transparency around prices, and the frequency with which medical tests were ordered.

The Dose will get you up to date on the latest research, personal stories about health care and the health system, and innovations that could make life easier for patients, family, and caregivers.

Click here to listen, and then subscribe wherever you get your favorite podcasts.

 

 

Doctors Like to Think Big Pharma Doesn’t Sway Them. It Does

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https://www.bloomberg.com/view/articles/2018-10-04/doctors-often-don-t-see-conflict-of-interest-in-drug-company-cash?srnd=opinion

Doctors Like to Think Big Pharma Doesn’t Sway Them. It Does.

Doctors, when surveyed, say they are opposed to the very idea of skewing their prescribing practice in favor of companies giving them money. The problem is, they still take lots of money in the form of honoraria, speaking fees, research grants, and outright gifts from pharmaceutical and medical device companies. Research suggests they can then fail to recognize that they’ve been influenced.

Psychologists George Loewenstein and Don Moore argued in a 2004 paper that while people consciously think about their professional obligations, the other half of a conflict — self-interest — is “automatic, viscerally compelling and often unconscious.” That theme keeps returning in more recent research.

As MD turned ethics professor Sunita Sah of Georgetown University concluded in a review paper, even if doctors don’t recognize what’s going on, those in the pharmaceutical industry understand social psychology and know what works. Reciprocity is a part of human nature, and field studies have shown that doctors change their practices to reciprocate gifts and favors. Those who ultimately lose in this game are the patients, who are at risk of prescriptions that are not entirely in their best interest.

Every once in a while an extreme case leads to a dramatic downfall. That happened recently when a New York Times/ProPublica story revealed that Memorial Sloan Kettering Cancer Center’s chief medical officer Jose Baselga had accepted millions from industry and then written numerous scientific papers without disclosing financial ties to the companies whose products he was studying.

He resigned within days. The larger problem remains: Conflict of interest is the norm in medicine. According to a 2007 survey, 94 percent of physicians had some sort of industry ties. And as Sah and other social scientists have shown in their research, this can bias their behavior even as they insist they are above it.

Sense of entitlement is a big factor in physicians’ acceptance of industry money. In one study she co-wrote with Loewenstein, doctors were more likely to agree they would accept industry payments when they were reminded of their sacrifices — years of medical school, debt incurred, sleep deprivation when on call. She compared the attitude to that expressed in the famous commercial for L’Oreal hair products: “I’m worth it.”

In addition to the lure of money, pharma and medical device companies can appeal to physicians’ egos by anointing them “key opinion leaders.” In one of her papers, Sah quotes one such leader, a psychiatrist, saying: “It strokes your narcissism. … The first thing they do is take you to a really nice hotel. And sometimes they pick you up in a limo, and you feel very important, and they have really, really good food.”

In another study, which examined conflict of interest and bias across professions, Sah and Lowenstein showed that people were less likely to offer biased, self-serving advice when they worked with individuals, known by name. In experiments, subjects designated as advisers could guide advisees in a number estimation game — the adviser having access to more information than the advisees. The advisers could benefit from causing advisees to make an overestimate, while the advisees benefited from getting the number right.

When they were giving advice to individuals, advisers were less likely to act selfishly. When dealing with groups, self-interest became a bigger factor, though subjects weren’t aware of the change. They reported afterward that they were unbiased and gave good advice. In interpreting the findings, the researchers suggested that in doctor-patient relationships, empathy might guide decisions. But people have more trouble feeling empathy toward nameless groups, as they would in, say, making clinical guidelines or public health recommendations. Grants for studies also appears to create a bias. Industry-funded studies are more likely than independent ones to show a product is effective, according to a 2017 review.

Disclosure rules are supposed to limit the damage, but other studies show they don’t help much. In a 2005 paper, researchers argued that advisers feel “morally licensed and strategically encouraged” to give even more erroneous or exaggerated advice once a conflict was disclosed. In another paper, Sah and colleagues showed that patients were just as likely to take advice after a conflict-of-interest disclosure. Some thought that if a doctor owned a stake in an imaging center, for example, then he or she must have expertise. Others reported they felt awkward about refusing. After a conflict-of-interest disclosure, she said, “advice can be harder to turn down because it suggests you think the doctor is biased and corrupt.”

The main benefit is that disclosure rules can discourage providers from taking money that creates a conflict in the first place. There is hope, however, that doctors can be more principled than other kinds of advisers. In a recent study, volunteers were asked to play the role of either doctors or financial advisers and were placed in a conflict situation where they could make money at the expense of advisees. Those who were reminded of their responsibility as doctors gave less selfish advice, and those reminded of their role as financial advisers gave more selfish advice. When researchers carried out the same experiment with real doctors and financial advisers, Sah said, they got pretty much the same result.

So maybe doctors are a little special after all, in that they work by professional standards that put patients’ well-being above fancy dinners, prestige and the almighty dollar. But with drug companies and others cleverly playing to doctors’ selfish desires, they may sometimes need a reminder.