Solving the Decision Bottleneck In Two Essential (But Not So Easy) Steps

Solving the Decision Bottleneck In Two Essential (But Not So Easy) Steps

Imagine a single organization from the perspective of two different cultures: Culture Accountability and Culture Bottleneck.

In Culture A (Accountability), things get done quickly and efficiently. Executive teams are cohesive and managers know what is expected. As a result, managers run a tight ship and are quick to course-correct any activity, behavior or process that doesn’t align with the shared mission and vision. Managers are confident that their decisions will be supported by the executive team. Conversations, both vertical and horizontal, are focused on both process and people; results and relationships. Those who do not fit the culture leave on their own accord.

In Culture B (Bottleneck), bottlenecks create frustration. Decisions seem to be an afterthought and lack of trust precedes the need to micromanage. Managers fear making decisions because their decisions are often overridden. Executives complain that their managers never get the job done. On the front lines, turf wars and internal drama erupt spontaneously. Uncertainty, unexpected change and chaos color the culture. Conversations are avoided and poor performance is justified until something major happens and firing is the only option.

“At most organizations, the bottleneck is at the top of the bottle.”– Peter Drucker

All other things considered, there are two components that distinguish Culture A from Culture B: Clarity and Communication.

1. Clarity: How and who makes decisions

In every single instance of time-wasting drama, no matter how it manifests, at the root is a lack of clarity in some form.

On the front lines, when employees are unclear about what success looks like, they lose confidence and waste productive hours getting reassurance and clarification — procrastinating when uncertain. At the highest level, lack of clarity about the real problem or the desired end result wastes time and resources hiring vendors and consultants offering “one and done” workshops or other ineffective solutions.

Even when there is clarity about the real problem, the end result and the process, a big road-block I often see is the lack of clarity about who is in charge and how decisions are made.

For context, let me share a quick example. Years ago I was on a project for a mid-sized corporation. My inside contact, a high-level director, had absolutely no power to push the project forward. Because of this fact, any work I did had to be approved by the top executive who would continuously change calendar dates and, in doing so, would “delegate” the date changing to the director, who had to navigate calendars and multiple dates. I estimate we wasted at least 40 productive hours chasing down the real decision maker to make a change instead of setting up one phone call.

Increasing clarity inevitably increases your productivity and speed. Here are some suggestions for increasing speed by increasing decision-making clarity.

What to start doing

  1. After identifying the real problem and the desired outcome, take the necessary time to agree on how decisions will be made among top executives. Whether you are a co-owner or a team of C-suite executives, your organization’s success and your peace of mind is dependent upon your maturity to clarify your decision-making processes.
  2. Have a plan in place to maximize efficiency and decision making for those times when change happens.
  3. Give real decision-making authority to those to whom you delegate power.

What to stop doing

  1. Stop going rogue on your senior partners. Before you make a major decision, get alignment from your executive team.
  2. Stop delegating when delegation creates a bottleneck. Instead, hire an assistant to do the grunt work and let your director-level people get their own work done.
  3. Stop complaining about your employees and team members. If you find yourself complaining, set a time on the calendar to confront the issue with the person (or people) who needs to hear the conversation.

2. Communicate: Initiate clear conversations

The number-one problem I see that slows progress and efficiency is the inability or unwillingness of leaders to initiate what I call executive conversations. Executive conversations (as I define them) are both results- and relationship-oriented.

Many drama-laden cultures adopt an either-or mentality: a mindset that it’s all about results — anything for a profit, or it’s all about relationships — avoiding conflict at all costs. Both mindsets create accountability-related issues.

In his bestselling book, Advantage, Patrick Lencioni says:

“Many leaders struggle with accountability but don’t know it. Some will tell me that since they aren’t afraid to fire people, they must not have an accountability problem. Of course, this is misguided. Firing someone is not necessarily a sign of accountability, but is often the last act of cowardice for a leader who doesn’t know how or isn’t willing to hold people accountable. At its core, accountability is about having the courage to confront someone about their deficiencies and then to stand in the moment and deal with their reaction which may not be pleasant.“

When there is a lack of accountability there is a lack of alignment, and when there’s a lack of alignment there’s a need for executive conversations.

What to start doing

  1. Increase your awareness of what is happening that should not be happening, and articulate it.
  2. Ask for the behavior or action you want directly and succinctly without blame.
  3. Keep the overall good of the organization in mind when you address the issue.
  4. State how the problem you perceive affects the revenues, productivity, team, client satisfaction or any other business case.

What to stop doing

  1. Stop holding grudges and realize that a grudge is a sure sign of a conversation that needs to happen.
  2. Get coaching support to learn how to initiate conversations that get results instead of resentment.
  3. Stop firing people before you’ve had the courage to have a couple of conversations. If you communicate effectively, they will either improve with some coaching, or they will eliminate themselves when they see they can’t cut the mustard. The good news is they will probably leave on friendly terms.

Conclusion

There are many factors that shape culture; however, it’s up to the senior leaders to eliminate the time-wasting bottlenecks that contribute to high-drama cultures. Get clear on the real problem and the desired end result. Clarify who is in charge and how decisions are made. Initiate executive conversations that are both relationship- and results-oriented to transform the Bottleneck Culture into a Culture of Accountability.

 

 

 

NC hospital system tries another megamerger

https://www.axios.com/newsletters/axios-vitals-f500be38-f71e-4984-955b-efc69e20a435.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for hospital market lack of competition

Atrium Health struck out a year ago when it attempted to merge with in-state rival UNC Health Care, Bob reports. Now, the hospital system has inked a new deal to combine with Wake Forest Baptist Health, which is 90 minutes away from its headquarters.

Why it matters: Research overwhelmingly shows these kinds of regional hospital mergers lead to higher health care prices (and, consequently, premiums) because providers gain negotiating leverage and make it harder for health insurers to exclude them from networks.

Between the lines: The primary hook that Atrium and Wake Forest are selling is that they would build a new medical school in Charlotte. Because who could be against more doctors and research?

  • The organizations didn’t mention how, or if, they would try to keep costs and prices down.
  • The combined system would have almost $10 billion of revenue, which is roughly the size of Boston Scientific.

 

THE SINGLE BIGGEST FACTOR IN LONG-TERM ORGANIZATIONAL SUCCESS

The Single Biggest Factor in Long-Term Organizational Success

“What ultimately constrains the performance of your organization is not its business model, nor its operating model, but its management model.” (The Future of Management, Gary Hamel)

Factors of organizational success:

Jim Collins says the key factors for success include:

  1. Getting the right people on the bus
  2. Getting the right people in the right seats.
  3. Getting the wrong people off the bus.
  4. Level 5 leadership – Humble leaders with indomitable will. (Good to Great)

Managers:

“Gallup finds that the quality of managers and team leaders is the single biggest factor in your organization’s long-term success.” (It’s the Manager)

Organizations ask, “How do managers get more out of people?”

“Ironically, the management model encapsulated in this question virtually guarantees that a company will never get the best out of its people. Vassals and conscripts may work hard, but they don’t work willingly.” Gary Hamel

Boss to coach:

The BEST managers are coaches, not bosses. Jim Clifton and Jim Harter say there are three requirements of coaching.

  1. Establish expectations.
  2. Continually coach.
  3. Create accountability.

3 tips for shifting from boss to coach:

#1. Understand the dance between freedom and intervention.

Give high performers freedom. Intervene when performance lags.

Intervention isn’t oppression or punishment. It might mean weekly one-on-ones, instead of monthly.

#2. Overcome the most difficult shift.

Solving problems for talented people devalues their talent. Over-helpfulness sucks the life out of talented people. Stop giving quick answers.

Coaches help people find their own answers. The old style of management, when people were tools, is to give them answers and expect conformity.

#3. Practice accountability that energizes people.

Accountability that energizes is self-imposed. We need to rise above the false notion that we can force people into high performance.

Noticing is healthy accountability. Walk around noticing performance as it relates to expectation.

Work that isn’t noticed goes down in value.

What factors enhance long-term organizational success?

How might managers bring out the best in people?

 

 

We Must Hold Big Pharma Accountable For Predatory Pricing

https://www.huffingtonpost.com/entry/opinion-beggelman-price-gouging_us_5ab45270e4b008c9e5f5c47f

 

It’s hard to remember now, but there once was a time when pharmaceutical companies were considered heroes, not villains.

In the 1920s, Dr. Frederick Banting and Charles Best discovered insulin could be purified and administered to diabetes patients via injection. Before this groundbreaking discovery, people living with diabetes were placed on starvation diets as a form of treatment, and many patients died.

Banting and Best understood the enormity of their discovery and considered insulin a public good. But as these researchers soon realized, insulin wouldn’t be able to save lives if patients couldn’t access it. They sold the rights to the drug to the University of Toronto for $1. The university, in turn, gave it to pharmaceutical company Eli Lilly for a 5 percent royalty so the company could manufacture at scale to meet the enormous demand. In 1923, insulin became widely available and saved countless lives, thanks to Banting and Best – and Eli Lilly.

Now, just under a century later, Eli Lilly and other insulin manufacturers are taking the exact opposite approach.

Big Pharma is pushing every scheme imaginable to squeeze money from the pockets of patients who need insulin to survive. Many with diabetes, faced with tripling insulin prices ($200 to $700 per month), are now forced to choose between life and rent. Some patients ― like 26-year-old Alec Raeshawn Smith, who aged out of his parents’ health insurance plan and whose job didn’t offer comprehensive coverage ― have died from a lack of affordable insulin.

Pharmaceutical companies can become heroes again, but only if they stop taking advantage of the patients who need them.

Eli Lilly says the company strives “to make life better for all those affected by diabetes around the world.” And because drug companies do save and improve lives (or, at least, are supposed to), the U.S. government allows them special privileges and protections. This includes tax breaks, government subsidies, extensive patent protection, free access to publicly funded scientific discoveries and more.

However, when drug companies use empty words to make promises they have no intentions of honoring, they do not deserve the public’s largesse.

Big Pharma has not shown any inclination to change its price gouging practices. On the contrary, drug companies continue to push higher costs despite the horrific impact this has both on human life and the U.S. economy. Price freezes in the U.S. are rare (and are exclusively voluntary). They also tend to be set at high levels, like the price “freeze” for the HIV drug Isentress, which caused a stir among HIV patients because of its exorbitant cost compared to competitive products.

Some companies have rolled back drug prices but typically only in response to public humiliation. Doctors at Memorial Sloan-Kettering publicly rejected Sanofi’s Zaltrap, a colon cancer drug, because it was priced twice as high as a competing product. Three weeks after the doctors’ announcement, Sanofi cut its price in half. This is why consumers shouldn’t be satisfied with price freezes; only rolling back prices will return us to reasonable drug costs.

Pharmaceutical companies do sometimes offer “solutions” to runaway drug prices, like value-based pricing and discount cards, but though these practices may help some, they are generally gimmicks meant to distract the public. Value-based pricing sets prices according to a drug’s perceived value rather than according to the actual costs of developing and manufacturing it. Such a practice can put a limit on the price of marginally effective drugs, but on the other hand, it increases the price of medications like insulin ― drugs that save lives but have been around for years and are cheap to produce. Discount cards are sometimes offered to a small subset of insured patients and do very little to help the vast majority of users or those who need the drugs most.

In the U.S., our 20 top-selling medications cost consumers three times more than the exact same drugs cost in Britain. I once paid $36 for a medication in Canada that costs me more than $700 here at home. In many European countries, government committees calculate “reference prices” for classes of drugs with similar ingredients, based on the costs to develop and manufacture them and their clinical effectiveness. That said, it’s probably not realistic to expect our politicians to agree to this kind of approach; in the U.S., pharmaceutical companies are some of the largest contributors to political campaigns, giving more than $2.3 billion over the past 10 years.

Big Pharma is pushing every scheme imaginable to squeeze money from the pockets of patients who need insulin to survive.

Our legislators, too afraid to challenge Big Pharma’s pocketbooks, continue to propose tepid solutions, like price transparency, that only work around the edges. Pharmacy benefit managers ― the industry middlemen who play a role in drug pricing ― take a piece of the pie, but how large a piece remains a secret. Legislation around transparency regarding undisclosed PBM deals could drive down drug prices somewhat, but it likely wouldn’t affect the baseline prices set by drug manufacturers.

The Right Care Alliance ― a group of patients, physicians, nurses, patient advocates, students and other community members with chapters around the country ― is currently organizing a campaign to target price gouging in the pharmaceutical industry. We are planning year-long grassroots actions, including town hall meetings, marches and demonstrations, to pressure Big Pharma to stop predatory pricing, particularly for life-saving medications.

We must force companies like Eli Lilly to address the gap between what they say they stand for and their actions. We must be loud with our demands to counterbalance the hold Big Pharma has on U.S. politics. Drug companies can become heroes again but only if they stop taking advantage of the patients who need them.

 

Tenet eliminates poison pill, adopts governance changes

https://www.beckershospitalreview.com/finance/tenet-eliminates-poison-pill-adopts-governance-changes.html

Image result for poison pill

Dallas-based Tenet Healthcare announced March 5 that its board of directors has approved several changes to the company’s corporate governance.

Here are five things to know about the changes.

1. The board approved changes to Tenet’s bylaws that allow shareholders with a 25 percent stake in the company to request a special meeting. The move comes after the board approved amendments to the company’s bylaws in January that allowed majority shareholders to request special meetings.

2. Tenet approved a short-term shareholder rights plan in August 2017, which was designed to protect $1.7 billion in net operating loss carryforwards and ensure the board could protect all shareholder interests as it executed CEO and board changes. Under the poison pill, if any person or entity acquired 4.9 percent or more of Tenet stock, all holders of rights issued under the plan are entitled to acquire shares of common stock with a 50 percent discount.

3. Tenet terminated the poison pill March 5. “The board made this decision based upon the reduced value of the NOL shareholder rights plan following recent tax law changes and an increase in the company’s stock price since the NOL shareholder rights plan was adopted, as well as shareholder feedback,” Tenet said in a statement. The poison pill was originally slated to expire following Tenet’s 2018 annual meeting of stockholders, which is typically held in May.

4. Tenet announced March 5 that it also eliminated the executive committee as a standing committee of the company’s board of directors.

5. “The board of directors and management have spent considerable time in recent weeks engaging with shareholders representing a majority of our outstanding stock and we received constructive input regarding Tenet and our objective to lead with best corporate governance practices,” said Ronald A. Rittenmeyer, executive chairman and CEO of Tenet. “We believe the actions which we are taking today demonstrate our continued commitment to being responsive in a timely manner to shareholder feedback and to implementing measures that increase transparency and accountability.”