Take off your clothes?


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Abstract:  This article takes a look at the role of culture in organizational performance.

It has been a while since I have written for my blog.   I’ve been a little busy on an engagement that has taken a lot of my time.   One of the most challenging aspects of working with organizations in transition is dealing with culture.   I have written a lot about culture in my blog and it continues to be one of the most vexing aspects of leadership and Interim Executive Consulting.    The following story is true and it happened almost spontaneously.   I now use this experience to make a point that people will remember about how they allow their cultural limitations to limit their capability.

I was listening to a group of managers debating the hospital’s preparedness for a regulatory survey.   Concern was being expressed about the fact that there were multiple known deviations from standards.   The longer I listened to this, the more frustrated I became.   At the breaking point of my patience, I stood up and said, “OK, that’s enough.”  “Everyone in the room, take off your clothes.”  The shock and awe were palpable.   People sat staring at me as they tried to comprehend what they had just heard.   I said, “I’m serious.   Everyone.   Take off your clothes right now.”  My audience was dumbfounded.   I suspect some of them were wondering if the psychiatrist was in the building.

I said, “Let me ask you folks a question.   If I continue to press this point, my prediction is that at least one of you will take the position that you will not take off your clothes.   You will refuse to do this because you have modesty, morals, ethics, decency and or religious convictions upon which you will base your refusal.”  My question was, “If you have standards that prevent you from taking your clothes off when all that is involved is a simple violation of modesty, how do you rationalize having knowledge of regulatory deficiencies in your areas of responsibility and not having done enough to resolve them when patient safety may be compromised?”  Remember the movie, ‘A Few Good Men?’  Tom Cruise asked, “Can you explain this?”

And so, I had another head-on collision with entrenched dysfunctional culture.   Several years ago, I had the privilege of doing work with Northside Hospital in Atlanta.   Northside’s culture as it relates to regulatory compliance is very simple:  Every department is expected to operate 100% compliant with applicable standards 100% of the time.   As a result, a compliance survey is or should be a non-event at Northside.   This is dramatically different from the culture in other hospitals I have worked in that go through episodes of horror when they are in the survey window and word comes that surveyors have been spotted in the next town.   These hospitals have a culture that says it is OK to have a laissez-fair attitude and approach toward regulatory compliance until they think they might be surveyed.  Then there is a mad rush to get into compliance.

I told the leadership team that the Board of Trustees had decided to commit the hospital to applicable accreditation standards.   Therefore, the question as to whether or not managers are expected to follow regulations is off the table.   Anyone that does not agree with this position of the Board should ‘punch the clock and get over the hill,’ as my dad would say.   I went on to tell the group that in deciding to comply with regulatory standards, the Board had a reasonable right to expect that the standards were being followed on a continuous basis and not just when the hospital was in the survey window.

I told the group that I needed a volunteer, someone that could explain to the Board if the survey turned out as bad as they predicted, how the organization had developed a culture of tolerance of areas of non-compliance with so many standards.   To my chagrin, I did not get a volunteer.   I told the group that this depressed me so much that I was going to go to the store, buy a bottle of wine and drink the whole thing, I was then going to bring the bottle back to the next meeting and use it to play spin the bottle to determine who the spokesman from the group to the Board would be.  I then exited the room.

Over the next couple of weeks, the leadership team of the organization responded admirably.   There was no need to go back to the meeting to play spin the bottle.   Every manager of every department went to work, around the clock in some cases to bring their areas into compliance with regulations.   Sure enough, in less than two weeks, the surveyors showed up.   The hospital had one of the best if not the best surveys in its history.

Was this result due to me making a speech?  I don’t think so.   All I did was challenge the hypocrisy of a dysfunctional culture that in some cases could potentially jeopardize patient safety.   What changed was that a group of managers decided independently that they were no longer going to be associated with substandard compliance in their areas of responsibility.   There is a one-liner that states that “You don’t have to move all of the cattle to change the direction of a herd.   All you have to do is to change the direction of the lead steer.”  Peer influence in an organization is extremely powerful.   This is what led me to redefine my own  understanding of the word ‘culture.’  Webster defines culture as the beliefs, customs, arts, etc., of a particular society, group, place, or time: a particular society that has its own beliefs, ways of life, art, etc.: a way of thinking, behaving, or working that exists in a place or organization.   I define culture as the lowest level of excellence a group will accept as tolerable and normal.   Groups in my experience do a very good job of enforcing the culture of the organization on their peers for better or worse.   When a group decides to hold itself to a higher level of performance or rejects the mediocrity that has held it back, its performance improves measurably.

So, I conclude with questions for you.   To what degree are you being limited by the culture that is surrounding you in your present situation?  What are you doing to change the culture?  Do you have the support you need to get the culture from where it is to where it needs to be?

Remember my challenge to take off your clothes.   Give some thought to where you will draw the line when it comes to the level of mediocrity you will accept and tolerate.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general.  As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the U.S., I might have an idea or two that might be valuable to you.  I can also help with career transitions or career planning.

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If you would like to discuss any of this content or ask questions, I may be reached at ras2@me.com.  I look forward to engaging in productive discussion with anyone that is a practicing interim executive or a decision maker with experience engaging interim executives in healthcare.

Temple University Health System hires restructuring officer for potential sale


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Philadelphia-based Temple University’s board of trustees announced June 20 the institution will hire a chief restructuring officer for its affiliated health system, and is considering the potential sale of two of its hospital assets, according to The Inquirer.

Temple University President Richard Englert and Temple University Health System CEO Larry Kaiser, MD, said in a joint statement to the community TUHS “faces significant operational and financial challenges. More must be done to maintain a viable and sustainable healthcare enterprise in a highly competitive and volatile market,” according to the report.

Officials also said the health system is considering the sale of Jeanes Hospital and the Fox Chase Cancer Center, both in Philadelphia.

The Inquirer reports Temple University Health System incurred a net loss of $31.1 million in the nine months ended March 31, compared to the system’s $19.9 million loss the year prior.


CEO, CFO of Missouri hospital resign over inappropriate reimbursements


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The CEO and CFO of Ranken Jordan Pediatric Bridge Hospital in Maryland Heights, Mo., have resigned after the hospital board discovered the executives violated the hospital’s paid time off policy, according to the St. Louis Post-Dispatch.

The hospital board requested and accepted the resignations of president and CEO Lauri Tanner and vice president and CFO Jean Bardwell, effective May 2, according to the report.

In a statement to the St. Louis Post-Dispatch, the hospital said the two executives were allegedly paid for time off “to which they were not entitled.” The hospital said the board is demanding Ms. Tanner and Ms. Bardwell repay the hospital, but it did not disclose the amount of inappropriate reimbursement the executives allegedly received.

The board’s executive committee initially identified the potential irregularities, and the board subsequently launched an investigation, which allegedly revealed the two executives violated hospital policy, according to the report.

To help prevent a similar issue from occurring in the future, the hospital has put corrective measures in place.

Ranken Jordan Pediatric Bridge Hospital COO Brett Moorehouse has been named interim president and CEO, and a hospital board member will serve as interim CFO, according to the St. Louis Business Journal.


Operator to bar New York hospital CEO, CFO and COO from expensing bi-yearly trips to Cayman Islands


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East Meadow, N.Y.-based Nassau Health Care Corp. officials expect to pass a resolution March 8 barring East Meadow-based Nassau University Medical Center officials from traveling to the Cayman Islands twice a year and charging the hospital for expenses incurred on the trip, according to Newsday.

George Tsunis, chairman of the board of Nassau Health Care Corp., which operates NUMC, told the publication the proposal is part of a series of resolutions to cut costs at NUMC, prevent corruption and make the public more aware of executives’ actions.

Nassau Health Care Corp. created a limited liability company, called NHCC LTD, in the Cayman Islands for tax purposes to self-insure for malpractice and general liability claims, according to the report. Company officials must meet outside the U.S. at least once a year to maintain the Cayman Islands location. NUMC’s CEO, COO, and CFO were all named to NHCC LTD’s board, and previously traveled to the islands for two weeks out of the fiscal year to discuss the company’s financial and operational activities.

Under the proposal, two NUMC executives will meet once a year for one day at an offshore location, such as a Canadian airport, to discuss the company’s activities.

The series of resolutions also calls for a reduction in the use of outside legal firms to handle internal legal issues, and to enact anti-nepotism disclosure requirements for hospital trustees, among other initiatives.

Nassau Health Care Corp. officials did not disclose how much the organization would save as a result of the proposed changes, Newsday reports.

Mr. Tsunis said as a safety-net hospital, NUMC should adhere to federal expense guidelines and not use taxpayer money to fund executives’ trips.

“[The proposed resolutions are] essential for credibility. The taxpayers of Nassau County need to be assured that we are protecting their tax dollars and operating at the highest ethical levels,” Mr. Tsunis told Newsday.


Tenet eliminates poison pill, adopts governance changes


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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.”


Top 6 Books Health Execs Should Read in 2018