Tag Archives: Productivity

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

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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.

 

 

 

Hospital cost containment plateaus, Kaufman Hall reports

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https://www.healthcaredive.com/news/hospital-cost-containment-plateaus-kaufman-hall-reports/551173/

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Dive Brief:

  • Hospitals are having a harder time controlling costs through labor and efficiencies and improvement efforts plateaued last year, according to Kaufman Hall’s 2018 National Flash Report. Profitability indicators show that operating margin improved by about 5% compared to 2017.
  • Kaufman Hall, which analyzed more than 600 hospitals, found that volume trends underperformed compared to the previous year. Higher-acuity patients resulted in higher reimbursement per adjusted discharge and adjusted patient day.
  • Drug expenses are one reason for the cost issues. Drug costs increased by about 4% from 2017. Also, bad debt and charity care grew, though at a slower pace at the end of the year. One piece of good news for hospitals is that revenue increased in 2018.

Dive Insight:

Kaufman Hall found that 2018 was generally a year of improvement in regards to profitability. However, volume indicators showed underperformance as discharges continue to drop.

Revenue indicators showed promise, but an ongoing problem is expenses. Hospitals are trying to contain costs by reducing full-time equivalents and bed numbers. However, those savings only go so far and hospitals expect they’ll need to add staff in the coming years. A recent Healthcare Financial Management Association/Navigant survey reported that 78% of hospital CFOs said their organizations’ labor budgets will grow in the coming years, with 18% expecting an increase of more than 5%.

Another factor working against hospitals is drug costs. A recent InCrowd survey found that physicians are pessimistic that those prices will change, with 82% saying it’s unlikely the situation will improve next year.

The Trump administration backs cutting prescription prices as a way to reduce costs. HHS released a proposal in January to end safe harbor protections for drug rebates through pharmacy benefit managers in Medicare Part D and Medicaid managed care plans. Those savings would instead go directly to consumers.

Hospitals have implemented cost-containment strategies, but the report shows there comes a point when hospitals can’t cut anymore. It appears the industry may have reached that point. “Hospitals will need to think more innovatively on how to manage expense,” according to the report.

Kaufman Hall pointed specifically to the West, which experienced “worsening labor efficiency.” Hospitals in this region “need to consider how to employ more advanced approaches to labor management,” the authors wrote.

There are other ways to squeeze dollars out of hospital costs, according to a recent McKinsey & Company report. It estimated that between $1.2 trillion and $2.3 trillion could be saved over the next decade on productivity gains and not expanding the workforce. The report highlighted potential opportunities to improve productivity through efficiency and care coordination.

 

 

Jerks need not apply: 7 ways to a skirt a toxic work environment

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https://www.beckershospitalreview.com/hospital-management-administration/jerks-need-not-apply-7-ways-to-a-skirt-a-toxic-work-environment.html

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We live in a time when acrimony and resentment seem to be at an all-time high. These days, individuals feel comfortable hiding behind screens to voice their opinions without giving much thought to the repercussions or the feelings of others.

I freely acknowledge that there have always been mean-spirited people in our lives, workplaces, schools and communities. However lately, it seems as if there is carte blanche to act like a jerk. Maybe this is why kindness seems a bit harder to come by, and why I find myself mentoring young people on how to deal with difficult colleagues more than usual.

I am certainly not immune to jerks. We’ve all dealt with them — the mean-spirited colleague who thought they knew everything. The person who did not like to share their toys in the proverbial sandbox. The team member who jumped at every opportunity to claim credit for success, plow over others or immediately blame others for failure. Simply put, we’ve all worked with jerks.

While jerks can be highly effective at delivering results, don’t confuse value with productivity. By this, I mean that the toxicity jerks infuse into a team and their work environment can significantly outweigh their contributions. These folks tend to be mean-spirited, manipulative, and can often undermine both the organization’s work and their colleagues’ productivity. They cause strife and, in some cases, drive excellent colleagues away from an organization. At the end of the day, they do far more harm than good, and they make the work environment an unpleasant place to spend the day.

Throughout my career, I have managed a few so-called jerks. While it has not always been easy, and I have certainly made my share of mistakes, I’ve learned to effectively deal with these personalities along the way. Beyond that, I’ve developed some management techniques for how to handle them.

As far as I’m concerned, jerks need not apply to positions within my organization. I have adopted a strict “jerk-free” policy for every organization I lead. From the moment I walk in the door on the first day, I articulate that jerks are not welcome. Personally, I would much rather work with a less experienced person who is kind-hearted and receptive to training than an arrogant jerk, any day of the week.

So, how do you move from simply putting up a “jerks aren’t welcome sign” to creating a jerk-free culture? How can you cultivate anti-jerk behavior across your team and coach others to do the same?

1. Communicate. Talk it out from the outset. You need to communicate, communicate and communicate again. Let your teammates and colleagues know what you need and what you expect. You want to set expectations from the outset, so everyone is on the same page, and there is no room for confusion or deniability. You should also be open, transparent and honest. While there are times it is not the easiest thing to do, the payoff is huge and will keep things running smoothly.

2. Lead by example. Jerks gravitate to jerks. Do your best to be kind, helpful, open and honest. It will do more to inspire others and generate positivity than anything else.

3. Build trust. You build trust and inspire loyalty when you foster an environment where differences of opinion are welcomed and encouraged. Where there is trust and good feeling, it makes it harder for jerks to thrive.

4. Let them know. If someone is a jerk and you feel uncomfortable, let them know. Don’t let behavior that bothers you fester. You want to nip it in the bud. In a positive non-judgmental language explain to them how their behavior is not working for you and reflect on how things can change. I always say the first approach to any situation should be: acknowledge, reflect, move forward.

5. Value differences. It’s important to celebrate differences and the wide variety of skills team members bring to the table. If folks feel they have a unique niche to fill and special skills to contribute, they are less likely to be passive aggressive and will feel confident in their contributions.

6. Celebrate. Having a good time is essential. Work is hard, and it’s important to let off a little steam sometimes. I can’t encourage enough the opportunity to have fun and facilitate opportunities where colleagues can get together outside of the office.

7. Coach it out. I have found that all is not lost when it comes to jerks. There is hope. Some jerks can be rehabilitated. They just need effective coaching to turn their attitude around. Of course, there are rare cases when a jerk is, and always will be, a jerk. Unfortunately, there are times when you will have to make the tough call and leave them behind.

A jerk-free workplace certainly has numerous benefits. Not only is your space more enjoyable and pleasant, but a no-jerk policy also attracts and contributes to retaining the best possible team members — those who are incredibly productive, highly effective and extremely positive.

What team member wants to sign up to work with jerks? A positive environment drives productivity as time is not wasted battling destructive behavior or playing pointless games. It also enhances quality and helps delivers excellent customer service, because team members are happy in their work. The ripple effect of that is that they pass it along to anyone with whom they interact.

Think about it: Your team is like a family, and frankly, we often spend more time with them than anyone else in our lives. While we all enjoy a wacky cousin or a wisecracking uncle, no one likes to engage with the family member who is always complaining or rude to others. So, do you and your fellow team members a favor and say goodbye to the jerks. Make more room at the table for positive and enjoyable folks. Everyone will be glad that you did.

 

 

 

Texas Health Resources utilizes work-from-home model to increase revenue cycle productivity

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http://www.healthcarefinancenews.com/news/texas-health-resources-utilizes-work-home-model-increase-revenue-cycle-productivity?lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3BjOr1uQoFRSCV0kd0MJgD3Q%3D%3D#.WXC_Vgx95F4.linkedin

Whatever hours they’re at their best is when Texas Health Resources wants them to work, system says.

When Texas Health Resources hires new staff members to work in its revenue cycle department, it’s now required — for most functions, anyway — that they work virtually from home. Staff who have been there since before the virtual implementation have the choice, but many choose to go the route of the new hires. It’s a nice perk for the employees, but an even nicer one for the system, which has seen productivity increase significantly since taking this approach.

James Logsdon, THR’s vice president of revenue cycle operations and strategic revenue services, said the concept emerged in 2011 during the Super Bowl.

Dallas was the host city that year, and the big game took place in the midst of a rare ice storm. Logsdon came into work with the wind still whipping and noticed immediately that the office was like a ghost town, with few employees in sight. The system lost three to four days of productivity because people simply couldn’t make it into work, and thus a challenge was born: Turn revenue cycle operations 100 percent virtual within a year.

“It started out as a business continuity plan, but progressed into an initiative,” said Logsdon, recalling the event during the Healthcare Financial Management Association‘s annual ANI conference in Orlando. “It was a drive.”

It took longer than a year, and it may never reach 100 percent; some functions have to stay in-house, particularly with the jobs that involve direct patient interaction. But the effects have been noticeable. Employee satisfaction and morale are at an all-time high, and the turnover rate has been reduced substantially. The system used to lose revenue cycle employees to jobs that paid 10 or 15 cents an hour more, but no longer.

The linchpin of the program’s success is quality. It can’t budge an inch, and employees have to be held accountable.

“The metrics have to be award-winning,” said Logsdon. “You’ve got to set the expectation that this is a privilege. It’s something that could potentially be taken away. Basically, the message was, ‘Don’t let me down.'”

So far they haven’t, and part of the reason is the flexibility the virtual job affords them. Workers are allowed to set their own schedules as long as they put in the minimum eight hours. At whatever hours they’re at their best is when THR wants them to work.

Benefits aren’t just limited to reduced turnover and higher productivity, either. The system allows for better use of its real estate. Where there were cubicles packed tightly together like honeycomb bees, there are now classrooms, war rooms and revenue cycle training areas.

All that saves the system money, since it now uses its existing space for such purposes rather than expanding its footprint. New revenue cycle personnel are expected to work at least 90 days in the office while they undergo their training and education, but after that, they’re released to their virtual offices.

That’s not to say there aren’t challenges. Logsdon said that in some instances employees feel a sense of entitlement, resisting requests to return to the office when the need arises. There are also distractions that differ from the usual office distractions — children, neighbors, friends and family can sometimes intercede. To address this, THR conducts unannounced site visits to make sure everything’s copacetic.

The arrangement has created some new challenges for management, as they now have to ensure employees are using the right equipment and protocols and have an appropriately speedy internet connection. Few issues have arisen.

“Productivity is a topic that always comes up,” said Logsdon. “The requirement for employees, in writing, is to increase productivity by 5 percent. They have no problem hitting it. It’s amazing what you can pull out of people when they’re motivated by the right reasons.”