How do you ‘hire’ (and manage) an interim executive?

How do you ‘hire’ (and manage) an interim executive?

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Abstract:  This article is about the optimum relationship between an interim executive and their client.  It has been a while since I wrote on Interim Executive Services.  In this article,  I  return to the primary topic of this blog.

What is the difference between interviewing and hiring an interim vs. an employee?

First of all, it is not in your best interest to ‘hire’ an interim.

If the interim is furnished though a firm, they are more than likely paid on a W-2 and you are not technically ‘hiring’ the interim, you are engaging or entering a contact with their firm.  The interim is ’employed’ by the firm and not you.  Employed is loosely used in this case because while the interim may be on a W-2 program with their firm, the only time they are paid is if they’re producing billable revenue. Sadly for the interim, they get to bear all of the disadvantages of being paid by W-2 while consulting without having the ability to reap any of the benefits of being an independent expert.

Now assume that you are smart enough and lucky enough to source the perfect independent or free lance interim directly, what then?

Congratulations, you are probably well on your way to having a far superior resource that will  be highly motivated to address your situation without the interference of a third party that in my experience, adds little if any value beyond sourcing the interim.  If you have experience with this, you know what I’m talking about.  When was the last time you saw anyone from the interim firm you engaged other your interim?

With a free agent, you will be contracting with the Interim or a company (LLC or S-4 Corporation) they own.  Legally, you are dealing with a sole proprietor in most cases regardless of whether their corporate entity is involved or not.  For this reason and depending upon the circumstances, you might want to get their personal guarantee of their firm’s performance.

I have a S-4 Corporation that I can use for contracting.  The problem for me is that if I bill though my corporation, I am obliged to pay the federal government 9% of my earnings in the form of federal unemployment tax or FUTA that I can never claim because as an independent consultant, I cannot be ‘laid off’ so I am ineligible to receive FUTA.  Don’t get me started.  I have been fortunate that my clients have agreed to engage me directly and individually.  A corporate structure when dealing with a sole provider affords disproportionate list to the provider.

What about insurance?  Increasingly, client firms are requesting or requiring professional liability insurance.  Setting aside the fact that I have never seen a claim against a professional liability policy for interim services, I have been successful in convincing my clients to name me under their Directors and Officer’s Insurance (D&O) coverage if I as an interim am going to be authorized to execute documents and take actions on behalf of my client.  To me, this makes more sense for the client because if I am required to obtain insurance that will most likely be less robust than the organization’s D&O coverage, that cost is going to be passed along and in effect, the client will be paying twice for the same coverage.  Not only that, in the event of a problem, you are more than likely going to be drawn into a subrogation fight.  If I have no authority and I am not going to be executing documents, i.e., I am engaged to do project work, then liability insurance should be a non-issue.

In another article, I talk about how to find interim executives.

If you have found the ‘perfect’ interim for your transition or challenge, good for you.  If the interim is experienced and sophisticated, you should not have any reservation about engaging them directly and putting them to work in your organization immediately.

Once the interim is aboard, do not lose sight and do not allow your organization to lose site of the purpose of the interim engagement which is usually to help an organization work through a transition usually while beginning the process of addressing major challenges or problems.  The scope of the work to be performed should be mutually understood and memorialized in the contract with the Interim Executive.  Subsequent departures from the agreed scope represent sub-optimization of the engagement at best and a useless waste of resources at worst.

An interim is not an employee and the more you treat them like an employee, the less effective they will be and the higher risk you will bear with respect to their status as an independent contractor.

A number of requirements must be met before your interim reaches reach the threshold of independent contractor status.  To name a few:

  • You cannot set the interim’s hours
  • You cannot dictate when and how the interim does their work
  • You cannot require the interim to use your facilities and equipment to do their job
  • You cannot subject the interim to your personnel policies and procedures like travel policies, etc.
  • You should not require the interim to participate in employee related activities like employee health, computer system training, etc., unless their specific responsibilities require patient contact or hands-on operation of hospital systems which should be very rarely.
  • You should never require interims to record time on your organization’s timekeeping system

The more you require your interims to engage in the actives of employees; things like requiring them to attend out of scope meetings, the higher your risk that the IRS may subsequently find that they were not independent contractors and subject your organization to payroll tax liability and overtime claims that you did not anticipate.

Time and again, I have been required by hospital personnel departments to go through all of the clearances and sometimes orientation of employees.  Then I get invited to every meeting in the organization.  All of this increases the client’s risk while wasting my time.  I have asked the person that executed my contract to screen and approve meeting requests to insure that I am able to stay on task and that the rest of the organization understands my roles and its limitations from their perspective.

I tell clients that regardless of the number of hours they pay for, they receive 100% of my mental capacity virtually 100% of the time.  I find it difficult if not impossible to mentally divorce myself from the needs and issues of my client whether I am ‘on the clock’ or not.  Because of this, flexibility of hours should not be an issue because when I am engaged, I am always working for the benefit of my client.  That said, I assure my client that regardless of the ‘normal’ schedule we agree to, I endeavor to make myself available on-site as needed.  This means spending weekends in the client’s city and/or traveling on behalf of the client for matters not related to Interim services commuting.

Take another look at my article about how to find an interim.  The effort you expend to locate a ‘free agent’ Interim Executive is worth the trouble.  My prediction is that you will thank yourself for taking charge of what should be expected to be one of the most important decisions you may ever make because of the potential of a well conceived Interim Engagement to be favorably transformative in your organization.

If you are a Board member or a CEO and you do not know where to start or how to go about finding an Independent Interim, get in touch with me and I will give you some pointers.

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 is coming from people that are demonstrating interest in advancing their careers and I am writing content to address those inquiries.
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If you would like to discuss any of this content, provide private feedback or ask questions, I may be reached at ras2@me.com.

Analysis: Nurse force to grow 36% by 2030, thanks to millennials

http://www.healthcaredive.com/news/analysis-nurse-force-to-grow-36-by-2030-thanks-to-millennials/506539/

Dive Brief:

  • Millennials are becoming registered nurses at nearly twice the rate of baby boomers, but that still won’t necessarily prevent a nursing shortage as boomers retire, a new analysis in Health Affairs concludes.
  • The number of younger RNs nearly doubled to 834,000 in 2015, after dropping to 440,000 in 2000 when Generation Xers were joining the workforce.
  • The number of millennials entering the space has leveled off recently, however, suggesting only modest growth over the next decade. Still, millennials will dominate the nurse workforce in the 2020s, the article says.

Dive Insight:

The average age of the nursing workforce in 2005 was 44, spurring widespread predictions of a nursing shortage as baby boomers retired from the field, according to the authors.

They attribute millennials’ embrace of nursing to several factors. The profession offers stable lifetime earnings and low unemployment as well as opportunities for advancement and relocation. And it can be parlayed in myriad ways across the healthcare industry.

“Considering the acceleration in retirement of the baby boomers and the stabilization of the entering cohort sizes among millennials, we expect the nurse workforce to grow 36%, to just over four million RNs, between 2015 and 2030, a rate of 1.3% annual per capita growth,” the authors write. “This is a rate of per capita growth similar to that observed from 1979 to 2000, but half the rate observed in the rapid-growth years of 2000-15.”

Whether that growth rate is enough to meet demand as baby boomer nurses retire is hard to gauge.

While nursing may be enjoying a surge in popularity, as professions go, retention is a growing problem. In a recent Medscape poll, about one in five nurses said they would not make the same career choice again. Nurses with more than 21 years in the profession were more likely to be dissatisfied than those who were new to the practice.

To retain nurses, hospitals need to provide opportunities for upward mobility and changing roles. They also need to address clinician burnout associated with increasing regulatory and administrative tasks. Allowing nurses to practice at the top of their licenses can also increase workplace satisfaction — not to mention helping address the problem of physician burnout.

New York City public hospitals take measures to conserve cash

http://www.healthleadersmedia.com/leadership/new-york-city-public-hospitals-take-measures-conserve-cash?spMailingID=12087951&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1260507154&spReportId=MTI2MDUwNzE1NAS2

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The head of New York City’s public hospital system says he will leave more jobs unfilled at the 11 hospitals he oversees to cope with a cash-flow crisis that emerged after the state withheld millions in aid. City and state officials have sparred over the funding in recent days as healthcare dollars from Washington become scarce. Stanley Brezenoff, interim president of NYC Health + Hospitals, said in a letter to staff on Thursday that he would fill just 25% of the 250 to 300 positions that become available each month at the hospitals the system oversees.

The digital hospital of the future

https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/global-digital-hospital-of-the-future.html

In 10 years, technology may change the face of global health care delivery

​As the cost of care continues to rise, many hospitals are looking for long-term solutions to minimize inpatient services. Learn how technology and health care delivery will merge to influence the future of hospital design and the patient experience across the globe.

Five use cases for the digital hospital of the future

The future of health care delivery may look quite different than the hospital of today. Rapidly evolving technologies, along with demographic and economic changes, are expected to alter hospitals worldwide. A growing number of inpatient health care services are already being pushed to home and outpatient ambulatory facilities. However, many complex andv very ill patients will continue to need acute inpatient services.

With aging infrastructure in some countries and increased demand for more beds in others, hospital executives and governments should consider rethinking how to optimize inpatient and outpatient settings and integrate digital technologies into traditional hospital services to truly create a health system without walls.

To learn what this future of health care delivery may look like, the Deloitte Center for Health Solutions conducted a crowdsourcing simulation with 33 experts from across the globe. Participants included health care CXOs, physician and nurse leaders, public policy leaders, technologists, and futurists. Their charge was to come up with specific use cases for the design of digital hospitals globally in 10 years (a period that can offer hospital leaders and boards time to prepare).

The crowdsourcing simulation developed use cases in five categories:

  1. Redefined care delivery
    Emerging features including centralized digital centers to enable decision making (think: air traffic control for hospitals), continuous clinical monitoring, targeted treatments (such as 3D printing for surgeries), and the use of smaller, portable devices will help characterize acute-care hospitals.
  2. Digital patient experience
    Digital and artificial intelligence (AI) technologies can help enable on-demand interaction and seamless processes to improve patient experience.
  3. Enhanced talent development
    Robotic process automation (RPA) and AI can allow caregivers to spend more time providing care and less time documenting it.
  4. Operational efficiencies through technology
    Digital supply chains, automation, robotics, and next-generation interoperability can drive operations management and back-office efficiencies.
  5. Healing and well-being designs
    The well-being of patients and staff members—with an emphasis on the importance of environment and experience in healing—will likely be important in future hospital designs.

Many of these use-case concepts are already in play. And hospital executives should be planning how to integrate technology into newly-built facilities and retrofit it into older ones.

Technology will likely underlie most aspects of future hospital care. But care delivery—especially for complex patients and procedures—may still require hands-on human expertise.

The hospital of the futureDownload the report

Laying the foundation for the digital hospital of the future

​Building a digital hospital of the future can require investments in people, technology, processes, and premises. Most of these investments will likely be upfront. In the short term, hospital leadership may not see immediate returns on these investments. In the longer term, however—as digital technologies improve care delivery, create operational efficiencies, and enhance patient and staff experience—the return result can be in higher quality care, improved operational efficiencies, and increased patient satisfaction.

These six core elements of an enterprise digital strategy can help you get started as you begin to push your hospital into the future:

  1. Create a culture for digital transformation
    It is essential that senior management understands the importance of a digital future and drives support for its implementation at all organizational levels.
  2. Consider technology that communicates
    Digital implementation is complex. Connecting disparate applications, devices, and technologies—all highly interdependent—and making certain they talk to each other can be critical to a successful digital implementation.
  3. Play the long game
    Since digital technologies are ever evolving, flexibility and scalability during implementation can be critical. The planning team should confirm that project scope includes adding, modifying, or replacing technology at lower costs.
  4. Focus on data
    While the requirements of data interoperability, scalability, productivity, and flexibility are important, they should be built upon a solid foundation of capturing, storing, securing, and analyzing data.
  5. Prepare for Talent 2.0
    As hospitals invest in exponential technologies, they should provide employees ample opportunities to develop corresponding digital strategies.
  6. Maintain cybersecurity
    With the proliferation of digital technologies, cyber breaches can be a major threat to hospitals of the future. Executives should understand that cybersecurity is the other half of digital implementation and allocate resources appropriately.

Is the Rise of Contract Workers Killing Upward Mobility?

http://knowledge.wharton.upenn.edu/article/the-perils-of-contract-workers/

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In the employment firmament, their star is rising. They appear when you need them, go away when you don’t, and there’s always a long line of replacements ready to step in. Contract workers are in wide use today, and it’s easy to see why: The short-term financial gains are simply too alluring to pass up, says Wharton management professor Peter Cappelli.

“Investors hate ‘employment’ because it seems like a fixed cost, even though most companies have no reluctance to get rid of employees, and many keep contractors around as long as their average employee,” says Cappelli, director of Wharton’s Center for Human Resources. “Even though it is typically more expensive per hour to hire contractors, it shows up on different budgets. But it also reflects a general short-term view of strategy: Rather than getting really good at something, which requires investing in competencies, we are going instead to just find new opportunities quickly.”

There are, however, costs to contracting out, and those costs are becoming increasingly hard to ignore. Lack of institutional memory and slowed organizational momentum are obvious deficits to relationships with contract workers. More important, by not investing in the individual, companies are also simply shifting costs.

“I think more than short-termism, this is a classic example of a so-called negative externality,” says Wharton professor of management Claudine D. Gartenberg. “By that I mean, here’s a series of decisions taken by companies — and not just for-profits, but universities, hospitals and across the non-profit sector, as well — that often benefits the organizations financially, but may have serious social consequences that are not borne by the organizations but by workers and society as a whole.”

Moreover, there is reason to believe that just as contract work is not a panacea for workers, it is also not a panacea for companies. “Contract workers have a fundamentally different relationship with the companies they work for than employees do,” says Gartenberg. “Just as companies under-invest in contractors, there are ample studies that suggest that contractors likewise under-invest in the companies. This could definitely hit the bottom line in areas like innovation and customer service.”

If we are in fact in the process of solidifying two distinct classes of workers — one employee in which firms invest, and another that is in a sense more disposable — what are we as a society losing?

“A lot,” says Gartenberg. “This is what the American Dream is built on — upward mobility. Contract work and outsourcing, among other factors, appear to be disrupting that engine, and it is not clear what the best policy response, if any, should be.”

“Investors hate ‘employment’ because it seems like a fixed cost, even though most companies have no reluctance to get rid of employees, and many keep contractors around as long as their average employee.”–Peter Cappelli

A Cost Masquerading as a Savings

While contract workers look good for the bottom line, that’s not the end of it. “It’s great having these people who aren’t part of the headcount, but then you discover all of these hidden costs,” noted Wharton management professor Matthew Bidwell during a recent appearance on the Knowledge@Wharton show on SiriusXM channel 111. (Listen to the full podcast using the player at the top of the page.) “Turnover is higher; often you have to pay them more because they need some premium in order to come to work. And it’s quite disruptive. When contractors move out, you have to move somebody else in and train them up again.”

The introduction of second-class status for some employees also changes the workplace dynamic. “It’s a big deal,” says Bidwell. “Whenever you start designating different groups it creates friction. We worry that contractors can feel threatening to regular employees — there is a sense of, ‘Is my job going to be next to be contracted out?’”

Contracting also appears to have a deleterious effect on one’s career arc. “One big issue is training,” notes Bidwell. “As an employee, your employer may pay to train you and keep you up to date on new technologies. They will also give you a chance to try new kinds of work and learn that way. As a contractor, nobody is paying for you to learn. They only want to hire you to do things that you have already demonstrated you can do elsewhere. That means you have to pay for your own training. You also suffer a Catch-22 when it comes to doing new kinds of work. People won’t hire you to work on different stuff until somebody else has already hired you to do it.”

Bidwell and Wharton doctoral student Tracy Anderson are working on a study that looks at MBA alums who work as contractors, and, in analyzing career trajectories, they find that people who spent time as a contractor seemed to suffer a career penalty later on. “The contractors also said that future employers didn’t take their contracting experience seriously. I think these challenges are particularly severe for contractors in managerial work,” Bidwell said.

Still, contracting out appears to be growing. Exact numbers are elusive because job categories are often only loosely defined. But the percentage of workers engaged in alternative work arrangements of various types — temp agency workers, on-call workers, contract workers, and freelancers — rose from 10% to nearly 16% between February 2005 and late 2015, according to Lawrence F. Katz of Harvard and Alan B. Krueger of Princeton. The percentage of workers hired out through contract companies showed the sharpest increase — from 0.6% in 2005 to 3.1% in 2015.

“A striking implication of these estimates is that all of the net employment growth in the U.S. economy from 2005 to 2015 appears to have occurred in alternative work arrangements,” write Katz and Krueger in “The Rise and Nature of Alternative Work Arrangements in the United States, 1995-2015.”

“Here’s a series of decisions taken by companies … that often benefit the organizations financially, but may have serious social consequences….”–Claudine D. Gartenberg

The consequences are rippling out. Large U.S. firms have played a big role in reducing wage dispersion, therefore helping to mitigate inequality, according to Wharton management professor Adam Cobb and University of Texas at Austin sociology assistant professor Ken-Hou Lin. But that is less the case now, they argue in “Growing Apart: The Changing Firm-Size Wage Premium and Its Inequality Consequences,” published in Organization Science in May, 2017.

Using data from the Current Population Survey and the Survey of Income and Program Participation, Cobb and Lin find that in 1989, although all private-sector workers benefited from a firm-size wage premium, the premium was significantly higher for individuals at the lower end and middle of the wage distribution compared to those at the higher end. But between 1989 and 2014, the average firm-size wage premium declined markedly. Significantly, the decline was exclusive to those at the lower end and middle of the wage distribution — while there was no change for those at the higher end. They conclude that the uneven declines in the premium across the wage spectrum could account for about 20% of rising wage inequality during this period.

“While large firms still compress the wage distribution, they do so to a much lesser degree than in the past. This suggests that although large U.S. firms in our observation period lowered wage inequality, their role as an inequality-mitigating institution has diminished considerably over time,” they write.

Can the Pendulum Ever Swing Back?

In fact, the spread of alternative work arrangements has resulted in “downward pressure on earnings and the shifting of basic risks onto workers and their households,” wrote David Weil, author of The Fissured Workplacein the Huffington Post recently. Weil, who led the Wage and Hour Division of the U.S. Department of Labor during the Obama administration and is now dean and professor at the Heller School of Social Policy and Management at Brandeis University, is arguing for a number of interventions: Creating greater transparency on wages and working conditions, drastically reducing the use of non-compete and mandatory arbitration clauses by employers, creating greater access to skill enhancement, and fostering more varied methods of third-party worker representation (including, but not limited to, unions).

A few trends and forces could slow the use of contract workers, says Gartenberg. “The first is the rise in data analytics within firms. Firms have long suspected the costs of employee disengagement. Gallup estimates $500 billion in lost productivity per year from low employee engagement, and another study shows the bottom-line benefits of having employees feel a strong sense of purpose, which contractors likely do not share,” she notes. “But until a clearer case can be made firm-by-firm, it is hard to justify a change. A range of new technologies for measuring employee productivity, innovativeness, and linking those outcomes to happiness may well help companies make the case to in-source and re-invest in employees.”

“This is what the American Dream is built on — upward mobility. Contract work and outsourcing, among other factors, appear to be disrupting that engine.”–Claudine D. Gartenberg

Another possible impetus for change could come via the decline in publicly traded firms and the increase in institutional common ownership of those that remain. “There are half the number of public firms today as there were in the late 1990s, and investment capital is increasingly concentrated within a few institutional investors,” she says. “Large institutional shareholders are feeling increasing pressure to invest in socially responsible firms. These two trends in corporate ownership may converge to swing the pendulum back towards investing in workers, if enough external pressure is applied and if a sufficient business case can be made.”

Surprisingly, automation may play a role in reversing the trend. If more of the rote work becomes automated, we may be left with work where hard-to-contract softer skills matter more and correspondingly mean higher pay, “at least for a subset of workers,” says Gartenberg. “As an example, I was recently talking with the head of operations of a health care logistics start-up. She said their entire logistics operations were essentially automated, and a real source of advantage was that their call-center representatives were freed up to provide the human face to the company. They had no intentions to outsource or automate that function, as they recognized the value of engaged employees interacting with customers, rather than the mind-numbing IVRs [interactive voice response systems] that we have learned to hate over the past 20 years.”

Bidwell points out that the question of whether the use of contractors continues to grow depends at least partly on legal enforcement. “[For] the previous [presidential] administration, one of their priorities was around companies that were incorrectly classifying independent contractors as employees. Obviously once you are classified as a contractor you are outside of some of the protections — you are under a different tax code, not subject to the minimum wage, all of those sorts of things,” he says. “And contracting shouldn’t be a means for companies to stage an end-run around a bunch of laws that are there because we believe that fundamentally most employers have much more power in the bargaining relationship than employees and we want to even that up a certain amount.” Ideally, we would update the law, Bidwell adds, but “getting anything through Congress these days is not necessarily easy, and so, with a different administration, how fierce they are on who is a contractor versus an employee is going to have at least some impact on this market.”

“It’s great having these people who aren’t part of the headcount, but then you discover all of these hidden costs.”–Matthew Bidwell

As it is, the “legal situation in the U.S. is a light touch,” says Janice Bellace, Wharton professor of legal studies and business ethics. When it comes to companies contracting for workers with another company — a temp agency, for instance — the law has little to say. When a firm engages an individual as independent contractor, there are rules to be followed, and the firm that flouts them risks the government stepping in and determining that they are employees rather than contractors.

But those risks were greater under Barack Obama, when there was a more worker-friendly National Labor Relations Board. In addition, Donald Trump has drastically reduced the enforcement capacity of the Department of Labor by cutting the budget. “Consider that Trump’s first nominee for head of the labor department was a man who headed a fast food chain that had been repeatedly cited for wage/hour violations,” Bellace says.

But what should the policy response be to the increased use of contracting? Gartenberg says that it is important to take note of two factors. First, there is a difference between involuntary temp-workers or workers for contracting agencies, and freelancers/independent contractors. For the latter group, many prefer contract status to full-time employment, and “grouping these people into the overall pool of contract workers overstates the problem,” she says.

Second, alternative work arrangements enable firms to be more competitive overall by lowering costs and providing a better way to respond to market fluctuations. “If, in an alternate world with 100% full-time workers, these firms would be uncompetitive, then these arrangements may end up helping on net, even if some are worse off,” says Gartenberg. “Or, firms may be stuck in a downward spiral where workers end up net worse off, but no single firm can undo this because they cannot bear the costs and remain competitive. These two factors highlight why this isn’t necessarily a cut-and-dry problem with easy answers.”

5 Things Every Wannabe CEO Needs to Know

http://www.healthleadersmedia.com/leadership/5-things-every-wannabe-ceo-needs-know?spMailingID=12034960&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1242515111&spReportId=MTI0MjUxNTExMQS2#

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Hospitals and health system boards are still looking for strong leaders, but what’s changing is the kind of experience you need to elevate to the top job.

So you want to be the CEO of a hospital or a health system.

Here’s the first thing to know: Like it or not, the role of acute care is slowly being relegated.

It’s still important, and it’s still a high-reimbursement area, but specifically because of that, scores of people and companies are trying to figure out how to use it less.

As a result, even in organizations where acute care represents the lion’s share of revenue, the competencies of today’s successful CEO range far from the acute-centric skills many hospital and health system executives and boards once prized.

All of today’s CEO candidates have to understand the critical interactions between the inpatient and outpatient realms, and the fact that delivering value rests on managing those interactions, not from maximizing patient census and inpatient days.

“Running a health system is about trying to provide coordinated care in an environment that’s patient- and family-centric,” says Jim King, senior partner and chief quality officer with Witt/Kieffer, a healthcare executive search firm.

Given the need to reduce reliance on acute care services, leaders who want to be CEOs have to learn skills applicable to the rest of the patient’s healthcare journey.