The High Price of Values


It has been over 14 months since I have been able to sit amongst my books. 


You see, my wife and I sold our house in town of 21 years and moved to a one-bedroom apartment while we continued our plans to build a new home designed by my wife’s brother, Dan. Well, one delay led to another and we ended up firing our first builder and signing a contract with a second general contractor months after we had intended to start building. All this occurred while my books, many on anthropology, sociology, philosophy, management, and art collected over decades of study and research, sat in tightly packed boxes in our garage. 


I had kept out a few books to reread, like Julian Jaynes’s 1976 mind-bending The Origin of Consciousness in the Break-down of the Bicameral Mind, but the majority of these volumes were kept locked away for what I had hoped would be a brief period. 


Ah, my.



As part of a leadership team of a former employer, I was told to read a book with a seemingly trite title of Why Should Anyone Be Led by You? authored by Rob Goffee and Gareth Jones and published by the Harvard Business Review Press. It was essentially many case studies and interviews across a wide spectrum of leaders and organizational experts. 


As with any required reading assignments, I started my reading as drudgery, but I became more engaged by reading the values quoted by one of my favorite observers of the American Scene, Studs Terkel:


We have a right to ask of work that it include meaning, recognition, astonishment, and life.  (p. 74)


And the conclusions drawn by the authors of this book including:


Authentic leaders require authentic followers—followers who care enough about the overarching purpose to challenge the leader’s position if they feel his or her judgment is impaired.  Further, leaders themselves must encourage strong followers.  (p. 211)


I began to wonder why the organization I was with then didn’t have published values and what cultural implications have I missed with all my staff and me performing our assigned duties off campus. Without explicitly stated values, I was taught as a social scientist to default to culture. Culture, of course, is ideas, meanings, knowledge, and, yes, values, conscious and unconscious, shared by a community of people. Unfortunately, I was estranged from the hospital culture, and Culture, to quote management guru Peter Drucker, eats strategy for breakfast


Not seeing the plate quite yet, that was strike two on me.


Now rereading this book and noting my frequent underlining and my notes in the margins, I can see clearly that I was becoming enlightened and aware and upset and disgusted and cheated and confused. 


Yes, I began to see that the organization I worked for at the time and I had different values. Furthermore, without a values statement, the organization and I made some assumptions about the other. This apparent organizational void could be violated and be used by those with their own personal agenda.


Ah, yes. And people do want to believe the worse about others.


Values or a value statement is another banner, like the mission and the vision statement that organizations fly at the masthead of efforts and enterprises in which they intend to continue or to undertake. 


Values are simply an expression of what an organization believes. Some organizations will incorporate a code of ethics along with their values statement. This code is a brief statement in how they intend to put their values into practice.


Unlike the mission and the vision statement, however, values are not always explicitly stated. And yet, stated values may reveal more about an organization’s personality and approach as well as give direction to strategic planning and daily action. 


It is too easy for many of us managing daily operations, often on the fly from one crisis to the next, not to think about the values, if there are any.



There are organizations, however, that do publish their values. Here is a selection:


Ben and Jerry’s has a product mission statement, a social mission statement, and an economic mission statement followed by detailed explanations and five value statements in how those missions will be fulfilled.


Coach has the following “core values” with detailed descriptions:

  •       The Brand is Our Touchstone
  •       Customer Satisfaction is Paramount
  •       Innovation Drives Winning Performance
  •       Our Success Depends on Collaboration


Disney ranks its order of Values: Safety, Courtesy, The Show, and Efficiency.


Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan, uses a series of bullet points:


  •                 Focus on patient care
  •                 Strive for excellence
  •                 Collaborate to achieve results
  •                 Take responsibility for performance
  •                 Are truthful and respectful
  •                 Embrace innovation


One exceptional example is Mercy Health St. Mary’s also in Grand Rapids, Michigan, which has a mission, a vision statement, and a promise along with the following core values and guiding behaviors:


  •                 REVERENCE – We honor the sacredness and dignity of every person.
  •                 COMMITMENT TO THOSE WHO ARE POOR – We stand with and serve those who are poor, especially those most vulnerable.
  •                 JUSTICE – We foster right relationships to promote the common good, including sustainability of earth.
  •                 STEWARDSHIP – We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
  •                 INTEGRITY – We are faithful to who we say we are.


Guiding Behaviors

  •                 We support each other in serving our patients and communities
  •                 We communicate openly, honestly, respectfully and directly
  •                 We are fully present
  •                 We are all accountable
  •                 We trust and assume goodness in intentions
  •                 We are continuous learners



As much as I like the values of Mary Free Bed Rehabilitation Hospital and of St. Mary’s Hospital, you can see even in this small sample, that published values are not just the domain of nonprofits and the caring professions. 


Published and discussed values bring clarity to how work is performed by removing ambiguity. 


Wouldn’t life be a little better if we could perform our duties at work without making assumptions?



Making Yesterday’s Vision Tomorrow’s Reality


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ImageDo you want to reach out and help your fellowman and see the difference 100% of your efforts make on humanity? 

A few of my friends have joined overseas missions and can tell you firsthand what that feels like.  The rest of us may have a different story in treating patients here stateside.

Civilization has its costs and following certain rules, regulations, and standards—for better or for worse—are mandated.  Prior to receiving my first job offer to work in a hospital, I’ll never forget the words uttered by my soon-to-be boss:  “You will need to get a haircut and lose the beard.  The revolution is over.”  Gulp! 

Needless to say, I did just that and so began my long career in health care.  I also found that in the decades that proceeded “work casual,” that the expectation was that I would wear a sport coat or suit and tie.  Yes, even on Friday and even on the weekends when I was called in.

Where all think alike, no one thinks very much.  –Walter Lippmann

Before you pass judgment on my stuffy professional genesis, please take a few paces backwards and look at the context in which this appearance edict was given. 

In the 1970’s, it was a world in which people had certain expectations when they went to the hospital.  They wanted their nurses to wear hats and starch white linen, their physicians to wear suites and/or white coats, and their professional staff to look… well… professional.  Just like when you visited a bank, you want to see your banker dressed conservatively because you expected him to handle your money in a conservative manner.  Likewise, you wanted your medical care to be provided in a starched, antiseptic, and professional manner.

A few years ago, I was told by my younger peers to dress down more.   It didn’t feel right, but I finally adjusted to wearing corduroy pants and shirts without ties.  The feedback from my patients was complementary and welcoming.  Oh!

It is the primary job of a leader to identify and clearly explain the context of the why, the what, and finally the how.  This can be a moving target. 

I mentioned in an earlier blog of the important role of an organization’s mission, vision, and values.  This blog will discuss the application of the vision.  The vision shows the direction where the organization wants to go.  (And, by the way, you dress for the job you want, not just for the job you are currently assigned to perform… your career vision, if you may.)

A leader not only looks for opportunities to talk about their organization’s vision with individuals, teams, and with groups, but he/she must have a plan to walk the talk.  This walk is not linear, however, and will demand that the leader take an active role to make the vision a reality.

I recognize that a vision statement can seem fully formed and organic in the sense that an organization grew in this direction pushed by forces such as reimbursement, staff, location, and other variables.  Yet, I have found that planning is key to making a vision manifest. 

Before a leader starts out, they need a detailed outline—with specifics if possible—of the plan from the start to the goal, with measureable benchmarks along the way.  A plan should always take into account competition and other obstacles. 

If a leader doesn’t have marketing savvy—or does not have a marketing professional on the team—now would be the time to find someone with these skills!  A marketing professional should be schooled in making messages and visions come alive, and in ways not considered by people with other strengths (a leader doesn’t know everything, and a wise one recognizes that!).

As an example to the work involved, let’s discuss the efforts needed to fulfill a vision for a health care organization to become a regional leader in sports medicine. 

Currently, the orthopedic and sports medicine arena is hotly contested. 

Customers and patients of such a program are a highly desirable target for health care organizations.  These customers are usually in good physical shape to begin with, tend to be highly motivated to stay physically fit, and once injured work hard to get back in the game. They also have better outcomes from surgery with no to few readmissions, and (also importantly) tend to have good payer sources.  Being active, they will probably spread their good results to others.  Positive word-of-mouth advertising, as we all know, is the very best way to market a product. 

Once a plan is in place, a team needs to be formed.  A sports medicine team will usually be made up of sports medicine physicians and/or orthopedic surgeons, high school athletic trainers, sports performance instructors, physical therapists, physical therapy assistants, and exercise physiologists.   

Physician involvement is crucial for any program in a hospital or health care setting to succeed as anyone pulling together a new program can attest.  Not only can their practice reflect the vision in another practical and results-driven way, but also customers and hospital administrators will listen more closely to what they have to say over the din of competing voices.

The physicians and the others on a team need to understand the vision, the plan, and their role.  In forming a team to actualize this vision, a leader may identify a “champion,” or maybe there will be a few “champions. “

Champions are unusually motivated spokespersons who understand the vision and the plan and can articulate it in a way that recruits and motivates others.  A champion will prove to be a great advantage to a team for moving the vision forward with their commitment towards the program’s success.  It is, however, not unusual for the leader to be the champion at first, to show what the role looks like and identify ad hoc champions or champions for specific tasks.

It is important to note here that with champions or no champions, a leader must keep engaged in the direction that the product is developing making sure that all efforts are fulfilling the vision.  A good leader should not be accused of being asleep at the tiller!  Ultimately all of this—the good, the bad and the ugly—will be a leader’s responsibility.

With a prepared leader, a solid and motivated team with the desired skills, potential champions, a plan that allows for unanticipated variables, a mission, and an inspiring vision, an organization is off to a good start with an itinerary and a destination.

I lost a former colleague and we all lost a wonderfully caring therapist and a quality human being this January.  He had a reputation for coloring outside of the lines in order to get the job done, but that combination of free-styling-high-energy and healing skills made him all the more wonderful.  Although we hadn’t talked in a few months, I will miss Henry Tim Heemstra, LPT as will the many patients and friends he made through almost four decades of practicing. 

Pedal on, Tim.

A Health Care Marketing Primer


How do you make decisions about where you go for your health care?

It is a given that everyone will need health care or the services of a hospital.  What isn’t a given is that everyone will chose your organization. 

I recall what I deem as a successful marketing trip was one I made to a small physician’s office along with some members of my professional team.  I arranged this luncheon meeting with the physician and his staff because I was puzzled why this physician rarely used our clinic.  We were the closest office to what I assumed was his patient population and we had plenty of openings for new patients.  Along with my staff, I brought a great lunch for everyone there. 

After the usual discussions about things we had in common—e.g., weather and my presentation—I could see that the physician had one eye on the door and was preparing to develop his excuse to depart.  Earlier walking through the hallways to get to the meeting room, I had noticed wall hangings of local Native American Indian art.  Taking the conversation in a new direction, I mentioned the physician’s art and that I had worked as an archaeologist as an undergraduate student and told him about some of our sites, findings, and my dealings with the local tribes.  The physician’s eyes lit up and we talked until it was impossible for him to ignore his afternoon patients. 

On the drive back to my office, I wondered what would be the results of this unusual meeting.  As I was preparing to leave the office to my next appointment, the office medical secretary reported that we had two new referrals from the physician we had just visited less than an hour before.  Clearly this marketing trip could be easily measured and was time and money well spent.

A slam dunk for this referral-directed marketing approach!

Gone now are the days that community hospitals could expect their community to go to them for help.  Also gone are patients accepting a referral from the family physician without question or without an Internet search for other options. 

It is now the norm that people will do their own referrals (thank you very much!) for the best care at the best prices and they are willing to drive the extra miles if need be.  This approach of taking more responsibility for one’s health care seems to reflect the desires of both the ever-increasingly-better-informed patient and their health care payer.

This, of course, demands a paradigm shift in the traditional approach of marketing health care to maintain what market share you have now and what you need to do to grow new business.  A successful marketing plan can no longer be strictly focused on physicians and nurse case managers as it once was when professional referrals drove new patients and revenue.  Health care marketing is more challenging now and demands a multi-faceted and all-inclusive approach.  Fortunately there are successful examples out there. 

In an earlier piece I discussed the importance of taking one’s organization’s mission, vision, and values to the streets and articulating them in the form of storytelling.  This is a powerful and meaningful approach that has been proven to stick in the minds of physicians and patients alike.  This is brand management in action and helps differentiate your organization from your competition.  And like an effective mission statement, keep your message to whomever you are seeking to make a connection; also, make it concise and easy to remember.

Regardless to whom you are directing your compact and easy-to-remember message, along with knowing and living the values and mission of your organization, make sure you have your facts straight.  Making stuff up and hoping you don’t get caught is not even an option with everyone having easy Internet access.  Always verify your data and take as long as you need to be satisfied with your resources and your information.

Retailers have long recognized the importance of reaching out to their customers and then holding onto to their business.  This is a new lesson for us who have been focusing on the traditional referral sources of providers and hospital discharge planners; intermediaries or gatekeepers, if you will.  Retailers know they have to connect directly with customers by:

  • Raising awareness of services with print ads in newspapers and magazines, billboards, television commercials, and mailers.
  • Making it easy for customers to connect with information on location, hours, and a telephone number via Internet website and Smart Phone. 
    • I would recommend going one step further and provide a prominent telephone number that connects customers to an individual that has been trained to answer all questions that may come up.  Furthermore, post that person’s name and position to truly begin a relationship.  Wow your customers and differentiate yourself from your competition with the best service even before they step in the door.  Don’t ever go cheap when positioning the right people to take calls and give out information.
    • Providing consistent and timely follow-up to everyone and with every call.

Measuring the success of your marketing efforts is a must! 

If you can’t show a return on your investment, why bother?  Depending on the nature of your marketing campaign here are a few ways you can measure its success by:

  • Increase in referrals for services
  • Increase in website hits
  • Increase in revenue trends
  • Increase in public awareness of your services via polling.

I have always found marketing to be fun, especially when meeting people face-to-face. 

I take time to prepare myself for how I want to present and I get to know my product or service so that I can talk about it with knowledge and pride.  I have, however, learned to read my audience and be ready to find a unique way to find a thread of connection and be ready to run with it.  You never know when you may have to talk about marathon times or the Hopewell along the Grand River. 

The Role of Missions and Leading with Honesty

ImageAs a leader, how do you know that your performance is meeting your organization’s expectations? How do you lead with honesty and integrity and then, when in doubt, know where to look for direction?  If you don’t know your organization’s mission, vision, and values take a moment to look.

Your organization’s mission sets a standard for behavior and leadership.  Furthermore, It is the glue that binds all employees and gives direction in making plans.  It is a compact statement, maybe under twenty-four words, is easy to remember, and includes your guiding core values.  Here are some mission statements, as concise as eight words, from nonprofit organizations that I find compelling:

Lifestrong: To inspire and empower people affected by cancer.

Wounded Warrior Project: To honor and empower wounded warriors.

Oxfam: To create lasting solutions to poverty, hunger, and social injustice.

Cleveland Clinic: To provide better care of the sick, investigation into their problems, and further education of those who serve.

The U.S. Fund for UNICEF fights for the survival and development of the world’s most vulnerable children and protects their basic human rights.

AARP: To enhance quality of life for all as we age. We lead positive social change and deliver value to members through information, advocacy and service.

Leukemia & Lymphoma Society: Cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families.

National Multiple Sclerosis Society: We mobilize people and resources to drive research for a cure and to address the challenges of everyone affected by MS.

Mayo Clinic: To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.

Susan G Komen for the Cure is fighting every minute of every day to finish what we started and achieve our vision of a world without breast cancer.

Compact and inspirational?  Absolutely.  The words in these missions are carefully chosen and clear in order to set a context; these mission statements can direct action plans and to help prioritize tasks and options when there is uncertainty and ambiguity.  They explain the “Why” the organization exists.  You can see why it is so important to get the mission statement right. 

Vision statements look toward the future and what the organization is striving to become.  Values are added to provide the “How” the mission and the vision will be accomplished and a template for plans, objectives, and action steps.  Furthermore, values define the organization’s character.

Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan provides a good example of keeping the Mission, Vision and Values succinct, easy to remember, and service oriented:


Mission:  Restoring hope and freedom through rehabilitation.


Vision:  To be a national leader in high value rehabilitation and post-acute care, and to develop an integrated system of care throughout Michigan.


Values:  At Mary Free Bed, we:

  • Focus on patient care
  • Strive for excellence
  • Collaborate to achieve results
  • Take responsibility for performance
  • Are truthful and respectful
  • Embrace innovation


In leading marketing efforts, I have found it imperative in dealing with the public to know my organization’s mission, vision, and values.  I would go as far as to state that if you want to have any traction in building a new relationship, a new contract, or simply wanting to be viewed as credible, you need to live and talk about your mission and values.  I have always made sure to have true stories to share that exemplifies how my organization puts our mission and values to work:  I believe that this approach is brand management in action.  I have found this approach an effective tool in dealing with people across the spectrum:  physicians, hospital administrators, board members, athletic directors, and in interviewing candidates for new positions.   

My experience has taught me that my organization’s values need to be taught to your new staff, repeated in your team meetings, and emulated by you for you to have the credibility to lead in your organization.   By living the missions and values like those noted above, brings an honesty, integrity, and transparency to your practice as a manager.  This practice prevents what I would call an ambush when dealing with issues that may come between you and your staff.

There are, of course, those managers in all businesses who find it easier to wield power by withholding information or by using intimidation.  Maybe it is because of insecurity or uncertainty that they feel that they cannot lead without having a “leg up” on their staff.  Whatever the reason, if you practice following your organization’s mission and values, your actions will have credibility and preempt this unsavory practice.  Often forming peer groups can be helpful for those managers who struggle with leading teams.  Here, one can share frustrations and look for answers without feeling threatened.

Granted, leadership can be most challenging with teams composed of professionals who are well educated, questioning, and assertive.  Personally, I love these kinds of teams.  I look forward to learning something new every day and this is the product of forming teams of this caliber and by you keeping an open mind.   And it this kind of relationship that makes the above organizations’ missions real for everyone involved.

Leadership as a Calling


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Policeman: Do you have any disgruntled employees?

Nathan Arizona Sr.: Hell, they’re all disgruntled. I ain’t running no damn daisy farm. My motto is “Do it my way or watch your butt!”

Policeman: Well, do you think any of them could’ve done it?

Nathan Arizona Sr.: Oh, don’t make me laugh. Without my say-so they wouldn’t piss with their pants on fire.

From “Raising Arizona”

With all my heart I want this fictional film character to just stay that:  fictional.

I would guess that we have all had a boss like Nathan Sr.  Without a detailed character sketch, one can see that he saw his employees as something less than human and pretty stupid at that.

Reflecting on why I chose a career path of leadership—a path that is never linear and more vulnerable to sniping than even Nathan Sr’s employees—I wonder how I arrived there.  One explanation I have is that much like the claims I’ve heard from priests, I’ve always felt that I, too, had a calling.  I had a call to leadership.

Early memories from elementary school include being asked by teachers to keep an eye on the other students when they left the room and being elected class president and editor-in-chief of the school newspaper.  Junior high and high school was more of the same with being elected to positions of leadership to sports teams, band, varsity club, and the executive board.  I took much of this for granted and just figured it was because I had an inclusive personality, I wasn’t afraid to speak up, and that I was more responsible than my peers.

One key experience one summer with the Leadership Development Corps of the State YMCA of Michigan at Camp Hayo-Went-Ha gave me the opportunity to learn about the responsibilities of leadership with my own group of campers.  Leading a group of boys, often only a few years younger than me, and not my peers from high school that retreated to their homes and families at the end of each day, made me realize the power of being a role model and of being a dependable support person during the long stretch of summer.  Honestly, this model of teenagers leading teenagers, had the potential of becoming “Lord of the Flies”, but it didn’t go there.  What I found was that I could be more than a benevolent big brother or a surrogate parent.  I was the leader most boys wanted: fun, positive, supportive, protective, zero tolerance to meanness, patient, and available.  I saw how quickly trust developed between us and I learned about the stuff of which I was made.

I liked what I discovered about myself and how it made me feel.

Now health care operational leadership, like camp counseling and like parenting, if you are doing it right, never really stops.

If your job is to oversee more than one shift or you have staff working every day of the week, you need to be available whenever they may need you.  On my designated times off, I first wore a pager and then a cell phone so that I could be alerted immediately in times of emergencies or sick staff or issues that couldn’t wait until I got back to my job the next morning or on Monday.  There have been several occasions when I had to leave a movie theater to answer a call and times I had to go in to help with coverage or talk to a physician or an athletic director.  Could this be considered a hassle?  Sure, but it is part of the job and I know that my staff, often flying solo, needs me to be no more than a call away.  I know that this is the kind of leadership I would want and so it is the standard to which I hold myself.

I’d like to make it clear that I make myself available not just to my fledgling staff, but also for those who have been out in the field for decades.  I have to be, after all, a role model for all of my staff, displaying by example my dedication to the job, to them, and to our organization’s goals.

The more I watch “leaders” and read about leadership—and there are more articles on the internet dedicated to detailing what elements are necessary to being a leader then you could read in a life time—I am always a little disappointed. See, I find this cookbook approach to leading deceiving.  Unlike baking a pie, one does not simply fold all the “necessary ingredients” into any one container with the anticipation that another leader has been made.

Employees know when they are being lead or being managed or being manipulated.  Creating teams, instilling a vision, and guiding people in developing their careers, takes the care and attention that I found manifesting in myself as a State YMCA LC and camp counselor.  Wouldn’t it be a perfect world if our managers treated us like someone’s son and daughter that they have the responsibility to protect, educate, and nurture as opposed to being a human resource?

Yet, you’re right about one thing thing though Nathan Sr.  I need to do a better job watching my butt.

The Mary Jane Legacy (It’s not about what you may assume…)


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This month marks the fifth anniversary of the passing of my mother, Mary Jane Southard.  She was a hard worker and a very smart woman with several graduate degrees, held a position in public education of which she was the first Michigan woman to do so, and was responsible for launching the education of innumerable children in our community.

Grandma S. copy

Even now, people in her town still recognize our shared last name and ask about her or have an endearing story to share of her seemingly unceasing generosity and kind heart.  It always fascinated my sons and me when out with her that people in their fifties or sixties would approach her and ask if she knew who they were.  And, like some sideshow act, she would look into these people’s eyes and without fail recognize them and call them by the name they preferred as a five-year old… and then go on to ask about their siblings by name.


Mary Jane and Charles, her husband, adopted me over five decades ago.  This couple provided me with an idealized sheltered middle class upbringing in a homogenous suburban community in America’s Midwest.  It seemed like everyone knew me, but now, looking back, everyone knew Mary Jane.

The most enduring lesson my mother taught me was her point-of-view about humanity.  See, she believed that all human beings were fundamentally good.  I heard her express this philosophy with:

  • “There are no bad children, only children who have made bad choices.”
  • “Give people enough time and they will do the right thing.”

I, of course, heard this at the end of every day when we sat and discussed our day.  She always found time for me between the hours of her more than full-time job, school board meetings, graduate school, PTA and church activities, and caring for her ailing father.

By a strange quirk of timing, Mary Jane’s philosophy fell into alignment with my high school years that included the Summer of Love, Flower Power, and “If you can’t be with the one you love, love the one you’re with.”

Was Mary Jane’s message of humanism, love, and respect imprinted into my developing psyche?  You bet!

One of my early bosses in health care warned me to be careful to not make myself vulnerable to everyone.  I guess what he wanted me to do was to be careful of those who may want to manipulate me or, if that fails, destroy me.  I’m not sure how Mary Jane would have reacted to this advice, but I continued to believe that if I provided the right role model that everyone would eventually fall into the ranks of collaboration and love for one another besides our different opinions.  My reasoning continued that this would eventually lead to business success.

As my career developed and I found myself either elected or promoted to positions of leadership, I was still my mother’s child:  driven yet patient about the challenges facing others; competitive yet nurturing; impatient with myself yet supportive to others who lacked my understanding: willing to forgive ignorance, but intolerant of meanness.  I also wanted to connect with people, learn new things every day, and have fun in the places where I spend most of my waking hours.

I freely and frequently talk about my vision for growth and new program development with my staff.  I feel that by keeping them in touch with the bigger picture that they will have a wider context and appreciation of why and how things happen.  This is part of my approach to educating my teams in the ways of the business of health care and, hopefully, developing future leaders to our organization:  educational fun with a purpose.

To my surprise, I have found that not all of my bosses appreciated my approach to management.  It couldn’t have been because my programs and offices were not meeting their fiscal or growth goals or because my staff didn’t turn over.  I know this because my leadership was making that happen.  What I was neglecting was the unspoken and unwritten needs of my boss in what is an inherently uneven relationship.  I was unknowingly working off an educational model once prevalent in public schools where teachers were tenured and had a kind of autonomy in their classrooms not always allowed in other work settings.  Oh.

Mary Jane, however, never lost sight of the importance of establishing and maintaining her relationship with her bosses who were all men.  I know this because she would often haul me along with her when she would visit them in the evening or on the weekend.  I learned early on to bring a book or two when we went on “errands.”  She once even helped one of her bosses move into a house down the street from our home.  Regardless, I learned much about public education administration and the many details it takes to make it run for the benefit of all involved.

And Mary Jane succeeded in her profession where no women before her had.  Even with numerous turnovers in bosses, principals, superintendents, and school boards Mary Jane worked in an organization in which she believed, including its culture, its mission and its management.  Furthermore, she felt that her work had a meaningful impact on the lives of others.  She never lost sight of her guiding principles and, an anomaly nowadays, had only one employer for almost forty-five years.

Now that I have forty-two years of being in the working world, I think that what we all aspire to is to have what Mary Jane found, loved, and nurtured.  Thanks, Mom:  I’m still learning.

Thriving Amongst Giants


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The United States is witnessing an unprecedented number of acquisitions, mergers, and seemingly unbridled growth of mega-health care organizations.  Undeniably there are fewer health care dollars now than a decade, or two, ago.  Larger metropolitan hospitals are merging their boards in order to dominate their region’s industry.  Smaller hospitals are finding that their traditional community-orientated health care model is no longer financially viable.

If you are a small or even mid-sized hospital, what do you do when a larger health care organization sets its sights on your market?

Two things you don’t do:

  1. Continue to do what you have been doing because it has been working just fine.  This is the complacency model.
  2. Attempt to go toe-to-toe with matching services.  This is the suicide model.

In both cases, the larger organization will find ways to beat you.  Simply put, they have more resources than you in money, people, influence, and time.

So what do you do?

  1. Create a new product or innovative approach and strongly market it so that any attempt to do the same will seem lame and duplicitous in comparison.
  2. Find a niche product that would require too much effort and expense for the larger organization to duplicate.
  3. Don’t be afraid to use the “local card” when marketing.  Examples include:
  • We are part of your community…
  • We know you and your family…
  • We share the same values…
  • We only care about you…
  • We are friendly, familiar, and part of your community…

Many consumers still respond positively to supporting community and locally-focused providers even at the expense of flying in the face of the old adage that the true experts are at least a 50 mile drive from home.

A giant is at the door of your hospital, what do you do?

Creating a Win Win


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A cartoon Bubbles laments:  “Why can’t we all just get along?” and for that moment, I know how a Power Puff Girl feels.

An unanticipated consequence of having other managers in the same department is the competition for limited resources.  If the goals of the department are uncertain, if the department priorities constantly change, if communication is spotty from the top down and then across the lines, and if I’m left to guess on what criteria my performance is judged, I will error towards hoarding what I have in resources:  staff, money, equipment, time, contacts.

I think that its this uncertainty within my own department combined with the uncertainty of the national economic scene that fuels my anxiety and brings out what others may interpret as my competitiveness.  There is no question that I’m competitive, but this is something else.  This high octane mix of uncertainty makes me a self-centered manager and an ineffective negotiator much less a collaborator.

How do I get above and beyond this troubling state of inefficiency?

My strategy is about forming and maintaining relationships:

  1. First and foremost is keep talking to your boss about the organization’s and his priorities.  Ask him how you fit in the larger picture.  Find appropriate opportunities for all of the managers to hear this information at the same time.
  2. Insist on regular meetings with your fellow managers to keep communication flowing.  If your ploys for meetings are ignored, stop by, often unannounced, with or without an agenda.
  3. Form your own informational network with managers and directors from within the organization and find opportunities to strengthen and extend this network.

One truth I have uncovered is that mangers aspiring to be leaders can’t always depend on their own perceptions and efforts and then hope to overcome all opposition by slugging it out as a solo act.  Success depends on keeping your boss informed, making connections, and building new programs with the power of dialogue and consensus.

Leadership and Team Building


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It can take months and years to learn and apply all the mechanics of daily to annual operations.  This aspect of management often eclipses what I find the most rewarding and fun part of my job:  building and leading a team.

Management doesn’t have to involve people while leadership insists on having others.  I compare my staff to that of a football team.  Similar to coaching a team of athletes with specialized strengths and physical attributes from the 145 pound kicker to the 250 pound lineman, I am assigned a staff of individuals with different strengths of educational degrees and certifications, experiences, skills, and potential.  It is up to the coach and leader to get to know and assess his team, help with sharpening skills, and then deploy whoever is best suited to the task.  Although this exercise of knowing your team is time consuming and often the most challenging for managers, I find that this is time well spent for both my organization and my staff.

Leaders see the BIG picture and can identify the context for any and all directed efforts. Leaders do the research and begin to identify opportunities.  Leaders look for the most capable staff with the appropriate skill set, educate them on the needs, and then set the goals for the work.

Communication and education to your staff is critical for successfully implementing a new program.  Where some more entrepreneurial leaders fail is by not continuing to review and provide feedback on those more routine, yet still vital, staff efforts.

With success, the staff on their own will place the bar of performance high and then hold everyone else accountable to clear it.  This is not too unlike a positive form of what Economic Behaviorists call cultural cognition or maybe this phenomenon is simply a carefully cultivated cultural norm.  These unwritten expectations work both ways and my staff will give me notice when I’ve fallen short of their expectations.

The most pleasing pay-off for your efforts is to hear your words and your goals repeated back to you from your staff and to read the objective data supporting your well-honed premise brought to life by your team.

From Clinician to Manager


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My master’s thesis was a thinly disguised, and self-serving, case for why an experienced medical social worker would make an ideal hospital manager.

This was the eighties with my early research papers painstakingly typed out on second hand IBM Selectric typewriter and liberally shellacked with whiteout.  Although my final work was saved on a true floppy disc for an Apple IIC, my motivation had not slackened:  to end my seemingly endless dues paying and be promoted to lead my department.  My efforts, amazing to me still, actualized with my promotion to supervisor just months prior to my graduation.

I certainly miss those days when hard work, a willingness to work whenever and wherever, combined with a wide-eyed optimism, opened doors.

Tempered by life-enriching experiences as a father of two sons and having been a state YMCA counselor, I wanted to lead by helping others actualize their goals.  My plan was to meet with each of my staff members to talk about what they wanted, what I needed from them, and how we could work together to create goals.  I reasoned that we’d provide each other feedback, support, and respect and build a better department.  As an act of solidarity, I would continue to keep some daily clinical responsibility and carry the on-call pager for weekday evenings and all weekend, every third week.

Although feedback from my staff felt I was on the right track, I clearly missed a very critical target of my efforts that, I think, is common among us promoted from within a department.  I neglected to pay attention to the needs of my boss and his goals.  This is not a case of not asking my boss on a regular basis:  “How are you doing?” but a failure to ask questions of substance and then sincerely search for opportunities for a meaningful dialogue.


Consider these openings that beg for more than a one-word response and the follow-up questions:

-“Tell me about your committee work on the new initiative?”

-“Is there something I could do to help?”

-“Is my performance meeting your financial goals for my department?”

-“Do you have some ideas on what I could try?”

Maybe these initial probings won’t produce results, but persist and eventually your boss will remember your interest and will seek you out.

You owe it to your career to put as much effort into keeping your job as you did to get it.