Sunday’s keynote presenter at the 2012 Society for Health Systems conference was Dr. Stephen Markovich, the CEO of Riverside Methodist Hospital, a 1000+ bed hospital that is the flagship of the Ohio Health System. Dr. Markovich is not only both a doctor and a CEO, but he achieve both of his boyhood goals of being both a doctor and a pilot (he flies in the National Guard). He was told “you can’t do both,” but he found a way to do both – very inspiring.
One of the main themes of his talk was some guidance about 10 things that process improvement professionals (lean, six sigma, management engineers, etc.) can do to “create value” for their CEOs. Ohio Health’s approach of “Process Excellence” combines Lean and Six Sigma.
Since there are a lot of young professionals in the SHS crowd, this was probably a helpful perspective that they might not get from their own CEO. It’s not all necessary “Lean CEO thinking,” but it’s worth sharing here. Here is his Top 10 (see my grainy picture – click for larger view) and my key points and paraphrasing of what he said.
1) The most important thing to the CEO is “transformational leadership” (as opposed to transactional leadership). How do people need to be developed so the organization can go where it needs to be in the future?
Dr. Markovich raised an interesting point that he views performance measures, including safety and quality, as “lagging indicators.” But, at the same time, he showed a very strong command of his hospital’s key operational metrics, including E.D. length of stay and others. He suggested that most hospital CEOs really don’t know these numbers.
2) P.I. people need to really understand how the hospital operates.
He said “you can’t just spend one day in a department and deem yourself an expert.” You need to “understand the hospital’s mission first” and know the “origin of existing processes” to be an effective change agent.
3) Learn to change what is important to me (as CEO)
But, Markovch said that staffers need to “help me refocus as the landscape shifts.”
4) Have an understanding and appreciation of the MD perspective about hospitals.
A key point seemed to be that hospitals are dependent on physicians bringing them a good portion of their revenue (via patients they bring or refer). He also emphasized that physicians, throughout their education, really aren’t encouraged to work in teams or collaborate.
5) Help me reduce subjectivity and “help turn down the emotionality of conflict” by providing data and facts
6) Identify real measurable opportunities that tie to the scorecard and goals (cost, volume and growth, quality and safety, aligning MDs)
- You can’t do every pet project
- You need projects to support each goal
Dr. Markovich told a story about the hospital realizing, one year, that they were halfway through the year when they realized they had NO efforts underway to support one of their goals.
My commentary is that this scenario perfectly illustrates the need for effective “strategy deployment” as practiced at ThedaCare (see the DVD) and other leading hospitals. Everybody, from top to bottom, needs to understand the goals of the organization and how that related to their work and their own local measures. ThedaCare, for example, selects and aligns projects and initiatives so that they are working toward improving all of their core measures. ThedaCare also is very disciplined about DE-selecting projects so that they aren’t trying to do too many things at once.
7) Solutions should solve problems strategically, not just “fighting the fire of the day.”
8) Help create buy-in for your solutions
Some key strategies include “over communicating” and being “overly inclusive.” Markovich reminded the audience that if you need to have somebody participating in a project, you’d better invite that person to the kickoff meeting.
He also added that we should “tolerate dissent but identify and address resistance early.”
He defined dissent as a good thing — “if there’s no debate, are we missing something?”
But, once a path has been decided on, you have to look for people who are nodding yes, but then “screwing with the process.” He’s right in saying that “challenging ideas doesn’t mean you’re not on board.” I agree that we need dissent and disagreement, otherwise people are just rolling over and being compliant… and I don’t think excellent organizations are full of people who just roll over and go along.
9) Acknowledge and examine mistakes
This is very much a Lean lesson, that we can’t “bury problems.” Dr. Markovich said leaders need to “celebrate problems and examine them.”
He had some brilliant advice that senior leaders need to first admit “their own vulnerability to mistakes” and that will enable the staff to take more risks. An organization that won’t take risks can’t improve.
10) Understand the CEOs limitations
I’ve found that the best CEOs (and best leaders in general) are very humble people (while being confident). Dr. Markovich said that CEOs have “limited bandwidth” and are always struggling to satisfy multiple constituencies.
As a staffer or a process improvement person, you won’t always get a personal reply to an email or a request (there’s just not enough time in the day, said Markovich). But, you need to “keep bugging me” if the issue is important.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.