Values

Building Courage

Courage by definition is the willingness to do something that frightens oneself. 

In a business context it usually requires people to do the right thing rather than acting in their own financial interest. Doing the right thing is frightening for those with a lot to loose.

Ethics and compliance with regulations is comparably a low bar for businesses but still a challenging hurtle for companies focused on maximizing returns to shareholders.

Tenet Health

Tenet is a good example of a leading edge company focused on maximizing shareholder returns that has experienced compliance issues.

The company has made early investments in technologies that help them reduce operating costs, streamline revenue cycle processes and accurately report revenue related numbers.

The problem is that some operators put the financial focus ahead of the company’s purpose of providing high quality care to the patients in the communities that they serve. In some instances, patients paid a very high price. 

If you need details, google Tenet’s issues in Redding, California. Nurses at the facility eventually “blew the whistle” but given the company’s focus on financial operations, others likely new something was wrong but they didn’t have the courage to question the physician or Administrators involved.

Cases like Redding create trust issues with payers, partners, employees and healthcare consumers. The company pays a hefty price for years even when corrective actions are taken.

The question that remains to be answered, is it worth it?

CVS

Did you know that CVS stopped selling tobacco products in all of the company’s pharmacies in 2014? Despite the loss of $2 Billion in annual sales, executives decided it was the right thing to do. 

The company couldn’t be an authentic partner to healthcare providers when they were selling a product known to create significant health issues. They put their mission ahead of their financial gain.

Reportedly, the company didn’t suffer because they were able to replace the revenue stream with new and enhanced services that better aligned with their core mission. Apparently, people in communities with a CVS have changed their tobacco consumption habits as a result – not their purchasing habits.

Other pharmacy companies have continued selling tobacco and claiming they are complying with all laws and regulations. Those companies continue to profit from the sale of tobacco and people continue to smoke.

Is compliance enough when we already know the negative impact to the consumer?

Values

Your answers will reflect your belief and values. For companies, the answers need to reflect how they operate in order to operate authentically and to attract the employees, partners and others that align with their beliefs and values.

Healthier Hospitals

A framework for Healthcare Finance 2.0 already exists.

Similar to leading edge retailers, hospital systems participating in the Healthier Hospital Initiative are working to make their organizations healthier and more environmentally friendly. 

I discovered the initiative while researching organizational values of leading healthcare organizations and noticed the reference on the old values page for Tenet Health. Unfortunately, the page is no longer available.

Tenet Health

Tenet’s new values are reflected by the acronym CARE which may make them easier for people to remember. However, what truly makes values memorable is whether they are reinforced every day by the way people work and conduct themselves on the job and in the community.

Change of Values

I started my healthcare career with Tenet Health and the values reflected now are fairly consistent with how the company operated back then with one important exception.

Innovation is no longer on the values list and there is no reference to the Healthier Hospital Initiative in the description. For me and likely many Tenet employees, that change is a big deal.

Innovation

With the number of innovation titles used now within the healthcare industry, you might think innovation has become more of a platitude than a meaningful organizational value. However, the Tenet that I knew was a leader in information technology. It’s how the company was able to develop Broadlane and Conifer and to provide services to other healthcare systems. 

Now it’s something that I have to question because there has also been a change in management. Do they have the internal courage to make the early investments in technology or not?

Healthier Hospital Initiative

The Healthier Hospital Initiative is what hospital systems need to challenge current financial models. When I posed related questions in my Healthcare Finance 2.0 post, some industry leaders dismissed the idea as something hospital providers couldn’t afford to do.

The reaction is to be expected during the innovation process. However, it’s also why we need leading edge organizations that can make those early investments to show other systems that it’s possible and to support others in the transition to greener, healthier organizations.

Risk Is Rewarded

Companies that take risks attract the people with the courage and drive needed to lead meaningful change. The value structure needs to support the courageous few for the organization to realize the benefits of innovation.

Culture

According to the book the Trillion Dollar Coach, good cultures need a healthy blend of ethics, values and trust. 

Tenet should have focused on trust because the company already has a strong framework for ethics and values. Plus trust is essential for moving healthcare organizations forward into value based care arrangements, retaining good employees and maximizing profits.

Courage

I’m reading a new book on developing the organizational courage needed to facilitate innovation and change. I’ll have more thoughts on that for you next week.

[Re]Building Trust

Why healthcare companies should be re[building] trust now.

Trust is more important than many leaders realize. I’ve been thinking about it in light of the 2019 allegations of wrongdoing in healthcare report and corresponding settlements being chalked up to the cost of doing business. 

The impact of wrongdoing whether it’s excessive charges, abusive billing practices and the mistreatment of patients and their data is likely having a much bigger impact than most healthcare executives realize. 

Healthcare Consumers

Healthcare companies undermined the trust Americans have in the system at a time when we are asking for more and need more data and engagement from patients and healthcare consumers. Granted there are other factors that have contributed to the mistrust felt more broadly but healthcare companies will need to rebuild that trust in order to transition into value based care models.

Employees

Employees of these companies are likely impacted too. The wrongdoing is not accidental but rather a function of the business practices that likely don’t align with the company’s stated values

How do employees reconcile what they believe versus what they do? They can’t reconcile it. The wrongdoing is likely contributing to the anxiety felt by the employees working within those companies. The impact of the stress and anxiety will only get worse until there is better alignment in the values and the work performed.

Profits

Did you know that companies with high levels of trust outperform their competitors by as much as three [3] times? Healthcare companies have relied too heavily on having a captive consumer. When people are sick, they surrender to the process to get better and deal with the fallout after the fact. 

That’s not going to work going forward. New approaches to medicine and healthcare services require participation from all consumers – not just patients. How is your company going to convince consumers to trust your organization and the process when there is no immediate need?

Trust

What is trust? The one common theme that I have found to describe trust is that trust happens when you’re willing to accept the risk of vulnerability or in other words, the risk of being harmed in some way. The perceived risk has to be lower than the probability of being harmed.

How do you convince someone to take the risk on your organization or you? Trust is earned by repeating actions that conveys trust. 

The book Trillion Dollar Coach, written about Bill Campbell’s work with leading Silicon Valley companies and executives, identifies five [5] key elements of trust:

  1. Keep your word: The commitment and/or fulfillment of one’s promises. Be accountable for mistakes, apologize and make amends when things go wrong.
  2. Loyalty: A strong feeling of support or allegiance. Establish clear boundaries and when you’re unclear about what’s okay and not okay, ask rather than ask for forgiveness after the fact.
  3. Integrity: The quality of being honest and having strong moral principles. Have the courage to practice your values and do what is right versus what is easy, fast and fun.
  4. Ability: The possession of the means or skill to do something. Avoid overpromising and underdelivering.
  5. Discretion: The quality of behaving or speaking in such a way as to avoid causing offense or revealing private information.

Trust can’t be won with one large gesture. It has to be built over time with actions that are consistent with the key elements of trust. Just remember – trust can be undermined faster than it is earned.

Be generous

Best advice from Dare to Lead for developing trust within an organization is for everyone to extend the most generous interpretation possible to the intentions, words, and actions of others.

Even if you believe that you are trustworthy, most only trust a handful of people. Chances are your assumptions about a situation, interaction or person are wrong. Default to truth but when in doubt, look for the data and trust the facts.

Stand Up?

Should you take a stand on important issues?

It’s something many leaders are rubbling with right now.  Eric Topol MD wrote an article for the New Yorker recently about the potential for a new doctors’ organization that would enable physicians to take a stand on important issues affecting the health and wellbeing of Americans. Issues such as vaccines, drug pricing, climate change, stem cell clinics and false health claims spread by celebrities involved in lifestyle medicine businesses. 

In the article, he noted several female physician leaders who took on the NRA and claimed the lack of adequate gun control regulations not only as their lane but as their highway. What gave them the courage to stand up to the NRA?

Dr. Topol hypothesized that their courage was attributable to dealing with long-standing gender inequities in medicine. Possibly but it likely has more to do with their values and their frustration with the lack of change. 

Organizing to take a stand on important issues is commendable but also challenging. The values and interests of the group need to align for the group to have a powerful voice.

Whether physicians organize or not, they should be encouraged to bring their whole self to work as employees in leading edge companies do and to speak out on issues affecting the health and wellbeing of Americans. Otherwise, how can doctors be held accountable for the cost of healthcare if they can’t speak out on the biggest drivers of cost?

Daring leaders who live into their values are never silent about hard things.~ Brené Brown

Valeant

There is a good documentary called the Drug Short that tells the story of Valeant to explain the problem with drug pricing in the US.

Valeant reportedly operated more like a hedge fund than a pharmaceutical company. The model was pretty simple:

1/ Buy companies that have a drug with a monopoly.

2/ Strip out the R+D so that the typical 18% spent on R+D goes to the bottom line.

3/ Raise prices on existing drugs.

The problem is that many of the drugs were life sustaining drugs for people in middle America who couldn’t afford to pay for them.

The company took extraordinary measures to bilk insurance companies for payment. To keep patients quiet about the issue, they provided just enough financial support to them through their advocacy efforts. 

Hillary Clinton started tweeting and talking about the issue during her campaign. Investors and board members could have looked into it and taken action, but they didn’t. They were reportedly paid large sums to look the other way. The company’s stock eventually tanked.

The returns on biotech companies now are largely due to price increases. The company’s can’t afford to lower their prices and profits. So nothing has changed yet.

Change in 2020 is likely because even though the pricing strategy is not illegal, many leaders feel that it is morally wrong.

Focus on Why

Do you know why your company exists?

If you answer is something like to provide high quality medical services or to provide a specific type of solution to the healthcare industry, you’re telling me about your company’s what – not the why. 

The why is the reason the company was founded and continues to exists. The why embodies the company’s beliefs about those that it serves and reflects the values that guide how the company operates. 

One Medical

I reviewed an investor report on One Medical recently that had this really wordy description of why the company exists. It made me wonder whether the company is loosing touch with their why [a common problem as companies grow] or if the why was just lost in translation.

However, most people are familiar with the company so it seemed like a good example to explain the differences between why – what – how and the value of focusing on why.

Early success:

1/ Why: The founder, Tom Lee MD believed waiting 29 days [the average wait time in the US] to see a primary care physician was unacceptable. So the company’s core belief is timely service is most important to their customers and members.

2/ What: One Medical found customers willing to pay a premium for on demand access to care. Employers and those without an established relationship with a primary care physician were willing to pay the premium. 

3/ How: The company solved the wait problem by incorporating nurse practitioners and technology into their service so that most if not all of their members are seen within 24-48 hours of scheduling an appointment. They also increased the length of the appointment to minimize the risk of wait times on the date of service.

Growth + Profitability:

The why has defined the company and is the reason existing customers and members value the company. As the company enters new markets and partnerships, the management needs to consider:

1/ Do other populations value timely access to care as much and are they willing to pay a premium for it? 

2/ Are they able to modify the how without sacrificing the why to achieve long term growth and profitability?

It will be interesting to see how the next chapter turns out.

Living your Values

If you’re thinking which values are you referring to – personal or company values? I’m actually referring to both because there should alignment in your personal and professional life.

If you need to google your company values or call human resources, chances are your company’s values have not been operationalized. Only 10% of companies have a short list of memorable values that they’ve associated with behaviors to reinforce their values.

Salesforce has done a good job of honing the values list to four [4] values and associating behaviors with each value. It’s how they are able to walk their talk in everything they do despite being a very large company.

Whittling down the values list from 100+ takes some time and careful thought. Most companies have a list of 10-15 values but within that shortlist there are usually 2-4 that encompass the company’s core beliefs. 

Operationalizing values is a process of linking values to behaviors so that people understand what’s an acceptable behavior as well as what’s not an acceptable behavior. Providing three [3] examples of each type of behavior is usually enough.

Once the values are operationalized, the company culture will develop to support and enforce those values.

If you’re questioning whether or not it’s worth your time, think about how much easier it will be for everyone in your organization to:

1/ Hire the right people 

2/ Manage customer relationships 

3/ Work collaboratively with people throughout the organization

4/ Make good decisions for the company

Defining and operationalizing your values is not something you want to put off until you’re the size of Salesforce. There are a lot of steps in the journey to realize that level of success. That’s why I think of it as one of those “the sooner the better” activities.

“Daring leaders who live into their values are never silent about hard things.” ~ Brené Brown

Our Values

I’ve been working on refining the values for Rush360 too.

Innovation is the heart of what we do. There are 4 steps in our process [Learn, Engage, Design and Transform].

So I started with the steps and thought about the values we need to have in order to do those things well and support the people on our team.

These are the four values that resonated the most with what we do and why:

1/ Courage: It takes a lot of courage to step into a new environment and to get up to speed quickly especially when people see you as a change agent.

2/ Open: It takes an open mindset to be constantly working with new people, new process, new system and in new environments.

3/ Creativity: We get the benefit of having a fresh perspective on the problem but it takes a lot of creative energy to work with all the stakeholders and to design a solution that works for them now and in the future.

4/ Innovation: It takes someone who loves to innovate because the stakes are high and the risk of failure is real. Failure on any scale is disappointing and tough on the ego.

That leads me to balance. I think everything in life – from our bodies to our businesses – needs balance. In Dare to Lead, Brene talks about daring leaders having a strong back and a soft front. It seemed like a good framework to test the balance of our values… it takes a strong back [courage and love for innovation] and a soft front [open and creative mindset].

Political Risk

Lower cost is one element of the triple aim. How does your company’s values address the cost of healthcare?

Cost is a big issue for the 2020 election. Some of the government findings about healthcare pricing and billing practices are clearly an issue that could blow back on companies that aren’t proactively addressing cost.

What are patients being promised about the cost of their care? Is your company promising the lowest cost, a market rate or a high cost for a premium service? There is no one right answer but patients need to know what your company is promising. Why?

Stakeholders have the ability to influence government action now more than ever thanks to social media. Social pressure from stakeholders including patients, employees and employers will force the government to regulate the reported problem. We’re seeing it now with proposed regulation for pricing and billing practices.

Leaders of companies should be thinking about:

1. Risk profile as it relates to cost.

2. Prioritizing cost as a risk and integrating it into their values + strategies.

3. Mitigating existing risk.

Companies that don’t will expose themselves to unnecessary political and reputation risk by not making a clear statement about cost.