Saturday, December 20, 2008

Were taking a break

It's that time of the year. Were taking a break for a couple of weeks. Shutting up shop to relax with friends and family over the festive season and take the opportunity to recharge the batteries. To all those that have followed our blogs throughout 2008, we thank you and we are humbled that you would chose to travel with us on our journey. We trust you all enjoy the festive season and we look forward to meeting up with each of you again in 2009.

John Coxon

Tuesday, December 16, 2008

MBA - Useful or Useless?

The November issue of Insite, the Aged Care industry newspaper has a feature on management. On its front cover it asks the question whether an MBA is purposeful or pointless for executives in the aged care sector?

I would like to take a slightly broader perspective than the aged care sector. Let me state first up that I dont have an MBA or even an undergraduate degree. While I have studied a variety of University level diplomas and courses, I have tended to get my education from the University of Hard Knocks. There are many, especially amongst those that have invested in higher degree level education, who would view my comment as being cynical. They would be wrong. I am totally in favour of continuous learning. The process of learning is more important than the channel used to learn.

More importantly, I believe than the actual qualification, is the reason why one believes the qualification is necessary. The often quoted outcome of MBA level education is that it teaches people critical analysis skills. Maybe. My question would be this. Does it teach people how to apply those skills in the real world of constantly changing environments and pressure to perform? Looking around the world at present and seeing the impact of the economic crisis and prior to that the meltdown of the dot-com era, I get a sense that those with the education somewhat lacked the ability to apply their learnings in a practical manner.

Some have a tendency to believe the qualification actually qualifies them to perform a certain role. Nothing could be further from the truth. Interestingly enough, research worldwide suggests the majority of current CEO's tend not to have post graduate level education. They got where they are by experiential learning and applying common sense. In future that balance will change, I believe, increasingly more CEO's will have higher tertiary education. This will not be because they need it to do the job, it will be a result of increasing numbers of people completing post graduate university degrees.

For those that enjoy the structured learning of University, and I did, then completing post graduate education may well be a good option, though a reasonably expensive one. The cost has to be recovered at some point and the question has to be asked whether the benefit is equal to or greater than the cost? In my case I have always been busy getting on with the job to find the time to learn how to get on with the job. I have also made a lot of mistakes and I am sure many of those would not have been made, or the impact may have been less, had I spent more time with colleagues in a more formal learning environment. Equally I could have made less mistakes had I spent more time seeking guidance from mentors already in my fields of endeavour.

This serves to illustrate there are many different ways to gain an understanding of issues - and that is what higher education provides, a broad understanding. It also opens your mind to different perspectives.

Just this morning, one of the people I follow on Twitter posted an item about free university education.

This intrigued me so I took the time to look through some of the offerings. I looked at the course material for a program on advanced strategic planning. Read it, enjoyed and decided it didnt add a lot to my current level of understanding, gained from 35 years of practical experience.

This is not a rejection, or a criticism of the course or its producers. For someone else, without my practical experience, such courses offer a cost effective means of learning at a higher level. For those that might be considering this option, I will offer this insight. While attending University in the past I have found many of the lectures only so-so. Where I have gained the most is from interaction with individual lecturers and with other students. While face to face interaction is preferable you can replicate this interaction online.

Would I hire someone with an MBA level degree over someone with experience and able to demonstrate understanding and the ability to achieve? Probably not. Would I hire someone with practical experience and and MBA over someone with just practical experience? Probably so. Would I use degree level education to filter out applicants for a position? Never. When I help clients hire, I am looking emotional competencies and a demonstration of continuous learning. We can develop all the other competencies over time.

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO
Skype: john_coxon
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Wednesday, December 10, 2008

Workplace stress and burnout

Work related stressors have repeatedly been identified as contributors to workplace stress and burnout of staff at all levels. See Spooner-Lane, R. Dr. 2007.Australian Journal of Advanced Nursing. Vol 25. No. 1 and also some excellent publications available from Australia's National Research Centre on AOD workforce development (NCETA).

The research clearly defines work related stressors as being an unsustainable workload, role conflict, role ambiguity, a physically demanding work environment and the impact of continuosly dealing with other people's concerns. NCETA's research shows that young and less experienced managers are more prone to stress and burn out than their older, more experienced colleagues. While this may be good news for those that stay the distance, the same research also showed that younger managers and workers were more likely to move out of the health sector as a result of these work stressors.

Which simply serves to illustrate the potential cost. Stress and burnout of staff increases the operational costs of your organisation through increased absenteeism, additional staffing costs, poor customer engagement leading to low quality service delivery.

According to NCETA's research there is evidence to suggest organisational issues and demands rather than the challenges of working with people in need, that have the greater impact on stress and wellbeing. (Skinner, N., & Roche, A.M. (2205) Identifying and preventing burnout in AOD managers and supervisors.National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia.

The cure here, if we might use that term, is for organisational management to take a holistic approach to reducing workplace stressors. It is not sufficient to focus only on the individual employee; instead the focus should be on the root cause of the stress, and on removing the root cause. Contact John Coxon to arrange a meeting to discuss how this issue may be addressed in your organisation. We can bring a very highly experienced project team of three people to work on this issue immediately. It could save your organisation a lot of money and angst.

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO
Skype: john_coxon
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Monday, December 1, 2008

Working with Millennials

If you manage a hospital, an aged care facility or a medical centre where should you be looking for lessons on how to manage your future staff resource? Try McDonalds. Why not talk to the military? The AFL or the major managment consulting firms. Why? Because these organisations are key recruiters of young millenials. What are millenials? This is the generic term used to describe those moving into the workplace. They will be your future management team.

Here is a newsflash. Baby Boomers are a dying breed. Now I don't mean that in the sense they are becoming extinct. Well actually, they are, even though the end is still a long way off yet. I mean it in this way. There are approximately 300,000 Baby Boomers remaining in the workforce in Australia and New Zealand. They will have all exited the workplace by 2030.

On the other hand, millenials, those born in the past twenty five years represent 50% of the population and will be the workforce of the future. Those from Gen X are currently moving into the management ranks as we speak. Those from Gen Y, now aged in their early to mid-20's already have their eye on the top spots and following only a decade or so behind them are those currently in primary school.

Ok, so you're a Baby Boomer, you're currently in the workplace and aged 50+. Your in survival mode. You are hanging on for grim death to every rung of your hard-earned, hard-fought for, career ladder. You can almost smell the roses of retirement. This is not really your problem is it?

Wrong. it is your problem. The bright young things moving into management are not going to wait for you to retire. They are going to force you to learn how to work with them or they will run all over you; leaving one question only to be answered. Why is that person still working here?

You need to develop the ability to form relationships with the younger managers and workers. How? Lesson #1. The up and coming managers crave feedback, constant feedback. Not superficial feedback, not platitudes, they don't lack self confidence. They can see right through bullshit. They have high expectations of themselves and of others. They want to know that what they are doing is of value and is a valued contribution. They want to know how they contribute. They do not want to be preached to or instructed. They want to learn, from good teachers, able to guide them through a process of discovery. Are you able to do this?

They are tech savvy, having grown up online. Their network of friends and contacts are online, in communities and social media spaces. These networks are trusted; it is where the next breed of managers go for referrals. They get their information online. They obtain feedback and info from multiple sources. Their confidence comes from the size of the contact group. Are you online? Are you on frontpage? Do you have a professional profile on LinkedIn? Are you following or being followed on Twitter? Do you have a blog? Do you even understand what I am talking about here?

Media have portrayed millenials as being self-absorbed and in a hurry to get places. To a degree many of these portrayals are based on fact. We cannot change the characteristics of the next generations. Let's not waste time trying to achieve the impossible. Instead let's learn to work with them. Instead of telling them what we believe they should be, let's ask them what they would like to be. Then we can put in place processes to achieve that while also achieving the needs of the organisation and of yourself.

My advice to those aged 50+ and still in the workplace. Develop the ability to become a coach, a facilitator, a mentor and a teacher. You have knowledge and experience. Delivered in an appropriate manner, there are 3 million people coming into the workplace over the next twenty years and they all need what you have. Do this and you will retire happy, satisfied and value beyond your wildest dreams.

Like to know how to develop the ability to lead and teach? Join our Managers as Coaches program for 2009. Go to to download an info kit.

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO
Skype: john_coxon
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Friday, November 28, 2008

Defining success

I've been thinking a lot lately about the definition of success. Everyone has their own interpretation of what success is, and what it is that successful people do to achieve their success.

One of the things that intrigue me most is how often others use 'financial success' as the definition of success. Is this the only true indicator of success? Certainly for some its an outcome of being successful. What about those that achieve success without it resulting in personal wealth? Are they any less successful for it? I don't think so.

I believe success is something one has to work at, regardless of how one defines it.

Success doesn't happen by chance. That is good luck. Success happens because someone makes a decision to actually do something. Taking action is the difference between those that achieve success and those that only talk about doing so.

Success is not a 'big bang' event. It doesn't happen all at once. Achieving success is an incremental process. A process of doing something, over and over again. A colleague of mine refers to this as the 1%er's. These are the people that do 1 new or different thing every day.

Furthermore success is iterative process. This means you have to keep trying. Rarely does success occur on the first effort. Like top sportspeople, success is achieved by practice and more practice. Every attempt is a part of the learning curve. Success takes time and requires patience.

The other aspect that seperates those that are successful from those that are not is the ability to bounce back from setbacks. Many successful people have failed more often than they have succeeded.

So what is my advice to you. Keep trying. When you fall down, pick yourself up and try again. Keep learning and . . .

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO
Skype: john_coxon
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What Are Your Final Wishes - Engage With Grace

A short blog entry. Along with 1000's of other bloggers on health related issues we are participating in a global 'blog rally'. This is where one single topic is picked up and discussed simultaneously around the world.

Now I reckon blog rallies will become messy and confusing in the future and we will have trouble deciding which cause to support - just like donating in the real world. Yet I kinda like this topic. It just isn't something we talk about. When we do, and have with friends, some of the topics have been pants-wetting hilarious, others more sombre. The point being this. You can't tell others of your final wishes **after** you have left this earth, so why not do it now?

Download this slide. It contains five questions. Answer them yourself, involve your friends, partner, lover(s) and soul mates. Take it to dinner, to a restaurant, in the car on a trip or to bed, whatever and wherever, just have the conversation.

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO
Skype: john_coxon
Follow john_coxon on Twitter
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Saturday, November 22, 2008

For Profit Aged Care in Australia

I wonder if it would be preferable for the aged care sector in Australia to operate as a for profit sector. By this I mean the funding for aged care infrastructure is provided by investors while the funding for residential care is provided by the Commonwealth. Accreditation standards and classification standards could remain in place as process of quality assurance. Instead of the Commonwealth issuing 'bed licences' it could instead offer a 'operator licence'. This licence would be dependent upon the operator meeting the minimum standards of operation and care and being subject to visits from accreditation agencies.

No doubt many could think of reasons why this shouldn't happen. There may be some good arguments in favour and maybe the time has arrived for the discussion and the debate. Clearly it is not something that is going to occur overnight. It may be possible to implement a dual process and let market forces sort out the final result.

Would smaller non profit providers be the losers? Undoubtedly. Market force feeds on scale of economy, systems and processes and the ability to share costs over a wide base. Many, larger, non profits have already moved in this direction. It may be that over the next twenty years the majority of smaller non-profit aged care operators in Australia will have been acquired and merged into larger groups anyway.

The age care sector requires a massive investment towards infrastructure over the next three decades, in addition to simply maintaining wages levels in line with cost of living increases. This is a significant drain on Commonwealth taxes. Why not transfer that cost and risk to institutional investors?

Would the consumer be disadvantaged? Those opposed to this concept will raise this scenario immediately, yet it may not be the case. Look around you. Even today, with vastly improved acceditation standards and continuous improvement processes in place over the past decade, still the papers are full of stories of aged care operators who have a complete disregard for the resident. These breaches continue to occur for a number of reasons, including; poorly trained managers and staff, inadequate enforcement of standards, low levels of funding for staff, resources, equipment and infrastructure and last but not least an inherent belief that you have to literally kill someone before you lose your operating licence. Even if that were to occur the financial cost is viewed differently by the facility operator. Private investors would not tolerate losing their licence to generate revenue and would likely be equally or more diligent in meeting the required legislative requirements.

Just a thought . . . .

John Coxon
Taking You From Frontline Manager to CEO

Friday, November 21, 2008

Boring, boring, boring

This blog is boring. Well that is not actually true. I just wanted to draw your attention to the fantastic offer I am about to make.

Would you like to participate in free management coaching? It’s an easy question to answer. Yes or No. If yes please read on.

Throughout 2009 I will be delivering a series of management workshops throughout Australia and New Zealand. At each event, on either the evening prior or the evening after I will be holding court in a lounge at the venue. I will be providing free, no obligation, coaching to those in attendance. I will help you solve management issues, develop competencies, reduce stress and enjoy your work more. It’s free, no cost, no obligation, no books, no CD’s, no hidden agenda’s or products and definitely no hard sell. If you are there you benefit from the combined knowledge of all in attendance. If you are not there then you miss out. Whether 5, 50 or 500 turn up I will find a place for us to work together. If need be we will move out into the street and work there.

Why am I making this offer? I operate a successful consultancy working with managers in the health, aged care and not for profit sector. The work I do allows me to travel throughout the two best countries in the world. It allows me to spend time with my wife, Liz, to enjoy holidays together and it allows me to spend time with my children, Tara and Byron. I do what I love and I love doing it. I also like to give back as much as I get. Most management advice is freely available. If you had the time you could read all the books, articles, blogs, research reports, white papers I do. After many years as a management coach I have learned one irrefutable fact. Most people can access information. What they need me to do is help them develop and implement the action plans that convert knowledge into results. By coming along, meeting me, letting me meet you, it means that when you do call me seeking my help we already have had contact. You are comfortable with and we spend less time becoming comfortable and move quickly to help you reduce stress and enjoy your work.

How do you register for these events? You don’t. Just turn up. If you wish you may SMS me a message on +61427390376 the day prior, regardless I will be there.

How do you find out about dates and times? Firstly, go our either of our websites, or and follow the link to services and to workshops. Here you will find details of cities, venues and dates. Court will be in session from 5.30-7.00pm.

Secondly, sign into and follow john_coxon, here you will see announcements of dates and venues also. You could also return to this blog in one week and you will see a list dates on here.

Are you in? What have you got to lose? Absolutely nothing. What value on the stuff you learn? Priceless.

Let me help you reduce stress and enjoy your work as a manager.

John Coxon

Thursday, October 9, 2008

Staff retention

Health providers in Australia and New Zealand, along with health providers in every developed and developing nation, are facing the impending impact of labour shortages. News media worldwide carries stories daily of the shortage of qualified medical staff at every level. Baby boomer, leaving aside current financial blues, are leaving the workplace to retire or work part time and that trend will continue to many, many years.

The healthcare sector embraces the extremes of earning capacities from highly paid specialists at one end of the scale to personal care attendents in aged care at the other end of the scale; in the middle are corps of nurses and medical staff. The majority of those employed in the health sector earn an average salary, the same as other people do in other industry sectors.

For the past five years Western Australia has dragged people away from other states to feed the mining sectors insatiable need for staff. There is no end in sight to that trend. The Western Australian situation does provide an insight into the problems a nationwide labour shortage may create.

The reality is that no single organisation, or industry sector, can prevent a shortage of labour. The shortage is being driven by shifting demographics as 20-30% of the population moves into retirement age. Health providers cannot afford the luxury of focussing on how they attract people to work for them; they must, instead, focus on how to prevent people leaving their organisations. If there was ever a time to be recognised as an employer of choice then that time is now.

The best people are attracted to the best employers. It doesn't take a Government funded research project to understand that. Good people do not tolerate mediocrity for long and when the shortage of labour drives up the price of labour; they dont tolerate mediocrity at all. Many, many employers will discover this for themselves over the next decade or two.

There is a number of things a health provider can do to improve its staff retention rate. Firstly, choose the right people to be managers and provide them with an appropriate level of professional development, coaching and mentoring. Secondly choose the right people full stop. Regardless of who you are hiring, hire them for their competencies and their demonstrated ability to do the required job, not for their technical knowledge or diplomas.

The younger generation of workers bring a far greater level of diversity to any organisation than at any time in the past. As much as you spend time and money on cultural diversity, spend more money on learning about and understanding how generational diversity can work effectively together.

A labour shortage will reverse one of the more insidious trends of the past two decades; that being to condemn mature workers to the scrap heap. It is possible employers will come to realise the inherent benefits in retaining knowledge and passing that knowledge on by mixing the old with the young. Mature workers, like younger generations, have their own needs and wants. As an employer you will need to retain mature workers for as long as possible - and you compete with their desire to spend the kids inheritance.

There is more, much more. Learn about various employer of choice programs and awards and put yourself on display. Even if you dont win you will serve notice to your employees that you wish them to remain on board.

Whatever you do, the solution does not rest with increased remuneration. You will never be able to compete with those driven only by the need for more money. Don't waste time on them, instead focus on the majority of your employees who simply want you to operate in a sustainable manner for the long term, be paid a level of salary that doesnt create stress, be treated with dignity and respect and be valued for their contribution - regardless of their age or position.

Monday, August 4, 2008

The Age of Collaboration

John Chambers, CEO of Cisco, recently contributed an article to the CEOFORUM GROUP website title The Power of Collaboration. In his article Chambers discusses how corporations and the business sector will learn how to combine technology, such as web 2.0 tools with the human ability to communicate to create the ultimate forms of workplace collaboration.

You may read the article yourself by selecting the link above. Obviously I am delighted to share John's insight with you as he mirrors everything I believe in - that the best outcomes in any workplace are achieved through collaboration.

For those unable to get to John's article, I will an insight here with you. John states "encouraging this collaborative behavior will also require us to teach students and employees how to work well together and to make good collective decisions". Oh, I can see the rednecks and those that fear the onslaught of the 'comrades' turning in their collective graves!

Go read, its is a short article. Afterwards I would be keen to hear from you as to how you believe technology might contribute to greater workplace collaboration.

Friday, July 25, 2008

Front line managers are the key

Let me share with you the results of a piece of management research conducted in 2007 amongst health providers in the USA. View summary and white paper here.

The research was conducted over five years and involved 500 healthcare organisations and 200,000 healthcare professionals. The study aimed to study, job satisfaction, organisational loyalty and degree of professional engagement.

What was the main finding? Here it is. Leadership capability at the front-line level influences overall performance more than any other contributing factor. Rankings of leadership capability showed positive correlations with -

  • Job Satisfaction
  • Organisational Loyalty
  • Professional Engagement
  • Willingness to continue employment
  • Voluntary Turnover
  • Patient Satisfaction
  • Performance to projected budget
  • Employee productivity
  • Financial success (profitability)

I welcome feedback on this topic. Why not share your stories of how your organisation has utilised the strengths of its front line managers and supervisors?

Ageing population in Australia

Australian Federal Minister of Ageing, Justine Elliott, recently provided an insight into the growth of the aged population in Australia over the next two generations. Click here to view media release.

Australia has the second longest life expectancy rate in the world, with only Japan having a longer life expectancy. By 2060 it is expected the average life expectancy of women will be 88 years and for men the average life expectancy will be 84 years.

By 2021 it is expected that 18% of the Australian population will be aged 65 years plus, and by 2051 it is expected 26% percent of the population will be aged greater than 65 years. By 2025 Australia expects the number of people aged greater than 80 to double and by 2055 some 78,000 people will be aged greater than 100 years. These figures are generally consistent with projections for aged populations in developed nations worldwide.

How are we going to care for these people? Leaving aside any scientific breakthroughs for halting degenerative body processes, and the assumption that if they existed, they would be affordable to people on pensions, one thing is certain, it doesn't matter what age we live to be, in general, our bodies degenerate at around the same time. They simply wear out. Possibly a combination of healthier living and medical technology may combine to forestall the inevitable however the reality is that between 2025 and 2050 the Australian nation will need to provide:

  • Residential care for around 350,000 - 400,000 people
  • The majority of those will require high care
  • Community care of some nature for between 4m - 5M aged living in the community
  • A pension process that enables increasing numbers of aged to live in rental accommodation in the community
  • Affordable, subsidised rental accommodation
  • Meals on wheels for a large group of people
  • A significant investment in Government infrastructure to meet the information needs of the elderly
  • A more equitable funding process for aged services, designed to meet the needs of the elderly, rather than the budgeting needs of Federal Government
  • An investment in training and development of aged care workers and community care providers
Aged care providers and retirement village operators will face increasing costs as the demand for services increases on one side and the demand for workers, across all sectors, increases on the other side. Workers employed in aged care, with the exception of Registered Nurses, have traditionally ranked amongst the lowest paid groups. The continuing demand for workers throughout Australia, and globally, over the next thirty years, will drive wages up and draw workers away from low paid roles. This will increase labour costs to aged care providers and increase their reliance upon the use of technology. Either way the cost of providing aged care will fall onto a diminishing group of workers as taxes are used to provide funding for aged care services. Those that are working today need to increase their superannuation savings and invest in other forms of investments so as to minimise their hardship when they retire. The Federal Governement in Australia in 2040 is unlikely to have the working base to extract sufficient taxation from to meet all the needs of an ageing population. Increasingly aged services, beyond basic services, will be available only to those able to pay for them from their own means.

Governments need to change the rules related to superannuation, investments during retirement and working later in life. They need to remove blockages that discourage additional saving, even reward saving earlier in life. They need to remove restrictions on how superannuation funds may be accessed or utilised. They need to remove restrictions on working and investing. In short, Governments need to do everything they can over the next thirty years to encourage those now in their 30's and 40's to become as self sufficient as possible.

One way Governments can assist at an early stage is to mount an educational program on retirement implications and options. A sustained public awareness program over an entire generation would change attitudes and behaviors, just as has occured for smoking and drink driving. For many people aged under 50 years, the subject of retirement is taboo. They don't believe they will ever grow old and they don't want to consider the possiblity, therefore they don't plan for the future. This needs to change.

Aged are providers and retirement village operators need to be planning for the future - a long way into the future. This doesn't mean 50-year strategic plans, it does mean 3-year plans, updated every three years. What is required is for the boards of aged care organisations to be thinking some 30 years ahead. Boards need to proactively recruit younger people. This will shift their focus forward from tomorrow to the future. Boards should be obtaining a constant flow of information about future population projects and building their planning around that information. Aged care management teams need to be looking long term at their staff needs. How many people will be required, where will they come from, what skills will be needed and how to create a competency pathway that provides interest and acts as an incentive to people to enter and remain in the industry. The future will be very different to the present, so don't plan for now, plan for the year 2050.

Friday, June 20, 2008

Enter the new executive

Over the past few months I have been helping two clients who have experienced issues with the introduction of new executive manager. The first is an organisation that hired its first ever CEO, after many decades of growth and management by committee. The second is a hospital that has recruited a replacement Director of Nursing, replacing an incumbent that had been in place for many, many years.

In both instances, the organisation experienced unrest and discontent as a result of the new appointments. This is not entirely unexpected. Whenever a new person arrives it creates a discord. Different experiences create different perspectives which lead to different management practices. Everyone involved is forced to adapt somehow.

Just because the discontent is unexpected does not mean it cannot be managed and the disruption minimised. In both instances the disruption in each of these organisations could have been minimised through better communication with stakeholders, in particular the existing management team. In both instances the repair work was as a result of improved communication. It's a funny word communication it just keeps cropping up!

In the instance of a new CEO being introduced, especially when there hasn't been a CEO in the past, everyone will be impacted upon. The collegial management style of the past will likely change. Decisions may be made faster. Due to the decisionmaking being delegated to a single individual there may appear to be less consultation, though the reality may be different to the perception. The Board has a role to play here, ensuring all stakeholders are advised of the appointment, of the strengths and experiences the incoming CEO will bring, expectations of the Board and some indication of the immediate direction and management plans. Secrecy does not aid integration, it actually hinders the incoming CEO as he or she seeks to implement change. Secrecy or a lack of information leads to rumour, innuendo and stalling behavior, all which results in the organisation becoming distracted from its strategy.

A new senior executive joining the ranks of an existing team has to deal with ingrained management behavior. Again change is inevitable. It is rare for an new senior executive to be hired for the purposes of maintaining the status quo. The situation lends itself to introducing change. When a new executive manager is introduced there is a fear factor amongst all existing staff. Some will fear being caught short as their competencies and work practices are challenged. Peers will resent any attempts to move in on their patch. Poor understanding of the role and expectations of the incoming executive may lead to suspicion and blocking behaviour. On the other hand the incoming executive will have their own fears. Depending upon their past experiences they to may fear being found short on experience and knowledge by peers or direct reports. They may feel obliged to meet seemingly unreasonable expectations by the CEO or may not even fully understand what is expected of them. They may face the challenge of having to make unpopular decisions before they have had an opportunity to become known and accepted.

The CEO has a role to play in helping to integrate an incoming executive manager. Again communication is the key. It is important to bring the management group together as a team. The CEO should communicate to the group collectively so that all hear the same message and any assumptions can be challenged. Ensure the entire management group understands why the new manager was hired and what is expected of this person. Discuss and confirm the roles, expecially any changes to the status quo. It doesn't hurt to discuss as a group any shortcomings the new manager may have (and they all have some) so that the group can work together to minimise any impact of those shortcomings. Hiding shortcomings does not help the organisation in any way.

Friday, May 30, 2008

Nurturing those middle managers

It has been stated that middle managers are the glue that holds an organisation together. Well okay, we will live with the generalisation. It is also possible that were there much better collaborative and participative management processes in place then there would be less requirement for middle managers, and for many senior managers for that matter!

Regardless of whether your organisation is the traditional command and control model or whether it operates within a flattened hierarcy , you will have some middle managers, or supervisory staff. They are important. They form the link between management and staff. They are the implementers of strategy. Executives design strategy but they rely upon the skills of their middle managers to build collaborative relationships with staff, to sell the benefits, to negotiate the change process and to provide feedback that enables adaptation. Without middle managers, the traditional organisation would grind to a standstill.

Yet this group of managers remain the most maligned and mistreated individuals in an organisation. They are between a rock and a hard place. Neither management nor staff. Unable to be loyal to any faction other than themselves. Some 20 percent of middle managers will eventually progress into an executive role. Another 20 percent will drop back into a staff role. This leaves 60 percent that will remain in a middle management role; for better or for worse. It is in the interest of the organisation to ensure those 60 percent are effective.

Just as there are numerous examples of ineffective senior executives creating blockages to progress, there are also examples of middle managers doing the same. The difference is that a senior executive will likely be found wanting when they are monitored for their ability to plan and implement strategy far quicker than a middle manager who is often protected by a senior executive. Of course, the removal of a senior executive that has been shielding a middle manager can result in the middle manager becoming exposed to the scrutiny of an incoming manager. It is doubtful an ineffective middle manager would survive such scrutiny.

The problem for organisations with middle managers is that only a small percentage of supervisors will progress into an executive role. In some organisations it will be less than the suggested 20 percent. This can lead to either a high turnover of middle managers or stagnation fueled by frustration, which in turn, leads to mediocrity. Those middle managers on the bottom of the heap, the blindingly obvious bad managers will out themselves and slide back into the ranks of general staff. The challenge for organisation is this. How can they get the best out of their middle managers?

It is recommended all middle managers have a mentor, or two, or three. Different mentors serve best at different times or in different circumstances. The benefit of mentoring is widely understood, however it is a relationship the middle manager needs to instigate. Mentors rarely present themselves to a manager. You have to approach them with the idea. Mentoring relationships are build upon mutual respect, the mentors understanding of your workplace environment and a willingness by the manager to be open and honest.

Management coaching can be expensive and has traditionally been reserved for the ranks of senior executives or up and coming middle managers on a fast track to the corner office. This needs to change. Our experience of providing coaching to middle managers has always been positive. Traditional practice suggests executive managers benefit most from coaching. Our experience is that many senior executives have become entrenched in their behaviors and find it difficult to acknowledge their faults after they have gained higher office. Middle managers, on the other hand, still have progress available to them, they have more to gain from coaching and are likely to offer more back to the organisation as a result. Effective organisations will remove ineffective middle managers and provide coaching to those in this role; simply because good management behavior developed during middle management years transfers to good executive behaviour in later years.

We persist with the belief that managers are born not made - well at least we do when it comes to providing management training. It appears that we believe any manager worth their salt will develop competencies by osmosis. This is partially true, much management competency is the result of accumulated experience. In the past, when managers took many years to work their way up through the system, this was very true. In today's workplace we promote the majority of managers on demonstrated competency rather than longevity. The result is many managers are younger and have not had the opportunity to accumulate experience. So what do we do? We send them away to residential management courses to learn the theory. Yes while there they engage in role places and situational game play, but these are no substitute for practical experience. Dont misunderstand. Management training, and ongoing training is essential, some would even suggest critical. The key is to apply critical analysis to those providing the training. Look for trainers with practical experience to back up the theory. Look for trainers with practical experience rather than just case studies. Look for trainers able to blend theory, case studies and their practical experience. Look for trainers that follow up their training with coaching, so as to increase the potential for implementation of concepts and methods.

Do organisations need middle managers? Yes they do. Do they need a lot of middle managers? No they should minimise the number of middle managers by creating more collaborative and participatory workplaces at all levels (very scary for senior executives). The outcome of this will be more effective middle managers and more effective senior executives and this will lead to more effective organisations.

Friday, March 21, 2008

The secret to successful teams

I recently came across this nugget of wisdom, contained in one of the numerous newsletters and websites that come into our consultancy daily.

In the United States an annual top leadership team competition is hosted by HealthLeaders Media, aimed at idenitfying the most effective management teams in the health sector. Jim Molpus, from HealthLeader Media was asked, what are the secrets of top management teams?

Guess what his answer was. There are no secrets. Well buggar me, that's two of us in the world who understand that there hasn't been anything new in management techniques or strategies since the days of Aristotle. Despite the best efforts of publishers, the media and the ever-growing corps of self-styled, management gurus - the truth is out, there are no secrets. There is just common sense applied to tried and true processes of communication. For those that doubt me on this, try reading (or rereading) management books by Peter Drucker and Charles Handy. I know you will find them far more relevant and useful than anything else that has been published in the past twenty years.

There are however consistencies that appear in effective management teams and the people at HealthMedia have picked up on these over the years, and I am happy to share them with you here.

  • Consistency--Many of the winning Top Leadership Teams have had their core of senior leaders together for a period of several years, as many of the worthwhile goals in healthcare take as long to achieve.
  • No tolerance for silos--Winning Top Leadership Teams have found ways to break down traditional silos and barriers that can block healthcare organizations from achieving their goals.
  • Strong at the top, but not dominant--Winning leadership teams have highly-effective CEOs. But we have found that almost every winner over the first four years has had a CEO who delegated key strategic responsibilities to top team members, held them accountable for achieving these goals, but ultimately stayed out of the way.
  • Transparent--Winning teams in healthcare have to be transparent about what they are doing, who is doing it, and how success or failure is measured.
  • Be a quality organization--Top Leadership Teams create high quality organisations
How well does your organisation rate? The following are some of the things the competition judges look for when reviewing entries into the competition -

  • Teamwork exhibited among an organization's senior leaders to achieve stated operational goals/objectives
  • How a senior leadership team works together to effectively overcome any challenges/barriers encountered along the way to reaching its goals/objectives
  • The success of senior leadership in meeting the team's goals/objectives
I am interested to hear from anyone reading this blog entry. How does your organisation rate on the above criteria. Rate your organisation from 1 - 7 with 1 suggesting your organisation is about to do a 'warley' and disappear into the ranks of health providers that are no more and 7 meaning your CEO has just been invited to speak to an international conference on hospital management.

I would hope you would email me your ratings and criteria. I will keep the information to myself, or if I did use it I would seek permission first to do so.

Here are the criteria again -

  1. How well does your management team achieve stated goals and outcomes? 1 - 7
  2. How well does your management team work together to overcome barriers on its way to achieving the goals and outcomes? 1 - 7
  3. How well does your management team actually work as a team? 1 - 7
  4. How well does your team retain its core members over a prolonged period? 1 - 7
  5. How good is your management team at dismantling 'silo's and creating cross-functional collaboration? 1 -7
  6. How well does your CEO delegate tasks to key executives and hold them accountable for the outcomes? 1 -
  7. How well does your management team maintain transparency by monitoring outcomes and communicating successes and failures throughout the organisation? 1 - 7
  8. A quality organisation is one where all the above occur, where innovation and continuous improvement is encouraged and celebrated, where employees at all levels would recommend their friends work there and where ethical standards are met at all levels. How well would you rate your organisaton as a quality organisation? 1 - 7
I look forward to hearing from you.

Tuesday, March 4, 2008

GP Waiting Lists

The Australian Federal Government has announced it plans to publish details of waiting lists. This is one piece of information consumers would like to see. The single biggest complaint about the health system is how long it takes a patient to recieve treatment. It is preferable to provide information on waiting times than on the numbers of people waiting for treatment.

I wonder how this information will be presented? Will it be presented in a manner that makes it useful for consumers? How will the hospital sector use this information? Will it reduce the actual waiting lists? Will health funding be tied into reducing waiting lists? Why should a hospital be funded to provide a service and then retain that funding when it fails to deliver? Will the waiting list information distinguish between in-patients and out-patients?

Logically the information should be broken down by State and then by hospital. There are difficulties in doing this however. Not all hospitals provide all services and in breaking down to the individual hospital inequities and anomolies might be created. It would be helpful to have the waiting list broken down by surgical procedure. The issue with aggregating State information is that it becomes difficult to hold individual hospital administrations to account.

Perhaps the Federal Government should also look at publishing details of the waiting list for those with private health insurance and seeking care in the public system and those without private health insurance. In this way it might be possible to identify the level of queue jumping that is percieved to take place. Likewise information on the number of surgical procedures that were 'rescheduled' and the reason for that would help also to induce a sense of accountability within hospitals. If rescheduled surgery information was provided, would the waiting times be accumulated for each patient or would only the shortest, most recent period of time be recorded?

Ten years ago, in 1997, in NSW, it was reported that there were often two waiting lists. One held by GP's and one maintained by surgeons. Perhaps the Government could collect data showing the differences between the information provided to GP's and what actually takes place.

Reducing waiting lists is important to consumers. There are records of people actually dying or suffering greater illness while waiting to recieve treatment. At the same time consumers have few options as to which hospital they might go to and recieve treatment. Yet that is not sufficient reason not to collect and publish data. Consumers pay for hospitals, they have a right to information on performance. Hospital adminstrators have an obligation to spend public money in an effective manner.

What might the Federal Government do with this information? There is little evidence to suggest that spending increased amounts on infrastructure and or additional specialists will actually reduce waiting lists. There is a straightforward reason for this. Specialists will act to protect their own interests. The answer may lie in removing the final decision from the specialists. Hospital waiting lists are also a necessary evil. Considerable investment is made in infrastructure, staffing and equipment. These resources cannot be allowed to remain idle. The aim should not be to eliminate waiting lists, rather to minimise the time an outpatient spends waiting for treatment. While decisions will always need to be made on a individual case basis, there is evidence that minimum waiting times can be introduced and maintained.

The case for minimising waiting lists is not a one way street. Consumers also have to take responsibility for their behaviour. When a patient doesnt turn up, as scheduled, for an appointment or procedure, they have effectively wasted an opportunity, not only for themselves, but they may also have contributed to someone else's misfortune. If hospital administrators are to be penalised for poor performance then it is reasonable to suggest consumers should also be penalised for poor performance.

GP's themselves may have to take greater accountability for their actions. GP's cannot treat every health issue, therefore they refer patients to specialists. How may times is this done for convenience sake? The Federal Government has clearly set out its priority and focus upon primary health care. Is it possible GP's might collaborate more with the primary care sector and perhaps consider referring patients in this direction, for preventative action, rather than automatically referring to a specialist? This might have a double benefit in that it may contribute to reduced waiting lists while also helping patients take greater responsibility for their own health outcomes.

Maybe it is time for greater collaboration between hospitals within States and between various State health sectors. Collaboration may lead to improved utilisation of resources within hospitals. Not every hospital in the country is fully utilised at the same time. While this would mean some consumers having to recieve treatment away from their home region - at least consider giving them the option. For some consumers the option of treatment now in another state would be preferable to waiting on a list for an unknown period of time.

Saturday, March 1, 2008

Performance monitoring in hospitals

The Australian Federal Government has reached agreement with State Governments to implement reciprocal performance reporting of public hospitals. This is a step in the right direction. It is not possible to improve performance without first collecting data for analysis. The reality is, of course, that hospitals already collect vast amounts of information about themselves. It might be that collecting the data is not the issue, the real issue might be that they chose not to act upon the information they collect.

Talk is cheap. In the past the State Government's have not been keen to be placed under scrutiny through performance monitoring. The New South Wales State Government has been particularly opposed to the idea. Only time will tell as to what the performance measurements will be, and how well the State Governments support the process.

In theory all hospitals should be the same. This suggests measurement parameters would provide comparable information. In theory consumers should be able utilise the information provided through monitoring to help them choose where they would like to go for care. The reality is different to the theory. Often consumers have little option where they go for hospital care. Even for those with private health insurance, freedom of choice, long touted by private insurers, is limited by the availability and location of services. Politically it may not be in any Governments best interests for its health service to come under close public scrutiny.

Consumers want certain information. For example, they want to know that hospital waiting lists are becoming shorter. They want to know about the safety record within hospitals. They want to know which hospitals experience outbreaks of infection within the hospital. They want to know which hospitals experience high levels of deaths by accident.

Hospital administrators also need information. They need to know what their patients think of their service. They need to know the level of staff turnover, the average length of hospital stay, the time taken for triage, the number of day procedures, financial data, the level of in-hospital infection, bed availability, number of surgical procedures. Much of this information is already collected within hospitals.

Hospitals have expressed reservations about the validity of 'league tables' comparing one hospital against another. Such reservations are often well founded, except, that is when the hospitals use the shortcomings of league tables to avoid overall scrutiny. There does not appear a lot of evidence to support the theory that creating league tables leads to improved productivity. League tables imply all hospitals are equal. They may well have been created equal but they do not operate in equitable environments. League tables do not take into consideration additional, regional, factors that individual hospitals may have no control over. It is unlikely league tables will provide consumers with usable information.

Consumers may not want ‘league’ tables. Tables can make for interesting, and sometimes controversial fodder for the media, however consumers have neither the time nor the inclination to analyse such tables. It is not even a given that consumers want raw data. It is possible all they require is reassurance the processes designed to minimise the impact and maximise the benefit to them are in place.

Saturday, February 16, 2008

New Zealand health targets

At the commencement of the 2007/2008 financial year the New Zealand Government, in conjunction with District Health Boards, introduced health targets. The objective being to improve universal access to health services throughout the country, to all sectors of the population.

Health targets focus upon 10 areas, these being:

  1. Improving immunisation coverage
  2. Improving oral health Improving elective surgery
  3. Reducing cancer waiting times
  4. Reducing ambulatory sensitive (avoidable) hospital admissions
  5. Improving diabetes services
  6. Improving mental health services
  7. Improving nutrition, increasing physical activity and reducing obesity
  8. Reducing the harm caused by tobacco
  9. Reducing the percentage of the health budget spent on the Ministry of Health

District Health Boards and the Ministry of Health are jointly responsible for working together to achieve target outcomes. Targets are negotiated for each District Health Board (DHB) area.

First quarter results were published in November 2007. Second quarter results are due around April 2008. These showed progress being made. In short, off the ten health targets set, eight were on track and two showed progress, however in these two instances, issues of data collection or implementation created difficulties in meeting targets.

It is noticeable these target areas appear not to include any direct focus upon the impact of excessive alcohol and drug use! Target areas 1, 2, 5, 8 and 9 have a primary care focus, where the aim is to help consumers take increased responsibility for their own health and consequently reduce the level hospital admissions. Achievement of these targets has a double benefit. The overall health of the population improves and the cost of providing public health services is reduced. There is a flip side to a healthy population. Healthy people live longer, thus increasing the cost of aged care.

The two areas where progress was made, but targets not achieved, were (3) improving elective surgery and (6) improving diabetes services. The measurement tool for improving elective surgery is the Elective Surgery Performance Indicator (ESPI). This measures the flow of patients through the hospital system. This target area is of particular interest to consumers as it measures the time those in need of surgery spend on the waiting list. ESPI’s go to the heart of productivity processes within a hospital.

There are three target areas within the health target for improving diabetes services. These include, free annual diabetes checks, good diabetes management and retinal screening.

One quarter of reporting does not an improvement maketh. In other words it is early days. Clearly some District Health Boards are experiencing difficulties establishing a quarterly reporting process. Given the Governments advance notice of health targets and the consultation process prior to their establishment, there is no excuse for quarterly reporting processes not being in place. Not having achieved this is a failure of management. Those District Health Boards experiencing such issues include two of the largest in the country, Auckland and Canterbury. The fact that significantly smaller DHB’s with lesser resources are able to achieve such processes doesn’t bode well for the larger ones.

It would be a reasonable expectation that all DHB’s would have in place quarterly reporting processes in time for the second quarter reports. The longer DHB’s take to achieve this, the more reason they provide both Governments and consumers with reason to ask why? A lack of transparency can lead to speculation, which is often incorrect, and can also lead to a suggestion that these DHB’s have something to hide.

Australia moves towards primary health care

The Rudd Government health strategy signal a move towards increased expenditure on primary health care. This assumes the consumer will take greater responsibility for their own health. It also suggests an increased level of expenditure by the Federal Government on creating awareness amongst the public off the consequences of poor nutrition, low levels of exercise, excessive imbibing and inadequate self care.

A recent media release by Federal Minister for Health and Ageing, Nicola Roxon, outlined the following:

  • National Preventative Health Strategy to tackle issues of alcohol, tobacco and obesity
  • An increased focus on preventative health care to be included in Australian Health Care Agreements with the State Governments.
  • A review of the Medicare fee schedule

With the exception of the review of Medicare fees, which may or may not, increase the cost to the Federal Government, the other two outcomes require substantial, and prolonged investment, in creating public awareness. As has been witnessed by the billions spent over decades to create awareness of issues associated with driving motor vehicles, it will likely take the same level of investment, maybe even greater, to shift the perception of the public away from their current expectation that the health system will cater for all their needs; to a perception where each individual takes personal responsibility for their own health outcomes.

As suggested in an earlier entry to this blog, one impediment to consumers taking responsibility for their own health outcomes is the perceived low cost of health care. It would be easy to simply suggest the Government should increase the cost to the individual in an effort to discourage each of us from living decadent lifestyles. This is unlikely to be effective. Our past experiences with raising direct costs associated with motoring, smoking and drinking alcohol have shown that such increases rarely, if ever, have a sustained impact upon consumption. On the other hand, extended and comprehensive public campaigns have served to raise awareness amongst consumers.

If, as the Government appears to believe, the answer lies in primary care, in creating increased awareness, in providing information and education and in the consumer taking responsibility for their own health outcomes, then the program to achieve this is likely to consume the major slice of health spending by the Federal Government.

Add to this an expectation that each State Government will increase their focus on preventative health, suggests also that a significant portion of State Government spending on health will be directed towards education and public awareness. For every dollar spent on preventative health, one less dollar is available to spend on maintaining and expanding the hospital sector.

Now here is the rub. Assuming the Rudd Government has set the correct long-term strategy and assuming State government health ministers will be able to stand the heat and maintain a good working relationship with Federal ministers and assuming subsequent Federal Governments continue in this direction then at some point in the future people will spend less time visiting their GP or specialist and less time in hospital. At that point the savings from reduced health costs may equal the cost of Medicare. When this occurs both the cost of maintaining Medicare and the public hospital system will become sustainable.

In setting this direction the Rudd Government has lifted the lid on the Pandora’s Box of public healthcare and it may not be possible to ever put the lid back again. It is possible, the consequences of this direction, though not highly visible at present, may revolutionise public health delivery throughout Australia for ever.

Monday, January 14, 2008

Changes to Medicare

Recently appointed Federal Minister of Health, Nicola Roxon, has indicated she would like to see changes to Medicare, specifically, changes to the fee structure. At present Australian GP's are paid the same fee regardless of the length of consultation. In effect this means they receive more for short consults than they receive for longer consults. Put another way, those patients requiring a quick consult with their GP are subsidising those that require a longer consult. The outcome of this is that it is in the financial interests of the GP to move patients through in the shortest time possible; thus maximising the number of patient visits and their revenue.

The Federal Government is concerned that such a practice results in less time being spent on the health management of those with complex health needs. If this were true then it is possible such practices also contribute to longer hospital waiting lists.

The intent of any such changes is admirable. Reducing hospital waiting lists is a good outcome for the public - and a good political outcome also. The question that needs to be examined is this. Will a change in the fee structure of Medicare actually result in improved health management of those with complex needs? In theory, a GP will want to spend more time on those patients with complex needs as the GP will be paid a higher visit rate. However note this is a visit rate not an hourly rate. At which point does it become more profitable for a GP to see 'X' number of short visit patients rather than a single long visit?

An increase in fee structure may result in GP's spending more time with certain categories of patients, however spending time with someone doesn't necessarily mean 'quality' time is spent. In other words it may not be that management of complex needs is in the best financial interests of the GP. Should the patients needs be managed to well then they may not need to visit the GP as often, possibly resulting in a reduction in revenue.

The other aspect to consider is this. What will happen to those patients that presently only require a short consultation, maybe a check up for blood pressure or a discussion about a seemingly innocent symptom? GP's, assumably spending more time with those patients with complex health needs will have less time to spend on those with less complex needs. It is possible some of those with less complex needs will defer GP visits, or see their GP less frequently. In some instances seemingly innocent symptoms may be misdiagnosed or even missed altogether by the GP during a hurried consultation. How many currently low complex patients may develop into highly complex patients in these circumstances. If that were the case, how many of them would require hospitalisation and how might that impact upon the hospital waiting lists?

No doubt the Minister will undertake a process of consultation. One can only hope such concerns are addressed during that process and that the final outcome doesnt, perhaps inadvertantly, in the pursuit of a highly public, political, outcome, create more problems for the public, and for our health system, than already exist.