Saturday, December 19, 2009

Prudent hospital management

As pressure mounts on State Governments to keep the cost of healthcare in line with budget expectations an increasing number of hospitals are reporting efforts to rein in costs. (http://bit.ly/6INrbM) Many are electing to reduce staff numbers. The concern with this approach is that any gains are short term. Simply making staff redundant might satisfy short term expectations yet fail to resolve the underlying issue. At the same time making staff redundant without addressing other areas of waste can serve to destroy moral and loyalty.

Tough times call for effective leadership. Not only the type of leadership that is able to make the hard decisions when they are required but leadership also able to ensure the highest level of communication throughout an organisation. The greatest concern for staff is when decisions affecting their work conditions are made without consultation and with full understanding of the need for change and the benefits.

Gone are the days where those employed in our public hospitals can expect Government's to simply bail-out a hospital management that spends more than its allocated revenue. Access to affordable, if not free healthcare should be a right of everyone, regardless of their situation; yet universal health care has a cost, funding is via taxation. Such funding will always be a finite source even while the cost of providing health care continues to escalate.

Reducing staff numbers without addressing workplace design issues can be seen as poor leadership, where managers make expedient decisions without having the courage to dig deeper and work to address core issues. On the flip side, the health sector is a political system bound by traditional and established rules of engagement between managers and unions. The future will require leadership, and a willingness to have another look at workplace practices by both parties as the sector struggles to attract and retain people. Failure of leadership can only result in increased efforts of management to keep costs down by reducing staff numbers.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO
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Saturday, November 28, 2009

Lean Processes in Healthcare

The difference between 'lean processes' as practiced in a manufacturing plant and that practiced in a service organisation such as a hospital, is that the manufacturer seeks to align order/stock inputs with streamlined production processes so as to eliminate wastage and reduce stock and labour costs. A service organisation, on the other hand does not have a 'production process' and therefore needs to shift its focus away from cost reduction to meeting the needs of multiple stakeholder groups.

I believe a core tenent of lean processes in a hospital should be 'do no harm'. This means the process should not result in any forced reduction of staff numbers and patient care must not be compromised. In fact the opposite should apply. Lean processes should seek to reduce workplace stressors upon staff while providing patients with the highest quality care at the least amount of pain and inconvenience. I also believe lean processes will become increasingly critical as labour shortages force hospitals, especially rural providers, to achieve more with less staff.

Case studies from a variety of hospitals that have adopted lean process show reductions in wastage, less time involved in non-core activities, reduced processing times and reduced waiting times. Imagine if Government were to focus on education designed to keep people out of hospital while hospital staff developed lean processes - it is possible this combination may lead to lower operating costs, improved utilisation of facilities and reduced waiting times.

It is time for hospitals to have another look at Total Quality Management, Continuous Improvement and lean processes. Each of these can be aligned as a service delivery process and can also be aligned with existing accreditation and risk management processes.

Let The Journey Continue
John Coxon
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Friday, November 27, 2009

Risk Management in Management

Recently have been involved in the delivery of a frontline management program to 20 supervisors in a regional hospital and during a workshop they were discussing risk management. Naturally being clincially oriented many were considering risk management from that perspective. In turn, I began to formulate some ideas on risk management in management. In other words what are some of the actual management risks? The following are my thoughts:

Failure to communicate effectively. By this I refer to a failure to develop a 'culture of listening' where people are encouraged to speak up, to ask questions, to propose ideas safe in the knowledge they will be listened to, respectfully and due dilgence given to their ideas.

Failure to set clear expectations.How can people acheive their outcomes when they don't understand, and agree with what is expected of them?

Failure to monitor, evaluate, provide feedback and hold people accountable Enough said!

Some, reading this might ask, hey what about failure to set strategy, or implement strategy, or hire the right people or design work roles? Everyone of those, and many more offer some management risk. What I am suggesting here is that the greatest risk of management is the inability to develop a 'people culture'. The greatest management risk is a focus on 'top-down' management rather than collective, collaborative leadership.

Let The Journey Continue
John Coxon
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Friday, November 20, 2009

Work place gossip

A recent email from a coaching client asked, How do I stop people gossiping in the workplace?

The reality is that you cannot stop people from gossip, we all do it from time to time. Each of us has a personal responsibility to ensure our gossip causes no harm, to either an individual or stakeholder groups.

What can you do as a manager? There are a number of things you can do and some things you should avoid doing. Firstly issuing an edict or ordering someone to stop gossiping is unlikely to be successful - all that will achieve is force the gossip underground, where it can be even more destructive.

As a manager gossip can be informative, it can alert you to potential issues. This is not to suggest you should encourage gossip rather that you should listen to what is being said around the traps.

Gossip is often negative. It is only someone's personal perspective, an opinion, often not based upon facts or the truth. This means there is an alternative, a positive alternative, often based upon the facts. As a manager you have a responsibility to provide a balanced, factual perspective. Even if someone negative is taking place inside the organisations, for example an unwelcome change to roles, if you think about it there will be positive outcomes.

Often people don't realise the impact their gossip can have upon others. Taking them aside an explaining to them the possible impact; even asking them how they might feel if others gossiped about them in this manner may help raise their awareness.

As a manager you often have a broader perspective of matters and are able to broaden the perspective off others. The most important thing you can do as a manager is be a role model. Avoid becoming involved in workplace gossip. Avoid unsubstantiated gossip of your own. Be concious of what you are saying, about who and to who. Be aware of the impact off your own language and stories.

Let The Journey Continue

John Coxon
Taking You From Frontline Manager to CEO

Monday, October 19, 2009

Rural health service management

In 2005, research by Couper & Hugo, published in Rural and Remote Health 5, 433. (Online) 2005 explored management factors attributed to the successful operation of rural hospitals. The research identified thirteen themes in three clusters. The clusters are (1)teams working together for a purpose, (2)foundational framework and values and (3)health service and the community.

The research indicated that teams that work together to solve problem through utilising their relationships and interdependencies; when they meet they have a unity of purpose and a commitment towards each other and to patients and stakeholders. They share constantly with each other and maintain open communication lines.

The research also indicated that effective teamwork is dependent upon a management culture that openly supports and encourages teams to form and work together collaboratively. This is the foundational framework which the rest of the organisation builds upon. The foundational framework therefore incorporates the values and culture of the organisation. A culture of success is one where people care for each other's long term sustainability rather than just their own short term needs. It is a culture where people moving out hand over to their replacements in a manner designed to ensure continuity of service.

In rural areas the integration between community and the health service is critical. Often a hospital is a key employer in a rural area as well as being a primary provider of wellbeing for those in the community. A lot of community identity is invested in a rural hospital. Hospital management at all levels must be involved with their community, they must do more than live in the community they must be a part. I am reminded of the CEO of one of our clients. He not only manages the nfp organisation he heads up, but is also a member of the board of governance of the local hospital and actively involved in the community. This level of engagement serves to eliminate elitism and ensures a steady stream of constructive feedback to help the hospital management meet the needs of the community.


Let The Journey Continue


John Coxon
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Wednesday, September 23, 2009

Leadership Dilemma

One Saturday in September. The day when many people in Australia stop to watch the AFL Grand Final, played in Melbourne. This years Grand Final has been titled 'The Clash of The Titans' and will be played between St Kilda and Geelong, both proud football clubs with a long history. St Kilda is seeking to win its second premiership ever, its first being in 1966. Geelong is seeking to win its second premiership in three years after being pipped at the siren in last years Grand Final match.

There are two leadership groups in play here. The respective coaches and the team captains. Both coaches have a dilemma on their hands. They have to choose between players that have served them well all season or drop them for a more experienced player returning from injury. How would you handle this situation? Coaches of course don't win or lose games; on the day its those on the field that make the play. Yet decisions made before the game can impact upon morale and even how those on the field play on the day. Everyday senior managers make similar decisions. Who to include, who to leave out, who is the most qualified, the most experienced, most able to handle the situation, the impact upon others in the team and the impact upon inter-team relationships.

Then there are the team captains. On the field they are the ones responsible for leading the way. In this sense sports teams differ from business teams. A sport team captain rolls up their sleeves and gets down and dirty with everyone else. In business, the 'captain' often adopts a more hands-off role. In both instances the team captain is responsible for motivating those in the team, helping them overcome the disappointments, picking themselves up from their mistakes and keeping on going. Again this is where a sports team differs, unlike a business team, if you make a mistake on the sports field it may cost your team the game - and there are no second chances in a Grand Final.

How would you lead in these pressure situations? As a team leader you will get recognition for the combined effort of your team, just as the captains of these two teams will. Just as they cannot play and win this match on their own, neither can you achieve success without all your team members working together in a collaborative manner to the match plan.

Grand Finals are a pressure cooker situation. Lose your cool you will make a mistake and be penalised. As a team leader you don't necessarily work in a pressure cooker yet if you allow your emotions to get in the way members of your team will lose confidence in you and fail to produce. In that situation you, as the team leader, are responsible.

On Monday 28th September, only one off these team will be on the front page of the papers. The other, the losing team, will have already faded into memory. Where will your team be next Monday? How will they view you as their leader? As the Australians say 'Up There Cazaly'.

Let The Journey Continue


John Coxon
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Friday, August 14, 2009

Hospital workplace stress

The health sector is by its design a high-stress environment. The sector, even in private health, is formed and driven by political policy and considerations, funding, whether from Government or fee-paying patients, will always struggle to maintain pace with the increasing cost of providing health care, staff deal daily with stressful patient-related incidents that impact upon staff emotionally and hospitals are system and process driven; often they struggle to create an environment that is conducive to high standards of staff support.

None of this is an excuse for mistreating employees or maintaining stressful environments. Managers in the health sector have an obligation, which they accept when they take on the role, to look our for the wellbeing of those staff working with them.

Workplace stress, created by a less-than-friendly workplace environment leads to increased levels of absenteeism, stress-related workplace insurance claims and staff turnover. Add to this mix those employees that experience high levels of stress yet continue to work, do so at minimal levels of effectiveness. It becomes clear the costs associated with workplace stress are high indeed.

As a manager in a hospital, an aged care facility or a medical centre, what can you do to minimise the impact of the workplace upon employees?

Firstly look to help yourself. You cannot help others if you are stressed, unwell or unable to cope. I was working with a manager recently and while we were talking she opened her Outlook task list and pointed out two things. The first was the number of overdue tasks. The second was the number of tasks that she continued to reschedule. These are tasks the manager would like to do, but it was obviously not critical she do them, and one day, if she had time she might get to do them. We talked about those constantly rescheduled tasks and pondered on how many of them were important and if so could they be delegated to others on her work group? A key reason for workplace stress amongst managers is our inability to manage the tasks in our workload. We procrastinate. We leave the unpleasant jobs till they become critical - then we impose stress upon ourselves - and others. We neglect to break large tasks down into a series of small, easily achieved chunks done over a longer period. We fail to plan our work effectively, leading to us taking work home or trying to sleep when we are worried about looming deadlines. That is just what we do to ourselves!

What we do to others on our work group can be much, much worse. When you, as a manager, are stressed and under the pump your capacity to engage in effective decision making is reduced. Your tolerance for working through workplace issues is reduced. Your ability to ask questions and identify the root cause of an issue is reduced. You are always rushing from place to place; unable to spend time facilitating and fostering conversations or listening to what is being said, or even observing what is taking place around you. When you are stressed as a manager you might as well go home because you will be totally ineffective. Your employer is wasting money on you when you continue to operate in a high stress mode.

As a manager you are a role model. Those in your work group will follow you lead. What do you think they see when you appear out of control of your own workload? Are you one of those managers who say do as I say not as I do?

Take some time during staff appraisals to discuss an employees workload, at least. Preferably have an ongoing discussion on this topic rather than once a year! Break down the work and tasks. Work together to identify the bottlenecks. Ask who is the best, most effective, well qualified, most experienced, person to be doing this task? Also ask what is the impact of having this person do this task? Seek out opportunities for sharing roles. Look for the dull, the mundane, the boring and do whatever is in your power to get rid of such tasks. Look for more efficient means of processing the mountain of paperwork demanded by Canberra and Wellington with little or no thought given to either purpose or impact. There are many, many things you can do, as a manager, to help reduce the level of workplace stress amongst employees and staff.

One of the most important management behaviors is to spend time walking around the workplace. I work with the CEO of a Lifeline organisation in Australia. This CEO has spent time in every part of the organisation. She regularly visits the Lifeline stores, wanders round the warehouse and eats lunch with her staff. This is not micro management, this is good management. This CEO has line managers and she leaves them to get on with the job they are entrusted with. When the CEO is walking around she is listening to the stories her staff tell her, she is observing the workplace conditions imposed upon them and her staff can see that she is making an effort to understand how their work impacts upon them. This is not a little thing, this is huge.

Keep your eyes and ears open. Look and listen for signs of distress amongst your staff. Move quickly to provide guidance and support. Whatever you do, do not ignore the signs. The longer you take to act the more it costs your organisation. The sooner you act the less it costs to intervene. When an issue is small and at an embryonic stage it takes much less time and resources to resolve. The more time and resources you devote to resolving an issue the greater the potential for causing distress elsewhere in the organisation.

Failure to observe and failure to act upon workplace stress is very poor management. As a manager you have a duty of care towards those in your work group.

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
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Monday, July 27, 2009

The Responsibility Of Management

Release of yet another report into health care in Australia will generate considerable public debate over the next twelve months. Much of this debate will likely centre around how the Commonwealth and State Governments could reduce the cost of public health care.

In the midst of this debate life in any health care facility goes on, yet the nature of the debate serves to create fear and uncertainty amongst those employed in the public health sector. In these circumstances management teams need to show leadership.

Public health care is a political football, it always will be, regardless of how health costs are funded. Management teams must focus on the efficient operation of their facility and leave the political postering to the bureaucrats.

In such situations the rumour mill will run wild. Stories will circulate about many things including control of hospitals, the future of various facilities and even staffing numbers. Rumours are counterproductive, they waste time and they distract staff from their work. Take the lead. Implement a comprehensive communication process. Focus on the facts in your communication and do not leave rumours unchallenged.

Management teams need to maintain a long term perspective. They need to continue to find ways to improve efficiency and effectiveness. During a Government review is not a good time to run up unsustainable operating losses. The level of public scrutiny on the health sector will increase over the next twelve months.

Now more than ever it is important to ensure your management team have the competencies to operate your facility effectively. Do they understand operational costs? Do they understand alternative strategies for controlling costs? Do they know how to source information, how to analyse information and how to work together to make the most appropriate decisions?

No more than ever, these are the things your management team should be focusing upon.

John Coxon & Associates have developed an integrated management process where we work with your management group to identify the various management competencies required, the existing level of those competencies and a process for improvement. All the money and technology in the world will not provide cost effective public health care unless management have developed the ability work together in a collaborative manner and make the right decisions.


Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
Email john@johncoxon.com.au
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Blog: http://healthsector.blogspot.com
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Tuesday, July 14, 2009

Reducing Workplace Stress

Notice I have use the term 'reduce' rather than to manage stress. My reasoning is this. The events that cause us stress are (a) either self generated or (b) we are able to put in place some countering strategies. Our aim should be to reduce the potential for stress rather than trying to manage stress after it has occurred.

Everyone experiences events that are stressful to them. For some its being late for appointments, or when others are late, or being interrupted when on the phone. Take a piece of paper. List the events that really give you the irricks at work. Prioritise the list - some events are more stressful than others. Now beside each event note down the signs you might observe that indicate the potential for stress. For example, you might be chairing a meeting, you notice a couple of empty seats. This is a sign. The aim here is to identify the range of trigger points that might send you into a tiz. When you can identify the event and the signs that such an event is likely to occur you can then identify a range of strategies to help you cope better.

In most instances a stessful event is not attack on you personally. When a person is late for a meeting, its not that they don't appreciate your time or topic, its that they have sloppy work habits. That is their problem; not yours - so try not to take it personally.

Be proactive, don't wait for something stressful to occur. Move yourself from the event. Get some fresh air, cold water to drink, move around so that you are more relaxed, create your own 'sadhana' a place where you go to relax and reflect or find an ally to talk things through with.

Many of the things that cause us to be stressed are created by our own behaviour. If you become stressed at being late for meetings then leave yourself more than adequate time to get there. I am aware of a colleague who absolutely hates walking into a room full of strangers. So instead she arrives early and makes a point of greeting people as they arrive. Relaxed and positive. Another person who becomes physically stressed at moving from fresh air to an air conditioned room. He experiences severe persperation. The strategy, arrive early, go to the indoor area, sit, relax, take off the jacket, have a cool drink of water and let the body acclimatise. Then attend the meeting feeling relaxed and confident. If you have a task that requires uninterrupted concentration, try moving to a secluded place (where people cannot find you), work from home or a quiet cafe or just close the door with a polite sign asking people to indulge your need for privacy at this moment.

Many people, when they are trying to get you to accept their point of view, will attempt to raise the stress levels. They intuitively understand we are at our weakest when we feel stressed. It is when we are mot likely to give into their demands. You can control the stress levels in these situations.

We increase the stress levels by being reactive. One of the quickest ways to to shift from being reactive to becoming proactive (and less stressed) is to ask a question. It means you have to listen actively, you have to think through the questions. Others have to listen and they have to think through the answer.

As a manager be constantly aware of stressful situations occuring in your work group. Keep your ears and eyes open. Coach employees through stressful situations. Bring the group together to discuss, reflect and set boundaries for behaviours. It is important you remain cool, calm and collective, and avoid becoming stressed yourself - or being seen to be stressed - you as a role model is critical. Others will follow your lead and that helps to design the culture that works for your group. Been seen to practice the very things you would like others to do themselves.

Develop the ability to say NO. If you are unable to say no, politely, then you will become a doormat for someone. It is possible to say no to your boss. The success is in the way you say it. Some people prefer to say yes for fear they might cause offence in saying no. Others simply dont feel comfortable saying no to their manager. Your manager would much prefer someone else, more able, to do a task, than have it only partially done because you have insufficient time or to have you break down at work. Be upfront. Say, I am sorry, I would like to help out but I've got XYZ to complete by this date, I would struggle to complete it well, and would prefer you ask someone else. It's that simple. And, if you have a boss who is a prick, then go find a better place to work.

You cannot do your job effectively if you are stressed or on sick leave. You have customers and patients that rely upon you. You must look after yourself by being proactive about reducing the opportunity for stress. Adopt a Buddhist approach, say the right things, take the right actions and be mindful of your environment.

Finally don't beat up on yourself. We are human, we make mistakes. Sometimes our emotions trigger off a reaction faster than we can spot it coming and do something else. When that happens say sorry, mend the bridges and move on. You will learn from the experience. Remember you dont have to like the people you work with, however you do need to develop the skills to work with them in a positive and productive manner

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
Email john@johncoxon.com.au
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Blog: http://healthsector.blogspot.com
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Sunday, July 5, 2009

None so blind as those that refuse to see

Recently I heard a television broadcaster pose a question. Will soccer become a bigger sport in Australia than Aussie Rules? My colleague, with me at the time, a true-blue Victorian, scoffed and said it will never happen. My response was to suggest her very response indicated it would happen.

Our choice of language is important. When we say it will never happen we may be opening the door to allow it to happen. Leaving aside the greater global popularity of soccer, the opportunities for players to represent their country, to play in almost any country in the world, to earn greater income, for television studios to demand higher advertising rates and provide greater sponsorship, for parents (and players) to avoid lifelong complications from a variety of horrendous injuries and the list goes on. In saying, 'it will never happen' we are closing our minds to the possibility it may happen and preventing ourselves from implementing flexible strategies designed to ensure sustainability.

How often do we say the words, 'it will never happen'? How often to we use these words to defend past ways of doing things? Part of our rationale is our fear of the unknown. We prefer to work with what we know rather than what we don't know. That doesn't mean we shouldn't take the time to discover what we don't know, in doing so the unknown becomes known, the future becomes clearer, our fears reduce and we move forward.

An army patrol has three options. The first is to sit and do nothing. The second is to send the entire patrol out at the same time, side by side, in a line and the third is to send out a couple of scouts to survey the approaching environment. If they elect to do nothing everyone will die. If they elect to walk shoulder to shoulder the majority will die. When they send out a scouting party, one or two or even maybe none, will die.

If you sit and do nothing then the future envelopes you to become the present and very soon you become the past. If you rush blindly into the future without taking time to gather information then you are gambling on survival - heads or toes. When we take the time to survey the future, gather information, blend it with past and create a new future, we adapt and the majority of us survive.

My colleagues approach to the question on the rise of soccer over Aussie Rules was to dismiss the possibility out of hand; in doing so took the sit and wait approach. If my colleagues perspective were representative of the majority of Victorians, then Aussie Rules may become a minority sport in time.

How do you avoid the 'sit and wait' approach at work? Firstly acknowledge the future will be different to the present. Nothing stays the same. Consider nursing, arguably the second oldest profession in the world, look at how it has evolved since the days of Florence Nightingale! I am sure many old-school nurses would prefer the profession to have remained as it was. Had it done so, how successful would hospitals be at attracting high quality people, today?

Take time to explore and ask 'what if' or 'how can we do this better'? In doing so you are intuitively exploring the changing needs of your customers and consumers. You are adapting.

I am certain Andrew Demetriou, CEO of the Australian Football League believes soccer could be bigger than Aussie Rules, if he and his executive team were to allow it to happen. I am equally sure they do not intend to sit and do nothing. The executive team of the AFL owe to their army of stakeholders and supporters to be aware of the the emerging environment and to prepare accordingly. As a member of the management team in your organisation you owe it to your stakeholders to do the same.

My question for you, this fine Sunday morning, is this. Is your management team hunkered down in a foxhole, content with present, believing it can survive a firestorm or have you sent out the scouts, to survey the emerging environment and to provide you with information to enable your organisation to operate in a sustainable manner?

If you are a manager in a public hospital perhaps I could pose the question to you in another way. Could the health system in Australia and New Zealand become a privatised system similar to that of the United States?

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
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Wednesday, May 20, 2009

Intelligent Leadership

Let's look at the word intelligent. What does it suggest? It is similar to the word intelligence - the gathering of information. To be intelligent is to make effective use of intelligence. We gather intelligence from a wide variety of sources and we constantly refresh our pool of knowledge - well we would if we were providing intelligent leadership.

With deference to Stafford Beer, let's see if I can compose a visual image of an organisation. Firstly we have have a group of primary activities. In a health provider, for example, theatre could be considered a primary activity. In an aged care facility the kitchen could be a primary activity. In itself, a primary activity is self sustaining and is a model of the entire organisation.

Around the primary activity units you have the administrative support activities that develop the information channels, enable communication between primary activities and coordinate activities.

The third group is those that provide operational planning and control. Let's refer to them as the management group.

There is a fourth group concerned with business development, marketing and research.

The fifth and final group is responsible for policy direction and identity - let's refer to them as the Board.

These five groups within any organisation for the internal environment. Surrounding them is another group we will refer to as the external environment.

The easiest way to visualise this is to draw six circles on a sheet of paper. The order doesnt matter and number them 1-5. Label the sixth circle 'external environment'. What is the first thing you notice? Is it that each of these group is disconnected to each other? Which means, of course, that their will be limited communication between the groups.

You're first reaction will be to say, well yes, that is possible but it is impossible for an organisation to function without communication. You are correct. It is impossible for an organisation to be its most effective without communication between those six groups.

This is where the intelligent leadership comes into play. It is easy to establish essential communication channels between groups in an organisation. Unfortunately all that achieves is day to day survival and eventually leads to demise. More is required. Intelligent leadership establishes multi-directional communication. Most people only ever achieve one-directional communication. That is they say, give me the information and I will decide if I want to use it or not. They offer nothing back in return. The do not consider the bigger picture and where else that information might be useful. They hoard the information they have due to a misplaced sense of gaining power. They fail to understand that they are a part of a much larger jigsaw and that the piece they hold may be the missing piece that completes the picture.

Stafford Beer refered to this as a viable system. When you have a group of self sustaining activities interacting in such a manner as to not only feed off each other but also provide nutrition to each other - independent and interdependent - then you have the most effective organisation. I refer to this as intelligent leadership.

Are you in a leadership role? Try this. Take out a piece of paper. Write down the outcomes your group are expected to acheive. Identify the communication channels that exist. Ask yourself what communication is needed to achieve optimum effectiveness. You now have the gap. Call me, John Coxon, on +61355612228 or email me and we can talk more about how to develop intelligent leadership in your organisation.

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Sunday, April 5, 2009

A new form of leadership

We need a revolution in leadership. The current economic crisis is a result of greed - a very specific form of leadership, one based upon oneself without regard for the impact one's actions upon others.

We need to move away from the individualised, ego-driven, form of leadership, baed upon charisma that we have been witnessing for the past twenty years.

The answers to our dilemmas and problems rest in collaborative action; our ability to work together, to have meaningful dialogue, to make promises and commitments and to establish trust. This is not the world of policies or legislation, organisational development or management processes. It is the world of people working together for the common good of all involved.

Each person in your team has something to contribute. As a leader your role should be to bring out the best in people, to help develop their potential and to encourage them to contribute to the collective leadership of the team.

The type of leadership required as we move past the current crisis and search for a more equitable world is one where we view the workplace as a community, a place where everyone works together in a collaborative manner to ensure ongoing and satisfying work, where the pool of money is shared more equitably, where multicultural diversity is celebrated and where everyone understands how every part of the organisation interacts and how they contribute to its success.

Let The Journey Continue
John Coxon

John Coxon & Associates
Taking You from Frontline Manager to CEO
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Tuesday, March 31, 2009

Coaching Case Study

John Coxon & Associates work with managers in hospitals, aged care facilities and medical centres. We provide management consulting services when asked and we work one-to-one with managers in a coaching relationship.

This case study involves one of our coaching clients. This client is a a part of the management team of a combined hospital/aged care provider. The client is a registered nurse working in acute care. Over the past five years we have provided a variety of services to this health provider and I have been involved in a coaching relationship with a number of managers. During the past few years, sparodically, I have worked with this particular manager to help develop her management skills.

When I first met this client she was a registered nurse working in a number of roles and showing potential by standing in for various senior roles when called upon. During 2008 an opportunity came along when the position of Director of Nursing became vacant. After some discussion my client decided to accept an offer to fill in as Acting Director of Nursing pending a recruitment process being implemented. My clients abilities were soon recognised in the acting role and she was eventually successful in her application for the role full time.

Why am I so excited about this outcome? Because this represents, to me, what a well executed coaching relationship should be about. It should be about developing potential. The title is nice, the pay is even better - none of this matches the excitement I heard in this ladies voice when she called me to confirm her full time appointment. Position and money are a result of developing potential, not the reason for doing so. I can tell you now there is not one single nursing manager anywhere in Australia experiencing a higher level of job satisfaction than this person at this moment. This person took responsibility for her own employment outcomes and took advantage of every opportunity, for professional development, available to her.

You can do the same. If you are a manager or aspiring to be in management and you wish to maximise your potential, call me now. It costs nothing to explore the options and I can guide you through the process of putting together a business case to your manager for a coaching program designed to maximise your potential and maximise your value to your organisation.

Let The Journey Continue
John Coxon

John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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Tuesday, March 17, 2009

Where is the evidence of need to change

Deming, the godfather of quality management, once said people are not very good at diagnosing problems because they are involved in it. We don't like to admit that what we are doing may be wrong. We don't like to change our behaviour unless we have a very good reason for doing so.

Regrettably for many, the impetus for change is in the form of a crisis. Such action is unnecessary and wasteful. Yet there has to be a reason for people to change. The clues lie in the evidence or the data.

Managers are judged upon their ability to acheive results; they need others to work with them to achieve this. Teamwork is required. Equally importantly, other people have to do the things they said they would do.

How often do you seek feedback from your people as to progress? How often do you know about potential issues before they become problems? If your response is not often then you are setting yourself up for a fall.

Issues cannot be resolved, problems cannot be solved and critical decisions cannot be made effectively without some supporting data. Try this. Form a working team with other managers. Bring to the discussions data and evidence of acheivement and issues. Share this information with each other. Avoid competition, instead work in a collaborative manner. Other managers bring an external perspective, they also being additional experiences, to your issues. As you do to theirs. In this way the management team is looking collectively and collaboratively at the systemic issues within your organisation. The group is able to distance itself from the issue and is able to use the available data and evidence to inform their decision making.

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Wednesday, March 11, 2009

Systemic crisis of failed management

Paul Fitzgerald, a former health advisor for the New South Wales Government, writes in The Australian newspaper that the Australian health sector is suffering from a systemic failure of management.

Paul's argument is that the delivery of health services is mismanaged due to non-clinical managers with a focus on financial management having control of hospitals, rather than clinicians themselves having management control. Paul also argues that poor management leads to higher turnover of all staff, the best leaving the industry, mediocre performance by those remaining and in Paul's, opinion, low standards of health care for the consumer.

Paul makes a number of other arguments in his article related to the efficiencies of health service delivery however I wish to focus on the management aspects. The first realiy of public health in Australia and New Zealand is that every manager must learn to deliver a service within budget and political constraints. Having to achieve this is not the cause of poor management. Managers are people and they work with people. They are ineffective as managers when they make poor decisions about people without regard for the people they work with.

Yes public health providers are professional bureaucracies, as are all Government funded organisations, and yes bureaucracies have their share of poor performers, as do organisations in the private sector. The challenge for management is to achieve the best from each person within the resources avaialable. Highly effective managers do make a career choice, they do seek to engage in management practice and as such they make a commitment to manage effectively.

It is erroneous to assume good clinicians will also be effective managers of people. They may be able to identify supply and demand and they may be able to adjust service delivery to meet demand yet if they fail to manage and develop the people that work for them then the outcome will remain the same.

The funding challenge for the public health sector is two-fold; firstly to adequately fund clinicians, equipment and facilities and secondly to adequately fund the development of management. Effective managers, clinicians or otherwise, with a good understanding of health processes, a well developed ability to get the best from people, an understanding of patient needs and the ability to manage within financial constraints are the key to high quality health care delivery at the lowest cost.

Research conducted in the USA from 2002-07 amongst 200,000 people from 500 health service providers, and published in a white paper by Success Profiles, titled Organisational Culture and Performance in Healthcare Organisations, clearly illustrated the relationship between effective management practices and operational efficiencies. The message was clear, develop your management capacity and capabilities. Develop the ability of your managers to lead and develop people. Hire the right people with the right skills to do the right job.

Let The Journey Continue
John Coxon

John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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Tuesday, March 10, 2009

Team Building

Building effective teams can be a challenge. In a perfect world we would be able to select the most effective people for our teams. We would discard those without the ability to be good team players.

Such a sentiment tends to disguse a fundamental factor. Building an effective team does not happen by accident. It has to be worked upon; just as we work upon developing individual competencies, we also need to work on developing team competencies.

Many managers actually do not understand this. They tend to assume team work will just happen. They tend to assume that if you have well developed people on the team then the team will function well. In a sense this is a reasonable assumption. The problem with this assumption is that it assumes access to balanced individuals. In reality we inherit our teams, we often have little control over who is in our team, therefore we have to work with what we have.

This is where the hard work comes in. Instead of assuming the team will work fine if it is full of well balanced individual; managers must instead be proactive at developing the capabilities of each individual team member - so that they are able to contribute in a balanced manner towards achieving team goals. The difference is this. Individual development doesn't cease the moment someone joins a team; in fact, it is at this point that individual development needs to move to a higher level.

Teams are effective because each person in the team contributes something. Rath & Conchie, from Gallup, emphasis this in their research into strengths based leadership. Their research into leadership teams found there were four key domains of leadership strength, these being:

1: Executing
2: Influencing
3: Relationship Building
4: Strategic Thinking

Each of these domains contains a host of strengths characteristics. The point being made by Rath and Conchie is that while individuals may not always be balanced, each individual brings strengths to the team, and when the team operates to the strengths of its members then the team is balanced and rounded. The key activity for team leaders is to be able to identify the various strengths characteristics required by the team and either (a) import those strengths into the team or (b) develop the latent strengths amongst existing team members.

Let The Journey Continue
John Coxon


John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Tuesday, February 24, 2009

Building leadership capacity

The Health Media Industry Survey 2009, of USA health providers, showed that only 9% of hospital leaders listed the development of future leaders as a priority. 49% of those surveys indicated the development of leadership capacity was in need of attention - but not necessarily a priority!

How do you go about developing leadership capacity in your hospital? By plan or by chance?

Evidence suggests a planned approach to leadership development pays dividends through improved management teamwork, a breaking down of functional silos, improved decision making, increased loyalty and perhaps most important, known and understood future leadership capacity. From a governance and staff perspective, people would rather have a new leader they had some knowledge and experience of, who has demonstrated their ability to lead and manage, than someone of unknown quality.

Consider the possibility of creating an accelerated leadership program, whereby potential leaders in your organisation work together as a team on self selected program, while also developing their leadership competencies through planned professional development, mentoring and coaching. The organisations benefits in many different ways, the individual managers benefit and the pathway to succession is a lot clearer.

To discuss how you implement such a program in your hospital call John on +61 3 55612228 and we can discuss how we might help you.

Let The Journey Continue
John Coxon



John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Monday, February 23, 2009

40 'dumb' questions

I follow the ‘projectshrink’ Bas de Baar, from the Netherlands, on Twitter. Bas writes stuff on project management. As you know, John Coxon & Associates has a workshop, ready for your team, titled Practical Project Management for Non Profits. (Give John a call on +61 3 5561 2228 to organise). Anyway back to Bas. He pointed me to a squidoo lens titled Not So Dumb Project Management Questions, hosted by Hal Macomber.

Even if you don’t have any interest in project management you gotta read this list of so-called dumb questions. They are not really that dumb – what is so dumb is that many people fail to ask them in the first instance. While written in the context of project management, every one of these questions applies to every other aspect of organisational management. I will even bet there are few in this list that you have failed to ask from time to time and wish afterwards that you, or someone, had done so. How dumb did you feel after not asking?
Let The Journey Continue
John Coxon

John Coxon & Associates
Taking You from Frontline Manager to CEO
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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Sunday, February 22, 2009

Hospital Front Line Management research

Back in 2006, researchers Lauren Arnold, Phd, RN, and Greg Nelson, conducted research titled Developing the new frontline manager. As a result of their research they identified five steps for preparing nurse leaders for success, these are:

1: Gaining management support
2: Creating a success profile of the ideal leader
3: Determining fundamental leadership skills and gaps
4: Training for gain
5: Sustaining momentum

In gaining support of management you need to demonstrate your understanding of key aspects of healthcare delivery - quality, retention, patient through put and leadership. When you apply for leadership development, frame your request along the lines of how the PD will help you develop this understanding.

Understand management models and those characteristics that determine effective leaders. Be aware of your own strengths and weakness and put in place a process for maximising strengths and turning weaknesses into strengths. Develop a training plan to help you achieve the knowledge and skills you need.

Sustain your momentum by taking on more responsible tasks, stretch yourself, work with mentors, apply the knowledge you have learned in the workplace at every opportunity.

If you are an aspiring nurse manager or already in a nurse management role and would like assistance to develop your full potential, call John Coxon on +61 03 5561 2228 to discuss how you would like to develop you career. We are able to help in many different ways.

Let The Journey Continue
John Coxon

John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Tuesday, February 3, 2009

Generational Change

Look around your management team. What do you believe the average age to be? If your management team is typical, then the average age will be somewhere between 50 years and 60 years. Sure there will be a handful of younger managers, often in front line management roles. The reality is that over the next decade many of those on your management will retire. They will be replaced by those younger managers currently in front line management roles.

This change will present many challenges. Being young and ambitious is not a qualification for executive management, it is simply a characteristic. Those younger Gen X managers moving into the executive suite over the next decade will need to build relationships with older, wiser, more experienced baby boomers. To not tap into the combined knowledge of those baby boomers still in the workplace will be a risky strategy.

For those currently aged in their 30's, with ambitions for leading our health providers, it is important, having achieved the top role, to avoid falling into the trap of believing you have all the answers. Effective leaders recognise the strengths others bring to an organisation. They gather round them people able to work together in a collaborative manner; that are aligned with the strategic direction of the organisation. The mantle of leadership is not a title to be claimed, it is a recognition bestowed by others, as a result of being seen to lead in a manner that develops trust, respects individuality while facilitating collaboration and ensure people are treated with dignity.

Let The Journey Continue
John Coxon
John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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Wednesday, January 7, 2009

Workplace Bullying

I was reading about some research into workplace bullying in hospitals. This piece included a case study from an Australian hospital. http://content.healthaffairs.org/cgi/content/full/21/5/189#SEC2

In an environment where health providers throughout the world face increasing shortages of skill employees, the cost of workplace bullying is magnified. The issue can be that bullying is a hidden disease. Often it takes places without the perpetrator actually being aware that they are engaged in bullying behavior. This is a reflection of poor development amongst managers. Front line managers in particular should be at the forefront of identifying incidents of bullying and provide a bully-free role model.

In this research, 38% of people interviewed reported being the victim of workplace bullying. A further 40% reported being witness to workplace bullying. These are significant numbers. It is possible they are conservative reports; certainly the percentages will be higher in some organisations than others. This suggests bully is a feature of an organisation's culture. Where workplace bullying is actively discouraged the message is one which demonstrates such behaviour will not be tolerated.

The cost of workplace bullying can be high. The direct cost may be measured in turnover and failure to attract the best people to work in an organisation. The cost of prevention is lower than the cost of allowing bullying to take place.

The first stage in prevention is education and awareness. Regrettably many of our normal social behaviours are bullying behaviours - and therefore not considered out of the ordinary. Staff at all levels need to be made aware of various behaviours and the impact these may have on other people.

Following on from education is a process whereby all managers are seen to be developing and reinforcing a culture free of bullying. This begins in the CEO's office. If the CEO bullies senior executives or middle management or any staff member, then the message is clear. Bullying is acceptable. It is the way we do things around here.

All other managers should make an effort to demonstrate to their team members their understanding of the signs of workplace bullying and show by their actions they will be proactive in stamping out such behaviours. It goes without saying, almost, that they to should avoid such bullying behaviours themselves in their dealings with staff.

John Coxon & Associates has created an in-house program designed to reduce the costs created by workplace bullying. This program is a mixture of management consulting, workshopping and ongoing management coaching. To discuss the program telephone +61 3 5561 2228 or email admin@johncoxon.com.au
Why have we done this? Simple, we view this as a management behavioural issue. We work with managers to help develop effective management competencies. In your organisation, this issue can be resolved only when your management team take responsibility for their behaviours.

Let The Journey Continue

John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
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Tuesday, January 6, 2009

Turnover is good

I 'borrowed' the headline above from an article by Molly Rowe at HealthLeaders Media. I hope Molly will not be to upset as I want to expand upon, and add my own perspective, to an article Molly wrote early in 2008.

Why would turnover be good? Especially in these difficult times with looming labour shortages forecast. The key is to hire the best people for the job. Those that have the right attitude as well as appropriate workplace qualifications. The key is to hang on to these people, come hell or highwater. Get rid of those with low skill levels and a lack of desire to learn new competencies or processes - they are a deadweight around the neck of efficiency. These people are the ones you want to turnover, fast and soon. In a difficult economy the most difficult people to get rid of are the deadweights. These people do not contribute to your organisation in any meaningful manner - in fact they contribute to its lack of effectiveness. These people stangle your organisation. They mire it in mediocrity. The contribute towards the turnover of good people - the very people you need to retain.

Why do we hire deadweights? There are a number of contributing factors. One is that many managers have poorly developed recruitment competencies. They assume to much, they do not ask relevant questions during interviews. A qualification is not a passport to competency - all a qualification does is get someone into an interview. Managers fail to follow up with properly conducted reference checks. Yes, applicants will always seed their reference list with supportative people. Use this technique. Say to the referee, "this person tells me they were involved in achieving xyz . . ". What are your recollections of this event? Listen for the gap between the applicants version and the referees version. There is no point in discussing with the referee stuff that is contained in the application - dig deeper and search for anomolies. Discovery of an anomoly doesn't automatically make an applicant unsuitable - it simply points you to areas for further discussion and exploration.

My point? Good employee relations begins at the recruitment stage, right at the beginning. Before you even advertise. Know what you want from this person. Understand the type of person you want. (Try involving existing staff in this process). Clearly define the role, expectations, responsibilities and outcomes. More tomorrow, where I will talk about some of the successful strategies we have employed when recruiting on behalf of clients.

Welcome to 2009. I trust all those that join us on our journey had an enjoyable festive season, however you celebrate it and we look forward to travelling onwards throughout the year.

Let The Journey Continue

John Coxon & Associates
Taking You from Frontline Manager to CEO
www.johncoxon.com.au
Email john@johncoxon.com.au
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Blog: http://healthsector.blogspot.com
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