Saturday, May 15, 2010

The Evolving Management Game

Let's face it, management hasn't changed a lot in modern time. How we managed has evolved as we have become better educated and more wealthy. I use the term wealthy in its broadest sense. People with means to lift themselves above poverty have time and energy to invest in making life even more comfortable - so we have an evolution, not a revolution - whereby management has evolved in line with changes in social expectations and behaviours.

The actions of managers have remained the same though. Managers continue to be responsible for financial management, organising work, providing feedback, making decisions and preparing reports. It's not what they do that has changed; it's how they go about doing these things that has evolved.

Take for example; the evolution from telling to asking. In a previous generation managers issued instructions and waited with full expectation that those instructions would be followed to the letter. Those that didn't appreciate taking instructions were encouraged to find employment elsewhere. Today that same manager, were they still employed, would be more likely to ask questions, to engage people and to seek input into the decision making process. The manager may even coach an employee through the process of determining what action to take next. Yet at the end of the day one thing has not changed. The manager remains responsible for ensuing the outcome is achieved.

Will that evolution continue or have we reached the pinnacle of management competence? I believe the trend will continue. I believe up and coming generations of people entering our hospitals and aged care facilities will demand to be consulted with and engaged in the process. I believe a new generation of emerging leaders will be even more inclined to manage by inclusion than their predecessors. Such a process is not a panacea for success; it is a process fraught with risk. It is a process that demands people in management have well developed leadership skills, often at a very young age, that they have developed continuously throughout the early stages of their life.

At the same time I believe those in the workplace will demand more of our future leaders. Leaders will be held more accountable by both peers and direct reports. Leadership in our organisations will require considerable patience and tolerance of well balanced people who have their feet firmly planted on the ground. For these people management will not be a theory; it will be grounded in action research, their own experiences combined with the experiences of mentors and those in their work groups. The relationships they form will determine their success or otherwise.

That much hasn't changed. Relationship building has been a part of management for ever; what will change I believe is that in the past many relationships were viewed for the power they delivered to someone. Future relationships will be viewed for the strength they provide to a team or a work group.

Let The Journey Continue
John Coxon
Taking You From Frontline Manager to CEO

Sunday, May 9, 2010

Where Have All The People Gone?

There are around 1300 hospitals, public and private throughout Australia. Collectively these organisations employ around 50,000 people in management roles. (On average, 1 CEO + 3 Directors + 15 middle managers + 20 frontline managers/supervisors). I appreciate this scenario may not accurately reflect your particular hospital. The concept I want to discuss is more important than the actual numbers involved. It is also possible I have underestimated the numbers.

Let's assume 50% of these managers will retire over the next decade. This means at least 5000 senior management roles will need to be replaced and around 15000 middle management roles. The majority of replacements will come from the ranks of 25-35 year olds currently in frontline manager or supervisor roles. Which means hospital will need to develop a further 25,000+ supervisors over the next decade. Were we to add the aged care sector to this then the number swells to around 30,000. Where will those people come from?

This upward movement of people into senior management roles will take place at a time of unprecendented low unemployment and labour shortages throughout Australia. The situation will be compounded by an increasing number of people leaving the sector, the low number of people entering the sector, an upward movement in remuneration, the fact that healthcare is process driven and more flexible working conditions in other sectors. What do health providers need to be doing?

It is likely the sector will have to look at how it goes about its service delivery. A smaller number of people will need to achieve more with less. A significant investment in non-traditional development will be needed - development that develops the ability of people to think, to take personal responsibility, to focus on quality service delivery from a customer perspective. Perhaps more importantly, the sector needs to develop flexible development pathways; that enable people to move in and out of the sector, and develop skills along the way. This will require more flexible learning and education processes, geared to the needs of the health provider rather than the needs of the education provider.

There is no doubt health delivery is process driven, especially inside a hospital or aged care facility. Yet this reliance on the procedures and policy manual creates inflexibilities that do not always benefit the customer and serve to frustrate employees. The end result will likely drive people out of the sector. Hospital management teams will need to develop the ability to drive non-wage related costs ever downwards through more efficient workplace practices. Governments cannot continue to fund a sector where expenses are outstripping the cost of living. It is likely Governments will face reductions in taxation monies as the ageing population goes into retirement. This will be reflected in Government spending on social services.

Technology will continue to make in-roads in every area. While healthcare has always required considerable investment in medical technology; the future may see a greater reliance on combinations of the internet and mobile telephony to reduce wastage, improve communications, speed up analysis, provide information, reduce the amount of face-to-face contact and minimise travel time. This will be made easier as Baby Boomers, reluctant to embrace the possibilities and potential of this technology leave the industry and move into retirement.

Restrictive employment practices may need to become more flexible. For the past three decades the focus of health sector unions has been to preserve jobs and increase benefits. It is likely for the next twenty years or more there will be little need to worry about preserving jobs, they will be abundant and remuneration will be driven upwards by market demand. Restrictive employment practices will serve to drive people out of the sector and into other areas of work.

The perception of working in healthcare will need to change. Younger generations have so many more enjoyable and lucrative options. Nursing in particular continues to revolve around shift work, body fluids, tired, uncooperative patients and medical specialists with poorly developed social skills. Compassion alone will only act as a motivator for so long in the face of other options. Public education programs promoting the sector will continue to be important. More important, health providers will need to develop ways of being seen as employers of choice.

Current Government practice is to throw money at hospital management teams to try and reduce waiting list times. This may have a short term benefit, yet if these other issues are not addressed it is possible there will insufficient people to enable sufficient beds to be available; which may result in even longer waiting times and greater patient inconvenience, regardless of how much money is thrown at the problem!

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO

Innovation in a controlled environment

Healthcare in Australia and New Zealand is a political process, even private, for-profit healthcare, is dominated by public policy, centralised industrial relations and Government regulation. It is a process that discourages innovation and free-thinking; it is a process driven by the procedures and processes manual. Does it need to be this way?

In these circumstances, the focus becomes more one of maintaining employment than looking after patients - not that you would ever hear anyone in the health sector actually state this; instead the language, if not the actions, always reflects a concern for the patient.

My concern here is that the patient becomes the reason for doing nothing new or different. When people do not want to think or they want to succumb to their 'lizard brain, to quote Seth Godin, they respond by saying, let's do what is in the best interest of the patient. Of course they are often saying let's do nothing; because if you look around you can see that we have many satisfied patients.

Yet innovation is not an outcome, it is a process of thinking, of reflection, of questioning assumptions, of experimentation and of bringing together like minded people to examine the alternatives. When we point to the patient we are often pointing to an outcome while avoiding the process of innovation. We are also excusing ourselves from the need to think. When we point to the P&P manual we excuse ourselves from taking any sort of risk.

Being innovative in a political environment requires bravery; the sort of bravery that is demanded on the sports field, where someone is prepared to put their head over the ball for the better good of the team. When our salaries are at threat, or our friendships or our social standing; many will talk about bravery but few will be brave. Yet many who cannot be brave continue to be dishonest and talk up their innovation credentials. Innovation in a political environment requires someone to come up with new ideas, to take the hits and to understand that the system will repel them at every turn, until you can prove it is safe for the majority to do something different. Maybe that is the challenge for innovators; to focus on creating safety and reassurance for the masses more than excitement for the innovation.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO

Tuesday, May 4, 2010

Personal Responsibility

Recently I was involved in a conversation with a group of healthcare managers, specifically with a CEO and one of their frontline managers. Our conversation was impromptu; the three of us happened to be in the same place at the same time, have similar interests and the time to talk. Our conversation commenced with three three of us standing around, chatting; and after a while we had gravitated to a nearby whiteboard and started mapping out our conversation.

We were talking about communication processes and relationships between managers and staff. There was no agenda, it was simply a wide ranging discussion about communication pathways and relationships. In time one aspect of our discussion stood out. As we mapped out our conversation on the whiteboard everything we talked about came back to individual responsibility. In short, whenever we identified a breakdown in the communication process we also identified that someone had failed to take personal responsibility for their actions or outcomes.

It also became clear that people were not aligning their personal behaviour with the mission and executive charter of the organisation. This organisation's mission statement specifically includes words and phrases that indicated the outcomes of the organisation; yet when we compared individual outcomes with the mission statment, it became clear there was a disconnect.

The CEO posed a question. He asked, if it is the role of the executive team to formulate mission statements, strategic plans etc, how do they get others to align themselves with these plan? We agreed that the CEO and the executive team had no control over what others choose to do. We agreed the foremost role of the CEO and the senior executive team was for them to be seen to be living the outcomes contained in the mission. In other words, every action taken by those in senior management must reflect and role model the behavior they expected of others. It was also the role of the executive team, particularly the CEO to educate and raise awareness at all level off the organisation, as to the existence and intent of the mission, strategy and outcomes. After that it comes down to each individual taking personal responsibility for ensuring that every action they take should be aligned with; consistent with the organisations goals and outcomes.

How often do you review your workplace behaviour, activities and outcomes and ask yourself; are the things I do aligned with the organisation's mission, strategic direction? Are the things I do a direct contribution to this organisation's outcomes?

From our impromptu conversation we came to the conclusion that this lack of personal responsibility at every level of management is directly responsible for many organisations having poor communication and commitment.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO