Healthcare Management

new management blog details

2011-01-06T08:47:00.002+11:00

Hello to all my readers and compliments of the season. Please be advised this blog is no longer being serviced, it has been replaced with a new blog on management titled Managers That Care and is being hosted at http://managersthatcare.wordpress.com I hope you will join me on my new blog
thank you
John Coxon

new management blog details

2011-01-06T08:47:00.000+11:00

Engaging people in recruitment (2)

2010-10-15T16:47:00.004+11:00

This is the second installment in a journey being undertaken by an aged care client. In this organisation the Nurse Care Manager has tendered a resignation and a recruitment process is underway. In keeping with the organisations current practice of engaging staff in the recruitment process, a team of staff including the Executive Officer, a Div 2 Nurse, an environmental manager and two personal carers have gathered for this purpose. They are assisted by an experienced consultant/facilitator, who has the role of providing advice and structure but not directing how the process should unfold.

Yesterday the group met to look at the wording they wanted for the situations vacant advertisement, to discuss where the role would be advertised and to set out a time frame for the recruitment process. The facilitator also introduced capability frameworks as a tool to assist with identifying what is expected of applicants. The group also engaged in a conversation as to the costs of recruitment and advertising.

Together the group created a draft of the situations vacant advt. There was spirited discussion on many aspects of wording and the sequence of information. Remember non of these people are skilled HR consultants; they simply work at the coal face and they know what they see every day, they know what works and what doesn't work in their environment. Everyone contributed to the conversation, even those that may have felt out of their depth asked questions and put forward suggestions. At the same time everyone there broadened their knowledge and their understanding.

Next week we meet to discuss the group's ideas on capabilities. What they expect from the incoming Nurse Manager and what they will be looking for from applicants. Their ideas will then feed into a position description to be included in an information kit sent out to applicants. Later their ideas will feed into the interview process as they will go into the interview with a clear perspective on what they are seeking and what it is they want to discuss with applicants.

I hope you will keep an eye on this blog and as always we would welcome questions or your thoughts. This is a live, evolving case study of empowerment in a healthcare environment.

I will keep you posted as this process unfolds.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO
Skype: john_coxon
Twitter: john_coxon
Facebook: johncoxon1
Email: john@johncoxon.com.au
Telephone: +61 247 390376

Engaging people in recruitment

2010-10-01T09:24:00.005+10:00

Over the past six months I have been guiding an aged care client through a process of engaging staff in the recruitment process. Early steps towards a more empowered model of operation. This aged care provider of 40 beds has operated in the traditional mode for many years.

Yesterday I sat in and observed a group of people, including a Division 2 Nurse and personal carers conduct an interview with a Division 1 Nurse. The applicant had already been assessed by a senior executive as having appropriate qualifications and experience but had been informed that a job offer was dependent upon a tick of approval by staff, while also providing the applicant with an opportunity to engage with the staff she would be working with, and supervising.

The staff involved in the interview process are all volunteers. They have not been provided with training in formal interview techniques as we want them to have a conversation. They have been provided with guidance on the types of questions they cannot ask for legal or privacy reasons and they have been provided with an assurance by the CEO that their recommendation will not be overruled.

Following the interview conversation I discussed with those staff involved how they felt about being engaged in this manner. Their enthusiasm was overwhelming. They loved it. Their grins stretched from one side of their face to the other. As we discussed the applicant one of the staff members raised a question that they didn't know the answer to. When they turned to me I suggested they ask the CEO to join them. The senior nurse present immediately jumped up and went to ask the CEO if he would do that. Without warning, without preparation, the CEO joined the discussion and as a result those present were able to ask a number of questions in an environment free of fear and where titles meant nothing. This was an act of bravery and trust amongst all those present. It was grass roots democracy taking place. It was common sense management.

Now I know there will be sphincter-inhibited senior executives, self indulging HR people, self righteous Registered Nurses and indignant union officials spewing into their coffee cups as they read this. How dare we presume a personal carer or assistant in nurse or a EN have the intelligence, the skills and the ability to make such a decision? Well they do and to those that don't applaud this concept, I hope you are nearing retirement because you are looking at the future.

There will be critics who point out that senior management had a hand in the process prior to staff engagement. This is true. On this occasion. Now here is the clincher. In this same organisation the Nurse Manager has just tendered her resignation and guess what - a group of staff members will be involved in the entire process, from reviewing the advt in the paper, assessing capabilities, reviewing position and job descriptions, short listing and interviewing and making a recommendation to the CEO. And I am prepared to bet my fee that the relationship between the incoming Nurse Manager and the entire staff group will be spot on from day one and will build into a sustainable long term relationship.

I will keep you posted as this process unfolds.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO
Skype: john_coxon
Twitter: john_coxon
Facebook: johncoxon1
Email: john@johncoxon.com.au
Telephone: +61 247 390376

The Boss Leads The Way

2010-09-24T07:57:00.000+10:00

Linda Hudson, CEO of BAE Systems, got this message after becoming the first female president of General Dynamics. After her first day on the job, a dozen women in her office imitated how she tied her scarf. Hudson realized, “It really was now about me and the context of setting the tone for the organization. That was a lesson I have never forgotten—that as a leader, people are looking at you in a way that you could not have imagined in other roles.” Hudson added that such scrutiny and the consequent responsibility is “something that I think about virtually every day.” http://bit.ly/cni8QP

This snippet above illustrates the importance of the CEO in setting cultural overtones for a hospital. In short, if you are looking out the window of your executive office and wondering why it is that people dont do things they way you would expect them to do them - then it is because they are following your lead.

Now let's be realistic. We're not talking about how people go about giving an injection, applying a bandage, cooking a meal or preparing a set of financial accounts. These are technical skills, these are taught skills. We're talking about the behaviours that make an organisation an enjoyable place to work, or otherwise.

What are your surveys telling you? Do you even take any notice off the picture they paint? Maybe you do and maybe that is why you are feeling a bit disappointed. I hope so. Now turn around, find a mirror and look into it. What do you see? Do you see a CEO who smiles, has a open, inviting posture, looks interested in other people, has a enquiring mind? Do you see someone who wants to help, wants to engage everyone in the organisation? If you were new to your organisation and you were looking at you on your first day, would you want to follow yourself?

Now the challenge is that what we see in ourselves and what others see will often be different. It is a rare individual that is able to undertake an accurate self assessment, and more importantly, make the changes without being pushed into doing so by someone else or some form of crisis. By that stage it is often to late and we are left wondering what it is we did wrong.

When you arrive in the CEO's office, newly minted, or any senior executive office for that matter, life does change. For a start you have immense influence over the careers of other people. In turn they have less influence over yours. This is an outcome of our hierarchial system of management. It can be different but not likely to be in the current climate. Those that you have influence over begin to observe you from day one. They note constantly every aspect of your behaviour, and they copy whatever they believe will help them to advance or remain in their role. This is natural behaviour. We prefer the status quo to something different and we do everything in our power to retain the status quo - to the point of going down with a sinking ship because our perception is that this is the least risky option.

If you decide that decision making will be a solitary exercise, take a heroic CEO stance, where you appear to know it all - then that is exactly the stance your senior executives will take. Those that are uncomfortable with that style will eventually leave and you will likely replace them with people similar to yourself. In turn, every manager throughout your organisation will adapt that style of decision making. In this instance the outcomes could be catastropic. This eventually leads to a culture of blame and backside protecting. Who would you blame? Yourself or your management team? I would suggest you start by looking at yourself.

How do you stop this from occuring? Firstly ask yourself, are you open to change, are adaptable, are you willing to listen to feedback from others, and if so are you prepared to act upon that feedback? If not, its time to go home. It's time to find another role. Let the Board appoint someone that is adaptable and able to work with people, able to engage with people and able to listen to what other people say.

Should you decide you have all the good qualities! Then it is time to seek some feedback, formally or informally it doesn't matter. What is more important is what you do with the feedback you receieve. Try this, speak to those that gave the feedback. Thank them, do not criticise their feedback. Have a conversation, seek more information and make a commitment to ongoing change. Ask for their support and feedback. Seek some executive coaching http://bit.ly/9og4Bn or mentoring. An external coach, with no political affiliation, no axe to grind, whose only desire is to see you be the best you can be, can also help you to challenge your assumptions, interpret your observations and develop new management behaviours.

When you seek feedback, go deep into your organisation. Many CEO's limit feedback to immediate direct reports in the executive team. Remember what was stated earlier about focusing on those with the greatest impact upon your career. Maybe the people with the most to lose are not the most reliable when it comes to getting feedback on your behaviour as a CEO. Afterall they are simply copying you. What would they see wrong in your behaviour?

Other people will see a different CEO. They will focus on the impact you have upon them. They will look at how you communicate with people, how you share information, how you engage them and seek input from them. They will judge you upon the quality of people you promote into management roles. Yes they will gripe about how little they are paid and how difficult their work is. You need to hear these things also. You need the reality check. Some things you can do something about, others you can do nothing more than listen. You will be judged upon how often and how well you listen. You will be judged upon how often rank and file staff see you in their territory, and when you are there, they will judge you on how you behaved towards them and their colleagues.

This will not be easy feedback to seek, to listen to, to absorb or to act upon. CEO's and senior executives assume a persona when you reach higher office. Its a coping strategy for all the issues they are faced with on a daily basis. It helps to protect them from the constant demands upon their time. It can also prevent them from being perceived as a real person, someone with heart and soul. Noone will doubt you have a brain; yet often they will doubt you know how to use it.

Becoming a CEO does not mean you know it all. It does not mean you have reached the pinnacle of management behaviour. It does mean you are at the beginning of the next stage of your journey, rather than the end of the journey.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO

Email: john@johncoxon.com.au
Telephone: +61 247 390 376
Twitter: john_coxon
Facebook: johncoxon1

Indian Healthcare Leads Employment Growth

2010-09-10T21:27:00.003+10:00

In 2009 there were approximately 8400 Indian nationals working in Australia on temporary visas, with a significant number, if not the majority involved in the healthcare sector. An increasing number of Indian nationals work as nurses in Australian hospitals. Why is this? Because Australia is facing a severe shortage of labour in all sectors, including healthcare. This is not going to change in the next two decades, which means that if the Australian health sector is to continue to meet its performance targets then it will need to (a) attract more Australian qualified medical practitioners back into the sector, particularly registered nurses or (b) allow a greater number of immigrants to work in the sector.

Now here's the rub. India is an emerging nation. Its health sector has recorded annual growth of around 8-9% per annum in recent years, in line with sector growth of other emerging nations. A report into the Indian healthcare sector by India Brand Equity Foundation predicted the Indian health care sector will grow to US$280B by 2020. Biz India on their facebook page recently reported that India will generate almost 300,000 new jobs in healthcare in the next twelve months and increasing over the next few years. This is a nation that will need every healthcare worker it can get and increasingly it will become easier for Indian nationals to remain in India or return there to work in the Indian health sector.

The impact on Australia, and other Western nations that currently 'import' Indian nationals to work in their hospitals and general practices will be significant. They simply will not have sufficient numbers of people working in healthcare or prepared to enter the sector. The impact will be felt in many areas. Service delivery can only be fully delivered when there are sufficient people to do so. Where there are insufficient people in the sector, service delivery will be rationalised. This will impact mostly in rural and remote areas. Competition for health care workers will increase and this will force an increase in salaries and other benefits. This will be good for those involved in personal carer roles which are often at the bottom of the food chain. The problem is that within the public sector the money for paying labour is provided by Government from general taxation. As the population ages, the tax base reduces and thus there is less money available for funding healthcare at a time when the demand for service is greatest.

As the cost of labour increases so does the cost of service delivery. This creates greater rationing of services in the public sector as hospital managers strive to maintain service delivery costs within budgets. In the private sector it contributes to increase in the gap between health cost and health insurance cover. In both instances the cost is incurred by the taxpayer through increased costs and longer waiting lists. A headache for policy makers seeking to appease voters.

Which brings us to medical tourism. India is an English speaking nation, based upon democratic principals, leaving aside sectarial differences, much of its key health care facilities are high quality and many medical professionals are trained to Western nation standards - and they operate from a lower cost base.

Already thirteen Indian hospitals are accredited with Joint Commission International (JCI), the largest healthcare accrediation agency in the USA. In 2009 almost 500,000 visitors travelled to India for medical treatment, only 50% less than the number travelling to Thailand for the same reason and slightly more than travelled to Singapore. More than 50 Indian hospitals are currently undergoing accreditation with India's National Accreditation Board for Hospitals and Healthcare.

Those that are most likely to travel overseas for treatment are those with high incomes and without private health cover or those with health cover and a high gap

The Evolving Management Game

2010-05-15T08:03:00.003+10:00

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

Where Have All The People Gone?

2010-05-09T13:18:00.004+10:00

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

2010-05-09T08:09:00.003+10:00

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

Personal Responsibility

2010-05-04T22:38:00.002+10:00

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

Do Managers Matter?

2010-04-07T05:57:00.003+10:00

A recent article at Workforce asked the question, Do Managers Matter?

I'm not sure this is the best question to ask. I would be more inclined to asked are managers needed? Personally I believe managers can matter. I believe they can make a significant difference. I continue to believe that many people leave organisations due to the impact of poor managers however I agree with the article in that I don't believe that is the sole reason people leave. For example, recent research at Harvard Business School showed a key role workplace motivator as being people's sense of achievement and making progress; therefore many people could leave due to feeling frustrated. At the same time their manager may have played a significant role in not removing or minimising the barriers that impact upon progress. Professor Henry Mintzberg suggests this also in the Workplace article where he suggests organisations should focus on changing organisational structures that impede management.

On the other hand I do not believe managers are needed? Given a change in corporate culture and structure a good many organisations could operate just as effectively or even more so with few if any formal management roles. The problem with creating a manager class is that the group of people then engage in behaviour designed to make them appear indispensible. A part of that behaviour is to generate a perception that without them the place would fall apart.

The reality is that the combined wisdom and knowledge of those in the workplace is greater than any single manager or in many instances the combined knowledge of a group of managers. In other words the people at the coalface have the best understanding of how to meet the needs of stakeholders in the most effective manner. The problem is that managers do not seek the perspective of those at the coalface. The entire hierarcial process relies upon each layer forming a misperception that they have a better understanding than the layer beneath them.

What about the managers big picture perspective I hear you ask? What about it? My experience is that outside of the executive group, very few frontline or middle managers have any understanding of anything outside their own somewhat narrow area of activity - and many a senior executive has demonstrated a complete lack of big picture awareness. How can a senior executive claim to understand the big picture when they focus entirely on the emerging external environment yet fail to understand the emerging internal environment or even understand the impact of those two environments upon each other? A much bigger picture would be obtained through accessing the collective wisdom of a broad workgroup or diverse stakeholders.

People in non management roles dont have the information to make effective decisions. I hear this all the time. Well give them access to the information and provide training in how to use that information to aid decision making. Having the ability to analyse information and apply it to an issue is not solely the domain of managers, it is something they had to learn to do, it is something non managers can learn to do. Essentially it is about power. The more someone is reliant upon someone else the more likely they are to be compliant. Compliance is always much easier to achieve than collaboration.

How do you go about accessing collective wisdom? For a start you need to create an environment where people have permission, not only verbal but also demonstrated by your own behaviour, to offer ideas, you need to remove the fear of being wrong or of being criticised, replace negative thinking with positive, creative thinking. You need to create an environment of discussion and exploration. You need to develop people's ability to assess situations, analyse information and apply sound judgment Sounds easy doesn't it? Well it's not, which is why the majority of managers don't go there. The reality is that many managers have in their workgroup people that operate home businesses, have experience of opearating businesses with their partners and manage their home affairs very competently; yet we persist in believing that as they don't have the title 'manager' they must be incompetent.

Another reason most managers cannot take such a step is because they see it as giving up some of their power. These managers are focusing on the wrong thing. They are focusing on their own ego at the expense of the greater good, at the expense of acheiving outcomes. Tapping in collective wisdom is not about giving up power; it is about showing you understand your power is in the group, collectively, rather than in yourself. The term 'manager' is only a title. It is what you do in your role that defines you, rather than the title you are given.

One of the first things you can do as a manager to foster collaborative and collective decision making is learn how not to say NO. Strange as it might be there is no need for any manager to ever say no. Instead try this, 'its an interesting idea, let me mull over it and we can get together in a couple of days for coffee to explore in more depth'. You haven't said either no or yes. You are fostering the thinking and discussion process, you are encouraging exploration, you are helping people to learn to think. Eventually through this process the appropriate and correct course of action will take place - without you needing to impose your management ego.

Many managers dismiss such processes out of hand as they feel they are time consuming. They are right, collaborative action is time consuming, its always much quicker to simply issue a directive. In the beginning, when you first commence accessing collective wisdom you will become frustrated by the process; in the long term as you develop amongst your people an ability to think things through, to discuss ideas openly, to share information and to tap into each others knowledge you will find they come to less often with problems to be solved, they will have solved the problem and moved on. You will find you time is taken up with acheiving the future rather than trying to change or remedy the past. You will find your role as a manager is less stressful and more enjoyable.

In such circumstances you will be needed as a leader and you will matter as you add value to the work group. Right now, the way the majority of people manage, they are not needed and they don't matter - were they to take a year off work without replacement, the place would operate just as well, and I would predict even better without them.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO

Managing Your Boss

2010-03-13T06:19:00.002+11:00

As a management coach I am asked this very question on a daily basis. It is my experience you cannot 'manage' your boss. You can manage how you do your work and how you interact with people. Those are the only things you have control over. You do not have control over how another person behaves.

There are two reasons for bad bosses, these are (1) inability to form working relationships with people and (2) inadequate professional development in management strategies and competencies. The only person with control over these is the boss. I recently coached a senior hospital executive who had been 'profiled' by his staff as a bad boss. He was open to change and subsequently resigned when he identified himself as being unwilling to make necessary changes to his behaviour. He is a good person, lacking skills who became a bad boss due to his inadequacies.

Advice to people to 'approach' their bad boss with detailed info on his/her behaviour are pointless. If the boss was open to that approach he or she would be naturally reflective and adaptive - and likely already be a good boss. In doing so one can also set themselves up for an unpleasant experience. Feedback is best left to formal processes.

Should you continue to work with a bad boss? In the long term no you should not. Why subject yourself to workplace bullying? On the other hand, I recently coached a lady to develop a range of coping strategies that enabled her to continue her work long enough to outlast her bad boss. For my client, this was her preferred option. She now has a new boss in a new department and is a happy person. In some situations it is just not practical to move to another role or organisation.

It is unusual for a boss to universally bad - that is disliked by everyone - in many instances 'bad boss' is really a personal relationship issue between a manager and an individual. Universally bad bosses become obvious to everyone, including their boss and their tenure is limited.

Confusing 'bad boss' with 'personal relationship' clouds the issue and prevents resolution. A personal relationship conflict requires either, two mature people to meet and discuss how to go forward or an external meditator to engage with both parties. Each of us needs to clarify our real situation.

If you are in that rare situation where you have a universally bad boss there are a number of things you and your colleagues can do, these include:

Developing individual coping strategies. (each person is different)
Reflecting on your own workplace practices
Being clear on what your boss expects from you
Meet those expectations
Rely more upon informal leadership/management structures
Commence preparing to work someplace else

These are positive strategies where the focus is on you as these are the only things you have control over.

Avoid negative strategies or reactions such as withholding information, withdrawing support, public derision, backstabbing etc as at the end of the day the only person that pays for that is you, with your self esteem and reputation.

If on the other hand you do not have a universally bad boss and the real issue is the relationship between you and your boss then you need to obtain external assistance - if you want to help yourself.

John Coxon
Taking You From Frontline Manager To CEO
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Why be a manager?

2010-02-19T10:16:00.003+11:00

Often as I observe managers in various coaching roles or in development workshops I ask myself why some people become involved in management? I read the research and I understand that money is way down the list of performance motivators yet there are times when I cannot help myself from forming a belief that many people become involved in management because (a) it pays more or (b) their ego doesn't allow them to turn down the offer.

How many really understand the role of a manager and what is expected of them? Back in the 1930's the granddaddy of modern management, Henri Fayol developed a set of management principles and activities which have guided managers for the past 80 years. At the same time I believe these same principles and actions, which truthful in what it is managers need to do along the way, have created a management 'thinking' that is flawed.

In 1982 Fernando Flores wrote in his Harvard thesis about conversations, commitments and trust. He was writing about the workplace of the future. The gap between how you think about Fayol and how you think about Flores is a chasm - one that many managers appear unable or unwilling to jump over!

In a recent workshop on decision making where we were exploring Roger Martins model of Integrative Thinking one participant observed, 'all this decision making seems very time consuming'. This person was being truthful, good decision making is time consuming. It involves two or more people in a conversation. To this persons credit she was also open to exploring the possible consequences of taking a short cut approach to decision making. The questions remained at the forefront of my mind. Why would someone who considers decision making conversations to be wasteful and time consuming want to be in a management role?

I believe the prime role of managers is to develop the potential of their team or workgroup and the individuals within that group. Nothing more, nothing less. What does this imply? Firstly the role of manager is to align workgroup activities and outcomes with organisational strategic outcomes. Secondly the role of the manager is to develop the capacity of the team to perform the tasks required to acheive the outcomes. Thirdly the role of the manager is to allocate or delegate tasks to ensure an equitable and effective distribution of work. Fourthly the role of the manager is to monitor implementation, coach people through being effective, review progress and provide feedback. Sure, inside these four groups of management tasks are preparing budgets, creating rosters and a heap of individual tasks.

Are you in a management role? How well can you assess yourself against the following:
1: How well is your workgroup aligned with organisation direction and outcomes?
2: How capable are your people in achieving those outcomes? Do they have the necessary experience, skills, resources and support?
3: How well is work delegated, by firstly yourself, then your supervisors?
4: How well do you monitor progress, follow up, offer support and resources, remove blockages, provide coaching and provide positive constructive feedback?

If you rate yourself as low on any of these four then I recommend you contact me and we can work together to help you develop those four areas of management. If you do not want to be proficient in any of those four areas of management then you need to review the reasons why you want to be a manager.

Are you in your role to develop people to achieve maximum performance and effectiveness or are you in there for the money and to satisfy your own ego? If you are there for the money or for ego then the only person you are serving is yourself. You are greedy and your greed will feed your incompetence. The best people will see through your greed and incompetence and will leave or refuse to work with you. This leaves you only those that don't care - and they will make you look worse still.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO

Email: john@johncoxon.com.au
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Workplace bullying and harrassment

2010-02-06T19:50:00.002+11:00

Bullying in the workplace is endemic. A 2009 survey in the United States found that 37% of workers believed they had been bullied in some manner. Management expert and author, Professor Robert I Sutton believes that workplace bullying is bad for business as it leads to absenteeism, staff turnover and performance issues. That is not rocket science, as a management coach I have witnessed and coached those that have been the victims off, or impacted upon by workplace bullying.

Our schools have had anti-bullying policies and practices in place for years. Why is it when we become 'adults' we forsake such practices? Surely experience would show that even adults experience problems coping with the impact and consequences of workplace bullying. A story in The Age newspaper in Victoria highlighted the extreme consequences of workplace bullying when it reported on the recent death of 19-year old Brodie Panlock. As parents, none of us would want the grief experienced by Brodies family. Yet as adults and parents many of us have at some point engaged in some form of workplace harrassment. When 37% of the workforce believe they have been bullied it would be reasonable to suggest another 37% were involved as the bullies. For every victim there is a bully. That is 72% of the workforce wasting time engaged in an activity that robs people of their dignity and self respect.

It has been suggested by some that workplace bullying is more endemic and has an even greater overall impact than sexual harrassment yet in every workplace there is policies and practices designed to eliminate sexual harrassment. It is difficult to imagine 37% of the workforce having experienced sexual harrassment and this is not meant in any way to belittle those suffering the impact of sexual harrassment.

In 2006 a report by the British Medical Association found that 1 in 4 employees in the National Health Service had experienced some form of bullying while at work. Interestingly 16% of medical staff believed they had been bullied by nurses. Bullying included, belittling people, undermining work, withholding information and imposing impossible deadlines. These behaviours indicate that much workplace bullying results in mental distress rather than physical violence.

A 2009 report into bullying in the Australia health sector reported that as many as 50% of healthcare employees had experienced bullying. Similarly in New Zealand there have been reports of up to 50% of some sectors of healthcare having experienced workplace bullying. Other research has found that less than 37% of those impacted upon actually reported the bullying. This means a lot of people may be running around your organisation suffering the mental anguish from being bullied. Why have they not sought help? Is it because your organisation does not have a clear policy on workplace bullying? Is it because they don't believe they will be helped? Is it because they don't know where to get help?

Have you been a victim of bullying in the workplace? Speak up now. Name and shame the organisation. This is not something to remain silent about. Share your stories and also share with others what you did to seek help and to cope with the impact.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO
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Turning Negative into a Positive

2010-01-19T09:32:00.004+11:00

During a coaching session yesterday I discussed with a client how she planned to approach some negative behaviour between staff members.

We agreed there were a couple of options. One, she could provide a 'lecture' to the staff group, thus avoiding any public identification of the culprits. Two, she could turn a negative into a positive by converting the lecture into a professional development opportunity.

Essentially the issue as my client understood was one of individual values and behaviours. How we would like to be treated by others and how we would like to treat them.

Were my client to choose to provide a 'lecture' many of those there would have tuned out. It is possible the culprits would have rationalised their behaviour by believing the manager was referring to someone other than themselves. At worst the message would have been wasted.

Instead, should my client choose to convert this into professional development opportunity she can use handover time to engage the group in a discussion on values and behaviours, have them identify how they would like to behave and be treated. This then provides opportunties for follow up. The Unit Manager could then take copies of the the whiteboard and circulate everyone's input for further comment. She could then create a series of 'values' posters to be displayed throughout the workplace.

Some of you may consider this 'soft' approach ineffective. Remember this. The deed has been done, it cannot be undone. The culprits are not known and trying to shame them publically would likely backfire. Why not take a different approach, a long term approach, why not educate rather than lecture? Thats the difference between leadership and management.

Let The Journey Continue
John Coxon

Taking You From Frontline Manager to CEO
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Prudent hospital management

2009-12-19T21:03:00.003+11:00

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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Lean Processes in Healthcare

2009-11-28T21:18:00.004+11:00

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
Taking You From Frontline Manager to CEO
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Risk Management in Management

2009-11-27T17:24:00.003+11:00

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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Work place gossip

2009-11-20T08:50:00.002+11:00

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

Rural health service management

2009-10-19T20:33:00.003+11:00

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
Taking You From Frontline Manager to CEO
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Leadership Dilemma

2009-09-23T22:12:00.003+10:00

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
Taking You From Frontline Manager to CEO
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Hospital workplace stress

2009-08-14T05:28:00.006+10:00

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
Email john@johncoxon.com.au
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Blog: http://healthsector.blogspot.com
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The Responsibility Of Management

2009-07-27T08:37:00.004+10:00

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
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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Reducing Workplace Stress

2009-07-14T15:56:00.004+10:00

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
Skype: john_coxon
Blog: http://healthsector.blogspot.com
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None so blind as those that refuse to see

2009-07-05T04:34:00.005+10:00

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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Intelligent Leadership

2009-05-20T07:42:00.002+10:00

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
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A new form of leadership

2009-04-05T22:20:00.003+10:00

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
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Coaching Case Study

2009-03-31T20:38:00.003+11:00

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
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Where is the evidence of need to change

2009-03-17T10:14:00.003+11:00

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
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Systemic crisis of failed management

2009-03-11T06:45:00.003+11:00

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
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Team Building

2009-03-10T16:50:00.002+11:00

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
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Building leadership capacity

2009-02-24T08:30:00.003+11:00

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
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40 'dumb' questions

2009-02-23T12:02:00.003+11:00

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

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Hospital Front Line Management research

2009-02-22T21:10:00.002+11:00

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
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Generational Change

2009-02-03T14:36:00.003+11:00

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
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Workplace Bullying

2009-01-07T08:43:00.004+11:00

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
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Turnover is good

2009-01-06T10:33:00.003+11:00

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
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Were taking a break

2008-12-20T22:59:00.001+11:00

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

MBA - Useful or Useless?

2008-12-16T17:14:00.003+11:00

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
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
http://www.linkedin.com/in/johncoxon
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Workplace stress and burnout

2008-12-10T21:27:00.005+11:00

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
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
http://www.linkedin.com/in/johncoxon
Follow john_coxon on Twitter
Join John Coxon on Facebook

Working with Millennials

2008-12-01T21:24:00.002+11:00

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 www.johncoxon.com.au/workshops.html to download an info kit.

Let The Journey Continue
John Coxon
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
http://www.linkedin.com/in/johncoxon
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Defining success

2008-11-28T19:18:00.004+11:00

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
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
http://www.linkedin.com/in/johncoxon
Follow john_coxon on Twitter
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What Are Your Final Wishes - Engage With Grace

2008-11-28T16:08:00.004+11:00

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
Email john@johncoxon.com.au
Skype: john_coxon
Blog: http://healthsector.blogspot.com
Blog: http://nfp-management.blogspot.com
http://www.linkedin.com/in/johncoxon
Follow john_coxon on Twitter
Join John Coxon on Facebook

For Profit Aged Care in Australia

2008-11-22T05:57:00.003+11:00

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

Boring, boring, boring

2008-11-21T17:40:00.001+11:00

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, www.johncoxon.com.au or www.johncoxon.co.nz 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 www.twitter.com 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

Staff retention

2008-10-09T17:08:00.002+11:00

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.

The Age of Collaboration

2008-08-04T20:11:00.004+10:00

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.

Front line managers are the key

2008-07-25T21:33:00.002+10:00

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

2008-07-25T07:15:00.002+10:00

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.

Enter the new executive

2008-06-20T21:42:00.003+10:00

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.

Nurturing those middle managers

2008-05-30T06:31:00.002+10:00

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.

The secret to successful teams

2008-03-21T10:20:00.002+11:00

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 -

How well does your management team achieve stated goals and outcomes? 1 - 7
How well does your management team work together to overcome barriers on its way to achieving the goals and outcomes? 1 - 7
How well does your management team actually work as a team? 1 - 7
How well does your team retain its core members over a prolonged period? 1 - 7
How good is your management team at dismantling 'silo's and creating cross-functional collaboration? 1 -7
How well does your CEO delegate tasks to key executives and hold them accountable for the outcomes? 1 -
How well does your management team maintain transparency by monitoring outcomes and communicating successes and failures throughout the organisation? 1 - 7
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.

GP Waiting Lists

2008-03-04T09:46:00.002+11:00

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.

Performance monitoring in hospitals

2008-03-01T22:57:00.002+11:00

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.

New Zealand health targets

2008-02-16T17:53:00.003+11:00

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:

Improving immunisation coverage
Improving oral health Improving elective surgery
Reducing cancer waiting times
Reducing ambulatory sensitive (avoidable) hospital admissions
Improving diabetes services
Improving mental health services
Improving nutrition, increasing physical activity and reducing obesity
Reducing the harm caused by tobacco
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

2008-02-16T08:10:00.003+11:00

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.

Changes to Medicare

2008-01-14T10:36:00.000+11:00

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.

Capital Health (NZ) to reduce medical staff

2007-12-09T10:44:00.000+11:00

As reported online on the Scoop website recently, Capital and Coast District Health Board in New Zealand is planning to reduce the number of employed doctors so as to limit future deficits. It is certainly one means of achieving that outcome, on the surface at least, considering staff costs to be the single largest cost component for a hospital, however any hospital considering such measures would need to consider the long term implications.

Medical staff perform a vital role within any hospital. One has to assume that government funded hospitals simply do not receive sufficient funding to enable them to employ a surplus of trained medical staff. Therefore it is highly possible that a cut in the number of medical professionals may lead to a reduction in the level of service available to patients, which in turn may increase waiting lists for surgery.

At the same time consideration needs to be given to the message such action might send out to those considering a career in medicine. It takes almost a decade of training to get a doctor to proficiency and full productivity within the hospital system, not to mention the time invested in ongoing professional development. Should the demand for medical professionals fall the it is likely less people will consider entering the profession or those that do may elect not to work within the hospital system. On the surface this may appear a good short term solution for reducing any excess numbers of medical professionals (if there is such an excess), however the time lag between entering the system as a trainee and becoming fully productive means it is necessary to have a full compliment of medical professionals available at all times.

Warley Hospital reflects private health issues

2007-12-07T21:33:00.000+11:00

During the 2003-04 year Warley Hospital discharged 602 medical patients and treated a further 2200 in A & E. Assumably those numbers have increased over the past three years, yet the hospital Board reports that Warley is no longer financially viable.

This situation has not occured overnight. Records from the Victorian Department of Human Services show consistent financial assistance to Warley Hospital over the past 5-7 years. In 2001 the Bracks Government provided additional funding of $22,000 to help maintain emergency services, $68,000 towards capital improvements and almost $200,000 towards the cost of developing an improved primary care facility. Again in 2005 the Bracks Government provided Warley with a one-off funding grant of $300,000 to enable the hospital to provide emergency services through to the end of 2006. A condition of the funding was that
Warley Hospital undertake business planning. In addition there has been significant private fundraising over the same period. This would suggest the issue is not necessarily one of poor management; rather an issue of ongoing cost escalation against declining revenues. That is assuming the Board and management have taken all the strategic cost cutting measures available to them!

Being a private hospital there are no publicly available records such as annual reports. This means we have to assume appropriate management of the hospital. If a private hospital is continuing to seek financial support from public funds then it needs to make its accounts and reports available for examination. Transparency is critical to ensure effective decision making.

Warley Hospital is a small, private, not-for-profit, hospital on Phillip Island in Victoria, Australia. According to the hospital profile, containing information that is three years old, the hospital has 13 acute beds, some of which are 'temporarily' closed and 30 residential aged care beds. The fact that Warley Hospital has been providing services to residents on Phillip Island for the past 80 years is off little consequence; the reality is that a combination of low levels of acute beds plus a low number of residential beds equates a low revenue base with few opportunities to increase revenues; at the same time costs continue to increase. Unlike public hospitals, private hospitals do not receive operational funding from the Federal Government. Private hospitals are funded from a mixture of benefits paid by health insurance providers and charges levied on services provided. Clearly a hospital that is not fully utilising an already low number of acute beds is limited in its ability to impose service charges, similarly its ability to attract benefit payments from health insurers is also restricted.

Should either the Federal Government or the State Government step into rescue Warley Hospital? Both the new incoming Rudd Government, through Health Minister, Nicola Roxon and the Victorian State Premier John Brumby appear to be distancing themselves from Warley Hospital. Perhaps they are viewing the long history of additional support funding and saying its time to draw a line in the sand!

Obviously the Phillip Island community would like to see all possible support for their hospital continued. Yet is a 45 minute drive on a good road, albeit the only road, to the next hospital that big an obstacle? Is it even necessary to have a full acute hospital service within the Port Phillip community? Could a smaller, satellite campus, serve the basic emergency needs of the community, before transfer to a regional hospital by ambulance? These are the sort of question that will be asked and need to be answered before the ongoing future of the facility can be assured. If it has a future.

A total of 80 people are employed by Warley Hospital, representing about four million dollars of salaries and wages being injected into the Port Phillip community. The hospital serves a permanent population of 8000. This swells to around 50,000 during the holiday periods and at the time of the Grand Prix. The reality is that a small acute hospital with restricted bed use is only going to be able to cope with minor emergencies; in the event of a major accident at the Grand Prix for example, emergency helicopter services would deliver patients to other larger providers.

It would be fair to suggest that in there rests the problem. Warley is private hospital based amongst a permanent population of only 8000, not all of whom have private health insurance. Despite the best intentions of the community and their desires for their own hospital, it is possible the community simply does not have the population base to sustain Warley. Furthermore the patient output figures would suggest, that within the current health environment, Warley Hospital is operating close to its capacity. If there is to be a future for Warley Hospital it would appear to be a future that requires increasing, ongoing, financial support. Should that be the case then the question becomes one of where will the money come from? Or maybe more importantly what value is Warley Hospital to either the Victorian State Government or the Australian Commonwealth?

Aged care trends in Australia

2007-08-11T08:22:00.000+10:00

According to projections made by the Australian Bureau of Statistics, half of the population of Australia will be 50 years old or more by the year 2051. In that time the population of Australia is expected to increase to between 25 and 33 million people, an increase of between 5 million and 13 million on current day population figures. Consider the projected population growth in these terms. It has taken almost 250 years for the population of Australia to reach 20 million yet over the next 40 years the population will grown by a possible 5-13 million. This is somewhere between a 25% and 65% growth in population in less than 20% of the time it took to reach the current figures.

The implications of this growth are staggering. The impact upon Australia's infrastructure will be enormous, especially when the projections are that 66% of the population will live in a capital city, with Sydney and Melbourne predicted to be the most populated cities. It is notable that Queensland is predicted to replace Victoria as Australia's second largest State during that time. Perhaps reflecting a move by both the young and the elderly to a warmer climate.

What are the implications for the health sector and for the aged care sector in particular with this growth in percentage of elderly? For a start elderly people require either residential services or they require services delivered to their homes. Currently around 33% of Australia's population is aged over 50 years. Over the next forty years this percentage will double. The need for residential services and community services will grow faster than in the past. Effectively the development of appropriate services will need to be put into place at a much faster rate. Potential developers of residential services will need to be looking a decade or two into the future and identifying now the need and available land for such services.

Government investment, for aged care, at all three levels of government will likely need to increase substantially. The increase in number of aged will create difficulties for Government when prioritising health funding. Governments will need to start identifying ways and means to encourage those that are not yet elderly to commence saving for the services they will require later in life. The family inheritance will go the way of the dodo for the average family as that capital base will be needed to pay for care. Those family members caring for an elderly parent in their own home should be eligible for carer funding support. It is much less expensive that having to provide Government funded residential or community support!

Technology will play an increasingly important role in aged care in the future. The generation of people requiring aged care services over the next forty years are computer literate, they are familiar will locating and identifying information related to their own health concerns and during that time it is likely systems will be developed that enable medical practitioners and patients to interact online in numerous different ways. Technology will also enable greater involvement in aged care by the extended family. Video conferencing technology via the internet will enable extended family members to maintain a watch on elderly parents from remote locations. Such technology will also enable the aged living in the community to communicate with their health providers and professionals. The ability to link the home refrigerator to the internet would be a boon for many elderly unable to undertake their own shopping. The baby boomers moving into elderly status will be familiar with and able to use online shopping, banking, bill payments, email, chat and so on. Governments need to invest funding into technology that will help the aged live more fulfilling lives at home and in the community rather than investing in support systems in the hospital.

Technology alone may drive many of the changes to how we deliver aged care services. Should the trend be towards more community living, aided by technology, then the role of those operating residential facilities will change dramatically; they will likely need to change from investing in infrastructure to investing in the delivery of services to a variety of locations. Those that already delivery community services will have a distinct advantage.

The increasing number of elderly people and the transient nature of young people, especially those within the workplace, means a premuim will be placed on those with experience and knowledge. Increasingly employers will understand the value of hiring and retaining mature workers, many of them will continue to work into their seventies. This group of people are in the workplace at present. They are learning to adapt to changing circumstances and they will continue to improve in their efforts to reinvent themselves. The emerging knowledge economy within Australia suggests also that many elderly will continue to work longer but may choose to work from home or from other remote locations. We will be less inclined to assume elderly means enforced retirement. It is feasible an increasing number of elderly will be partly retired while continuing to work from either home, or interestingly enough, from so-called retirement villages!

Interestingly the ABS forecasts predict the number of elderly aged 85 plus will increased during this period from around current levels of 350,000 to somewhere between 1.6 million and 2.7 million, to make up around 7% of Australia's population. These people will be those likely to require medical assistance, yet at the same time they will be fitter and healthier than their counterparts in 2007. The services they will require will change also. As with the elderly today they will continue to require meals to be provided - the growth in meals being delivered into the community will spiral. Those that provide meals into the community will need to provide 506X that currently being supplied. This will require improved facilities, greater nutritional advice and an increasing number of volunteer drivers. The tastes of the future elderly will be different, more cosmopolitan, they will demand variety and diversity of meals in line with their previous experiences as global travelers.

Kathryn Roberts, CEO of United States-based Ecumen when conducting research into future aged care needs in Minnasota wrote that the future represents an opportunity for Governments and providers to listen and to act and importantly, to work together to shape solutions that help the aged live where they want and how they want.

The implications for the retail sector, and its associated industries, such as advertising are enormous, and already these sectors are beginning to understand that their environment will be changing constantly over the next 40 years. There will still be a need for branded items, just less of a need, as the population ages. Older consumers use a different criteria when making purchasing decisions. In the past the aged have been patronised by almost every sector of the community - continue with those practices in the future at your own peril.

The acute care hospital sector will always be needed to provide medical assistance to the elderly, it is a fact of life that the elderly are more susceptible to illness than those much younger. Future governments need to streamline the funding of health so as to make the transition from aged care to acute care and back again seamless for the patient. This is difficult to achieve when different funding models apply to acute and the aged care sector ensuring each sector jealously guards its funding allocation by trying to transfer the patient and the cost to the other.

No cost, no consequence

2007-03-18T12:26:00.000+11:00

Consumers are often berated by all and sundry for not taking personal responsibility for their own health. The assumption being that were consumers to be more responsible then they would choose to remain healthier and thus require lower levels of primary care.

There is a thread of logic in the above argument. Afterall, why would someone choose to be unhealthy rather than healthy? A question that is difficult to answer. The reality is that the population globally make choices daily that are likely to lead to reduced healthiness. For example, many choose to smoke cigarettes, consume chemical cocktails of drugs or drink excessive amounts of alcohol. Others elect to involve themselves in sporting activities that often lead to ongoing health issues, others choose to drive motor vehicles in a dangerous manner or without the use of safety equipment. Is it possible they continue to make these choices due to their being no consequence? Some would argue that the potential for losing a limb or being institutionalised in itself should be sufficient consequence, but it often isn't. Again the reality is that even with instances of extreme disability, at least within the developed world, one can continue to live a life. Therein lies the possible answer to the issue of accountability. As individuals we often have little concept of the actual cost of healthcare.

We understand that should an event occur that results in some form of incapacity then our options will become limited, however do we fully understand the costs of the system and the processes that are then utilised to enable us to enjoy even a limited level of life? More to the point, are we, as consumers, able to make an informed decision with regards to our health care?

Public education campaigns have proven to be successful at reducing the level of illness caused by smoking and motor vehicle accidents. While we may appear as a population to be gamblers by choice, our reaction to such advertising campaigns indicate that when presented with the right information we often can change our actions. It is possible that our lack of understanding of the true cost of poor health decisions lead us to believe the cost is low - maybe even to the point where we believe healthcare is effectively free! Could it be that a part of the strategy to help consumer take personal responsibility for their health lies with them having easy access to a greater level of information as to the real costs?