A Leader’s Downfall (mine)

One of the most frequently asked questions I get regarding new facility leaders is …

‘Why do they stumble or fail?’

While we can ‘see’ what’s going with a struggling leader (analysis paralysis, mistaken priorities, taking on too much, bad hiring, inattention to details, etc.), it’s practically impossible to discern what’s really going on in one’s heart/mind/motives that might be causing the shortcomings we see … unless, of course, I’m talking about myself.

My first facility was in AZ and was a ‘beast.’  Huge campus.  Tough part of town.  Tough patients/residents.  Horrible reputation (newspaper named it the 2nd worst facility in the state shortly before I arrived).  And, I was brand new.

Here’s a sample of why I refer back to my time in AZ as Desert Storm …

  • Evening call at home: Hi Dave.  I think you should come in.
    Why is that?
    Scott’s (patient’s name has been changed) passed out on the floor.
    How can I help?
    The police want to know why he’s got a homemade crack pipe next to him.
    I’m on my way.
  • Evening call at home: Hi Dave.  I think you should come in.
    Why’s that?
    Because I just worked a double, and I’m not working a triple and my replacement isn’t here and I’m going home so you need to find someone to replace me.
    I’m on my way.
    (Repeat that phone call about 20 times in the first few months)
  • Evening call at home: Hi Dave.  I think you should come in.
    Why’s that?
    Because they’ve got the place surrounded.
    Pardon me?
    Yeah, the Burger King across the street got burglarized and they think he’s in the facility someplace.
    I’m on my way.
  • Call from the nurses station: Dave, can you come help?
    What do you need?
    You can’t hear that?
    (I hear screaming in the background)
    I’m on my way.
    I see a 30-something patient screaming at the *bleeping* grandmas to get out of his way so he can get his pain medication.  He continues to yelling profanities at my nurses who are trying to explain why the MD has indicated that he has to wait a few hours in between doses.  I escort him away as he’s screaming at me in my face and threatening bodily harm.
  • Nurse walks in my office: Dave, we have a problem.
    What’s that?
    Jose is missing.
    Yeah.  Jose, from our locked unit is missing.
    Locked unit.  Right.  Locked.
    Dave, if we don’t get to him in the next couple hours, he may die (it gets hot in Arizona)
    We canvas the entire area/neighborhood for 3 hours – extending the radius every 30 minutes.  No luck.  After 4 hours I’m about to call the media (local news) to have them run a picture of him so people can find him – thus, debunking the myth that we’re the 2nd worst facility in AZ.  Clearly, we’re the 1st worst.  I receive a call from an ex-employee who says Jose is sitting in his living room.  He recognized him and invited him in.
    I’m on my way.
  • Phone call: Hi Dave.  This is Dr. Thornton
    Hi, how can I help you?
    I’m just calling to make sure you’re aware of the sexual activity in the facility?
    (Now curled in the fetal position) Tell me more.
    Right.  So … a couple of my male patients in Assisted Living say that they occasionally have relations with a female patient from the SNF side.
    Right.  Thanks, Doc.  We’re working on that one …
  • I walk in my office and there’s a couple waiting to see me.
    How could you let that happen to my mom last night?
    I’m sorry, what happened?
    Nobody called you?
    No (the one time I don’t get a call) I’m sorry nobody called.  What happened?
    Your *bleeping* nurses gave my mom insulin last night when she shouldn’t have and almost killed her.  She’s at the hospital now in ICU and the doctors aren’t sure she’s going to make it.  What kind of place are you running here?
    (I had no idea)

And, that was just week #1.

That’s a small sample of stories from Desert Storm.  9 months after starting there, I was dismissed.  When people ask me why I was let go there, I usually say flatly, ‘failure.’  That’s true on one level.  But, the WHY behind the failure is something that I learned months later.  I was given a second chance.  A fresh start.  A Do Over.  I was really lucky.  Although burned out and pretty much over skilled nursing after 9 long months, I accepted the merciful gift of a second chance and lived a very different story at the subsequent 2 facilities.

With a bit of distance from the storm, I was able to see more clearly in the mirror.  I wasn’t happy with what I saw.  I call it the dirty under belly of my motives.  I realized that at the core of my mistakes, problems, failures was pride.  Let me explain …

The type of pride that motivated me in AZ was that I wanted to be seen as the best leader they ever had.  Any time, in your heart of hearts, you want to be seen as, viewed as, admired as, thought of as, believed to be, etc. you’re doomed to fail.  When you make decisions, like I did, to be liked/popular instead of making decision based on what needs to be done because it’s the right thing, period, you’re going to fail.  Period.  It was that desire to be liked and highly esteemed that led to the outward signs of failure: analysis paralysis, second guessing, not saying ‘no’ enough, etc. that my partners saw.

When you combine that dirty little under belly of pride with the inherent insecurity that comes from your first facility … yikes.

I changed my style (and motives) at each subsequent facility … becoming more and more assertive and demanding — setting higher and higher expectations.  Requiring more and more of my staff in terms of customer service and quality care.  The irony, of course, is when I replaced my interest in popularity with interest in excellence, the esteem of my staff took care of itself (not to say I was beloved by all.  Not at all).

I see different versions of that same theme in a lot of brand new administrators.  Proverbs 16:18 warns that “Pride goeth before destruction, and a haughty spirit before a fall.”  If you’re lucky, you’ll learn the easy way this lesson that I learned the hard way (and seem to need to re-learn over and over).

And … for those of you who made it this far, a tribute to all of our spectacular professional ‘wipe outs …’

Honesty, Humility, & Domino’s Pizza

We’ve all had those moments when a truly unhappy, disappointed, angry customer lets us have it. Many of you run operations that have poor reputations (earned over the years one unsatisfied patient/resident at a time). How do shake the bad rep? How do you deal with the consistently negative feedback? Domino’s Pizza demonstrates some keys to taking the criticism, owning up to it, empowering their people to fix it, and inviting the customer into the solution.

Some key takeaways:

  1. Listen to the criticism
  2. Own up to it
  3. Empower your best people to solve it
  4. Invite the customer in on the solution

Because our daily plates are so full (pardon the Pizza pun), we often see complaints as To Do items.  We see our dealing with them (ie, calling back the complainer) as things we have check off a list.  I assume that’s how Domino’s treated the complaint about cardboard crust for years.  “Someone write this guy back.”  I’m not sure what woke them up to just how bad the problem is, but I assume it was the numbers.  Is it safe to assume that their numbers finally caught up to their poor quality?

The wisdom, of course, is to recognize that for every 1 complaint there are 10+ more people who feel the same way.  Let’s act with more urgency to see the complaints not as isolated incidents but as a choice EXCUSE to own up to our systemic deficiencies, empower our best people to solve it, and to invite our residents and patients in on the solution.

What Domino’s did here makes me want to try their pizza again.  I’m a straight Pepperoni guy myself.

A leader’s role: MEASURE

Sometimes cliches work.

  • cry like a baby
  • nothing ventured, nothing gained
  • 2 wrongs don’t make a right

When it comes to leadership in healthcare, one cliche (or in this case, several variations of the same theme) is definitely true:

  • What gets measured gets done
  • What gets measured matters (What we don’t, doesn’t)
  • We perform according to how we’re measured

What’s unique about measurement in our context is that it is the LEADER who decides the why, when, how, and what gets measured in their organization.

What you choose to measure (for yourself and for your company) reveals to others who you are whether you like it or not and whether it’s true or not.  Based on your preeminent measurements, what MUST your people believe you care about?  By preeminentmeasurements I mean the ones that really matter.  The ones that really matter are the ones that have a consequence (good or bad) tied to them.

  • What measurements are you using to give bonuses?
  • To award raises?
  • To offer more benefits/freedoms/opportunity/promotions?
  • What measurements costs people their jobs?

I can’t think of anything that undermines your message and vision as much as missing or flawed measurements.  Step back.  Look at how you’re measuring and why.  Are your preeminent measurements consistent with your values and vision?  Are they too one-sided?

It’s a new year.  It’s a great time to re-examine our direction based on our measures.