Working-the-floor hazards

In my first facility in Glendale, AZ, I was eager to prove myself as the best leader my staff had ever seen.  One problem with that was … that I wasn’t.  But, I’m getting ahead of myself.  In my AIT program (Administrator in Training) I learned as much as I could about the departments I was to oversee.  But, I failed to dive deep enough into the nooks and crannies of the facility which resulted in insecurity in me, the new leader, when it came to supervising department heads and holding them accountable and teaching them.

So, instead of investing in building a relationship of trust with my department heads who could then, in turn, do the same with their staff, I felt much more comfortable working out on the floor with the line staff.  I would show how much I cared for them and the residents by staying out of my office and walking around.  I would be visible.  I would get to know everyone by name.  I would get to know their lives.  It didn’t occur to me at the time but my department heads resented my behavior.  I’m saying they resented me being visible and out of my office.  We all should do that.  The ED who’s stuck in his office all day becomes out of touch, ineffective, and won’t be employed very long.

BUT … what they resented was that I was spending the necessary time to hold them accountable, invest in our relationship, and help them succeed.  Some of them felt like I was ‘going over their head’ or ‘undermining’ them.  What I learned, the hard way, was that when the ‘line staff’ feel so comfortable with you/me as the administrator, that can threaten their direct supervisor’s relationship with them.  And, their supervisor (your department head) feels it and trusts you less.

It happened to me.  Don’t let it happen to you.

Of course we should know everyone by name.  We should have an open door.  But, we should direct them to talk to their supervisors first before rushing in to solve problems.  And, we should make time, at least once a week, to have a meaningful status review with each department head.  That tweak to my management approach made a huge difference in my effectiveness and results in my next two facilities.

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 …’

Finding YOUR Voice

I love the book ‘What Got You Here, Won’t Get You There‘ by Marshall Goldsmith.  Our CEO introduced it to me/our organization a year or so ago.  As I see Administrators in Training (AITs) learn, grow, lead I see some of them not understanding a similar truth: ‘What got THEM THERE, Won’t Get You There.’  There are certainly lessons to learn from more experienced leaders that new leaders would be wise to not repeat the hard way.

However, the very essence of leadership is wonderfully defined by Warren Bennis in his classic, ‘On Becoming a Leader.’  He says …

“…no leader sets out to be a leader per se, but rather to express himself freely and fully.  That is, leaders have no interest in proving themselves, but an abiding interest in expressing themselves.  The difference is crucial, for it’s the difference between being driven, as too many people are today, and leading, as too few people do.” On Becoming A Leader,” pg. 5

On Becoming a Leader, Warren Bennis
On Becoming a Leader, Warren Bennis

A friend of mine who is in his second semester of his first year in the school of hard knocks shared this with me and it rang true as I talk to new leaders who are trying to duplicate the ‘voice’ or the ‘vision’ or the ‘religion’ of other leaders before them.

My advice for the new Executive Director is to …

  1. Take the time to earn CREDIBILITY with your team/employees.  How?  Using the 3 Signs of  Miserable Job framework, spend the first couple months with each of your direct reports to get to know them deeply (Anonymous), helping them see the importance of their job (Relevance), and deciding together how to best measure their performance (Measurement).  This shows them how much you care for them and their success.  It builds trust.  It lays the foundation for loyalty.  Which prepares you to establish, with them, the WHAT/VISION.
  2. Instead of using someone else’s vision (unless your passion for it matches or surpasses its creator), empower your team to create a shared vision or direction for your operation.  This process usually takes a couple months if done right.  The creative/participatory process earns the vision/direction immediate buy-in that force-fed vision/direction lacks.

Taking the time to establish the credibility and forming the relationships of trust is the lubricant that allows the establishment of a successful, shared vision of the future.

Talent & Leadership

Over the years I’ve been involved with leadership development from several perspectives:

1) The brand new, first time leader (mostly failures & school of hard knocks)
2) The new leader of a turnaround business (different set of skills needed)
3) Member of the leadership team for an organization
4) Director of Leadership Development, training over 50 individuals to become GM/business unit chiefs.
5) Lifelong student (MBA @ USC’s Marshall School of Business)
While I love learning (reading, watching) from other experts, I can’t help but apply all of that through my real-world lens that prevents me from swallowing everything put forth. And, since successful leaders are needed now more than ever in healthcare, I’ll dedicate several posts to the subject here.
Recently one of my company’s new, promising Administrator-in-training/CEO-in-training (AIT/CIT) questioned some of my statements/critiques of Marcus Buckingham’s best seller, First Break All The Rules (Great Book) during a training week we affectionately call boot camp. My email response is below:
TO: Eric

RE: my rejection of Gallup/First Break All The Rules … I like MOST of what’s in that book. I really like the 12 questions and the scientific basis for their conclusions. However, I think they ignore one major variable in the talent/success formula — chemistry with supervisor. Good to Great talks about ‘the RIGHT people on the bus,’ as you know. I think G2G also ignores this in determining what makes someone ‘right.’ I have seen (and seen in my partners) many times when someone was ‘great’ at what they did for one leader and then that same person was not the ‘right’ person for the new leader. If the person has the talent for the position, s/he should thrive according to both G2G and 1st Break. But, the reality is chemistry with the talented person’s leader is critical to his/her ability to thrive. Furthermore, where there is strong chemistry/trust, I’ve seen (again, many times) a great leader be able to help underperformers change and succeed. Instead of debating whether or not the person had the talent to become great, I believe we’re better served by focusing on creating rock-solid relationships with the people we lead — allowing them to become what sometimes only we can see them capable of becoming (the Dulcinea concept).

So, I don’t reject Gallup. Just like I don’t reject G2G. I just find their discussions of talent incomplete. Talent-mapping or profiling for a position is really tricky business. We came very close to attempting this for our Administrator in Training/Executive Directors selection a couple years ago. You can maybe find a few common characteristics of successful leaders in the company. How do we know that very different people can succeed here or do better than we’ve seen. This approach becomes even more troublesome when you see the huge difference in types of operations, geographies, rural/urban, size, demographics, stages of stability, etc. I would have a much harder time thriving in a small rural town than someone who is better equipped for that. Yet, we don’t have luxury of knowing the nature of what opportunities will be available for the new CEO in Training when hired.

What I take from Gallup is playing to people’s strengths. We need to do a better job of this here. We’ve learned by sad experience that just b/c you’re very successful at one operation does not mean you’ll be successful at a very different one. What happened to our previously very successful leaders when they change facilities or market dynamics or people dynamic change significantly and then they fail? Didn’t they have talent? In other words, I find predicting success based on past experiences or exhibited talents incomplete. Fit and timing are more predictive in my opinion. I’m not saying past experience and talent is meaningless. Of course it’s useful. So, what do I look for in an AIT/CIT? I look for how likely they will fall prey to the factors of derailment below. I’ll take very different talents b/c we need all types and all types have been successful here. But, I don’t want the leader who appears to be perfect for the position who is clueless about his/her blind spots, weaknesses, and has never changed his approach based on learning from hard experiences. That’s what I focus on in my interviews.

See the article and book excerpt attached for a better explanation of this school of thought. I don’t see it far off from what Gallup or G2G is saying. I just think it’s a more complete viewpoint taking into account an individual’s chemistry, timing (peter principle), fit, and pride.

I’d love to hear your thoughts.


And, I’d love to hear YOUR thoughts too …