Monkeys: LIBERATING Time Management Concept [Video]

Monkeys are the “leading cause of death” of new leaders.

Recent conversations with a few new(er) leaders about this common pitfall, prompted me to post this here. If you don’t have time (28 min) to watch this, then you probably really need to watch this. 😉

This time management concept saved my professional life.

After about 7 years in operations of skilled nursing facilities at The Ensign Group, a skilled nursing, seniors housing, home health & hospice, and radiology company, I spent 5 years there as the Chief Human Capital Officer. What an exciting time. Ensign’s “First Who, Then What” approach to growth meant we had to attract and train a lot of AITs into facility-level CEOs fast.  Over those 5 years, I personally participated in the training of about 100 new leaders. Week long boot camps, case studies, online tests, conference calls, assignments, analysis, etc.  I saw, up close and personal, what helped new leaders succeed … and fail.  

Monkeys has a lot to do with both.

I’ve trained the topic to groups in the hundreds at association conferences to 1:1. And, I wrote about monkeys years ago here:

But, this is the video that gives a thorough explanation of Monkeys and that my colleagues and friends have found most useful to understand the time management concept from theory to practical application.  While there are several healthcare operations and Ensign references, the principles are universal.

I hope it helps you or someone you know:

 

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McKnight’s Guest Column: Show Me The Money!

Happy Thanksgiving!  I just realized that another guest column was posted to McKnight’s.  This topic of whether or not staff should EXPECT a raise with their review came up when a friend of mine, Josh (new administrator) asked my opinion about it.  His question reminded me of when a CNA taught me a valuable lesson years ago at my first facility … You can read the entire article by clicking HERE or on the article image below.

Guest Column for McKnight's regarding annual reviews and raises
Guest Column for McKnight’s regarding annual reviews and raises

Stooping to Greatness, Part 1

It’s ironic that I spend as much time as I do here and with colleagues on time management.  Ironic because I’m not naturally a very organized person.  The opposite is true.

I’ve learned the hard way (and the incredibly rewarding way) that the only way I can get to the VERY IMPORTANT x NON-URGENT stuff that will either transform a facility or take it to the next level is to become great at time management.

There’s a great thought in scripture that goes like this: Where your treasure is, there will your heart be also (Matthew 6:21).  Adapted to the nursing home administrator, we can say …

What you spend your time on, that’s what matters most to you.

You may protest.  You may say, “No, Dave.  The reality is I can’t get to what matters most to me because I have to spend so much time on this other stuff that keeps coming at me.”  As we climb up to the balcony and look down at our operations and at ourselves, we’ll probably see way too much work that is reactive vs. proactive.  Reversing that pattern is what separates the great leaders/facilities from the pack.  So …

  • First things first = First who, then what.  Let’s first surround ourselves with people more talented and driven than ourselves.  They’re there.  In every position.  If we settle for less than “A” talent, we will be settling for mediocrity and burnout.
  • Second (simultaneously), get the fundamentals in place.  Apply our Daily, Weekly, Monthly system approach to marketing, expense management, labor, clinical metrics/outcomes.
  • Third, control the monkeys before they lead to your downfall.
  • Fourth (and finally!), you now have time to dedicate to the fine-tuning, pro-active, culture building work that ONLY YOU can lead.

This post is the first of a series that I’ll dedicate to what I believe is the most important work of a healthcare leader: to create a powerful, unique culture.

Culture Model
My step-by-step, “how-to” reinvent the wheel. If you take your parent organization’s mission statement or use some other company’s culture stuff, you are missing the chance of a leader’s lifetime. There is a POWER that comes from the creative process. Or, the birthing process. What you collectively give birth to becomes your baby. You want to protect it. Nurture it. It becomes your competitive advantage that your competitors cannot replicate.

DOWNLOAD PDF Version Here: Culture Model

The title for this post, Stooping To Greatness, is stolen from a similarly themed article by Patrick Lencioni.  I’m a big fan of his books that illustrate simply and powerfully that what matters most to create lasting, quality success is the SOFT stuff.  The attention to people and culture.

Why we sold the franchise

Turbulence

Almost 12 months since my last entry.

I find myself on a plane headed back to Maryland after meeting with my partners in SoCal about my short- and long-term plans now that the sale of Doctors Express has been finalized.  We announced the sale of the franchise business to American Family Care (AFC), based in Birmingham, AL a few weeks ago.

What took me away from doing what I love with and near the people I love in the place I love?  One of my best friends and Ensign partner, MikeD, started a new venture within the org. in a new sector of healthcare – urgent care.  He had already brought on a couple urgent care veterans to accelerate his learning curve as he planned to build several centers de novo.  Quickly after the venture got off the ground, their plans expanded into a couple new paths including the acquisition of the only urgent care franchise in the country – Doctors Express, based in Maryland.  Mike asked me to lead that business and they made it worth my bet.

Personally, it was a high risk/high reward proposition.  Much to my surprise (and the surprise of my family and friends and colleagues) my wife and I decided to go for it after just 4 days.

By the time I could transition my role to “the upgrade” BHulse, my new partners were already underway with Doctors Express.  10 months after I joined … at our annual conference in March in Vegas, I told the franchisees that the best word that I could think of to describe the last 12 months is TURBULENT.  Turbulent because even though there were bumps along the way, the plane kept moving forward and the system made huge improvements in terms of number of centers, patient count, and revenue.  2013 is definitely poised to continue its upward trajectory.

So why sell?

Good To Great

You have to understand Ensign’s culture to understand the answer.  The book Good to Great teaches a lot of the same values and strategies that have been part of the Ensign Way for years …

“The pivot point in Good to Great is the Hedgehog Concept. The essence of a Hedgehog Concept is to attain piercing clarity about how to produce the best long-term results, and then exercising the relentless discipline to say, “No thank you” to opportunities that fail the hedgehog test. When we examined the Hedgehog Concepts of the good-to-great companies, we found they reflected deep understanding of three intersecting circles: 1) what you are deeply passionate about, 2) what you can be the best in the world at, and 3) what best drives your economic engine.” (source)

hedgehog and fox

Mike and I (both 11 years with Ensign-related businesses) concluded that, in spite of the promising future for the Doctors Express franchise, being a franchisor was a significant departure from our hedgehog.  I found myself in the peculiar position of recommending that we sell the business I lead – making my future uncertain – b/c I believed it was the 1) right thing for Ensign and 2) the right thing for the franchisees.

A cornerstone to the culture at Ensign is the independent/interdependent nature of the facilities, agencies, and companies.  Franchising requires strong (sometimes rigid) corporate control to retain brand standards among franchisees who bring a vast range of values, motives, and competencies to the system.  At Ensign, the word “corporate” is a ‘bad word.’  I constantly wrestled with the misfit between my/our approach/culture and the approach/culture a franchise system requires.

square peg round hole

Fortunately, we became acquainted with AFC and quickly saw their huge corp. infrastructure and decades of urgent care experience AND TRADITIONAL CENTRALIZED CORPORATE structure to be a better fit for franchising.  Could we have continued the upward ramp of the last 12 months?  Yes.  No doubt.  I think many, if not most, organizations are driven principally by the numbers.  In our case, no matter how pollyannish this may sound to outsiders, Ensign’s success is largely attributed to our hedgehog-based discipline to say no to seemingly great financial opportunities that are only attractive because of the numbers but do not fit with who and what we are.

I admire many of the franchisees and staff I worked closely with and I will be cheering AFC and Doctors Express on for years to come.

Gratefully, I will be returning to what I know and love: senior care/skilled nursing. In the coming weeks & months I’ll be writing about lessons learned 1) at DRX and 2) from returning to skilled nursing.  Good to be back …

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 …