Archivi del mese: giugno 2013

Una politica per gli anziani @Medici_Manager

Gavino Maciocco

In Italia non c’è una politica nazionale per gli anziani. Come non esiste alcuna politica nazionale per qualsivoglia settore della sanità (se non quella dei tagli).  Questa mancanza di una identità nazionale nelle politiche  per la salute rende il sistema estremamente vulnerabile anche sul piano dei principi e dei diritti.

Pisa. 7 Maggio 2013. Aula Magna della Scuola Superiore S.Anna. Seminario internazionale su “Cure primarie, anziani e cronicità”. Per la Svezia interviene Eva Nilsson Bågenholm MD, coordinatore nazionale dell’assistenza agli anziani. E’ una presentazione molto ricca di dati e di utili informazioni.  Viene descritta l’intera filiera d’interventi che riguardano l’assistenza agli anziani partendo dalle cure primarie all’assistenza specialistica, fino all’assistenza residenziale.

In Svezia le cure primarie sono basate su team multidisciplinari, “primary care units” (ne  esistono 1100 in tutto il paese, libera scelta tra team pubblici – due terzi del totale – e team privati). Il team è composto da medici di famiglia, da 2 a 8, infermieri distrettuali specializzati,   assistenti infermieri, assistenti sociali,  psicologi, fisioterapisti, terapisti occupazionali, logopedisti, dietisti.  Per quanto riguarda l’assistenza residenziale, la Svezia dal 1992 ha abolito le “long term care institutions”, equivalenti alle nostre Residenze Sanitarie Assistenziali (RSA), sostituendole con unità abitative composte da 10-15 mini-appartamenti, dotati di servizi comuni il cui uso è facoltativo (come mensa, soggiorno, libreria, lavanderia, etc) e di assistenza alla persona per l’arco dell’intera giornata: attualmente sono 90 mila gli anziani residenti in queste strutture.  La presentazione tratta di investimenti, di linee guida nazionali, di progetti di larga portata e con risultati eccellenti, come quello relativo all’assistenza ai pazienti con Alzheimer.

Durante l’intervento della collega svedese cresceva in me lo sconforto nel confronto con la situazione italiana. Pensavo ad esempio che mentre, agli inizi degli anni novanta, in Svezia abolivano le RSA in Italia scoppiava lo scandalo “Italsanità”, un’operazione speculativa per la diffusione in tutta Italia dei “ghetti d’oro”, le RSA appunto.

Cercavo di collegare la situazione dei due sistemi sanitari, quello svedese e quello italiano, molto simili per alcuni versi: entrambi appartenenti al modello Beveridge, sistemi sanitari nazionali finanziati prevalentemente attraverso la fiscalità generale, con un forte decentramento nel governo e nella gestione della sanità, affidata alle Contee in Svezia e alle Regioni in Italia.

Ma il decentramento in Svezia prevede – a differenza che in Italia –  un ruolo centrale del governo centrale e del ministero della sanità nella programmazione nazionale e nella definizione dei modelli organizzativi, anche in presenza, come oggi, di un governo conservatore, favorevole a politiche market-driven anche in sanità.

Cercavo di immaginare un equivalente italiano della Eva Nilsson Bågenholm che partecipa a un seminario internazionale in Svezia sullo stesso tema di quello organizzato a Pisa. Lo cercavo, ma invano.  Perché non c’è una politica nazionale per gli anziani. Come non esiste alcuna politica nazionale per qualsivoglia settore della sanità (se non quella dei tagli).  Questa mancanza di una identità nazionale nella politica (o meglio nelle politiche: nelle strategie, nei programmi) per la salute rende il sistema sanitario estremamente vulnerabile anche sul piano dei principi e dei diritti. Chi ha a cuore il diritto alla salute in Italia, chi vuole difendere il sistema universalistico, dovrebbe non solo preoccuparsi dei tagli e dei ticket, ma anche battersi per correggere la devolution in sanità,  prodotta dalla modifica del titolo V della Costituzione avvenuta nel 2001.

The Face of Future Health Care @Medici_Manager @muirgray @WRicciardi @pash22 @HealthLeaders

By  The New York Times, March 27, 2013

When people talk about the future of health care, Kaiser Permanente is often the model they have in mind.

George Halvorson, chairman and chief of Kaiser Permanente, says that the way to get costs lower is to move care farther from hospital settings.

The organization, which combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages.

Kaiser has sophisticated electronic records and computer systems that — after 10 years and $30 billion in technology spending — have led to better-coordinated patient care, another goal of the president. And because the plan is paid a fixed amount for medical care per member, there is a strong financial incentive to keep people healthy and out of the hospital, the same goal of the hundreds of accountable care organizations now being created.

“Over the course of the last 15 years, they’ve been just going into high gear and doing everything right,” said Dr. Thomas S. Bodenheimer, a health policy expert at the University of California, San Francisco who recently chose Kaiser as his own health plan.

Yet even with all of its effort, its chairman and chief executive, George C. Halvorson, acknowledges Kaiser has yet to achieve the holy grail of delivering that care at a low enough cost. He says he and other health systems must fundamentally rethink what they do or risk having cost controls imposed on them either by the government or by employers, who are absorbing the bulk of health insurance costs. “We think the future of health care is going to be rationing or re-engineering,” he said.

Mr. Halvorson is convinced that Kaiser’s improvements in the quality of care save money. But he also says that the way to get costs lower is to move care farther and farther from the hospital setting — and even out of doctors’ offices. Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all. He also argues that lower costs are going to be about finding ways to get people to take more responsibility for their health — for losing weight, for example, or bringing theirblood pressure down.

“The obesity work is incredibly difficult,” he said. “It’s very, very hard to move the needle.”

Other health care experts say that while Kaiser has a place in the future, whether it is the best model for the country’s health care remains unclear. “They have not translated some of their strengths into better prices,” said David Lansky, the president and chief executive of the Pacific Business Group on Health, which represents employers on the West Coast, many of whom purchase coverage from Kaiser for their workers.

And there are other concerns, such as whether an all-encompassing system like Kaiser’s can really be replicated and whether the limits it places on where patients can seek care will be accepted by enough people to make a difference. Or whether, as the nation’s flirtation with health maintenance organizations, or H.M.O.’s, in the 1990s showed — people will balk at the concept of not being able to go to any doctor or hospital of their choice.

“The more you restrict the patient’s ability to do what they want, you risk reigniting the backlash we had in the past,” Mr. Lansky said.

In many ways, Kaiser has been ahead of the curve on health care for decades. Started by a surgeon running a tiny hospital near Desert Center, Calif., to serve construction workers, Kaiser became an H.M.O. with its own doctors and hospital in the mid-1940s and expanded beyond California over the next 50 years. But, as H.M.O.’s fell out of favor, it was forced to leave states like New York, Connecticut and Texas.

But Kaiser persevered, and its membership, which peaked in 1998, is now about the same as its previous high of 9.1 million, about three-quarters of whom are in California. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand in the Mid-Atlantic region, where membership had been dropping.

The organization, with some $50 billion in annual revenue, owns 37 hospitals and employs 17,000 doctors, all on salary. And its integrated model is in favor again. Hospitals across the country are buying physician practices or partnering with doctors and health insurers to form accountable care organizations, or A. C.O.’s, as a way of controlling more aspects of patient care. Doctors are also creating so-called medical homes, where patient care is better coordinated.

The days when doctors, hospitals and other providers are paid separately for each procedure will disappear eventually, health experts say. Instead, providers will have financial incentives to encourage them to keep people healthy, including lump sums to care for patients or provide comprehensive care for a specific condition. “All of care is going to move down this path, and it has to,” Mr. Halvorson said. “Medical homes are doing it; the very best A. C.O’s are going to figure out how to do it.”

The move by hospitals to buy physician practices is being viewed cautiously by health experts, who say there are downsides to the creation of large health care systems that may be motivated by the desire to increase their clout in the market, making it easier to fill beds and charge the insurers more for care. “They become these huge local monopolies,” said Dr. Robert Berenson, a health policy expert at the Urban Institute.

But having an integrated system seems essential to the success of Kaiser and a handful of similar, if smaller, organizations, like Intermountain Healthcare in Utah and Geisinger Health System in Pennsylvania, although some work with doctors whom they do not employ. In California, Kaiser controls nearly every aspect of a patient’s care, from providing the M.R.I. for a diagnosis to filling a prescription at one of its pharmacies to running a hospital where the patient undergoes surgery.

“We have all the pieces,” said Philip Fasano, Kaiser’s chief information officer. “Anything a patient needs you get in the four walls of our offices,” he said. As a result, while Kaiser can point to an analysis done by Aon Hewitt, a benefits consultant, showing that its plans are typically at least 10 percent less expensive than others, especially where they control all the providers, its costs are more like the average in places in Ohio, where it does not have its own hospitals and offer as broad a range of services.

And some patients outside of California, where Kaiser operations are less concentrated, complain about being forced to travel for treatment by Kaiser providers. Arva Priola, a 62-year-old Kaiser patient in Fredericksburg, Va., said her Kaiser doctors “are wonderful,” but that the plan recently started requiring her to get some treatments where they had physical facilities.

To get IV antibiotics after surgery, for example, she recently had to drive an hour and a half to a Kaiser office in Tysons Corner, Va. “Who wants to drive when you’re sick?” she asked. Kaiser says it is adding more services closer to Fredericksburg.

A California state agency recently criticized Kaiser for the long wait times its members had for mental health services and for providing inaccurate information about what services it provides. Kaiser says it has corrected the misinformation and is working to reduce and better track member wait times.

Where Kaiser has a head start that others may have difficulty catching up to is its use of electronic records and technology systems for tracking patient care.

When Dr. Jennifer Slovis, a Kaiser internist in Oakland, recently saw a patient, she was able to spot that the patient had an abnormal blood test several years ago. By reading through the patient’s medical history, she determined he was now overdue for an M.R.I. to check the status of a growth in his brain. She was able to e-mail his endocrinologist and schedule the necessary tests without the patient having to make an appointment with the specialist or her having to make her own diagnosis. “It saved a lot of starting over,” she said.

In the last five or so years, Kaiser has also been using the information to identify those doctors or clinics that excel in certain areas, as well as those in need of improvement. The organization has also used the records to change how it delivers care, identifying patients at risk for developing bed sores in the hospital and then sending electronic alerts every two hours to remind the nurses to turn the patients. The percentage of patients with serious pressure ulcers, or bed sores, dropped to well under 1 percent from 3.5 percent.

“The tool is an enabler to give information to people who give a damn,” said Dr. Jack Cochran, the executive who represents Kaiser’s physicians through the Permanente Federation.

Mr. Halvorson, the Kaiser chief, who plans to retire at the end of this year, says the organization is providing evidence to other health systems that re-engineering works. “All of that adds up to better care and cheaper care,” he said.

6° Congresso Nazionale SIHTA – Bari, 7-9 novembre 2013 @Medici_Manager @SIHTA_Italia

Segnate la data del 6° Congresso di SIHTA: per la prima volta organizzato al Sud, a Bari; per la prima volta analizzata la metodologia della valutazione etica e d’impatto sociale nell’HTA; per la prima volta focalizzati i temi del cambiamento di cultura dei professionisti e degli stakeholder a sostegno dei cambiamenti organizzativi e strutturali.

Dal 7 al 9 novembre 2013

Quattro sessioni plenarie dedicate a: la valutazione etica e di impatto sociale in HTA; HTA come leva per lo sviluppo economico del Paese; HTA tra innovazione e disinvestimento; equità e sostenibilità del Servizio Sanitario Nazionale.

Sessioni parallele e workshops.

Sessioni posters.

Eventi precongressuali tra cui la sessione autunnale dell’Health Policy Forum (a invito).

Quote d’iscrizione molto ridotte rispetto alle edizioni precedenti.


Resilience is critical for a healthy life @Medici_Manager @aringherosse @pash22


It’s been reported that James Eagan Holmes, more infamously known as the movie-theatre gunman who killed 12 people during a midnight showing of Batman in Aurora, Colorado, sent a text to a classmate asking whether she knew what “dysphoric mania” was. (It is a bipolar condition that in its extremes, can include mania and paranoid delusions.) Did he have it?

Similarly we wonder whether a near-death accident in childhood, one that was marked by severe head trauma, affected Jeffrey T. Johnson, a.k.a. the Empire State Building gunman, so deeply that it influenced his decision to kill his former boss on his way into the office. Is that possible?

So often we focus on the mental conditions and environmental stressors that may have influenced the perpetrators of horrendous violence. Likewise, in the immediate aftermath of a horrific event—be it violence, an accident, or a devastating natural disaster—the media reports on the nightmares, sleeplessness, anxiety, and other classic sequelae experienced by the trauma survivors. Too rarely, though, do we explore the mental and emotional recovery of trauma survivors, and that of the family, friends, and colleagues who were affected by a victim’s death or lifelong disabilities.

Some 90 percent of us will experience at least one traumatic event during our lives, and no two of us will react or recover (if at all) in the same way. Resilient individuals who do recover typically employ one or more coping mechanisms to help them process the crisis and even become stronger for it. Drawing on social networks, emulating role models, and facing your fears are among the most successful strategies for fostering resilience in times of adversity.

Humans are biologically wired to bond with one another. Very few can “go it alone,” particularly during difficult times; emotional strength comes from close relationships with people who know you well or who can relate to the experience you had. And while today the term “social network” might bring to mind the landing page for Facebook or Google+, for one group of American prisoners of war in Vietnam, a life-saving network was as low-tech as taps against the prison walls.

The group mapped out the alphabet in a grid of five columns and five rows, and each letter was represented by a series of taps: first for the row (one tap meant row one) and then the column (three taps meant third column). Using this auditory alphabet, the so-called Tap Code, the group painstakingly spelled out messages to one another, offering one another information and plotting out resistance strategies. It was also an essential tool for preserving their sanity.

Indeed, one study of nearly 2,500 Vietnam veterans showed that those with low social supports—few friends or family members to rely on, or safety-net organizations to turn to—were over 2.5 times more likely to suffer from post-traumatic stress syndrome than those with high social supports.

Strong members of social networks may also become role models whose coping strategies are worth imitating. Imitation is one of the earliest and most powerful learning techniques we learn in life. While role models may be people we know personally, they can also be famous people, legendary members of our own family tree, or individuals we observe at a distance. Using imaging technology, scientists have found that when a role model performs a positive behavior, both the observer and the role model experience activity in the same region of the brain. Studies along these lines point to the possibility of mirror neurons that help facilitate social interactions by promoting shared understanding. Our brains are “turned on” by behaviors we deem impressive.

We might select some of our role models because they appear to be able to do something we cannot do, and that is facing our fears. Avoiding them—for example, never going to the movies again for fear of being shot—can greatly reduce your quality of life and sometimes your circle of support. Al DeAngelis is one individual who wasted no time in facing his fears. He and his friends went on their first-ever skydiving excursion on Memorial Day 1989. The rickety plane they were in became airborn and then made a crash landing in a nearby field. Miraculously, everyone on board survived. Most left the area to put the scene behind them, but DeAngelis joined the next skydiving plane and successfully faced his fears.

Not many people could do this so quickly and in such a dramatic fashion, and brain science indicates that it isn’t absolutely necessary to be so immediate. New memories are at first malleable before a synthesis of proteins encode them for long-term memory. Acting on instinct, DeAngelis took advantage of this period to alter the memory in its malleable state before it moved into long-term storage. This helped him get over his fear as soon as possible, but new research shows that even long-term memories can be altered. Every time the memory is recalled, a brief malleable period ensues and the memory could be updated and transformed.

While most of us will not experience trauma such as a plane crash, the Aurora shootout, or even extreme natural disasters, crisis can take many different forms, including long-term unemployment, chronic illness, homelessness, or divorce. Given the overwhelming odds that we will someday need to bounce back and move on, it is important to actively think about the importance of resilience even when everything appears to be going well.

Dennis S. Charney is the Anne and Joel Ehrenkranz Dean of Mount Sinai School of Medicine in New York City.  He is also coauthor, along with Steven M. Southwick, of Resilience:The Science of Mastering Life’s Greatest Challenges.  Cheryl De Jong-Lambert is a writer and editor.

Managing “Rebels” Guiding Independent Thinkers @Medici_Manager @helenbevan

You lead a team of talented individuals. Everyone has their quirks, of course, but Jack is the team member who gives you the most problems.

Jack is a star performer and often has great ideas, but he constantly pushes back against your authority.

He often offends his teammates, too, by accusing them of not being innovative.

Jack is a “workplace rebel.” You sometimes think that he’s instinctively contrary – that whatever you do, he’ll come up with a different way of doing it.

In this article, we’ll look at workplace rebels: who they are, why they can be valuable, and how to manage them – so that they can realize their full potential, positively.

What is a “Workplace Rebel”?

The Random House Dictionary defines a rebel as “a person who resists any authority, control, or tradition.” Rebels like to challenge the status quo – and, in the workplace, that includes management, business practices, and colleagues’ ideas.

At first glance, rebels might seem to be nothing but trouble. However, when managed correctly, they can be a valuable asset to both teams and organizations. Rebels can make things happen – they bring about change, and can even transform entire organizations.

For example, rebels aren’t afraid to stick their necks out for things they believe in. They often tell the truth, even when it’s unpopular. They have innovative ideas because they enjoy challenging existing ones, and they’re not afraid to express those ideas, even when they’re the only ones to do so.

Rebels tend not to be afraid of risk or hard work either. Colleagues may find their energy disconcerting, but this isn’t always a bad thing. After all, innovation can stagnate when people get too comfortable.

It’s important to differentiate between team members like Jack, who are disruptive but work hard and have good intentions, and those who cause trouble but also under-perform – for example, by producing low-quality work or ignoring quality processes.

We cover this second group in our article on Managing “Rogues.”

Getting the Best From a Workplace Rebel

It’s tempting to shy away from tackling the challenges that rebels present for fear of causing more disruption. However, if you don’t manage a rebel effectively, you’re not only condoning their behavior but you’re also failing to give them the chance to change.

Use the strategies below to help rebels live up to their positive potential, and to restore harmony in your team.

1. Understand a Rebel’s Motivation

Your first step is to understand what’s behind your rebel’s behavior. What’s really going on? For example, some rebels push against authority and alienate others because they’re frustrated. They want to bring about change, but they have hit a brick wall.

Instead of channeling their emotions into positive change, these rebels complain, break rules, and argue with team members. They may also become negative, affecting colleagues’ motivation. This type of rebel is described in more detail in our article on Waldroop and Butler’s Six Problem Behaviors.

Other rebels are more positive. They may take risks, because they’re passionate about a project, or pursue a personal agenda that they believe in, even if it strays from the organization’s goals. They may disagree with senior colleagues because they believe that they’re standing up for a better idea.

You’ll find that many rebels care deeply about the organization and their team. This is why they can’t be silent and follow along – not when they believe that something is wrong. They’ll pick apart ideas or established processes, and come up with new ones.

Some rebels have more complex motivations for their behavior. They may be unhappy in their job and may be using “rebellion” as a means of expressing this. It’s also possible that they lack the emotional maturity or the vocabulary to talk about problems directly.

It’s essential that you uncover the motivations behind a rebel’s behavior before you decide how to act. The best way to understand this is simply to listen.

Open a conversation by recognizing your rebel’s commitment before asking open questions about what’s prompting the disruptive behavior. Invite your rebel to tell you, in private, what he wants to say in public.

2. Show Them the Impact of Their Behavior

If your rebel is causing negativity, then you must ensure that she understands the consequences of her behavior. Explain that while it’s acceptable to be passionate and committed, it’s not OK to cause arguments or drive down team morale.

Remind her of the scope of her role, and of the subjective view of the organization and her colleagues’ work that this inevitably presents. Then restate where the boundaries in your organization lie. For example, if your rebel has concerns about a colleague’s work, she should raise this with a manager rather than airing her views in a team meeting.

Encourage her to make amends if she needs to, and to reflect on how her behavior affects others.

Note 1:
If your rebel’s behavior has more serious implications – for example, if she is taking excess risks or causing damage to the company’s reputation – this is a disciplinary matter and you need to take appropriate action.

Note 2:
Rebels may also try to take advantage of your insecurities or gaps in your knowledge. If a conversation with your rebel reveals this, treat it as a wake-up call. How can you address your confidence issues, or update your knowledge?

3. Refocus Energy

Your rebel likely wants to change things – so give him a chance to do that. Assign him a project to solve a specific problem.

Encourage your rebel to use the project to find a balance between getting what he wants and working with the status quo. What difficulties did he come up against? What tactics did he use to overcome them?

Ask your rebel to document the project’s progress, so that he can use this as a guide for future work.

4. Encourage Her

Often, financial incentives or public recognition won’t motivate rebels. Business strategist Lois Kelly researched corporate rebels in her 2011 study Rebels and Work: Motivated to Make a Difference. According to this research, rebels are most motivated by the ability to make a difference in their organization. They’re also highly motivated by encouragement from managers and leaders.

Begin by simply asking your rebel about her ideas more often. Manage expectations carefully, however: ensure that she understands that you’re not able to follow up every suggestion, but that you’ll look into the ones that you believe could be beneficial.

Encourage your rebel to think her ideas through and to put together business cases before proposing them. For example, she may want to do a cost-benefit analysis to demonstrate the viability of her ideas.

5. Coach Her to be a Team Player

Rebels can get frustrated with members of the team who are reluctant to change. This can make them speak harshly to colleagues or drive them to push ahead on initiatives before others – including you – have discussed and accepted their ideas. Over time, rebels can become unpopular in the office. This is why it’s important to help them become better team players.

First, let your rebel know how much you appreciate his input – but remind him that that no one gets far alone. If he wants to see his ideas make a real difference, he needs to know how to win his team’s support, so coach him to practice empathytoward his colleagues.

If your rebel is inspired by a particular business leader, remind him that it probably took this person years – and many setbacks – to achieve his goals. Slow, measured change is still progress, and it’s more likely to be successful if it has widespread support.

Finally, encourage your rebel to “be the change he wants to see.” How can he find ways to make changes without also making waves? Remind him that the most powerful change of all – and the one that will help him achieve more in the long run – is learning to manage his own behavior.

Key Points

Rebels can present management challenges, but they’re often also valuable assets. Unlike rogues, who are disruptive and don’t perform well, rebels often have innovative ideas, and they’re usually the first to talk about problems that no one else wants to discuss. However, they can also upset colleagues and bend rules to pursue their own goals.

To get the best out of workplace rebels, follow these steps:

  1. Understand their motivation.
  2. Show them the impact of their behavior.
  3. Refocus their energy.
  4. Encourage them.
  5. Coach them to be team players.

Remember that the reasons for rebels’ behavior can be complex. But if you’re clear that they simply want to make changes, give them the chance to do this. Remind them that while it’s great to want to make changes, these won’t happen overnight, and that changing their own behavior will pay the most dividends in the long run.

“Glass, passami il bisturi!”

Andrea Silenzi, MD, MPH, PhD

Un medico americano dell’Eastern Maine Medical Center ha documentato l’operazione allo stomaco in tempo reale sul suo blog, in un post intitolato ‘Glass, passami il bisturi’, specificando che lo streaming di video e foto non ha mai mostrato dati identificativi né il volto del paziente

ROMA – Degli ormai noti occhiali a “realtà aumentata”, Google Glass, se ne parla da mesi, sia in termini di funzionalità che di privacy, ancora prima che approdino sul mercato. E dagli Stati Uniti arriva una notizia di un altro possibile impiego: un medico li ha indossati in una sala operatoria per un intervento di chirurgia allo stomaco e ha documentato il tutto in tempo reale sul suo blog. Si chiama Rafael Grossmann e lavora all’Eastern Maine Medical Center.


“Ho preso ogni precauzione per assicurare che la privacy del paziente, da cui ho ottenuto un consenso…

View original post 258 altre parole

Tough choices: how to rein in Australia’s rising health bill @Medici_Manager @pash22

With health costs rising and costly medical innovations on the horizon, it’s crunch time for health funding. In the lead up to the May budget, The Conversation’s experts will explore the options for reining in costs – but warn governments must make some tough decisions.

Successes and Failures of Health Policy in Europe @Medici_Manager @muirgray @pash22

In the last 40 years, the health of Europeans overall has improved markedly, yet progress has been very uneven from country to country.

Now a new study, Successes and Failures of Health Policy in Europe: Four Decades of Divergent Trends and Converging Challenges, draws on decades of research to examine the impact health policy has had on population health in Europe. It asks key and incisive questions about mortality trends and health policy activity and seeks to evaluate the most effective policy for the kinds of challenges Europe has faced.

Edited by Johan P. Mackenbach and Martin McKee, and based on the latest evidence-based research, this volume is an important read for policy-makers and those working in healthcare as professionals, researchers or students.

The book is a joint publication between the European Observatory and Open University Press. It can be ordered here:

How to Manage a Micromanager @Medici_Manager @pash22

This is a guest post by Simon North, co-author of the eBook How to Get the Job You Want

If you’ve ever worked with a micromanager, you know how unproductive and demoralizing it can be. This control freak is reluctant to delegate, may second-guess everything you do, and can shake your confidence in your own abilities. Simple tasks that you could accomplish quickly if left to your own devices take twice as long. Your efforts may be reduced to dust as the micromanager completely re-does your work.

Sure, you may be tempted to bolt, but at a time of high unemployment, you might not have that option. So better to master the art of managing the micromanager.

Start by understanding what causes someone to act this way. Often it’s a need for control that stems from insecurity: lack of confidence, workplace instability and pressure to produce–both individually and as a team. Deep-seated psychological issues and problems at home can also influence the way people behave at work. Many of us have the propensity to be a micromanger, but some of us rein it in better than others.

With this in mind, here are eight practical steps you can take.

1. Look for patterns. As annoying as micromanagers are, they’re incredibly predictable. Watch for behavior swings. There will be certain situations, times of the day or week, when they get especially agitated. Knowing their pressure points can help you ease them.

2. Anticipate needs. Once you know what triggers them, you can stay ahead of those stressors and ease the tensions early on. Flag potential problems before they escalate and offer solutions. Always have a stockpile ready of new initiatives and demonstrate that you are proactive. This helps them curb their responses to the pressure points without slipping into micromanagement mode.

3. Show empathy. Remember, the micromanager is under pressure to produce. Show that you understand his or her plight and are willing to share the load. This could be as simple as offering to help. Tomorrow might be the day when this colleague has to take a child to school but also has an early meeting. So today ask what you can do to make life easier tomorrow.

4. Be super reliable. It’s much easier to manage an office where everyone turns up on time and meets work deadlines. This goes back to the fact that a micromanager hates feeling out of control. If some members of the team don’t deliver, the micromanager gets aggravated and makes unfair demands on everyone else. Discuss as a team what you can do to coordinate things in such a way that there’s no need for the micromanager to fret about how everything is running.

5. Be a role model. Treat the micromanager the way you would like to be treated. Give the micromanager space. Don’t smother or micromanage back. In working with other people, show how your management style is different –and gets equally good results.

6. Speak up—gently. Often micromanagers are oblivious to the effect they are having on other people. They actually think all their micromanaging is producing a better work product. Show encouragement and support for the micromanager’s strengths. Then, without being confrontational, find a way to let this person know how micromanagement affects you. A little levity could diffuse the tension. Or you might just ask how he or she thinks it feels to be second-guessed and mistrusted all the time.

7. Enlighten others. It’s not just you who should be shouldering the responsibility of neutralizing someone’s instinct to micromanage. And chances are you’re not the only one suffering either. Explain to others on your team what you’re doing to ease the micro-manager’s anxiety and encourage them to do the same.

8. Run interference. If a micromanager reports to you and has a detrimental effect on other team members, be a sounding board. Often the micromanager has a skill or quality that’s important to the organization. But it’s up to this manager’s boss to play a leading role in preventing other team members from getting squelched.

Practice Redesign Isn’t Going To Erase The Primary Care Shortage @Medici_Manager

Jeff Goldsmith 

Most experts agree that primary care needs to be re-invented.  There are a lot of promising ingredients of practice redesign:  better scheduling, electronic medical records with patient portals, redesigned clinician workflow, and work sharing.  Linda Green’s intriguing article in the January Health Affairssimulates a strategic combination of these changes and argues if they all happened at once, we would have no primary care physician shortage.

Even if we make much more effective use of clinical time and energy, however, Green’s formula isn’t going to get us far enough fast enough.  The baby boom generation of physicians is fast nearing its “sell by” date.  In 2010, one quarter of the 242,000 primary care physicians in the US were 56 or older.  One in six general internists left their practices in mid-career.  Many more hardworking clinicians delayed retirement due to the 2008 financial collapse.

Few manpower specialists have noted the cohort effect likely to manifest itself shortly.  A continued economic recovery and, more importantly, a recovery in retirement plan and medical real estate asset values will lead as many as 100,000 physicians of all stripes to leave practice in the next few years.  We will be replacing a generation of workaholic, 70-hour-a-week baby boom physicians with Gen Y physicians with a revealed preference for 35-hour work weeks.  During this same period, we’ll be adding 1.5-1.7 million net new Medicare beneficiaries a year and enfranchising perhaps 25 million newly insured folks through health reform.  “Train wreck” is the right descriptor of the emerging primary care supply situation.

Green suggests that this demand pressure could be accommodated with a much smaller replacement cohort of primary care docs if we:  increased each physician’s patient visits slots to 28 per day; enabled more same-day scheduling; had physicians practice in pods of 3-8 docs where any doc in the pod could see one anyone else’s patients; leveraged patient portals to substitute electronic visits for in-person ones; and plugged in physician “extenders.”  Implementing all these innovations across the entire health system has the effect of doubling physicians’ patient panels to more than 5,000 and, voila, no physician shortage.

Real-World Problems With The Model Green Lays Out

Several of these redesign elements aren’t going to be well received either by physicians or their patients.  I’ve visited real-world group practices organized this way.  They reminded me of nothing so much as “I Love Lucy’s” famous chocolate factory assembly line.  It was exhausting simply watching the physicians sprint through their days. You wanted to install oxygen carrels for them to catch their breath.  Gen Y docs aren’t going to practice 28-slot days, with intensive “break times” to answer their emails and make phone calls.  Neither are Gen Y nurse practitioners.

And without the sustaining influence of genuine relationships with their patients, the new generation of primary care physicians are likely to burn out even faster than their boomer elders did.  Moreover, aging patients will need relationships with physicians who understand the context for their chronic disease risks and can motivate them to manage those risks.  Even though they will like on-demand scheduling and e-visits, baby boomer patients, in particular, aren’t going to embrace a “bullpen” approach to their primary care coverage.  Twenty-eight-slot physician work days staffed by physician pods is an inferior primary care product.

In Group Health’s Factoria medical home practices, panel sizes went the other way, shrinking to 1,800 rather than growing to 5,400.  Visit times were doubled, to about 30 minutes, not halved.  Previous Group Health primary care practice redesigns improved physician productivity, but at a terrible price:  increased turnover and markedly reduced professional satisfaction.

The Factoria redesign leveraged Group Health’s successful patient portal, physician extenders, and better scheduling and resulted in improved clinician morale and patient satisfaction.  And, most importantly for Group Health’s business model, the redesign markedly reduced emergency visits and hospital costs per-member per-month.  Similarly, the widely cited ProvenCare Navigator model developed at Geisinger Clinic achieved panel sizes of about 2,500, less than half of Green’s 5400 panel target.

The Limitations Of Potential Strategies To Increase Productivity

Better use of nurse practitioners.  Leveraging physician extenders is a key to making more “medical homes” work properly.  Here too, however, there are cohort problems.  The current nurse practitioner population is even more “boomer intensive” than the physician population is.  In 2008, 63 percent of nurse practitioners in the US were over the age of 45, and 15 percent over the age of 60.

While Green suggests that nurse practitioners have been growing faster than population (e.g. faster than 0.8 percent a year), that growth won’t be anywhere near enough to offset the impending retirement of the baby boom NP cadre, many of whom work a lot of unpaid overtime completing their documentation tasks.  And many of the new NP’s are being snarfed up by the expansion of federally qualified health centers and by non-traditional care providers like the Minute Clinics.  There won’t be many left over for redesigned primary care practices.

Electronic health records.  Green’s optimism about the potential productivity improvements from electronic health records might also be misplaced.  Despite, or perhaps because of, the pressure from meaningful use to automate office practices, physician offices added 162,000 workers from 2007 to 2011, even with a 10 percent shrinkage of visit volume.  Many of these new hires were medical secretaries, physician assistants, and the like.

If there are productivity offsets for practicing physicians from automating medical records, they are hard to detect.  Most physicians I’ve talked to about their EMR conversions are spending less time with patients and more time feeding their EMRs coding information and complying with new Medicare documentation requirements.   The result:  richer coding and more dollars from fewer patients.   Unless documentation requirements are reduced, it is not clear that the EMR will actually make it easier for physicians, or other clinicians for that matter, to see more patients.

A Potential Way Forward

There are potential solutions in addition to the ones Green identified.  They include payment models that markedly consolidate payment transactions (bundling or partial capitation), and more targeted documentation requirements focusing more tightly on patient safety and outcomes.  We can also, per Green, reduce “unnecessary” visits by markedly improving patient communication and leveraging texting, email and social media linkages.

Green does not address the market barriers to adequate primary care physician supply.  Presently, primary care physicians earn about 55 percent of the income of their procedure oriented colleagues, a number that will be barely dented by the Affordable Care Act’s nominal increase in Medicare’s evaluation and management payments.  Unless you’re a trust funder, or someone with no medical school debt, selecting primary care as a specialty doesn’t make a lot of economic sense.  Primary care docs will still be paying off loans in their sixties.

To surmount this problem, we must markedly increase per-hour compensation for primary care physicians, or they will continue selecting life-style friendly subspecialties instead.  We’ll all have great skin, but we’ll be waiting three months to see a primary care physician.

This problem isn’t going to wait for Commissions, Blue Ribbon panels and learned pontification.  And it isn’t going to be wished away by clever economic modeling.  Despite Green’s optimism, we are going to experience a horrendous shortfall of front-line caregivers in the next decade.  Medicare beneficiaries whose physicians retire in the next ten years are going to have great difficulty replacing them.  Making more intelligent use of caregiver time is an urgent priority, but it is not going to be enough to meet the rising demand for primary care services in the next 20 years.

Sustainable Leadership @Medici_Manager @LeadershipHub

This a guest post from Khaled El Mor on Leaders, Respect and why you need more than that, in order to create Sustainable Leadership.

Khaled Elmor, Egyptian. Has engineering back ground, has 23 years of working experience working for multinational organization, currently leading the MEA IT organization at Henkel Sustainable Leadership – by Khaled El Mor

Whenever I ask somebody to provide a feedback about a person, they normally conclude the feedback sharing how much he like that person and how far they respect them.

Often, seeing a person you like gives you a good feeling inside, or makes you smile. Indeed, you might find it hard to put into words exactly why you like somebody, but you know you do.

There is a lot of work in Psychology showing that you can come to like someone not because of anything they have done, but just because you tend to feel good when you are around them.

In business environment, and life, we feel good with people who are warm to us, who radiate positive energy, who recognize us and are taking care of us and our interests. In some cases we like those who just own sense of humor and may not necessary to be high performers.

Respect is earned, through respecting both yourself and others.

Respect is accorded to those who conduct themselves with integrity and treat others with dignity regardless of their culture, religion, and beliefs.

When people “walk their talk”, when what they say and what they do are in alignment, when they keep their promises consistently, this is a signs that someone lives with integrity, and they earn the respect of people.

Also respect is linked with the esteem of somebody vision, excellence, a personal quality, and ability. Sometimes you may respect somebody but don’t like him, or like somebody but don’t respect, from my view to have sustained success as a Leader, it is necessary to be liked and respected.

If you have only one of them, then it is not sustainable for bosses to be considered a leader.

The combination of like and respect enable leaders: to inspire their people; to get their trust; to get them to follow them; and most importantly ensure peoples utmost support specially in tough time. Imagine a boss neither liked nor respected … How he can influence his people, this is the case where people normally leave the organization (leaving their bosses).

The challenge is, nobody can force anybody to like or respect them, this has to be earned.

This is the case of new Egyptian President, months after the election, a lot of people neither Like him nor Respect him, but are stuck with him.

The problem here is the people can’t resign from the country, and keep struggling for their own freedom and dignity.

Come the next election, the people will have the chance to make a change, and bring an end to this Unsustainable Leadership.

If you want to create Sustainable Leadership then focus on both being respected and liked

Change Management Is Bigger Than Leadership @Medici_Manager @HarvardBiz

by Gregory Shea and Cassie Solomon

If an organization needs to undergo significant change, that’s a leadership issue, right? Old dogs will learn new tricks when the lead dog — or ape, or penguin, depending on the management fable of the moment — shows them off. Leaders need to craft compelling elevator speeches, relentlessly deliver the message of change, and above all, walk the talk.

That is all well and good for animal packs, and it helps with humans, too. But by itself, the lead-animal theory is woefully insufficient for changing large organizations or large parts of organizations. Leaders modeling behavior and talking the case for change can indeed help enterprises transform. But how often is that corporate alpha dog actually sitting among the pack? Most people in large organizations catch a glimpse only briefly, via dispatch or WebEx or the rare visit. Soon, the appearance fades and the banners droop. The workers, the managers, and even the executives look around to see if their environment has changed, if the tried-and-true behaviors that made their world work will continue to do so. If the environment has changed, fine; it’s time to adapt. If it hasn’t, then why bother to change?

How, then, does one lead the changing of an organization, whether it is a company, business unit, service line, department, or work unit? By changing the work systems that comprise the work environment around the people whose behavior is supposed to change. Therein lies the key to successful, embedded, and sustained change: alter the environment, and people will adapt to it. Call it a species strength. We behave based on the reality around us.

Eight aspects comprise our world at work and, therefore, patterns of behavior at work: organization(organizational chart), workplace (its physical or virtual configuration), task (work flow or processes),people (specifically the skills and orientation), rewards (and punishments), measurement (the metrics employed), information distribution (who gets to know what when), and decision allocation(who is involved in what way in which decisions). A skilled change leader can convert these eight aspects into eight levers for change.

That is just what Hyundai’s Chung Mong-Koo did and the results speak for themselves. He took a carmaker arguably within sight of going out of business in 1998 and led the creation of what Bill Holstein (writing in Strategy+Business) describes as “a coherent mix of quality improvement, design, and marketing that gives Hyundai a clear advantage over its industry competitors.” A remarkable feat made only more remarkable by the fact that it occurred in a highly competitive, well-established global industry.

This change took time and far more than an inspired “motivational” leader. It took a concerted, coordinated, and sustained reworking of multiple work systems. For instance, Hyundai established a new and powerful quality division along with a Global Command and Control Center and brought transmission design and manufacturing in-house, implemented many Deming and systems-oriented approaches to task or work flow, flattened organizational hierarchies to drive more collaborative decision-making, made far more production information available throughout the organization in real time, significantly upgraded the level of technological tools available (especially on the production floor), altered measurement to include “qualitivity” (a unique combination of quality, productivity, and customer satisfaction) and rewards (e.g., good pay by local standards in an Alabama plant), and hired outside designers leading to a new approach to design termed “fluidic sculpture.”

At another global organization, the Roman Catholic Church, a change in leadership has many hoping for the revitalization of what some see as a scandal-ridden, unresponsive, and secretive organization. What might a change-minded pontificate learn from Hyundai? Do the aforementioned levers of change apply? They might start by articulating what scenes they want to see occurring regularly and reliably within the church that currently do not, and, conversely, what now-common scenes they wish would stop. That work done, they might step back and look across the scenes and ask questions such as the following:

  1. What changes in the organizational chart or in supporting structures (such as meetings) would support the scenes occurring? For example, does the traditional parish structure facilitate or hinder the scenes occurring?
  2. What design of physical or virtual space would make the desired scenes more likely? For example, would easy access to global digital connections serve to build a larger sense of community?
  3. What protocols might ease realization of desired scenes? For example, how standardized should the handling of financial or educational tasks be?
  4. What skills and orientation should people playing key roles in the desired scenes bring to their roles? For example, what attributes should qualify someone for hire into those roles?
  5. What rewards or punishment should depend upon people acting consistently with the desired scenes? For example, on what basis should disbursement of church funds occur?
  6. What measurements would foster the regular unfolding of the desired scenes? For example, is there a RCC version of Hyundai’s qualitivity?
  7. What distribution of information would facilitate desired scenes occurring and frustrate the occurrence of undesired scenes? For example, would greater transparency be a goal? If it is, with whom would the RCC wish to be more transparent and how would this work, from speed of message to method of communication?
  8. What allocation of decision-making roles would serve to bring desired scenes to life? For example, what role should clergy and laity play in which decisions to support the occurrence of desired scenes?

Watch the Roman Catholic Church. The more that it approaches the need for change strictly as a need to “get a different leader,” the less real change will occur, let alone endure. The more that it approaches change as a concerted, coordinated, and sustained reworking of multiple work systems, the more real change will occur…and endure, as it has at Hyundai, and as it would for your organization.

Gregory Shea and Cassie Solomon


Gregory P. Shea, PhD, is president of Shea and Associates, Inc. and an adjunct professor of management at the Wharton School of the University of Pennsylvania. Cassie A. Solomon is the president and founder of The New Group Consulting, Inc. Their new book,Leading Successful Change: 8 Keys to Making Change Work, is just out from Wharton Digital Press.

Ministers blame workers for system dysfunction created by Ministers @perfect_flow @Medici_Manager

What Poses More Danger To The NHS; Dirty Data Or Dumb Leadership?

Writing blogs on poor management of the NHS is like shooting the proverbial fish in the barrel, but two articles in the papers this weekend have raised the insanity levels higher than ever. The first piece brought forth the startling revelation that Jeremy Hunt wants to criminalise the gaming of targets

The Government is going to solve the problems in the NHS by prosecuting anyone deemed to have fiddled figures to meet their targets. This angers me on many levels, so let me try to summarise the situation that Hunt is attempting to solve;

  • Government sets arbitrary targets, which trigger punishments if not met.
  • Targets become the important focus of attention for management, who push targets down the hierarchy, imposing them on the workers in the system.
  • Government sets the policies and thinking, which dictates how managers create systems and budgets, by which people must work to meet the targets.
  • Inadequate systems created by wayward thinking, cause targets to be missed.
  • Fearful of the punishments that will arise, people do the only thing available to them to meet the arbitrary targets: they “game” the system.
  • Patients die as a result of the poor systems, whilst management. focus on the targets and the workers.
  • Government is provided with copious evidence that the focus on targets has caused the system to fail patients.

Targets do not work. There is a tidal wave of evidence that tells us this, from bankers to schools, via policing and the NHS, but consecutive Governments have clung to them like a comfort blanket. Targets give the illusion of control, but the truth is the complete opposite. I do not intend to go into detail on why targets are such a bad thing, as I have done just that in previous blogs. If you want to find out more, please follow the links I have provided at the end of this blog. @AndyTBrogan nicely summed up the effect of targets when he said that “in the short term, they may get people to do stuff, but they suck the heart and soul out of what they are doing”.

So, what are our Government proposing to do to improve things? Is it;

  1. Abolish targets and refocus attention on the needs of patients;
  2. Remove some of the worst targets, most prone to gaming;
  3. Enforce the targets more rigorously and make it a criminal office to record inaccurate data

Only option 1 will work. Words fail me that any sane person could choose option 3. However, this is Jeremy Hunt we are talking about. To quote Deming; “wherever there is fear, there will be wrong figures”. This policy takes the culture of fear and ratchets it up to 11. More fear will lead to more wrong data, but it will just be more cunningly concealed.

Let’s think about Hunt’s proposal logically for a moment…

  • How will prosecutors distinguish between an honest mistake and a deliberate fiddle? If I transpose a figure, did I do it deliberately or accidentally?
  • Who will define exactly how the figures need to be prepared? Think of tax laws; is it avoidance of the target, or evasion?
  • If figures were found to be falsified, were they caused by a “rogue” worker, or systemic fraud? How will we truly know?

To answer those questions will require policing. The logical conclusion is that figures will have to be more rigorously audited. Will we have a specific accounting body that verifies hospital data? How much would that cost exactly? Cost that is, in terms of the auditors themselves and the time and effort incurred by the NHS in preparing and checking the figures.

Criminalising data falsification will focus management attention even further away from the patient and further into accountancy and accountability. It is the wrong thing spectacularly wronger. This policy is like recognising that corporal punishment isn’t working and then proposing that we make it more brutal.

The problem is that the system is the main factor affecting performance. In turn, the system is affected by the thinking of those at the top. We currently pass responsibility for performance down the hierarchy, but do nurses actually have the power and authority to change the system? If they can’t change the system, the only way to hit the targets is to cheat the system, or cheat the figures.

So what to do instead?

The unavoidable truth is that sustainable improvement will not happen until the thinking changes at the top. If the thinking changes, it will allow us to replace arbitrary targets with measures of performance that are linked directly to purpose. The crucial part is that measures must be used to learn about current performance, but not to make people accountable. Instead they must be used by the people who actually do the work to help them improve the system.

There are 5 tests of a good performance measure. To be truly useful they must;

  1. Helps us understand and improve performance
  2. Be derived from the work
  3. Demonstrate capability and variation
  4. Be in the hands of the people who do the work to control and improve the work
  5. Be used by managers to actively, act on the system

Which brings me to the second article, which alleges that the Government was guilty of  ignoring data on hospital death rates Professor Sir Brian Jarman, who co-founded the health statistics and research service Doctor Foster, claims that in 2010 he sent the then health secretary Andy Burnham a list of hospitals with higher-than-average death rates, but no action was taken.

The fundamental fact that most people fail to understand is that producing any sort of performance data does not in itself change anything. Measures can never provide us with any answers, but good ones will prompt us to go away and ask the right questions. Used correctly, managers can identify where they need to go and look, to see what actual performance looks like and why it is delivering the data seen in the measures. This is absolutely not achieved by sending others to carry out audit and inspection. This is managers using data intelligently to go and see the work themselves, which is the only way to understand and improve the systems they ask people to work in.

None of these changes are possible until the thinking changes at the very top of the NHS. If Government continues to believe that fear improves performance and enforces it with inspection and prosecutions, then the future looks very bleak indeed.

Here are some fantastic links that explain why targets do not work;

Try almost any of Inspector Guilfoyle’s blog entries here;

Type targets into the search box here;

This is a great summary piece, which provides further links to plenty of evidence;

You can also read my previous blogs to see the effect that targets had on me. For example;

Leadership and Management @Medici_Manager @muirgray @pash22

Muir.gray, 13 March 2012

Leadership has become very fashionable and the number of books and papers on leadership increase all the time. So, what is leadership and how does it differ from management? This is not an easy question to answer because, as always happens, the more widely a term is used, the more meanings it acquires. One of the most influential writers on leadership emphasises this problem:

“There is no one correct definition of leadership, or any one set of personal qualities or competencies that characterise leaders.” (1)

One approach to differentiating leadership and management is to define management as primarily concerned with the running of an operation.  In the excellent book Trying Hardest Is Not Good Enough – a very important book for everyone involved in healthcare, even though it is primarily about education – Mark Friedman says that management is “the day to day, month to month running of operations”. Leadership is more than that. John Kotter, another very influential writer, distinguishes the two clearly:

“Management is a set of processes that can keep a complicated system of people and technology running smoothly. The most important aspects of management include planning, budgeting, organizing, staffing, controlling, and problem solving. Leadership is a set of processes that creates organizations in the first place or adapts them to significantly changing circumstances.   Leadership defines what the future should look like, aligns people with that vision, and inspires them to make it happen despite the obstacles.” (2)

There are probably two features of the work of the leader that are crucial. One is that the leader has to help people adapt to bad news, to reframe their view of the world and to help them overcome significant problems.  The other is that the leader is primarily responsible for shaping the culture of the organisation, whereas the manager works within the culture.

“Five common themes have emerged that capture the essence of leadership:  visioning, creating a culture of shared values, strategy forming and implementation, empowerment of people, and influence, motivation and inspiration…[The] ability to perceive the limitations of one’s own culture and to develop the culture adaptively is the essence and ultimate challenge of leadership.” (1)

In the words of the writer who is most highly-regarded on culture, Edgar Schein, the role of shaping culture is of fundamental importance. In fact he said it was one of the defining tasks:

“When we examine culture and leadership closely, we see that they are two sides of the same coin; neither can really be understood by itself.   If one wishes to distinguish leadership from management or administration, one can argue that leadership creates and changes cultures, while management and administration act within a culture.” (3)

How does a leader go about shaping culture?  One obvious approach is by their own personality and how they behave. However, the culture itself is determined by the way people think and therefore by the language they use. If one went into a healthcare organisation as a new leader and found that no one understood the word ‘value’, or that everybody was using the word in a different way, one of the leader’s first jobs would be to define the word and ensure that everyone used it in a common way.

The active management of language and concepts plays a crucial part in the shaping of culture and therefore in leadership. To this end, we will be delivering podcasts on key terms and key books, specially selected for the FMLM, in our ‘Concepts of Leadership’ series available on this website.

1. Gill, R.   (2006)   Theory and Practice of Leadership.   Sage Publications  (p.26, 26-27).

2. Kotter, J.   (1996)   Leading Change.   Harvard Business School Press.  (p.25).

3. Schein, E.H.   (2004)   Organizational Culture and Leadership.  John Wiley & Sons Inc. (pp.10-11).


20 Leadership Questions Answered @Medici_Manager @LeadershipHub

Question 1 – Can you name a person who has had a tremendous impact on you as a leader? Maybe some one who has been a mentor to you? Why and how did this person impact your life?

I have had several mentors or influences throughout my life, each being involved at a different stage, and having a different impact.

First of all was my dad, I wrote a blog about him, called “Heroes and Influences” back in Oct 2012.  My dad showed me that we are not tied to a destiny based on our history, but that we can take control of our own futures and shape it the way we want. He was the first member of his family going back several generations not to work down the coals mines, which was an impressive feat.

My next major influence, my mentor, was my Dan Corbett, who was my father-in-law at the time. He had started working in a supermarket stacking shelves and then 20 years later he was the Operations Director for one of the biggest chains in Ireland. He too showed me that with hard work and determination we could achieve much.

He also taught me a lot about leading and managing, about keeping things simple and getting people to focus on the right priorities. Too often people fail because they don’t understand the problem they are dealing with and they focus on unimportant things.
He taught me about commitment, making commitments and meeting them, as a way of building credibility and trust.

We used to talk a lot about business, finance, and P&L he used to try and get me to look at things from the business or customers perspective. To help me think about IT less as a technical discipline, but more of a service to the business.

He really helped round out my education.

To be honest from there on, most of my remaining development came from positive or negative influences that I experienced, or from coaching.

Positive influences came form the people who worked with, or for, me. Their feedback helped me understand some of my own strengths and weaknesses better, and also what worked well and what didn’t from a leadership point of view.

The negative influences mainly came from some of the bad bosses that I had, who showed me what bad management and bad leadership looked like, and showed me exactly what not to do as a leader. Seriously.

In the early 2000′s, one particularly bad boss, probably my worst, not only showed me how not to lead and manage, but also how not to do business too. This was a great learning opportunity, although a particularly stressful time.

Most recent significant influence was Julie Starr. Julie coached me during 2005 when I worked at DHL in Prague.

Julie taught me an awful lot about myself: about what I was capable of; about self limiting beliefs that were holding me back; about playing a bigger game & having more influence; and also about how to realise more of my potential.

Julie helped boost my self confidence which allowed me to go on and be a better manager, and more importantly, leader.

Question 2 – What are the most important decisions you make as a leader of your organization?

For this question I will ignore any of the direct work related decisions regarding daily operations as I see these more as management decisions and I will focus on what I think are the most important leadership decision.

Firstly, I think the most important decision is goal setting.

We need to set inspiring goals, that will set the organisation on the path towards success.

The goals need to be challenging, but achievable. Set them to high and people will be demotivated, make them too easy and they will not be inspiring at all, and we will not be able to drive the organisation forward.

When I set goals, I try to make them a ambitious but achievable, and then I also like to set a real stretch goal in addition too.  If you can get this right, and get the team to focus, you can often achieve both goals, or even surpass them easily, if you can build momentum.

Secondly, I think the other most important decision is on the organisation, you need to get the right people, in the right positions.

You need to appoint people who understand what you’re trying to achieve, have the right level of drive and leadership, in order to support you in your leadership role.

The more people sharing the leadership burden, the more success you will have.

For me these are the two most important decisions a leader must make.

Question 3 – As an organization gets larger there can be a tendency for the “institution” to dampen the “inspiration.” How do you keep this from happening?

In my opinion Inspiring an organisation is one of the most important tasks for a leader.

I think the best way to do this is: to set clear bold goals, monitor these goals and report progress regularly against them.

These goals need to be: simple to understand;  challenging and aspirational; easy to communicate.

At my current firm, our CEO Kasper Rorsted, did a great job of doing this across the entire organisation of 47,000 staff.

We had 3 clear targets

14%     Ebit margin
3-5%   Organic growth
>10%  Earnings per share

These targets were communicated clearly, including the reasons behind them, progress was measured regularly, and reported back to the entire organisation on Quarterly basis.

There was also a consistency to them too. Kasper always repeated “the targets remain the targets”.

Everyone in the organisation knew the targets, understood why they were important and knew that the targets were not going to be changed.

This helped inspire an entire organisation.

In my opinion, I don’t think it’s the size of an organisation that dampens the inspiration, I think it is the quality of the leader of that organisation.

Good leaders inspire, it’s what they do best.

But often organisations don’t choose good leaders, and that’s where dampened inspiration comes from.

Question 4 – How do you encourage creative thinking within your organization?

I believe the best way to encourage creative thinking is to ask tough questions and to set ambitious goals or challenges.

Problems which are small, or unchallenging, can often be solved easily and do not require anything too creative to resolve them

Big challenges which cannot be resolved by just doing more of the same, by working harder, or by  conventional solutions require us to think outside of the box.

This is what leads us to be creative.

Also, we should remember that creativity can come from anywhere. Too often I have seen assumptions that creativity is limited to a single group, or just to senior managers.

I like to set the challenges and then leave the teams to come up with creative solutions, this empowerment encourages them to be creative.

We should also be non-critical of proposed solutions, no matter how bad, we can just reject them politely. Nothing kills creativity quicker than constant criticism.

Question 5 – Where do the great ideas come from in your organization?

In my opinion ideas can come from anywhere within the organisation.

No one has cornered the market in good ideas, although some might like to think that they have.

Whilst working for a company in north America, I was given a task of running a project to reduce operational running costs.

I was told by some of the senior management that this was not possible, everything had been done to optimise costs.

But as I started with the project, and had some quick wins, and people could see I was committed to the project, people would come up to me secretly and tell me about ideas that they had had for saving money.

It was unbelievable how many ideas people had, and great ideas at that. Our mainframe operator, thought it would be possible to eliminate one of our three mainframes by sharing its load across this other two with just a small increase in their capacity. This increase would costs us $100k but save us $1m per annum.

When I asked him why we hadn’t done this before he said that his previous manager hadn’t wanted to listen. He clearly didn’t think anyone so low in the organisation could have a great idea.

Within a year, by implementing all of these ideas we achieved the saving $20m per annum.

The only idea I had was to set a bold target at $20m, all of the actual saving ideas came from within the organisation, from many different sources.

I always find it strange too, that we often have to bring in consultants to tell us what we already know, because we won’t listen to it from our own people.

This is what makes me believe that great ideas can come from anywhere, we just need to listen out for them.

Question 6 – Which is most important to your organization—mission, core values or vision?

In my humble opinion Core Values are the most important for any organisation. Once you have these, then aligning Vision and Mission are fairly straight forward.

However, if you don’t really know what your Core Values are, then you can’t align the Vision and Mission with them, and anything which is not aligned to Core Values will fail.

Our Core Values are what drive us, they are aspirational and when our aspirations are not being satisfied, then we don’t give our best efforts.


Questions 7 & 8
– How do you or other leaders in your organization communicate the “core values”?
– How do you encourage others in your organization to communicate the “core values”?

Invariably  in most companies I have worked in, the “core values” have been very well communicated, either by big launches in case of new “core values”, or by poster campaigns, flyers, mugs and business cards, etc., etc,.

I think this is a good way of informing people what the ‘core values’ should be, but the best way to really communicate them is to live them.

We need to create the right example, be a role model for what the ‘core values’ are, what they mean and how they should be lived.

I also believe that we should encourage others in the organization to communicate them in exactly the same way, as role models who live the “core values”.

If we don’t do this, then we can have the ‘core values’ tattooed on the foreheads of all our staff, so that everyone can see them every day, but this will not make them lived or supported.

It’s walking the talk, which brings the talk to life, not talking the talk.

Question 9 – Do you set aside specific times to cast vision to your employees and other leaders?

Every year we have a strategy conference where we provide details on the vision, the targets associated with that vision, for the current year, and then discuss how we will achieve those targets, and what the challenges and opportunities are.

This meeting usually involves the next two levels of management, probably totalling around 60 staff or so, we hold it over 2-3 days and include team building and networking opportunities.

The messages are kept clear, simple and easy to understand, this is to ensure that there is no ambiguity, and that everyone knows what our focus is.

It’s then expected that the managers will transport the messages to their teams, so that we can try and communicate the vision throughout the entire organisation.

We then hold quarterly town hall meetings, where we share the vision & targets again and communicate the progress against them.

This continual communication of vision, targets and progress really helps to embed them within the organisation and help maintain the focus on the objectives.

Question 10 – How do you ensure your Organisation and its activities are aligned with your “core values”?

Easiest way to do this is to ensure that all objectives and targets align with your core values.

For instance,  if diversity is a core value, then there should be clear targets for diversity that are communicated, measured and reported on regularly, and ideally bonuses tied to achievement.

If diversity is one of the core values, and there are no associated targets, then this is clearly not a real core value its just lip service.

If there are targets, but they are not reported on, no one is accountable for them or they are not bonus relevant, then same again, this is just lip service, it’s not a lived value.

If you want to know what a companies ‘core values’ are then look at what they bonus and reward, and those will be their ‘core values’.

Question 11 -How do you help a new employee understand the culture of your organization?

I usually try to recruit people who’s ‘core values’ are aligned with the companies ‘core values’. If you can do that, then the probability of them living the ‘core values’ will be much higher.

If their values are not the same, then expecting them to change is not really likely to happen, as our ‘core values’ are part of who we are they define us.

Question 12 – When faced with two equally-qualified candidates, how do you determine whom to hire?

Easy to answer, it’s all about attitude. I will take the person with the best attitude every time, even if they are lesser qualified. If you get people with the right attitude you can provide them with the right skills and experience.

If you team has the right attitude then there is no limit to what you can achieve.

If you get the person with the wrong attitude, then there is very little you can do to change that attitude.

I like to understand peoples aspirations too, if I have someone who’s aspirations are aligned with what we are trying to do, and they have the right ‘core values’, then this can be a great recruit.

If people are both equal in terms of qualifications and attitude, then I would look at diversity, look to bring another perspective into the team.

Question 13 – What is one characteristic that you believe every leader should possess?

There are many characteristics that leaders should possess: honesty; integrity; vision; drive, energy; charisma; the list of desirable traits is long.

Integrity is very important, this is what allows a leader to build trust, and we all know how important trust is in a relationship.

However, if I had to pick the most important characteristic, I would say that humility is number 1.

Humility is the quality or condition of being humble; modest opinion or estimate of one’s own importance, rank, etc.

In ‘Good to Great’ Jim Collins highlights humility as one of the key characteristics which differentiates Level 5 leaders from the rest. With Level 5 being the highest level of Leadership.

I think three great examples of leaders with Humility are Gandhi, Martin Luther King jr, and Nelson Mandela.

Question 14 – What is the biggest challenge facing leaders today?

I think one of the biggest challenges is going to be communication and connectedness.

As we see the huge growth in social media and social networking, I think any leader who can leverage and master this will have a tremendous opportunity to significantly increase their influence, and consequently their leadership.

I already know of several leaders who shy away from social networking, either not participating completely, or only participating with their own peers in small exclusive communities.

I think that this will become a problem for them, as its not what people, especially their followers are looking for, and it will alienate them and highlight the distance between leader and follower, which is contradictory to the direction in which we are going.

This could lead to their followers looking to move to people, other leaders, that they can relate and connect too.

I would suggest to any aspiring leader that they master social networking tools as these will become more in demand and expected channels for leaders to use for communication.

Another challenge is the global economic crisis, I don’t think anybody believes that this is over, nor do they know where it will impact next, which makes planning for future very difficult. Leading in uncertain times is always difficult, and it’s a time when people look more to their leaders, which in turn increases the challenges.

Question 14 – What is the biggest challenge facing leaders today?

I think one of the biggest challenges is going to be communication and connectedness.

As we see the huge growth in social media and social networking, I think any leader who can leverage and master this will have a tremendous opportunity to significantly increase their influence, and consequently their leadership.

I already know of several leaders who shy away from social networking, either not participating completely, or only participating with their own peers in small exclusive communities.

I think that this will become a problem for them, as its not what people, especially their followers are looking for, and it will alienate them and highlight the distance between leader and follower, which is contradictory to the direction in which we are going.

This could lead to their followers looking to move to people, other leaders, that they can relate and connect too.

I would suggest to any aspiring leader that they master social networking tools as these will become more in demand and expected channels for leaders to use for communication.

Another challenge is the global economic crisis, I don’t think anybody believes that this is over, nor do they know where it will impact next, which makes planning for future very difficult. Leading in uncertain times is always difficult, and it’s a time when people look more to their leaders, which in turn increases the challenges.

Having thought about it some more, I think I would answer it differently today, in a slightly more philosophical way.

That’s not to say that I think the challenges I wrote about yesterday on Communication, Connectedness and Inspiring people are not important challenges, it’s just that thinking about if from a different perspective, I have a different answer.

I think one of the biggest challenges leaders face is maintaining their own principles. The higher up the greasy pole we climb, the more our principles and ‘core values’ get questioned. We then have to maybe make trade offs and compromises.

That’s not to say that we sell out on our principles, but maybe that we need to prioritize them and focus on the ones that we believe are more important, and let some of the lesser ones go.

Imagine if you had the possibility to be the next Pope, according to Forbes Magazine, the Pope is the fifth most influential leadership position in the world.

This would give you tremendous opportunity to do good, to serve people, to maybe make some real changes in the world.

But imagine if you were very strong on fighting: sexual abuse in the church; for women priests; and say vatican corruption; but that the people who controlled the election told you there is no way you could be elected if you were to look to fight for all three.

That they could guarantee you would be Pope if you chose to  make a strong stand on sexual abuse, and woman priests, but stayed away from Vatican Corruption, and that the rest of your energy should be spent on making Catholicism relevant in the 21st century, and focus more on helping the poor and growing the church.

Would you accept, would you let your anti corruption principle go in order to achieve two of your goals?

Many leaders face similar dilemmas, I’m sure Barrack Obama has had to put many of the plans he would like to have implemented on hold.

I think this is the biggest challenge leaders face, maybe not in their current role, but if they want to go higher up the leadership ladder.

I have copied some of the dialogue from the movie Braveheart, when William Wallace is given the opportunity to sell out on his principles.

Princess Isabelle: The king desires peace.
William Wallace: Longshanks desires peace?
Princess Isabelle: He declares it to me, I swear it. He proposes that you withdraw your attack. In return he grants you title, estates, and this chest of gold which I am to pay to you personally.
William Wallace: A lordship and titles. Gold. That I should become Judas?

I think we would all like to think we would have principles as strong as William Wallace, but until we are truly put to the test we will never really know.

I am not suggesting that we would all become Judas, but we will definitely have to make compromises or prioritize our principles.

This is what I think is a leaders biggest challenge, especially if they wants to advance!

Question 15 – What is one mistake you witness leaders making more frequently than others?

Leaders are human, and like all humans, they make mistakes, I know I do, certainly more than I would like to admit.

I think that for this question, I will answer it slightly differently, looking at what I think are some of the bigger mistakes that leaders make, and the ones that I try to avoid.

Firstly, I think that as leaders that we always need to do, what we say we will do. This builds trust.

I often see leaders say one thing, and do another, or they don’t apply the rules in the same way to themselves, as they apply to them to their staff. We then compound this mistake, by assuming that our teams are too dumb to notice.

They’re not, and they do notice!

This then leads to a lack of trust, and when we lose trust, we lose our followers. I think this is probably the biggest makes I see leaders make.

Another big mistake I frequently see is, leaders taking as much of the credit for their teams success, as is possible.

Everyone knows what the leaders contribution was, and credit will always be given for it, there is no need to take it away from the team. Maybe this is a confidence issue.

With Manchester United, we know Alex Ferguson is the manager, we know he selected the team, the tactics and provided the motivation. Yet in the press interviews, he gives all of the credit to the players, it’s as if he wasn’t involved.

This gives great to motivation to team, as well reward, recognition and respect, and this leads to respect for the manager.

If the leader looks to take all of the credit, then effect is completely the opposite, but its amazing how often we see this happen. Nothing demotivates a team as much as the leader claiming it was all about them.

Question 16 – What is the one behavior or trait that you have seen derail more leaders’ careers?

I would say, without doubt, that the number one trait that I have seen derail the most leaders is, honesty.

This comes in many guises, such as not being honest about:

  • what was achievable, i.e. over committing, then under delivering;
  • the current status of the project, i.e. misleading people on the level of progress made;
  • costs:
  • the real reason for why actions were being taken;
  • personal interests

It could also be arrogance, in that they don’t think that their lies will be found out, but it all comes down to honesty.

Without honesty there is no trust.

This is why honesty is probably one of the most sought after quality in leaders.

Question 17 – Can you explain the impact, if any, that social networking and Web 2.0 has made on your organization or you personally?

From a personal point of view Social Networking has had a huge impact for me, and I do see this an major change and important topic for Leaders.

Social Networking allows us to connect so much more with our teams, it really does break down communication barriers, and closes the leadership gap somewhat which I think is really important – although not all Leaders agree with that.

Because of this closing of the gap, I get so much more feedback about what people like about my leadership, and also any areas of opportunity, and I think this feedback is invaluable as we strive to improve ourselves.

Also, it provide an informal communication channel which allows people to approach me, without having to go through an assistant, or arranging a meeting, or trying to find time in a busy schedule, and I have certainly benefited from things brought to my attention which I probably otherwise might not have found out about, which allowed me to deal with them earlier and successfully before they became bigger issues.

This communication channel is also excellent for global teams, I certainly have a lot of informal conversations with the colleagues out in Asia and the US, who are outside my time zones, and this really helps to bring us closer together.

I actually think that we are much more advanced on this in private life, than in professional life, although there is more and more overlap, and I think that the next generation of leaders will really leverage Social Networking to significantly improve their leadership and take it to the next level.

Question 18 – What are a few resources you would recommend to someone looking to gain insight into becoming a better leader?

Rather than just limit my answer to just a few resources, I will tell you the approach that I take, and then tell you some of the resources that I would recommend.

My approach to my leadership:

  • I read extensively on Leadership, not just the well known authors but also some of the other lesser known ones, there are great ideas on leadership to be found everywhere, and not just from business leaders but also other areas such as politics, sports, military history etc.
  • I take a lot of on line assessments to better understand my own my own strengths, weaknesses, preferences, etc. We need to know and understand ourselves before we can understand others. Try this
  • I try to understand different the leadership styles, which works best in which situation, and I try to understand what my style of leadership is.
  • Watch Leadership Videos on Youtube, there are plenty of them.

If I could only choose 3 authors, then the ones I like best are:

Ken Blanchard: Gung Ho, Raging Fans, One Minute Manager, etc

Jim Colling: Good to Great, Built to Last

Stephen Covey: 7 Habits of highly effective people, 8th Habit, etc.

I would finish by saying that Leadership is a journey, not a destination, we never stop learning.

Question 19 – What advice would you give someone going into a leadership position for the first time?

These are the thing I would recommend a first time leader to consider:

  • Be yourself, don’t try and be someone else. People respect and appreciate authenticity.
  • Set the example for what you want to see from your team.
  • Respect your team, just because you’re the boss it doesn’t make you better than them, and they will respect you  for it in return.
  • Be polite. Ask people to do things, don’t tell them. They know you’re the boss, they don’t need you to remind them.
  • Listen.  My grandma use to tell me, you have 2 ears and one mouth, and they should be used in that ratio. So listen more than you speak
  •  Create a positive ‘can do’ atmosphere.
  • Be clear and consistent in your communication.
  • Admit it when you make mistakes
  • Create some quick wins, get people used to be successful under your leadership
  • Provide positive feedback, even for the little things, get people used feeling good about what they do for you.
  • Be bold, set ambitious goals, not impossible goals, but goals that you will feel proud about, once you have achieved them.

I could add more, but I think this is a lot of tips to start with.

Ideally, I would hope that people aspiring to be leaders, had already developed some of the informal authority leadership skills prior to having the formal position.

We shouldn’t be looking to lead for the first time when we are offered a leadership position.

As Mark McGregor says, “Leadership is a choice, not a formal position”

Question 20 – What are you doing to ensure you continue to grow and develop as a leader?

Leadership is journey not a destination, so I am continuously learning. I read a lot of books on leadership, watch videos, anything where I can get a new perspective.

I have started writing, this really helps me understand my views on leadership, get feedback on them and see how I can adapt them to improve them.

I try to get a better understanding of my leadership style, it’s impact, and how I can tailor it for different situations.

I look to get feedback from my teams, to see what people feel is working, and what isn’t.

Finally, I look to get leadership coaching, get an outside view of what I am doing.

The more we learn, the better we understand, the better we understand, the better we can be!