Speaking candidly with Glenn

I have always been concerned about how others view me as a person. I asked Glenn, "How do you ensure that when you finish a conversation that others have a positive view of who you are?" His answer was surprising. He said, "I don't view it that way. I view it that I want to let others know about who I am as an individual. The #1 word is respect - mutual respect. The first thing that I make sure I do is show respect. I respect the position and responsibilities that the person has. Whether a janitor or physician, I respect a person and expect the same back. For example, when a physician comes in, I need to respect that physician's commitment to his or her patients. In response, that physician needs to respect my commitment to my employees, the board, and the rest of the organization. Although the person may not like my decision, my hope is that they understand who I am and realize that I am being true to myself and my organization with the decision that I make."

Don't talk through your rear, Jonathan

Today I met with Glenn to discuss how things have gone up to this point in my internship. It was a great discussion, up until the point when he asked me what I thought of healthcare reform. I pulled some answer out of my butt that was fluff, I knew it and he knew it. It didn't have any substance, and he saw right though it. He didn't say anything about it, just mentioning that I need to be clear and concise about numbers and information. People assume that you know things, especially in health reform. Since you're in the industry, people will turn to you and want to know what you think about the recent health reform proposals. It is our responsibility to be informed and clear with information that is presented to them. In the future, though, if I don't know or can't think of a way to answer the question at that time, I need to respect the other person enough to say that although I don't know, I can find out.

Shadowing the CEO of UNMCP

Today I met with the CEO of UNMC-Physicians, Cory Shaw. Since the start of my internship I've looked forward to meeting him, especially since he took much the same track as me. He's an MHA from the University of Missouri who has gotten where he is obviously based on his excellent communication skills and understanding of the industry. He's also been lucky to have been placed in positions at a young age that typically aren't available. A couple of things that I gained from working with him is that:
1) Having a sense of humor is critical! Being able to diffuse a tense situation with a little humor is a trait that cannot be underemphasized.
2) Most deans and health care leaders derive power not from how much they make, but how much money they are able to allocate to others from departments.
3) There's an important difference between being productive and being efficient. Productivity is derived from how many hours you spend working. Efficiency is derived from the amount of time it takes to perform a particular task. We must never confuse the two.
4) Nothing's done by fiat. Therefore, you must have excellent communication skills in order to make progress with ideas, solutions, and implementation.
5) If ever I get let go by an organization in the future, make sure you say that I'll walk out today if you want me to, but if you want I can also temporarily help the new person get acquainted, all I ask is that during the time that 1) I am paid and 2) you purchase COBRA for 6 months. That way you leave on a good note and it gives you time to continue looking for other opportunities.
6) Although being CEO for a physician group can be difficult, it's a great and worthwhile place to be.

Cheating

Today has been a welcome and much needed slower day for me to be able to catch up on a number of projects. I've spent a large portion of the day reading articles for our health policy project, specifically from the Advisory Board and Deloitte. One of the nice things about using these tools is that the analysis has already been done. All I need to do is look at their assumptions, evaluate the recommendations, and present it to management in a meaningful and applicable way. It saves incredible amounts of time, especially considering that I'm involved in multiple projects and don't have very much time to collect data, analyze it, formulate a hypothesis, and write up a full report. It feels like I'm "cheating" at times, but it's definitely better than reinventing the wheel.

The Marketing Team

One of the nice things about being a CEO is that you have people working to make you look good.

And the people at NMC do a great job with that task. Today I met with a number of directors in the marketing department, each charged with the task of improving the hospital's image in one way or another. Since taking business classes in college, I've come to appreciate marketing's role in communicating effectively with employees, stakeholders, and the general public, and how difficult the charge can be at times. It takes money, ideas, and a lot more time then people usually realize. I appreciate the time the marketing team set aside to answer my questions and aquaint me with what they do.

I met with Annette in the morning to go over our plan for the diabetes service line project. It was great to watch the process she took in formulating a strategy for what we needed to know and what we needed to focus on. She basically made sure that we knew exactly where our revenue came from, what our costs were, what the payer mix was, and what patients were included in each "bucket". By getting this information as detailed as possible, we were able to start making some connections and inferences about diabetes center patients. I'm glad I was able to be in on the action during the exercise.

I then met with Krista who's in charge of internal communications. Krista is actually a former news anchor for an Idaho TV news station, and it's evident in the professional way that she talks, thinks, and acts. She communicates very well and made me feel very comfortable asking questions about her role at NMC. She moved to Omaha about a year ago, was hired by NMC, and since then has led a team in developing a number of marketing tools that standardize the message that management is trying to get across to patients and employees, such as a style guide, campus map, online marketing request form, and an overall communications strategic plan. She also gave some good advice on communicating well, such as remembering that audience members want to know "wiff'em" (WIIFM-What's In It For Me), anticipating questions and answering them, being flexible and not agressive when managing others, knowing your own strengths and weaknesses in communication, and making "talking points" that give you an idea of what you're going to say and helping others stay on topic.

I then was introduced to the data guru of the bunch - Debbie. She did a superb job in introducing me to the world of DRGs and procedure codes, and I was impressed with the excel spreadsheets she developed in order to create a number of reports that NMC uses on a regular basis. I also met with Nizar to discuss the Advisory Board tool that NMC uses to get market research information, specifically relating to strategic planning. He was helpful in getting some information for my summer projects.

My time with Leslie was full of valuable insights into the external marketing portion of the department. First of all, you should be aware that Leslie and her team has a bookshelf full of awards that NMC received from various organizations. She has a whole row of "Tellies" - awards that recognize achievement in local and regional healthcare advertisements. As you can see from the picture, they look a lot like Oscars (it made me want to grab one and thank all the people in my life who have gotten me to this point - I resisted the temptation). She was eager to talk about NMC's tagline as being most recognizable and the importance of creating a brand promise for the organization. I'm doing a Facebook/Twitter project for her and am excited to share my results with the team on Friday.

Keepin' Busy

I'm starting to gain an appreciation for advanced scheduling now that I've been an intern at NMC for a month.

Who knew I would have so many meetings, projects, and introductions that I would need to schedule them weeks in advance for them to happen. I'm almost starting to get to the point where I need to schedule dinner and sleep in or else I'd put those off as well. Of course, I like being busy...it not only makes the time go by fast, it also makes me feel that I've been productive. I realize that being busy and being productive are two different things, but I enjoy the feeling that comes from knowing that every minute counts.

As I look at my calendar today, I was completely packed from 8 to 5. I attended a Senior Executive Meeting this morning where we discussed . . . nice try Alegant - I'd like to keep my internship, thanks. This afternoon I attended the Clarkson Regional Health board meeting. Clarkson is part owner of the Nebraska Medical Center and also has investments in SimplyWell and PPA. A number of board members are on the NMC board as well, so it was a good opportunity to reacquaint myself to them. I sat next to Randall and had a good conversation with him about my mission to Russia and other experiences I've had. He's a great listener. . .he'll be a great Development director.

I also had the chance to meet with Paulette Davidson, the Executive Director for Primary Care Services. We discussed the general trends of primary care, especially when it comes to working with physicians in one form or another. There are 3 main ways to bring more Primary Care Physicians (PCPs) into the hospital: 1) Employ them by paying them salary, 2) Incubate them (providing an initial outlay of money for them to develop their own practice), and 3) Giving the organization that they represent money, whether it be a private physician group or academic-based practice. One of the big issues is that the demand for PCPs is growing due to the increase in the baby boomers' ages and due to growth in the area. This leads to more hospitals wanting to employ their own physicians, which demonstrates the current trend. NMC is actively seeking to build relationships with PCPs, which is the area Paulette is particularly focused on. The discussion with her was insightful and very helpful to understand the dynamics of what is happening in the current environment.

Lastly, I met with the marketing gurus of the ECCP 2nd floor. Man, I'm excited to work with them this week. They are bright, energetic, and full of passion for marketing that was evidenced during my conversation with them. I'm looking forward to shadowing them and learning from their experiences in the healthcare field.

HR and the Diabetes Center

Today was my last day in the HR department.

Jennifer Acker, the manager for recruiting, gave me an overview of what she does on a daily basis. Basically, everything from the point of when an applicant fills out an application to the point at which that individual is hired is under her responsibility. I had no idea how structured the whole process is! I guess that's how it has to be when there are over 20,000 job applications, 4,000 interviews, and 1,700 offers in a given year.

David Burrack then gave me an understanding of his role as Manager of Compensation, Benefits, & HRIS. NMC most often uses the Haygroup tool in order to determine salaries for exempt (or full-time) workers rather than focusing just on salary surveys. Haygroup classifies job roles based on know-how, problem solving, and accountability measurements to systematically determine the appropriate salary level for a particular job. It’s based on a point system that identifies a pay grade. Each pay grade has a min, med, and max value that is typically based on experience. Some of the major takeaways from the meeting were that communication is key in any compensation conversation. Just because you receive a salary located in the median range does not mean you are average. NMC goes through great measures to ensure that its employees are justly compensated. In addition, maintaining thorough documentation is extremely important because it provides proof in case of a dispute. Recognizing that NMC has over 5,000 employees, the Human Resources department does a great job.

After lunch I headed over to the Patient Services Pavilion to check out the Diabetes Center. Beth Pfeffer gave Annette and me a tour of the Center, and overall I was impressed with the attractiveness of the facilities and the resources that are provided for those with endocrine/diabetic problems. They are doing great work at the facility and I am excited to work on a project that brings these things to the forefront of people's minds.

Human Resources Continues

Ann, Julie, and Mindy showed me around the employee relations side of Human Resources today.

Basically, they're responsible for improving morale among unhappy employees and keeping happy employees happy. Much of what they do is interpreting corporate and department policy for managers and employees, such as clarifying when holiday time can be taken, what qualifies as a leave of absence, and when timecards should be submitted. They are also involved in taking a mediator role when conflict arises between employees and their managers. Education and training managers can play a major part in reducing the number of these negative meetings, so they are involved in that as well. You'd think that dealing with negative issues all day would wear you down, but they also get to plan fun activities and events for employees as well, giving them a reprieve from the tougher aspects of the job.

After being in HR for the morning, I was able to sit in on a SimplyWell board meeting for lunch. SimplyWell is a wellness program/initiative that allows employees of firms that purchase a subscription to get a detailed physical and health status report, have access to online health resources, and be given a detailed list of health goals for individuals who need to manage a chronic condition.

This afternoon I went to a meeting with a number of UNMC physicians who discussed health reform issues with Joe from Senator Nelson's staff. It looks like I'll be doing a summer project with them, which will be challenging and rewarding at the same time.

Meeting with Senator Nelson

I had the privilege of meeting Senator Ben Nelson from Nebraska.

Senator Nelson held a special healthcare roundtable for various representatives from the provider side of healthcare, and since Glenn was invited, he was able to get me into the meeting as well. It was a memorable experience to be among members of a very select group that had a lot of sway in terms of healthcare policy that is developed in the Nebraska region. They had CEOs of hospitals and hospital systems, representatives from provider groups (such as physicians, nurses, pharmacists, and therapists), and healthcare policymakers. The whole point of the roundtable was to solicit feedback on proposals for healthcare reform that have been discuss in and around Washington. It was interesting to see everybody's viewpoints, especially since a number of stakeholders had opposing priorities that were difficult to reconcile. It will be interesting to see what happens with health reform as time passes.

More Great Material

I got my first taste of Operations Council this morning. One of the interesting topics discussed was a new Barcode Medication Administration Report that showed incredible results. After completing the first phase of data monitoring, results showed that 4 potential errors were averted/1000 attempts, which is stunning data. It is this type of information technology that is the future of medicine.

New Acronyms:
BSI: blood stream infections
RCA: root cause analysis
RRT: rapid response team
KIR: key indicator report

Meeting with Glenn:
A CEO's role is different than others. It requires vision, knowing where to go, having people you trust on the boat, and then having the ability to make it go there by supporting them.
One of the secrets is knowing when to intervene.
Referrals: we're doing it because we need to protect our employees' jobs
There are certain times you've got to be willing to draw a line in the sand and be serious
When Glenn was an MP, he matched force with force. However, if you go to him objectively, he will go out of his way to be helpful.
First thing he did when he became CEO: 1) Started defining priorities, 2) Showed commitments (quality)
Believe and have confidence that you can help
Find your style...watch others' styles
I want people to feel comfortable and work with me.
I get the greatest satisfaction when I hear I am doing a good job

Regional Referral Growth Summit

This morning I headed over to the Qwest Center here in Omaha to be a part of the Regional Referral Growth Summit, a conference of administrators and providers focused on increasing the number of referrals throughout the region. There are a number of reasons why the executive team would want to bring these individuals together, most importantly because NMC wants to continue its focus on "Serious Medicine" and get referrals for the big ticket items such as transplants, cancer care, neuro cases, and heart care. By building lasting relationships with employees and patients, NMC wants to continue to lead the area in these product lines.

Takeaways:
The more a customer interacts with your service, the less customer sacrifice should occur. (ex. Ritz-Carlton has a guest preference pad where every time the guests make a request, they make note of it on a database and amek sure that when you stay there again, your preferences are provided for.)
It's time to move to a new level of economic value: EXPERIENCES
ex. Coffee (commodity - $0.02/cup, good (ground, packaged) - $0.15/cup, service (cafe, etc.) - $1.50/cup, experience (Starbucks) - $5.00/cup)

Quotes of the day:
"You can accomplish a lot in life if you're willing not to take credit for it."
"We're not in the education business, we're in the transformation business." London Business School

Employee orientation and meeting with Glenn

I came away from today incredibly glad that I was at the Nebraska Medical Center for the summer. Most of my day was spent listening to the story of NMC and how it's developed over the years to be where it is today. I was also able to sit down with Glenn and talk with him about the future.

New learnings:
Red status bed = means that you don't have a med surg available
FMEA = Failure Modes and Effects Analysis (what can go wrong)

Takeaways:
Change Acceleration Process (CAP) and Workout have been two tools that NMC has used to positively promote change within the organization. Q (Quality) x A (Acceptance) = Change

Interesting Quotes:
"Can you shut the door so they don't hear me screaming?" -Glenn
"We face significant challenges...welcome to the ride." -Glenn
"Quality improvement is like religion, you can't go twice a year." -Glenn
"You know when you're really into quality when you go to the bathroom and analyze how many pieces of toilet paper you've used." -Glenn
"There's not a lot of 75 in a row of anything we do in this organization." -Glenn
"From the first day I came to the Nebraska Medical Center, I wanted two things: 1) when I finished my career as CEO I hoped people would care, 2) I wanted our competitors to curse the day I came into this office." -Glenn

Start Day

Today was my first day as an intern for the Nebraska Medical Center. It's good to finally be here and start meeting the people I will be working with for the rest of the summer. This morning I met with Jason Lebsack and Terrie Johansen, both involved with quality initiatives at NMC. They mentioned the development of the mortality committee, a new program where they review 100% of deaths to see what they can learn from what happened. What they've found is that 50% of documents show inadequate documentation of the situation and don't accurately reflect what happened. In addition, they've been able to find evidence to support the development of a palliative care program to help create a comfortable experience for patients when they pass away. It's obvious that NMC is interested in improving quality, which is one reason why I am so excited to be here for the summer.

In addition I was able to meet with Glenn to discuss plans for the summer. We talked (well, he mostly did the talking) about the healthcare situation (volume is down b/c people are holding off on elective procedures, we make most of our profits on out-of-town referrals to our main service lines, these profits subsidize other parts of the hospital such as primary care and OB/GYN) and about his style as CEO (his job is to #1: Define and develop a vision, and #2: Get people to go there). He had a number of one-liners that I thought were notable:
- Don't mess with my people. I don't like it when people pass the blame onto others who are not responsible for a particular mistake.
- This is not a democracy, this is business. When things go bad they fire the CEO, and I don't want to go home to my wife without a paycheck. Nobody in this business is more important than my family.
- We are a communication entity. Be clear and concise with numbers. Use the "gee" word. Don't do something that's not sincere. Sincerity is a hard thing to argue against (ex. lowering voice in classrooms). "Come see me if you have any problems."
- Look at others' management styles and adapt them to your own. Monitor them and find out what is right for you.

I enjoyed talking with him and have a feeling this is going to be a great internship.