What Price for Leadership?

Cheap shot.  Defined as an unsportsmanlike act.  Or as unnecessarily aggressive and unfair remark directed at a defenseless person.  Other words that can be used in place of the term "cheap shot" are jibe, barb, dig, slam or shot.

As a former (very) recreational hockey player, I've seen and experienced my share of cheap shots on the ice.  These types of actions are border line and might or might not result in a penalty being called.  They are below the belt and can look like a face wash, an extra push in front of the net, a little whack with the stick on some body part of the opposing player.  You come to accept some of this as part of the game.  You also make a choice as to whether to respond in kind.

As a former health care administrator I unfortunately have to profess to have been subjected to my fair share of what can be characterized as cheap shots in that forum as well.  The difference between the hockey reference and the administrative experience is that on almost all occasions there is no ability for an administrator to defend themselves.  Most times we either self-restrain or are restrained from responding in the interests of professionalism or maintaining good relations with one or more set of stakeholders.

So it was with more than passing interest that I've noted a number of media stories of late that I would characterize as taking cheap shots at senior managers, civil servants and administrative functions in general. 

First off the mark was the story about Alberta Health Services senior executives getting bonuses, or pay-at-risk payments, totalling $480,000.  Naturally, this made headlines in media outlets across Alberta and engendered some interesting comments from opposition politicians, journalists, and union leaders.  Wildrose Health Critic Heather Forsyth was quoted as saying "This is incredible...that they even have the guts to give themselves a bonus when they haven't met their targets." and "What kind of message does that send to the people in the front lines, the ones who are really doing the work?  It's cocky and flippant and arrogant and unacceptable."  (italics are my emphasis).  As harsh as those statements were it was nothing compared to the editorial put out by Don Braid of the Calgary Herald.  Some of this commentary went as follows:  "Your boss sets your performance target for next week.  There is extra pay for meeting it.  But you decide, hey, the weather's nice, I'll play some golf, work at half speed for a day or two.  You achieve only 50 per cent of your target.  And you get 50 per cent of the bonus, along with congratulations for half a job well done." 

Could AHS have handled the whole bonus/pay-at-risk situation better?  Probably. It's a system that is not well understood by almost anybody.  However, are Dr. Chris Eagle and other members of the senior leadership team of AHS overpaid?  Not in my estimation.  In fact, I consider Dr. Eagle and his executive colleagues to be grossly underpaid for what they are accountable for, for the level of scrutiny they are subject to, and the fact that they are pretty much working or on-call 24/7.  The comment about working at half speed for a day or two is extraordinarily laughable and speaks to the lack of information and insight on the part of the speaker.

Similar stories played out in the next few weeks.  There was sharp criticism over increases in administration costs at Alberta Health Services.  NDP MLA David Eggen (former Friends of Medicare executive director) was quoted as saying, "There's been a lingering perception that AHS is top-heavy and this does nothing to dispel that perception."  This was despite the fact that some of what made up the increase in administration costs related to such things as investments in infection control.  Unfortunately, accounting rules that AHS is subject to cause many of these types of expenses to be categorized as administrative.  Not the typical definition that most of the public and media would work by.  Rather they tend to think of administration costs as being those senior executive types that work at half speed and play golf when the weather is nice...

Next up for criticism was a pay increase for provincial civil servants.  Premier Redford approved an order-in-council that provided 4 per cent increases for senior civil servants.  Wages for these leadership roles had been frozen since 2009.  The reaction was not unexpected.  Wildrose Leader Danielle Smith was quoted as saying "Oh my gosh, you've got to be kidding me, in the middle of a budget crisis...I think it's not going to pass muster from the public,"  Scott Hennig of the Canadian Taxpayers Federation was similarly critical, implying that the positions were already well paid (if not overpaid) saying "The raise is not going to be the difference between whether they are eating cat food this month or not." 

On the bright side at least, Health Minister Fred Horne and AHS Board Chair Catherine Roozen came to the defense of various administrative leaders and their salaries as was appropriate.  Too often that type of leadership is absent in these situations and the easier, more political thing to do is freeze (or even cut) wages, suggest that some sort of investigation and corrective action will take place, and take whatever other action might be necessary to demonstrate "public accountability"

The reality is that there is a "price" that must be paid for leadership.  That price must be commensurate with the responsibility and accountability placed on these positions, and the education and experience we expect of individuals holding these positions.  These are not private sector roles to be sure, where customers and shareholders will ultimately weigh in on the appropriateness of executive salaries (although that equation has fallen apart on more than one occasion of late...).  And I'm not suggesting that public health care match private sector positions in salary and benefits.  However, if we want to recruit and retain good to excellent leaders we must appeal to more than just their altruistic nature.  Similarly, we create significant risk for our health system without investing in "administrative functions" like finance, human resources, infection control, materials management, information systems, and a host of others who are required for the safe and effective operation of a multi-billion dollar operation like Alberta Health Services.  Without an appropriate investment in these skilled people, doctors and nurses and other clinical professionals will not have the ability to provide you and I with high quality, safe care when we need it.  The Canadian health care system has always underfunded these requirements. 

Politicians, reporters, interest groups and the public should do more to inform themselves on what exactly are administrative costs and what we require of our leaders.  Cheap shots, while they might help somebody score some points in the short term, or sell some papers, or give us a sense of victory over some faceless bureaucrat or public figure - who can't defend themselves by the way - will only devalue a critical piece of our health system and demoralize those trying to help make our health system function at a higher level.  We should be concerned about not only creating a better working environment for doctors and nurses but for everyone associated with our health system.  We need the next generation to prepare for and take on leadership roles as very many of our current leaders retire in the next number of years.  And at this point, there is little incentive for people to aspire to positions of leadership in health care.  The pay is not exorbitant, the workload and demands are excessive, and the expectations and timelines are unrealistic.

Ultimately we need to place as much value on leadership for health care as we do on education and training for clinical professionals, as much as we do on the bricks and mortars of hospitals and continuing care facilities, and on investment in the latest medical technology.  If we don't, the success of our health care system will be constrained by this deficiency to the same extent as if we failed to build enough capacity in our system to deal with population demand.  It is about leadership.

  ______________________________

Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.



Mentorship - A Leadership Imperative

Mentor - A wise and trusted counselor; a teacher; an adviser; a master; a guide. 

As I contemplated this latest blog entry, these were some of the terms that popped up in my thought process.  There were certainly some images that came to my mind as well.  Some of those images relate to personal experiences in my career and people who I knew then, or appreciate now, as being mentors to me.  There are also of course some more fantastical representations of mentors that my geek mentality can relate to. 

Like Yoda.

The image of Yoda being carried by Luke Skywalker definitely conveys some particular aspects of mentorship.  Someone looking over your shoulder, acting as a guide, pushing you forward and beyond your self-imposed limits.  At times Yoda's perspective could be quite demanding - "No!  Try not. Do, or do not.  There is no try."  A seemingly harsh perspective, but this approach did move his mentee to a new level of performance. 

I've become much more interested in mentorship in the past couple of months as I've made the transition out of a senior leadership position into the role of management consultant.  Perhaps this should come as no surprise when one considers this is the biggest career transition I've made to date.  But there's more to the story.  The transition made me realize the lack of mentoring I had experienced over the past few years.  It's not that I was unaware of that lack of support.  I felt the absence of a mentor and took a conscious step to enlist one outside of my own organization.  However, it has only been as I've started this new venture that I've more fully appreciated the value that a mentor can bring to my career and life - even for someone who has been in the working world for the past 25 years.

Right now, I count myself particularly fortunate to have two senior level professionals who have stepped up to the plate to guide me through this transition.  In both cases, there was no formal mentorship kick-off meeting, no mutually agreed-upon goal setting process, no established timeline or agreement on frequency of meetings.  I've known these senior level professionals for different periods of time - one for over 15 years, the other for only three.  They have very different backgrounds and experiences.  They are different in a multitude of ways. I don't believe they have ever met or even heard of each other.  They do, however, share at least one thing in common - they both appear to have an interest in my success and development.

So, I'm going to start at that point in describing what I think makes a successful mentoring relationship.  First, I really believe that it is my professional obligation to be a mentor to others in health care (and beyond if my skills and experiences allow).  But it's more than just meeting credentialing requirements for my professional associations that I'm talking about.  I believe that I have a personal obligation to help others if I can.  And I believe that this is the same perspective that my two current mentors hold towards me.  They have a passion for advising, coaching and guiding others and they certainly don't do it because of a credentialing requirement, for any public accolades, nor for the money.  I believe this illustrates that a truly successful mentoring relationship comes from a personal investment in that relationship.  Sounds corny, but I believe they care about my situation and my success.  Unfortunately,  I've seen too many other scenarios play out where the motivations, particularly on the part of the mentor, are less altruistic.  Ultimately, these relationships die off rather quickly with other obligations getting in the way of a mentor/mentee connection.  The outcome is a mentee feeling rather disillusioned by the experience and the mentor breathing a sigh of relief that this particular activity dropped off their already busy calendar.

First step then, make sure there is a commitment and interest on the part of both parties to mentorship.  Closely related to this factor is the requirement that there actually be some chemistry in the relationship.  It's not necessarily about liking one another - although that certainly helps - but you'll both probably know within a few encounters whether there is some type of connection or basis upon which to build a respectful and productive learning relationship.  Do you look forward with some level of excitement or expectation about an upcoming opportunity to interact or do your feelings tend towards anxiety, trepidation and dread?  Listen to your gut on this and don't be afraid to pull the plug.  Hopefully that is a mutual conclusion you reach and if so I would suggest your next step as a mentor is to help your mentee find a better fit with someone else.

As can be seen from my example, mentorship also does not need to be, nor should it be, an exclusive one-on-one scenario.  In fact, it's unrealistic to expect that one mentor will have all the "answers" and there is going to be far more benefit to a mentee in seeking and cultivating a network of mentors.  A mentor must also recognize their own limitations.  As a mentor you won't have all the answers.  That should take some of the pressure off of you to be all and know all.  It's not that you can't still be of assistance to the mentee, but that assistance might now actually come from helping them to connect with others in your network who might be more able to address a particular situation or circumstance. 

Don't be surprised as well by the two-way flow of mentorship.  Without doubt, there is probably going to be more mentoring flowing in one direction than another.  Typically, that also means that the more senior or experienced individual is giving the more junior or inexperienced individual the benefit of their knowledge.  But I've rarely experienced a situation where I haven't also received some mentoring from my supposed mentee.  Each of us has life and career experiences that are relatively unique and can be used to inform and educate others.  In addition, mentees often have a way of posing questions and challenging established conventions that we seasoned professionals no longer have the freshness to see.

I believe a successful mentorship relationship does not have to be an onerous, calendar-driven initiative.  I have started more than a few of my roles as mentor in that way as part of formal mentoring programs - complete and review profiles, have written objectives for the mentoring opportunity, set up regular meetings, and so forth.  However, I've been able to sustain (and build new) relationships on a much more informal basis beyond the initial formal framework.  In fact, that's what I think has made them successful and sustainable.  It still requires commitment which comes in the form of being available when called upon.  And that doesn't mean having a formal meeting in the mentor's office - for me it's been as simple as a phone call, an e-mail or a conversation over a cup of coffee.  In this way I believe I've been able to successfully maintain a number of mentoring relationships - about twelve on the go right now.  The intensity of each mentoring relationship is different.  Some connections happen on a regular basis - every 2 to 4 weeks - while others have become annual events.  But all of mentees still feel comfortable touching base when the need is there.

A good mentor also just doesn't wait for a call or an e-mail from a mentee to become or remain engaged.  Rather, they have developed an understanding of their colleague, their goals and objectives, their strengths, and the areas in which they can benefit from further learning opportunities.  Again, this is because a good mentor is invested in their mentee.  And rather than waiting for that next call, a good mentor is scanning the environment for opportunities that will support the mentee's development.

It really does bring us back to the image of Yoda and Luke Skywalker.  Ultimately Yoda and Luke succeed together in their mutual endeavor.  That success comes from time spent together, undertaking difficult tasks, developing trust in each other, coming to understand that together they could do great things, and a willingness to take that leap of faith and being willing to learn.  There needs to be that same joint commitment in a mentoring relationship, one that not only develops the leadership potential of the mentee but hones the leadership skill of the mentor. 

After all, it is all about leadership.
  ______________________________

Greg Hadubiak, MHSA, FACHE, CEC, PCC
TEC Canada Chair/Executive Coach/Senior Consultant
hadubiak@wmc.ca

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.

Deming's 14 Points Stand the Test of Time

I've been on a personal leadership journey for 25+ years now and I've definitely hit some bumps along the way.  And I have much yet to learn as the journey continues!  That learning comes more from the bumps than it has from successes I've enjoyed - and I've had the privilege of working with a few great teams in my healthcare career.  Those teams have taught me a lot about leadership and basic human values over the years and I owe them a great debt of gratitude.

One of the things that I have come to believe is that you cannot discover leadership lessons if you lack humility, a commitment to ongoing learning, and a sincere willingness to always being open to hearing what others have to say about our leadership capabilities.  An unwillingness to be that open or honest can at best reflect unfortunate naivety and at worst pure arrogance.  We must be prepared as leaders to objectively and critically assess our areas for personal improvement on an ongoing basis. 

Objectivity - and sometimes distance from a leadership experience - is crucial in drawing the right conclusions from our current and past positions.  In addition, if we can have the courage to build relationships with some strong confidantes who will help us assess our experience so much the better.  I recall now with more than a little trepidation my first leadership role at the beginning of my career.  That first role was very challenging to my ego as I learned the on-the-job realities of healthcare.  Most importantly I experienced the key aspect of healthcare management - the experience of working with people and managing relationships.

The first and most immediate lessons I took away from that leadership experience were the wrong ones.  Of course, they were discovered immediately on the heels of leaving the role and were arrived at without benefit of external validation.  At the end of this first role, I truly believed that in order to be as successful as I thought my peers were I would have to adopt a tougher, more unyielding leadership style.  Maybe that's not what my more experienced peers thought they were modeling to me as their leadership style but that's what I initially took away from my formative experience - be tough, demand performance, get respect through fear, be distant from your staff, be above your staff.

I am very grateful that immediately following this experience that I had an opportunity to reflect on my formative experience in the course of my master's degree, including an internship in another healthcare organization.  It gave me time, distance and other people to learn from before I set myself down the wrong path of leadership.  Through my studies and internship - an opportunity to learn from two healthcare organizations implementing total quality management - I became exposed to the work of Dr. W. E. Deming.  I further explored his teachings through my master's thesis on total quality management.  It was eye-opening and his principles really struck a chord with me at the time.  Over the succeeding years I have come back to his basic principles time and again.  I have learned from other leadership guru's as well, but Deming's perspective has continued value for me.  I want to touch on only a few of his 14 Points with the belief that these have much to inspire those in leadership positions - or those looking for good leadership.

Point Seven - Institute Leadership. 

Dr. Deming calls upon management to lead rather than manage.  Simple statement but what does it really mean for us as leaders?  Well I'm pretty confident that if you were to talk to many of our frontline staff and management personnel outside of the executive suite they would provide you with countless examples of where they felt they were being "managed", not "led".  This bias towards "management" is without doubt enhanced by the immense pressure the health system is under to perform and achieve better results.  A typical management response is to exercise greater control and oversight to make sure results get better.  More often than not in these circumstances efforts of this nature only seem to put more barriers in the way of getting good work done - more reports to generate, more signatures to get, more unreasonable timelines to meet, multiple and conflicting demands, and failure to hear and act upon input and recommendations from staff. 

Point Eight - Drive Out Fear.

I've already made my confession in regards to violating this particular principle, at least insofar as thinking that fear might be an effective tool of leadership.  And maybe it can be in the short-term but not if you are trying to create a high-performing organization for the long-term.  With fear in an organization there cannot be open communication, innovation, and teamwork - and these are all required for an organization to achieve the full measure of its potential.  Leadership of any organization - and at all levels of the organization - must actively model open communication, encourage appropriate risk taking and innovation, and promote teamwork from the executive suite through to the front lines of operations.  With fear in place an organization shall continue to squander the full potential of its people and the organization to the detriment of the people it purports to serve.

Point Ten - Eliminate Slogans, Exhortations and Targets for the Workforce.

Everybody needs to measure performance.  Deming did not intend, nor do I suggest, that system performance not be evaluated on an ongoing basis.  Rather, what Point Ten addresses is the notion of trying to assess an individual's performance without reference to understanding of the system in which that individual works.  If an individual is prevented from achieving higher levels of performance by a system (that management has created or allowed to be created) then performance managing an employee, setting new targets for them to achieve, and giving them "motivational" speeches will have little impact on performance.  It is far more likely that such efforts will actually cause frustration, demoralization and reduced performance.  Deming's red bead experiment is a great illustration of this principle - given an equal number of red and white beads, an employee is tasked with collecting only white beads with an employer-provided scoop or paddle.  Inevitably, the employee collects some red beads in their assigned task.  As a result of "failing" in their assigned task, the employee may be given further direction by their supervisor, there may be encouragement to do better, they may be applauded if their red bead count has gone down, or they may be chastised if their red bead count goes up.  Regardless, their individual effort and various interventions at the personal level will have no impact on actual outcome.  It's like expecting employee engagement scores in an organization to go up simply by saying that the target is 10 out of 10 on the next engagement survey.  Only by changing the system and the organizational environment will better, more consistent results be achieved.  I see a strong correlation between Point Ten and the need to Drive Out Fear from an organization as noted earlier.  In fact, I believe that what leaders often create by exhortations to do better is an environment in which results and information are hidden through fear of rather than discovered.  And only by discovery can we improve.

Point Twelve - Remove Barriers to Pride of Workmanship.

In this Point, Deming was referring to unclear expectations, lack of timely feedback (or any feedback), lack of training and support, and systems that focused on short-term results rather than long-term goals.  Staff and front-line managers are often frustrated by multiple tasks or changing priorities (see Point Seven) as leaders change focus or react to external stimuli without, it seems, due regard to long-term objectives or stated core values.  And unfortunately, more than one of us can relate to the fear that the performance evaluation process creates in us - either as provider or receiver of the experience.  Too often this is because we establish the evaluation process as a one-time event, not as a continual process of discussion, engagement and opportunity.  There is a need too to ensure that the evaluation process becomes an opportunity for leaders and staff alike to identify and invest in skills and intellect.  It is also a great opportunity for leaders to model desired behaviours and reinforce common goals.  On this latter point, I firmly believe that there must be a high degree of visibility and sincere engagement with internal audiences on par with leadership visibility and engagement with external audiences.  Without the kind of internal alignment that I believe comes from such effort the ability to deliver on commitments to external audiences and customers stands on shaky ground.

As the title of this blog implies, I will continue to come back to this theme of Leadership over and over again.  Moreover, I will focus on a particular style of Leadership that I think is the right and crucial one for us to achieve our desired goals for a better healthcare system.  We need to invest more in our leaders and place just as great a value in that development and those people as we do in the bricks and mortar of our healthcare system.

______________________________

Greg Hadubiak, MHSA, FACHE, CEC, PCC
Executive Coach/Consultant
BreakPoint Solutions
gregh@breakpoint.solutions
780-250-2543

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.

A new beginning...

So why a blog about leadership?  Or perhaps a better question, why another leadership blog?  What more of value can I add to this subject that hasn't already been said?

There are a few motivations at play as I enter into this hazardous world of blogging.  And hazardous it is!  It takes not a bit of courage and arrogance to put one's opinions and musings out in cyberspace for all to see and evaluate - "Better to remain silent and be thought a fool than to speak and remove all doubt".  My hope is that my perspectives will not be deemed foolish nor arrogant but rather helpful to leaders of all backgrounds and experience levels as they strive to make their mark on our healthcare system.  In that, I hold a few motivations that I trust are held in common with my colleagues at the coal face of Canada's healthcare system.

First, I have been and continue to be motivated to make a real and substantial difference in the lives of my fellow human beings.  In the case of healthcare, I choose to do so in an industry where people are typically at their most vulnerable, dealing with circumstances that at the very least cause them discomfort or in the worst case cause them to face their own mortality.  Second, I believe in my obligation to do my part to advance and support the quality of my profession - in this case healthcare leadership.  I also have a strong commitment and belief in the skills and abilities of our health human resources and that the best means of unleashing that full potential is through effective and empowering leadership.  Finally, and certainly not least, I believe that Canada's healthcare system can advance the quality and efficiency of its operations simultaneously through a commitment to empowerment, continuous learning, and continuous improvement. 

My leadership blog will be very much a personal venture.  It will reflect my growth and development as a healthcare leader over the past 25 years and it will reflect my transition from a senior leadership role to one of management consultant.  The circumstances will continue to change but my core values and motivations will remain steadfast.  The blog will be a bit of everything - and in that way reflect my own continuous learning - with commentary on events of the day; interpretations of leadership articles, journals and books which may or may not be healthcare specific, and experiences gained through my ongoing work.

Ultimately, I hope that the blog will serve to support the work of other leaders.  I hope that it can be a starting point for many conversations with colleagues, friends and future acquaintances as we strive to make a difference for Canada's healthcare system.

______________________________

Greg Hadubiak, MHSA, FACHE, CEC, PCC
Executive Coach/Consultant
BreakPoint Solutions
gregh@breakpoint.solutions
780-250-2543

Helping leaders realize their strengths and enabling organizations to achieve their potential through the application of my leadership experience and coaching skills. I act as a point of leverage for my clients. I AM their Force Multiplier.