Building Healthcare Teams with Values-Driven Leadership

<p>the highest achieving individual doesn't mean they can gel in a way that gets you to the best possible outcome. And you're in a health system. Therefore, you've got to be worried about what are the outcomes for the system, not just the individual practitioners within it. [Music] Hello everyone. This is Cole from the American Journal of Healthcare Strategy joined by a really special guest today. I'm really excited to uh introduce him to all of you.</p> <p>We were looking on LinkedIn and on uh some of the publications that are out there and came across uh Eric McNelte who's really renowned in this leadership space. Uh Eric, can you please introduce yourself? Sure, Cole. Thank you for having me on. So, I'm Eric McNelte.</p> <p>I am the associate director of both the program for negotiation in conflict resolution and healthc care as at the Harvard Thchan School of Public Health as well as the uh associate director of the national preparedness leadership initiative at Harvard. We really appreciate you coming on again. Uh first question I wanted to ask how did you get where you are now?</p> <p>what what was the path that took you to being this kind of leadership expert and somebody who's an expert in leading in this adverse environment?</p> <p>That would take a long time to tell you the full story, but let let us just say that over my career, I've worked in in many different organizations and in several different industries and I found uh I worked in some places that were great and some bosses who were amazing and some organizations who were pretty terrible and some bosses who were worse than that.</p> <p>uh and so I really wanted to bring more humanity and and I believe leadership is great in the conditions under which people can can give their best. I wanted to do that and it was my work uh coming out of corporate communications into Harvard that I got to meet some of the most renowned leadership experts in the world. This was my introduction to the whole government. Ah here's a way to do this. Let's study this.</p> <p>Let's try to propagate what works and what doesn't and really uh get people so that they are uh oriented toward again creating the conditions where the people who work for and around them can absolutely contribute their best. That is wonderful and that's what we need right now in healthcare, right? We're seeing a lot of challenges in healthcare whether it's due to the kind of administration just changing at such a rapid pace with things.</p> <p>Uh there's also kind of the economic difficulties that have been building for many and many years. So healthcare has a lot of problems. Why? How did you get involved in healthcare as well? How did that come about where you started to get involved in that healthc care leadership? Well, I did my role at Harvard evolved such that I was uh began working for two people who I hired as speakers.</p> <p>I was running a conference business and uh their expertise was negotiation and conflict resolution specifically within the healthc care space. So that was my introduction to it from that side. I mean I've been a you know the other side I've been a patient I've been a care coordinator for my parents as they did their final aging.</p> <p>So I've seen the assistant from that side and then was introduced to her from the from sort of the the both the clinical because one of my colleagues was a uh ac orthopedic surgeon as well as the administrative side and I have to say you know there is no business more complex. Um like you say the business models are evolving quickly as the uh courses of treatment are evolving quickly. The patient population is changing.</p> <p>Uh somehow people think everyone makes a lot of money but no one seems to make a lot of money. It just it's a system that is put together by lots of components that where the incentives aren't necessarily aligned nor are there necessarily smooth handoffs from one part of the system to the other.</p> <p>So, it's a it's a area ripe for a greater understanding and uh application of of leadership with all the speaking that you're doing and all the individuals you're acting with whether it's at at Harvard and MGH or or in other areas. What what's the biggest challenge that you're really or some of the biggest challenges that you're really seeing? So, I think you know I do I teach a course every uh an exec course every spring called uh healthc care uh healthcare leadership for emerging executives.</p> <p>That's where I get a room full of people who are actually in the health care system and some clinicians, some administrators, some have a combination of roles. And the things that they they talk about one are one is that the the traditional approaches of we can spend our way out of this or we can hire our way out of this um aren't working anymore.</p> <p>uh and it really is trying to keep up with how do we meet the needs of a very diverse population with a lot of as people age uh more compounding conditions and challenges in terms of caring for them when we've got a nursing shortage when we've got a shortage of PCPs and on the business side where again things just get more and more complex of how how do you actually make any money things that may you know we had good margins five years ago now are maybe break even or money losers and you have to figure out what's the next place we can make some money where they're always trying to sort of compensate from one one side of the house to the other of because the services you have to provide where you're not going to make a lot of money or you're actually going to lose money.</p> <p>Uh but that's part of the business and and getting that whole thing right and while doing that creating a an environment where people want to work or patients want to show up uh where good things are happening and it's a uh it's a very multiaceted challenge and I I've seen that a lot. I was just talking with Dr.</p> <p>Myers from John's Hopkins and he's he studies healthcare leadership as well and what he was saying is very similar pretty much identical to what you said is that you know one of the examples he gave was robotics right that we're trying to do like robotics now to really get those efficiencies but when you implement them sometimes you're only seeing a couple percent whereas when you implement leadership initiatives sometimes you're seeing 20% 15% enhancement in uh you know turnaround time h how I guess do we navigate one of the other issues and I'll bring this one because I didn't discuss this with Dr.</p> <p>Myers, but it's this staffing shortage, this leadership shortage as well where we can't get people in the door fast enough, but we also don't have the leaders really ready to uh to manage them as well, right? There's is it's a struggle all across the board. What are some of the solutions to that area?</p> <p>So I think I'll think the second half of that question first which is one thing I think we are are beginning to realize is that you can't just put people in leadership positions because they are the best surgeon or the most senior nurse or whatever that happens to be. I mean that technical expertise is essential. Uh but it doesn't necessily get you there in terms of being able to work with people to to manage them to motivate them to understand what's going on in the field.</p> <p>I just read a a piece over the weekend that suggested this is broad of in healthcare but I think in healthcare particularly true managers spend up to 25% of their time resolving conflict because there's so much friction in the workplace and so you know I think we've got to look at that that's where we got to orient people toward this is not look beyond your silo look broad more broadly at the entire system at the entire patient experience how do we take some of the friction out of that and find way to work better together across our various organizational boundaries which you can pick up efficiencies in the system.</p> <p>You could certainly make it easier and better for for patients and also people working in the system. But one of the sources of the workforce shortage right now is that people are just frustrated, right? It's it's wall work. It's hard work. You have to do it in person for the most part. The hours aren't always great. Um and if it's not going to be pleasant and you don't feel like you're helping people get healthier, the motivations just go away.</p> <p>So I think that we can we can look at how do we structure the organization in ways that we are we're focused on those that's of true north of uh quality outcomes you know patient safety and patient experience is where I would go in a way that makes it better for everybody in the system and then you'll get people this will be a choice uh to to come do this job as opposed to trying to find something else to do where they can make equal to equal or better money right because when your employees are empowered to actually do their job and they are actually able to do their job, right?</p> <p>So, it makes sense. But but still, that that thing you mentioned about, you know, just because somebody's the best surgeon or because they know, you know, all the CPHQ standards or whatever it is does not mean that they're ready to be a leader.</p> <p>One of the examples of this um there's a a great law firm here in Philly and for the first time they appointed a non- lawyer to be the CEO of the law firm and that's that's very rare at least here it is in Philly and he did an amazing job and it's because he was really uh he had spent a lot of time learning how to lead lawyers like that was what he really wanted to do uh and so he was a great leader but in medicine we really still struggle with that right like we we don't you know clinical teams have their leaders administrative teams have usually administrative leaders the two don't talk to each other and then you're also struggling with this issue where because we're in this staffing shortage, people are going from being entry level to very quickly having to manage people and then they're falling short of the leadership skills.</p> <p>So, how do you find people or get your organization primed to have that real people leadership that's needed? Well, I think that one of the ways you can do this is to um first of all, you can begin to screen for this as you're hiring people. Look at people who seem to have good people skills. Um talk to them, ask them about your experience on their team. Why do they what what's their what where they get satisfaction at work?</p> <p>Uh you know, some people will say, "Well, I just want to, you know, do the the best thoracic surgery I I can possibly do." And that's where they get their satisfaction out of that piece. Well, they may be great at that and want them doing that. you may not be the one having him also be the one who leads people. Um, so I think it's, you know, looking for some of that.</p> <p>You know, the old thing at, uh, Southwest Airlines went to public time, every job interview you were asked to tell a joke because their friendly service was was their hallmark, right? And they wanted to get people who really were comfortable with people and that was part of how they did it. Their way to to bring people like that, Ian. Um, I think we also have to get a greater appreciation. This is hard. This is a major cultural shift across medicine and healthcare.</p> <p>Uh because what did we always pride be a prized technical expertise and you compete to get into a pre-med program, you compete to get into medical or nursing school, you compete to get residency, you compete, you're always competing with each other and usually at competing as individuals and we're really seeing yourself now as part of a care team. We do it in name more than we do it in practice. Uh seeing the interdependencies and and yes, we we still want people who have those excellent skills.</p> <p>They have to have that in order to get good outcomes. and you've got to be able to do uh to do that while being cooperative and working with people. You know, one of my favorite stories, and pardon me, it's be it's going to offend you as a a Philadelphia person, but the 2004 Red Sox when they won the World Series. Um that was a team that was known as a team that loved each other. They got along. They had fun together. They, you know, the old story in Boston was always 25 players, 25 packs.</p> <p>the end of the game, everybody went their separate ways. These guys hung out afterwards. Some of them were real superstars. Some of them were just kind of reasonably good players, but together they made a great team and they broke the, you know, the curse of the Vanino. Few years later, we had a team that was on paper looked like it was unstoppable. We wound up in last place. Wow. Yeah.</p> <p>And so, you know, just because you have all the all the the highest achieving individual doesn't mean they can gel in a way that gets you to the best possible outcome. And you're in a health system. Therefore, you've got to be worried about what are the outcomes for the system, not just the individual practitioners within it.</p> <p>So, as senior leaders, when you when you're in a situation like this where you have people who are on paper as very good leaders, um, which, you know, I've seen a lot, right? Everyone is like you're saying, they're very accomplished because they've had to compete throughout. I mean, so it's not like we're dealing with people who, you know, are are have never worked in healthcare before, who have never managed before, right? These are So, so what do you do in that situation where there's disarray?</p> <p>Maybe your press gaining scores are looking really bad for your your kind of your internal customers. You're having a hard time getting nurses in the door. You're in this situation that's really frustrating. And I think one of the solutions I'll say that we don't want to do, I know, is we don't want to say once this crisis is over then we'll fix our leadership because that won't work. So what do we do? Yeah.</p> <p>So I think you start you start looking for ways to to improve those skills, you know, on the job or as close to it as you can. So, it's this doesn't have to be as of stop everything, let's go learn some stuff and then come back because you can't close the hospital. You can't send everybody away. Um, those people who you can, you know, I teach executive education courses. I would love health systems to send me some more folks. We'll do our best with them.</p> <p>Uh, get people some one-on-one coaching can often help and don't do it as a penalty. Uh, but, you know, every, again, every great sports person has a coach. every you know you know typically great public speakers have coaches have a coach to help people understand what those skills are. Um but then again this the the senior executives who I've seen do this well um first of all they they point that true worth that is us together.</p> <p>So be it around patient quality uh patient outcomes and patient safety for example that's something that can only be achieved together and pointing out the interdependence in the system and that you're realizing that the custodian has a role to play in patient outcomes right that the lowest the lowest paid technician has a role in that as well and getting people to see that this is our our shared goal and we only get there together and at a senior level you've always be talking that and demonstrating that you want people to actually come together.</p> <p>Uh you if people are not going to play well sometimes you actually have to move them out of the way which is not always good but again you're looking at the overall ability of the system to deliver what you need to deliver it. Sometimes that doesn't mean like the bread socks have wound up in last place that you just by putting all the allstars together you get you get there.</p> <p>Um so I think you really got to be able to see that and then again I think you start developing people as leaders much earlier in their career. We tend to think of it now as well, you're either in or about to be in a leadership role. Now, we're going to see about us in leadership development. I would do it much much earlier. You can do that through discussion groups around books or podcasts.</p> <p>Um there's lots of ways to do it that don't cost a lot of money, don't take a ton of time, but you but people uh feel like you're developing them. That's one of the ways to retain talent. I was talking to a young person uh not long ago uh just in her early 20s and she calls up her phone and said, "You know, this thing in my in my pocket, it's updating itself every single day.</p> <p>If I'm not updating my skills constantly, I feel like I'm falling behind." And so we again had this idea, well, once you've been with us for six or seven years, then we're going to start developing. We know you're going to stick. um or we'll send you to you know a oneoff or two off kind of experience and expect you to do the rest.</p> <p>You know, look for the ways you can be developing people every day and make that part of, you know, making the more senior people are are charged with mentoring those who are younger than them. And again, there's lots of way when you're creative about it, you can find it don't cost a ton of money, don't take a lot of time, you can begin to get it going and then you'll see who you really want to invest in that's with the pension.</p> <p>So with the seauite we can that that needs to be the people who are leading the way in terms of setting the mission the true north possibly getting that co that that coaching or even spending a week at you know I know um here at Wharton of course but also at Harvard Business School great executive programs for healthcare leaders and so I like that you're saying it needs to trickle down so everybody needs to kind of mentor the next person here's the question I have and it goes back to this leading through disruption idea you know I know that if we were to bring this up to charge nurses at a lot of our busy, you know, hospitals, they're going to say, "I do not have five minutes to discuss the podcasts or things like that, right?" What What do you do in those situations where your staff is just too busy to even take a minute, you know, five, 10 minutes to discuss these kinds of things?</p> <p>So, I I would flip the question around and say if your staff is so busy that they can't be doing some self-development or peer-to-peer development, they're probably degrading in their skills. They're probably degrading in their commitment and their morale uh and their ability to actually get you get you to where you want to go.</p> <p>Uh I mean, there's the old joke where the the CFO says, "Well, what if we develop these people and they leave?" And the C the smart CEO said, "Well, what if we don't develop them and they stay?" Um Thank you. That's really I like that a lot. Yeah. And um and I also think that we do a lot of things that are but they seem microefficient but they're macro inefficient with we lose some of our our of our time where we get into conflict between departments and different parts of the organization.</p> <p>Uh somebody pointed this out the other day I was listening to was email message is very efficient in and of itself.</p> <p>uh right there's no you type a few couple lines I hit a button it goes off to you you're several hundred miles away and you instantly get it to respond well how much time do we spend on email every day that is monous we're deleting things we didn't wish we had we're CCed on things we really don't need to read so overall email actually is a fairly inefficient part of the of the larger system even though each piece of it and you go into our EMRs and some of our our processes and protocols there were things that were designed that look efficient but that actually cause a lot of friction and inefficiency And if we I would involve the people who are doing the work and saying let's let's take a a breath how can we design this so your life is easier right we still get to the good outcomes is the people who are doing the work they know where the problems are they know the form that's not designed well or the process that actually is fairly meaningless but they have to go through it for one reason or another and they often aren't empowered to speak or they don't know to whom to speak but sit down and involve them in designing the process and they will figure it a a charge nurse being that busy.</p> <p>He or she's not having any fun anyway, right? This is not a pleasant way to come in. Uh, and this is part of why people are leaving healthcare. They just completely overworked and there's no there's no bottom to the pile. It just keeps coming. And so, I would involve them.</p> <p>And I I think you'd be surprised at what you can find out in ways that you will uh you'll create those little pockets where you can begin to do some development and things get better and then people think, "Oh, they're investing in me. This is great. I feel better." And so on. It's a you hit that flywheel of continual improvement. Yeah, I appreciate that quote too. That's a great quote.</p> <p>And when you think about that continual improvement, where should it lie within an executive's priority at the seuite level or at the SVPVP level in terms of the room for their staff to develop? Should that be the number one priority, number two priority, you know, looking ahead to 2025? What should it where should it be at? This will be a bit self- serving, but I I think it should be a number one priority because I think it it underlies your ability to achieve so much else.</p> <p>Uh again, whether you're looking at quality outcomes or financial performance or utilization rates, whatever it is, you know, the way you're going to get there is by having your people uh engaged, contributing, and feeling like they're making a difference. And that and that's what's going to that's what's going to get you over over that finish line.</p> <p>Uh again I was talking to a C CEO recently um not in healthcare and financial services but you know he said he is a CEO and he charges every one of his uh sees counterparts is they need to have 50 50 to 60% of their direct reports as he has with his who could credibly take their jobs. He that's the only way we're a resilient management team and executive team is if we have 50 to 60% of everybody who reports up could take our jobs.</p> <p>And that means you've got to develop it if you want those people to get be ready for that. And uh but that's how you again crisis to crisis which is the world we live in as a permanent ali crisis these days.</p> <p>The only way you're going to get through it and be stronger longer is to make sure you've got a lot of talent around you and talent you're continually nurturing because you never know when you're going to need them to step up and do something new or do something different and you ready to be able to do it. Why don't you think that that is very common, right?</p> <p>because it seems like that's actually like quite uncommon when we talk to people like they they almost I mean there's been a lot of stories of course maybe some are disgruntled and I'm sure some are not that say my manager doesn't want to train me because they're afraid I'm going to take their job you know I haven't personally experienced that my boss wants me to take on as much as I can so I can learn so I can eventually take his job but I have heard from others that that's not the case why is that part part of it is that people feel threatened and again if you're in that environment okay if I've somebody who's too strong below me.</p> <p>Well, I'm a little bit older. I cost a little bit more money there. Then you get rid of me and bring up the younger person and and maybe do save some money. So, they can't jail threatened. So, I think you've got to build a culture where that is seen as a strength, not as a weakness to have those strong people around you. Um, and I think you've also got to have a a strategy and a long-term plan where the the the system is going to be growing so there's more opportunity for people.</p> <p>Um, and so that's, you know, you want to have that and and be known within the or being known within the organization of the net exporter of talent is a good thing. People will want to do it. I think what happens is we get so focused on expenses andor making it hard to replace people that you're afraid that someone's going to go. I' I've led teams where uh oh, whether someone quits or gets promoted or whatever it is, you have to go back and rejustify the FTE.</p> <p>You have to go through a whole big process. You lose productivity for weeks on end. So you want to just keep people happy as happy as you can and in place where they are and try and have nothing change and that's really a long-term a recipe for disaster. U so I think it is it's a shift of mindset and it is again if people will just take a breath. One of the things again I say at our accepted uh courses is that you've been given a gift.</p> <p>You've got whether it's two days or a week or whatever it happens to be to step back and actually think about things. Think about what's going to get you the strongest health system over time. You've got to have good people. You've got to have people you're you're going to be attracting the best talent in the marketplace. You're going to be attracting the patients who want to come be treating where you are.</p> <p>Uh you want your the the vendors and suppliers to be saying, "Hey, I'm going to take care of them first." So, how do you build that kind of system? And again, I think it's more of reframing and creativity and thinking than it is hard obstacles of, oh, we really, we actually can't do it this way or we, you know, we can't do that. It's a matter of deciding you're going to find a way to do it and then you usually will.</p> <p>That's really important advice even for me because, you know, at the journal we really try to give people a lot of opportunities to learn. One of the struggles I faced with that though, so and this is kind of the last question. So, let's say those listening are are on board with you, right? And I I love the advice. It's excellent. We're ready to take the reigns of this.</p> <p>We're ready to start really moving towards this kind of continuous process improvement which really also means continuous change. Um and one of the issues with that is that makes some employees uh team members feel uneasy that makes them have more stress.</p> <p>So when we're talking about introducing leadership initiatives, introducing training initiatives, a lot of these things, is there any messaging advice or communication advice you have for the seauite to maybe not create anxiety or disarray while also moving the organization in the right direction regarding leadership?</p> <p>Well, I think it's pretty obvious now again between the the changes in policy at the federal level to the the uh developments in AI, everywhere you look, things are changing around us. Uh if you're in a healthcare system, um and so if we're not changing, we're becoming less relevant. So to set the expectation that we are always going to be changing, we're always going to try and do it in a way that is thoughtful and careful and takes care of as many people as we can.</p> <p>Um and so get people ready for that. about it. I think again if you if they know you're going to be true to your values, your core principles, that gives them certainty to hold on to, okay? You know, I'm I'm on for the ride. It may be a bit bumpy here and there, but again, if you're always trying to be thoughtful about it and it's not just done uh for pure efficiency or not just done through the bottom line all the time.</p> <p>I mean, everyone has to realize there's financial viability concerns in any health system, but we're doing this in a way that we're again when you could say we're trying to take care of patients. We want to make sure we know you as staff are essential to being able to take care of patients. We're going to take care of you and together we're going to figure out a way to give us keep us financially viable. That gives people something to hold on to.</p> <p>And then I would start again a very simple, this is not my original idea at all, but a very simple exercise is just start asking people, give me one thing you think we should start doing differently, one thing we should never change that works really well, and one thing we should just stop doing that's stupid.</p> <p>And you can't change all of those at once, but you'll begin to surface some things that are in a system that you're probably overlooking if you're at a very senior level that actually you're making making lives harder and making things more difficult. So, you'll find opportunity there. That's so important. Thank you so much, Eric. And I that true north is probably the biggest thing to take away from this discussion.</p> <p>Even when you and me had met privately, you know, a couple weeks back to prepare it. I I've been using that in my discussions because in every kind of meeting, in every situation, if you have that true north or those core principles at the very front, all the arguments seem to kind of just go away or at least a lot of the the sillier arguments seem to go away. Yeah.</p> <p>If you really actually live into those values and principles and people say this is where we're going, it's we care about, then you're not arguing about those things. you just argue that h how do we do a better job of getting there? And that's usually more a productive argument rather than a destructive one. Yeah. And that's that's beautiful for healthcare because that's what the patients want as well. They don't want us talking about extra, you know, nonsensical things.</p> <p>So, thank you for coming on, Eric. This has been a great conversation. I'm going to of course link people so they know where to find you and your work. Uh but I really appreciate your time. My pleasure. Thank you so much. And to all of your listeners, you're doing great work. Get out there and do some more of it. So, thank you very much.</p>