SHELDR 2020-#1: Executive Time Out?  Yes, Three Skills Need Improvement
STRATEGIC HEALTH LEADERSHIP (SHELDR) THOUGHT LEADERSHIP SERIES

SHELDR 2020-#1: Executive Time Out? Yes, Three Skills Need Improvement STRATEGIC HEALTH LEADERSHIP (SHELDR) THOUGHT LEADERSHIP SERIES

 Introduction - The essence of “executive time out” and the Three Skills You Need

 Note: Hyperlinks provide additional resource materials

Making decisions is hard. That is why critical thinking is imperative. However, too many strategic health leaders (SHELDR) accept the first solution proposed, jump to conclusions, or allow dysfunctional teams to flourish. Few rarely call “executive time out.” Fewer discuss the need to improve their critical thinking.

To guard against these mistakes, SHELDRs can hone your critical thinking skills. First, question your assumptions, especially when the stakes are high. Go ahead, get outside your comfort zone. If you are coming up with a strategic action plan, ask: Is this the best alternative? What do the analytics e research say about our expectations for the future of the market? What are the opposing views? Second, poke at the reasoning and logic. When evaluating options, consider the evidence and logic. Does it support a sound conclusion? Do data support the thesis? Are you uncomfortable with divergent thinking?  Third, seek out fresh perspectives. Actively listen to others by asking questions. Relying on your inner circle could be your downfall. That’s the essence of “executive time out.”

 Do You Know These Leaders?

With more than 30 years of experience and observation (and good note-taking if you know me), including my research on strategic health leadership (SHELDR), I’ve helped struggling organizations, departments, and functional areas succeed at thinking through tough issues. In my experience, these leaders share a root cause: lack of critical thinking. Many leaders turn a blind eye to trends or do not reason through pressing issues. Take the time to evaluate a topic from all perspectives, assess future moves, and opportunities.

A few years ago, a rural Health System-X CEO assured a group of graduate students and myself their organization was "THE" three-county health market leader. During the tour, he noted with great pride, “Patients will not leave our system for others. Look at the number of new facilities we’ve built, partnerships established with local group medical practices, and a steady stream of referrals." Now, Health System-Y, a competitor, has penetrated the market by doing the same things; however, they've also acknowledged the need for more primary care, telehealth, and improved coordination of care with social services. They've built a new group practice across the street from a new Health System-X group practice. I affectionately refer to it as the “medical gas station wars” and use it as a case study for obvious reasons. Health System-Y did their homework by engaging in critical thinking. They confirmed the need to increase primary care and mental health services with data analysis from sources such as the County Health Rankings and have publicly acknowledged the need to leverage the social determinants of health for mutual community, individual and organization benefit. Health system-Y was also exploring the use of telehealth services, supporting homelessness initiatives, and aligning themselves with county-level health coalitions.

Leaders often jump to the first conclusion or kill good ideas on arrival, regardless of the evidence. For example, I love to challenge some of my colleagues about integrating drones into their supply chain as a means to reach rural patients. Most roll their eyes or give me a non-verbal pat on the back "… that nice, Doug, thanks, but I have better things to do …” Worse, many senior health leaders choose evidence to support their prior beliefs, have unwittingly trained subordinates not to have not prepared themselves to be better strategic thinkers. The good news is, critical thinking can be learned through habit. Based on my personal experience, observations, and research, I’ve pulled together four actions you can take to improve your critical thinking skills:

1.     Question Assumptions - As Easy As Setting Up A New Drug Sample Display With Free Donuts

2.     Seek Understanding with Reason and Logic – “Doug, we don’t close SW hospitals.”

3.     Insist on Diversity and Inclusion-Its Hard Being the Only Male in the Group

 I know, you’re rolling your eyes, “I do that already.” You probably do, but maybe not as often, deliberately and thoroughly as you could. Remember, it’s about CQI and Adaptive Leadership! Lead by example! That includes you too. Developing these habits will go a long way in helping you and your organization become more competitive.

Question Assumptions - As Easy as Setting up A New Drug Sample Display with Free Donuts

When I work clients, I’ll start by questioning assumptions and subtlety challenging their status quo. For example, when I worked with a large pharmaceutical company (Pharma-A) who wanted to do business with the Veterans Affairs (VA) to offer their FDA approved Digital Therapy-X APP to help substance abuse (SUD) patients sustain recovery as part of their 12-week cognitive therapy program (CBT). I soon discovered the client presumed the VA would willingly adopt their product since the VA had such a large number of SUD patients, had plenty of funding due to the passage of VA MISSION Act, and everyone was into digital health as if selling the APP was as easy as setting up a new drug sample display with free donuts.

Once a set of stakeholders, acquisition processes, and budget timelines were explained to Pharma-A senior leader’s erroneous beliefs wilted. They moved on. Had Pharma-A sought to question their assumptions, they would have made better assumptions about their efforts. Yes, it's hard to question everything. You do some level of "what if'n" and creating mental scenarios. The first step is figuring out when to question assumptions or challenge the status quo. A questioning approach or leading with questions is particularly helpful when the stakes are high, and the premises need to be examined.

So, if you are in a discussion about long-term strategy such as doing business with a large government agency or expanding primary care in rural region of your ask fundamental questions about your own beliefs: How do you know the VA will welcome your product? Am I saturating the market, or are there still shortages of primary care? What does the research or data say? Have you taken time to ask local VA providers on their propensity to adopt an APP or critical stakeholders in the local area on the shortages of primary care services?  A way to question your assumptions is to consider mental scenarios such as would the VA’s research community be willing to listen to the evidence of using the APP to increase recovery rates? What if we focused more on telehealth than bricks and mortar facilities to improve outreach to rural patients since many don’t have reliable transportation? Asking the right questions will help you gain valuable perspectives and insights. Here are three skills:

Seek Understanding with Reason and Logic – “Doug, we don’t close SW hospitals ….”

Honing your thinking by seeking first to understand will help others succeed. As COO at Military Treatment Facility-A (MTF-A) in the late 1990s, I received a call from the regional headquarters-SW (RHQ-SW)) senior health administrator-SW. I will never forget his opening comments, “Doug, we don’t close SW hospitals ….” The conversation did not go well. He heard we were planning to propose closing the new ER (opened six months earlier after three-year process), outsource OB/GYN services to approved network providers, and proposed becoming an ambulatory surgical center (ASC) (interesting how we had more nurses than patients on each shift) as part of a “healthcare is process not a place” concept. Despite corporate headquarter guidance on “Out and In” sourcing opportunities, projected personnel cuts, and growth of the local healthcare network and our bulletproof analysis, the answer was an empathic “NO.”

While I could not grasp for the correct critical thinking terms then, now, I would say senior health administrator-SW suffered from over-generalization and emotion and making sweeping conclusions based on limited evidence. Active listening for what mattered for patients and cost-effectiveness regarding another perspective would have sufficed. He believed in the “preserve and protect my place” mentality. It served him well throughout his career. It was out of touch with the new realities. He was convinced significant stakeholders (i.e., installation commanders) would not buy-in. In both cases, he was wrong, dead wrong. He was a victim of his success. He did not have the complete story. For example, the installation leadership bought into the idea so long as flight line emergency support and aviation medicine stayed intact. Nailed it. We had already coordinated with local hospitals to accept OB/GYN workload. We hosted three focus group sessions, local family support, and spouse groups on the opportunity to continue prenatal care and deliver their baby at a hospital closer to their home. The ER did present a dilemma. Unfortunately, after the ER opened, three patients died after passing three local ERs on the way to MTF-A in deference to recapturing workload. While the ER was new, it was not the right level and scope of care required, given the robustness of the network. The “preserve and protect my place” thinking became a crucial and ongoing conversation later. 

Improved logic and reasoning helped MTF-A finally win their case. Formal training on logic dates back to Aristotle. Logic, coupled with facts, has demonstrated its merit by assisting others in reaching sound conclusions and overcoming politics, emotion, and personal biases. Analyses based on guidance, resource constraints, and reliable analytics were our first line of defense: logic, not emotion, over-generalization, and making sweeping conclusions based on limited evidence. Regardless of what level you work on, ask yourself: Do facts support the argument? Does all evidence build on each other to produce sound conclusions? What’s missing? Am I too emotional? Being more aware of common fallacies will help SHLEDRs think more logically. For example, senior health administrator-SW engaged in what’s known as “post hoc” thinking. In this fallacy, the senior health administrator-SW believed leaders in the field are not battle-tested, naïve, or do their homework. However, until their reasoning or logic is questioned, there’s no way senior health administrator-SW can know if his belief is correct or how many opportunities have been passed up as a result. It's easier just to say, “NO.” It’s also easier to accept “NO” rather than move forward with ideas, logic, and reasoning when the stakes are high and visible.

 

Insist on Diversity and Inclusion-– Its Hard Being the Only Male in the Group

 

I’m the only male on a WV Health and Human Services Collaborative Steering committee of seven. It’s weird. While I work in many capacities these days, the feelings and observations I take away from this committee are revealing. By virtue of my background, experiences, and gender, I tend to see things differently from the other members. The potential for dysfunctionality as a team is high. My opinion, of course. Yet, I question my value to a group. I’ve wondered why I was even there. Now, I play it to my advantage. Since I’m new, I’m not immune to groupthink either. That’s the point.

 

I’ve learned (and taught), it's natural for people to group themselves with people who think or act like them—gender, age, politics, meeting routine, culture, and slow curve topics. This new experience has given me a whole new perspective on the need for diversity and inclusion. The experience has taught me what it’s like to be a minority. Or, it taught me to overcome some of my own self-limiting beliefs and be resilient concerning setbacks—emotional intelligence.  Since I’m new, I’m not immune to groupthink either; therefore, I can bring diversity of thought to the group and slowly build trust and confidence in my comments and ideas. If everyone in the committee thinks the same (and they do), we become more rigid in our thinking, and less likely to change beliefs based on new information. I vow to overcome the lack of passion and purpose as a member of the group nor wallow in self-pity.

 

As aspiring or current SHELDRs, it’s crucial to get outside your personal thought bubble. Start small. Start with yourself. Make it a habit, as explained in The Power of Habit: Why We Do What We Do in Life and Business. If you work in administration, make friends with nurses and clinicians. Change your habit to one of asking questions and catching the triggers leading to self-limiting beliefs. Doing so helps you question your logic and placing yourself in uncomfortable situations will make you a better leader. Conduct listening tours or rounding, but do them with a purpose by asking the right questions and connect the dots later. Training yourself will help you escape your usual thinking and gain insights. As I have learned in this committee, ensuring everyone has the chance to give their opinions independently helps leaders come out of the comfort zones and builds team cohesion. This tactic prevents team members from engaging in groupthink, reinforces diversity and inclusion, and helps them grow as a team member.

 

Summary

 

Maybe, just maybe, it’s time to call “executive time out” or your own time out. These critical thinking skills may sound easy or obvious. The research supports they’re rare in practice, particularly in complicated healthcare settings. They have long term effects on the individual and organizations. Actively listening bridges these gaps. Too many organizations don’t call “executive time out” to engage in critical thinking or ask themselves, are we designed to adapt or create the right habits for critical thinking? The important work of critical thinking will pay off. While luck plays a role, the most significant victories are achieved through thinking smarter by challenging others and yourself.

 

Don't blindly accept the first solution proposed or be wowed by glitzy powerpoint slides. If you do, maybe its time for an "executive time-out." Ask the tough love questions. Don’t jump to conclusions on crucial plans. Do your homework and listen to reasoning and logic, then, connect the dots before you launch on a subordinate or leader in the field. Actively listen by ending with questions. Don’t allow dysfunctional teams to flourish. Infuse diversity, inclusion, and alternative perspectives, even if you’re the lone voice or gender in a group. Your organization’s future and reputation could be at stake. And to all my colleagues, have you heard about smart toilets of the future that could protect your health? Smile. Happy New Year!

About the Author: Douglas “DrQD” Anderson, DHA, MSS, MBA, FACHE is a healthcare consultant, adjunct professor, strategist, executive coach and group facilitator. He is coauthor of Health Systems Thinking: A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. Follow him on Twitter: @Doug_Anderson57 and his Strategic Health Leadership (SHELDR) E-Zine.  Contact him at douglas.e.anderson57@gmail.com.

 

Disclosure and Disclaimer:  Douglas E. Anderson have no relevant financial relationships with commercial interests to disclose. The author’s opinions are his own and do not represent an official position of any organization including those he consulted. Any publications, commercial products or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request. Not responsible for broken or outdated links, however, report broken links to douglas.e.anderson57@gmail.com

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