The cost low quality of our fragmented approach will never get resolved if healthcare stays a political bouncing ball focused primarily on how people pay for healthcare services. It’s not the method of payment that matters nearly as much as where does the money go in terms of ensuring high quality low cost care through the system from “cradle to grave.” At some point, the people of the US will demand it.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Mark Samuel. Mark is the Founder & CEO of IMPAQ, a sought out speaker and an award winning / bestselling author. For the past 30 years, Mark has guided organizations around the globe to higher levels of long-term, sustainable success. He is frequently called upon by companies and organizations in health care, higher education & industry to address leaders in solving the challenges of culture change, performance improvement, leadership development and effectively managed teamwork. Mark has inspired positive, profitable, sustainable improvement in companies worldwide, including American Express, Genentech, Baxter Pharmaceuticals, Nissan, Universal Studios, Pacific Bell, UC-Berkeley and many others.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I was a student at the University of California, Irvine in a class on Organizational Development — my focus of study. My professor had Peter Drucker come to speak with our class. During his talk with us, he mentioned that Health Care was the most complicated industry because it represented many diverse businesses — housekeeping, food service, labs, engineering, plant operations, pharmacy and many more “stand alone” businesses under one roof. The complexity is enormous and that was when the industry was much simpler without EMR, an aging population, or the Affordable Care Act.
Can you share the most interesting story that happened to you since you began leading your company?
Being in business as long as I have, there are so many interesting stories! I’ve been talking about the Middle Management Miracle for decades. This involves breaking down the silos at the middle management level to develop them as a unified problem solving and decision making team. This is a strategy we still use to achieve rapid breakthrough results positively impacting the culture, patient experience, and profitability at the same time.
Recently, one CEO of a standalone medical center, called me into his office and asked the following question…wait for it…”What if we restructure our organization so that the upper middle managers for a standalone team where VP’s on our Executive Team have NO Direct Reports?” Needless to say, I was stunned.
I responded very hesitantly, “Theoretically, it could work, but it’s never been done before.”
“Great, then we will be the first, and you will lead it based on your model.” I gulped and said okay.
We structured both teams based on Individual and Shared Accountability, where the Middle Managers reported to the Executive Team for their results, and the Middle Managers were required to hold each other accountable for performance and the results of the medical center.
For the next decade, they became a benchmark for Patient Satisfaction, lowest hospital stays, a 5-star energy rating by the US Federal Government, becoming ISO certified and having one of the highest levels of employee satisfaction and retention.
The CEO not only traveled the US giving keynote presentations on his Medical Center’s culture and performance, but they created an additional revenue stream by hosting others from the US and Internationally for a day walking through the medical center and discussing how they developed such a high performing and patient centered medical center.
Can you tell our readers a bit about why you are an authority in the healthcare field?
My consulting business has been focused on the Healthcare industry for over 35 years. I have worked with every department (administrative, clinical, and ancillary), outpatient clinics, surgery centers, mental health hospitals to build teams, develop leaders, restructure organizations, and facilitate the implementation of major change.
In addition, I have worked with the medical systems in Canada, the United Kingdom, the Netherlands, and Columbia to create transformational change based on the high and rising costs associated with healthcare. This includes new service delivery models not yet used in the US like District Nursing that combines home healthcare and mental illness.
What makes your company stand out? Can you share a story?
Our approach to working with medical centers is to transform their culture and business at the same time within 6 to 12 months with measurable results. Our approach focuses on creating a new reality rather than only fixing the old one, and changing Leadership Habits of Collective Execution, the key competency for business results and culture.
A rural medical center called me 4 years ago. They had been focusing on managing to metrics, but they were threatened by 2 of 3 years operating in the red and six months in the current year in the red with a projection of being in the red by the end of the year. Even with their focus on key metrics, they were still trending downward with over 25 travel nurses, missing reimbursements based on low scores, and having to choose whether to stay in business as a full service medical center for their community or have to sell to a large medical system that would reduce the care to the community.
We started with the Senior Leadership Team to make a commitment to sell or stay in business and do whatever it takes to keep the doors open. They all agreed that the care they provided to the community was too important to sell. We agreed on their 8 Breakthrough Priorities and established new Leadership Habits to optimize their execution as a Senior Leadership Team. Then, we brought together about 50 Directors representing each functional and clinical area to build them as a Unified and Aligned Operational Leadership Team to breakdown silo thinking and behavior, and optimize cross-functional support and accountability.
The focus for all leaders on both teams turned from primarily focusing on metrics to “collective execution” — the teamwork between functional areas to optimize results.
By the end of the year, the medical center was profitable. Key metrics were trending up even though the focus was on execution. Employee satisfaction and engagement began improving as noted in volunteer fundraising. By the second year, and profitable again, travel nurses were reduced to a handful, further cutting costs indicating an improvement in the culture. Reimbursements went up based on improved healthcare scores. Finally, most functional areas were acknowledging the support of other functional areas as key for their accomplishments.
By the following year they were profitable to the highest levels in a decade, and were preparing to become a Magnet Medical Center with nursing care scores that equaled the upper half of all Magnet Medical Centers. Travel nurses were down to zero, even though the rest of the country was dealing with nursing shortages. Almost all metrics across the board hit the highest levels in a 10 year period. And, the medical center was voted by the Rural Medical Center Association as in the top 20 rural medical centers in the country.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
We align the Senior Leadership Team on the “Non-Negotiable 6 to 8 Breakthrough Changes” that will improve the financial and care metrics and identify the key habits of organizational execution that needs to shift.
We bring the Directors together to transform them from being functional managers to Organizational Business Leaders — responsible for the organization, not just their department. They solve problems and drive the accomplishment of the Non-Negotiable Breakthrough Changes.
We integrate the culture of the organization to the “business” of the organization to optimize both by using Collective Execution as the direct link between the culture and the business.
We correlate measurements of Deliverables, Collective Execution, and Relationships to identify root causes and to ensure sustainability.
Are you working on any exciting new projects now? How do you think that will help people?
In recent years, we have been working with the Netherlands Nursing District Teams which use Self-Managed Nursing Care Teams to serve Amsterdam and the surrounding community for providing mental/home healthcare. Using this system there are 600 nurses for 16 managers — how view their role as support for the nursing teams instead of pure oversight. For five years in a row, operating costs have declined while quality and patient satisfaction scores are going up.
In the UK, we are bringing together different healthcare institutions to integrate and optimize the services between major medical centers, children’s hospitals, cancer centers, mental health institutions, and clinics based on Population Health Statistics.
In the US, we are working with major Healthcare that are managing multiple medical centers in building cross-functional accountability within each medical center and building cross-medical center support and thought-leadership to optimize care, efficiency and effectiveness.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- I wish someone told me that applying the “proven” Organization Development approaches I learned getting my Master’s Degree, weren’t going to meet client needs. I did a team building program for a leadership team, got great evaluations, and three months later came back to the organization and received praise for the effectiveness of the program and individual growth experienced. But, when I asked how the team was doing, they shared, “the team is still dysfunctional, but we all individually loved the program.”
- I wish someone told me to focus more on outcomes and deliverables instead of only focusing on process. I was involved in many process improvement efforts in which efficiencies were gained in isolated circumstances, but didn’t help to accomplish Strategic goals.
- I wish someone told me that the key to successful change wasn’t getting buy-in to the change. I’ve witnessed organizations that attempted to get buy-in by including a huge number of employees from all levels involved with a major change only to observe confusion, anger and resistance from the conflict between the people involved. In one case, it caused a change effort to be aborted for 6 months until the climate was calmed down.
- I wish someone told me the difference between the culture of medical centers and outpatient surgery centers. In one surgery center there was an unusual level of bickering and blame between the highly qualified nursing staff that were all hired as ICU/CCU nurses based on qualifications. However, the pace in the medical center was much higher and emergency-oriented care than the routine scheduled surgeries in the Surgery Center where everything was planned. The nurses had so much extra time on their hands that they turned their angst on being negative with each other. As soon as the nurses were delegated major continuous improvement projects, the conflicts and bickering went down.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
- No medical practitioner gets reimbursed for preventative care, yet, it’s been proven to lower costs, reduce sickness severity, and improve healthcare.
- Healthcare is highly specialized and not as integrated as necessary to provide full health services to each individual.
- There isn’t an effective way to truly evaluate patient satisfaction. A survey is given out to patients a week after they are at home, which doesn’t give accurate data regarding patient satisfaction, which would be more accurate during the patient’s stay and a month after their return home to better understand the sustainability of care.
- Physician burnout is a real challenge in the current system given the change in the business model for compensation of physicians and the high cost of medical school.
- Follow-up with patients can be very weak, because there is no reimbursement for follow-up. And, when someone doesn’t receive their test scores back in time, it can result in a growing medical problem that will increase the cost of care.
- Major costs of healthcare rises as the population ages including the rise of mental health. In the US, we haven’t come to terms with this reality.
- When people don’t have health insurance they stay away from getting medical treatment as long as possible, but this raises the risk and cost of treatment.
- The cost of Pharmaceuticals is so much higher than in other countries and thus aren’t taken which cause diseases to progress.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
The issue is not only that the care in the US is relatively poorer than other countries, it’s also that the cost is significantly higher.
The Key to Success: “United we stand, divided we fall.” Aesop.
It is critical that all factions of the healthcare system find a way to get united in talking about reducing the cost of healthcare in the US — Pharmaceuticals, Medical Centers, Psychiatric Centers, Insurance Companies, Senior Centers etc. for solving the problems we face in healthcare (cost and quality of care). We have to all get on the same page about funding healthcare in the most economic manner possible, establishing systems of care that increase prevention and keep people at home, while removing any unnecessary “middle men” or bureaucracy that drive the cost of care up. We have to provide more custom care to communities using Population Health Statistics.
Other countries are addressing healthcare challenges with a united country approach…some better than others, but all with a focus on quality and lowering costs. Most have very comprehensive preventative care incentives in place. Cost and Quality is an international issue, but we are behind because of our current system’s complexity and our fragmented/political approach to solving the problems rather than learning from other countries who are ahead of us in lowering costs and improving the quality of care.
Thank you! It’s great to suggest changes, but what steps would need to be taken? What can the individuals, corporations, communities and leaders do to help?
The cost low quality of our fragmented approach will never get resolved if healthcare stays a political bouncing ball focused primarily on how people pay for healthcare services. It’s not the method of payment that matters nearly as much as where does the money go in terms of ensuring high quality low cost care through the system from “cradle to grave.” .
At some point, the people of the US will demand it.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Leadership is an Art by Max DePree — a great book on authentic leadership
The Big Leap by Dr. Gay Hendricks — a brilliant book on identifying your zone of genius and addressing the “upper limits” that blocks any person from realizing their true potential
Loyalty to Your Soul by Drs. Ron and Mary Hulnick — Puts the human factor back into the model of caring for oneself and others
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!