Good is the Enemy of Growth | E. 89

The Healthcare Leadership Experience

‘’Good is not the enemy of great, it’s the enemy of growth.’’ Sue Tetzlaff explains the transformational power of a strategy focused on greatness and the formula of leverage, to Jim Cagliostro.

Episode Introduction

Sue shares how creating a volunteer army transformed a struggling community hospital into a profitable, national award-winner, why the patient experience and the employee experience can’t be separated and reveals strategies that can move 20% in a patient satisfaction metric in 18 months. She also explains how leveraging greatness in people, service and growth creates a magnet for talent, and why hospitals can never declare victory in greatness.

Show Topics

• A moment of realization in a Michigan hospital

• Good is the enemy of growth

• Setting up a formula of leverage

• Creating a strategy for ‘’greatness’’ is not an easy fix

• The patient experience is tied to the employee experience

• Growth can happen when leaders ‘’get real’’

04:34 A moment of realization in a Michigan hospital

Sue said acknowledging that 75% of employees wouldn’t use their own healthcare organization triggered change.

‘’I remember sitting in a room with the executive team and it was our strategic planning cycle. I had already been there 10 years through three-year strategic planning cycles. We're there at the table again and we're looking that these trends are just as ugly or worse than they were last time. We sat down to craft our strategy for the next three years, and we're looking at them, and one of the things jumped out like no other. It was all ugly, but one thing jumped out to me. 75% of our own employees would not use the healthcare organization that they worked at. And that really reflected of how the community was engaging or not with using their local healthcare services. And so put that in the pile of all the other data that was bad about patient satisfaction, safety, quality, profit, market share, out-migration, everything. When you look at that, all of a sudden, I remember looking up and I looked around at my peers and I said, "I am not going to be on the leadership team that loses this community's important asset. I did not come to this work to do that. And we have to figure it out. We can't just tweak our strategies this next time. We have to do something big and different. If we keep doing what we're doing, we're going to keep getting what we're getting and it is not going to be good. We could actually spiral to closure and lose this important community asset." So that led to me being volunteered, of course, to lead a team to figure this out because it was my moment …’’

15:10 Good is the enemy of growth

Sue explained how that realization helped to create the framework of achieving great results.

‘’You know how Jim Collin says, "Good is the enemy of great." Well, good is the enemy of growth. And my explanation of that is these patterns that we saw. Starting with our very first organization, we saw it there. And sometimes it wasn't only until retrospect and that repeated pattern of looking back that you saw that good is the enemy of growth. So when we first packaged, how do we take this down the road to another hospital, we created a framework called the framework of achieving great results. And in the center we were creating great strategies, then creating ownership and alignment for those strategies to be successfully executed on. And then over time, we added then creating agility because I really believe that the agile and the enduring committed organizations are the one that's going to survive. You’ve got to be agile. You’ve got to be willing to change. You’ve got to be willing to improve. You’ve got to be willing to grow.’’

17:30 Setting up a formula of leverage

Sue said the secret to success is not just in balance, but in leverage for growth.

‘’So this people, service, quality and growth at first, making sure we were balanced and we truly did have strategies under people, service and growth, as well as finance that we had them all. But then we realized that the magic was really not in just being balanced across there, but really setting up a formula of leverage there where if we invest, especially because we're in crisis there, in people, service and quality and our strategies there, if we invest more attention, energy, focus there and we nail that and move it from good to great, then growing actually just organically happens. Especially when you're a hospital and your community is right around you. You can say you're great all you want, but if it's not true, your community knows it. You can just have a billboard and run more ads, but guess what? You could add more services, but they're not going to come. Build it, they'll come. Okay, people. That is not the reality always, especially when your reputation is whatever you have now isn't good, why is something new going to be good too? Your community and those bad stories in people, service and quality, especially in small communities, those are loud and they're lasting, and you got to overcome that. And it's only through people, service and quality that you're going to overcome that. So the new formula under creating great strategies is people, service and quality, good to great, and then leverage that for growth, which then improves your finances. So it's not just in balance. It's in leverage.’’

24:45 Creating a strategy for ‘’greatness’’ is not an easy fix

Sue explained that in the early stages, the focus is on people, service, and quality before growth.

‘’……..when I work as a strategist with new organizations that have been fine or good for 20 years, and their market share shows it, and your revenue growth shows it or whatever, is I actually for the first three-year strategic plan I do with them, I put almost all of their emphasis on people, service and quality and tame down their growth plan. It's almost like an early investment of shore this up, move it from good to great, and then now the next cycle is truly a growth cycle. And now you can leverage all of that improvement that's been done, and now your growth efforts are easier, more successful. You're a magnet for talent. You're a magnet for patients. And so I stage it that way. So it's not a quick, easy fix. It never is. None of this is a quick, easy fix, but I'll do that a lot when I'm mapping out a strategy for an organization, is if they need to shore up day-to-day operations, people, service and quality, put your time, energy and focus there for three years. And I can tell you that it will have decades of lasting impact on everything, everything.’’

28:48 The patient experience is tied to the employee experience

Sue said you can’t improve one in isolation as both are tied together.

‘’And so that's where it started, and that really is people, service and quality. Employee experience, people, patient experience, and we truly, truly believe, Jim, that you cannot improve the patient experience, which is both about safe and satisfying care. It can't just be about service and friendliness and nice. It's important. It's part of compassion and caring, is to be civil and friendly and all of those things. But if you're just that and your quality and your safety sucks, I'm sorry, it's like lipstick on a pig or painting the shack. We really have to have substance behind that of true patient experience being safe and satisfying. But we believe that you can't, and we've over and over again shown this to be true, that you can't really improve the patient experience if at the same time in parallel, you're not improving the employee experience, that they're so tied together that you can't even separate them. People caring for people. Both of those things have to be working well. So those really fit under that people, service and quality pillar. So since so much of our emphasis of our work was definitely on those solutions that made us a magnet for talent, those solutions that made us a magnet for patients were really about improving the employee and patient experience, people, service, quality. That's where we realized that that was where the magic was and then leverage that for growth.’’

38:09 Growth can happen when leaders ‘’get real’’

Sue said understanding their exact position and trend can help healthcare leaders discern if they need external expertise.

‘’So get real with yourself. Get real with yourself, and then get real with do you know how to execute on strategies for people, service and quality? Do you really know? Do you have the inside expertise? And if you don't, you need to either figure it out, which I can tell you, it took us six years to figure it out, three years to mastermind it, three years to test it. You can spend that time or you can find somebody that can help you. There are experts out there. That's what we do. I know there are others. There's other formulas, frameworks that can do this work too. But I think you just first have to assess and get real about where you are, and not just where you are right now but that trend. Are you trending up, down, all over the place, out of control and your quality is whatever? That's your sign that you have a problem. Maybe you have to own up to yourself that you don't have the fix. I had a CEO say to me the other day, Jim, he said, he goes, "Well, I think I want to try to fix it on my own first, and then if we fail, then I'll seek some outside help." And I said, "If your boiler broke right now and you didn't have heating or cooling for your patients or employees right now, would you as a CEO go down there and say I'll give it a try to fix it myself before I call in an expert?" He goes, "No." I'm like, "Well, how is people, service and quality any less important than heating your building?" So …my parting advice to frontline leaders is even if your organization truly, truly, truly isn't making this a priority, it can be yours.’’

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You’ll also hear:

Sue’s 20-year journey to Co-Founder, Chief Strategist & Executive Officer of Capstone Leadership Solutions, Inc: ‘’My original career goal, Jim, was to be a hospital CEO, and I was checking all those boxes. I became a registered nurse. I got a bachelor's degree in health information management. I got my master's degree in hospital administration. I got my fellowship and my board certification in American College. I got my first VP job in quality and then as a nursing officer and then as an operating officer.‘’

How ‘’creating a volunteer army’’ dramatically transformed a small community hospital: ‘’We went to over 900 (employees). We went from losing millions of dollars to making $11 million the three years after we started. Our patient satisfaction went from the bottom 25% of the country to the top. Some of our quality statistics were at 17% compliance. Now we were winning national awards …’’

Identifying common patterns to create a common solution: ‘’…it's data and it's opportunities and it's problems. But when you work with multiple organizations, especially all at the same time, doing the same thing, you start to see patterns….this is not just a unique opportunity or solution or problem in one place. … This is a common problem. Can we have a common solution? ‘’

The problem with ‘’good’’: ‘’…And so the human behavior around something that's good is I may or may not use it again. I may or may not talk positively about it in the community and I may or may not recommend it to others. And that could be even if it's poor. If it's good, average, it's a may or may not kind of attitude or decision for the buyer. But when something is great, it's their go-to place.’’

Why hospitals can never declare victory: ‘’…really John Kotter would say, "Don't declare victory too soon." But I would add never. You can never declare victory on this. You have to just start, keep going and it is the infinite game. There is no end. No matter how good you get, you have to keep getting better in people, service and quality. You cannot give up or you will go backwards.’’

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