ResultsResultsWhere Our Mission, Vision and Where Our Mission, Vision and Values Rubber Meets the RoadValues Rubber Meets the RoadThe Ten Toughest Leadership ProcessesThe Ten Toughest Leadership Processes1,21,2

A Presentation and Discussion Guide for A Presentation and Discussion Guide for Lake Local Schools LeadersLake Local Schools Leaders

Kendall L. Stewart, MD, MBA, DFAPAKendall L. Stewart, MD, MBA, DFAPAAugust 24, 2009August 24, 2009

1This is intended to be a discussion guide.2No group of leaders has perfected these tough leadership processes.

Why is this important?

• We know why leaders exist.• We exist to produce and

sustain exceptional organizational results.

• We also know how hard that is.

• Organizational excellence results—in part—from exceptional leadership behaviors.

• We cannot produce excellence by ourselves, but we can prevent it.

• Unless we transform our Mission, Vision and Values statements into results, they are just words.

• The leadership processes that follow will help with that task.

• After mastering the information in this presentation, you will be able to – Identify three common

leadership behaviors that undermine clinical excellence.

– Describe three tough leadership processes that encourage organizational excellence.

– Explain why leaders should deploy these tough processes in spite of the effort required, and

– Explain how to deploy these processes successfully.

• Your Mission is to provide education to achieve success.

• These leadership processes are the keys to fulfilling that mission.

1After a lifetime of passion for organizational excellence, I have enjoyed only modest success.2It is the leader’s job to persuade people to do what they don’t feel like doing.3The lessons of LIFE Center memberships and Christmas gift bags still haunt me.

What common leadership behaviors undermine organizational excellence?

• Failure to focus on results• Failure to remain uncomfortable• Failure to make others

uncomfortable• Failure to lead by example• Failure to be predictable1

• Failure to take an informed position• Failure to do what you can• Failure to field the best possible

leadership team• Failure to extrude the net-negative

people from the organization• Failure to deal with the hard stuff

1At least Maude was predictable when Claude wanted to take a ride in a plane.

What are some of the processes leaders follow to produce results?

• Begin with your motivational values.

• Clarify and model values-based behavioral expectations.1

• Make the case for change.• Create discomfort. 1

• Measure things that matter.

• Focus relentlessly on results.1

• Publish your results.• Manage your feelings. 1

• Set demanding goals.• Manage criticism. 1

• Adopt evidence-based processes.

• Field the best possible leadership teams. 1

• Extrude the net-negative people. 1

• Reduce processes to simple tasks. 1

• Hold people accountable. 1

• Insist on innovative action plans.

• Confront poor performance.2,3

• Demand process improvement.

• Confront disruptive behavior.

• Deploy effective leadership teams. 1

1These are the toughest leadership processes to deploy successfully.2People don’t like to be confronted.3I cut the corner and my neighbor sounded the idiot horn; my son, Jonathan, confronted a woman in Kroger™.

Clarify and model values-based behavioral expectations.• Why?

– Our behaviors reveal the real values that drive our lives.

– When our behaviors don’t match what we preach, our hypocrisy is evident to all.

– Actions, not words, set the organizational tone.

– Most of us will do just what we feel like doing if we think we can get away with it.

– This process holds us accountable.

• How?1. Clarify your values.2. Decide how a leader

with those values would—and would not—behave.

3. Distribute those expectations widely.

4. Strive to conform your behavior to those expectations.

5. Require all leaders to sign a commitment to conform.

6. Confront each other when you slip.1,2,3

1A fellow executive confronted me.2These will always be open to interpretation.3This past month, I intervened to prevent a collegial ambush.

Create discomfort.

• Why?– Human beings long for

comfort above all else.– People avoid

discomfort like the plague.

– But only change when we become uncomfortable.

– Intentionally making people uncomfortable makes many leaders uncomfortable.

– The goal is to create energizing discomfort, not paralyzing discomfort.

• How?1. Make yourself

uncomfortable first.2. Let your discomfort

show.3. Ask permission to

make others uncomfortable—or give fair warning.

4. Explain your discomfort.

5. Make the case for discomfort so compelling that they will see that discomfort is the reasonable leadership response.1,2,3

1I am the CDO at SOMC.2When use 360-degree evaluations extensively for physicians and leaders at SOMC; these cause intense discomfort.3The typical physician jerk response is “ignorant and stupid people saying ignorant and stupid things.” But I’ve learned. . .

Focus relentlessly on results.

• Why?– People want to talk

about what they want to talk about.

– They usually want to talk about feelings, complaints, gossip, family or sports—anything but results.

– People really do believe that just being at work is enough.1

– Wasteful distractions are ubiquitous in every workplace.

• How?1. Begin every

meeting with current results.

2. Ask about most recent results.

3. When colleagues go on a tangent, ask what result we are trying to produce with this discussion.

4. Display individual and team results publicly.2

5. Display results on the Web.

1I came across a man hiding in an unlocked bathroom at SOMC.2We post our physicians’ billings and targets at receptionist’s desk weekly.

Manage your feelings.

• Why?– Everybody has them.– Most people take

them much too seriously.

– Feelings often hijack conversations, decisions, action plans and even results.

– Arousal suggests your case is weak.1,2

• How?1. Recognize your own

emotional arousal.2. Shut your mouth, and

never click “send” when you are aroused.

3. Choke off your arousal.

4. Take some time to reflect.

5. Return with a thoughtful position or a dispassionate list of options with their pros and cons.

1A senior surgeon came to see me in a rage because he had been bumped.2He said that the Administrative Director of Surgery would not speak to him.

Manage criticism.

• Why?– Criticism is

inevitable.– Leaders take heat for

two things:• Doing the wrong

thing, and• Doing the right thing.

– No leader likes it, but fear of it will paralyze you.

– You can neither ignore it nor be pushed around by it.

– It is evidence that you are causing some discomfort.

• How?1. Expect your

opposition to press you hard.1

2. Make a proposal and invite criticism.

3. Admit the weaknesses in your case up front.

4. Admit your mistakes immediately.

5. When a better option emerges, change.

6. Limit your pointless rumination about it.

7. Do not make it personal—even when it is.2,3

1A physician came in to complain about me to the CEO right after I was hired.2You cannot always predict what people will feel the need to criticize.3A suicidal patient stopped crying to complain about my ugly shoes.

Field the best possible leadership teams.• Why?

– This is every leader’s moral obligation.

– This is a playground reality that we conveniently forget when we get to work.

– Relieving a leader who is doing the best he or she can is the leader’s hardest duty.

– The courageous leader who makes this decision can expect little support and only grudging respect.

• How?1. Explain this

obligation to your boss.

2. Then remind yourself that you have the same obligation.

3. Trade up at every opportunity.

4. Make your expectations clear.

5. Give people a fair chance.

6. Stop harboring unrealistic expectations.1,2

7. Act.1A woman kept expecting her husband to behave better.2A CEO replaced several executives because he believed he could—and must—trade up.

Extrude the net-negative people.

• Why?– They poison the

workplace.– They are often

hardworking people with great skills.

– They are often stunned to learn that they are perceived as net-negative.

– They sincerely believe that spreading the misery around is their calling in life.

• How?1. Identify them.2. Confront them.3. Give them a fair

chance to turn net-positive.

4. Do not give them forever.

5. Make your case.6. Act; those left

behind will be grateful.

1Some miserable people cannot see anything positive in life.2A man went to apply for Social Security.

Reduce processes to simple tasks.• Why?

– People are busy doing what they consider to be most important.

– They will deviate from that briefly to accomplish a simple task.

– They will not rethink their priorities on a daily basis.

– They will not be eager to take on a lot more stuff.

– Foot-dragging is a time-honored and effective coping strategy.

• How?1. Maintain a task list

for every recurring meeting.

2. Go over it at every meeting.

3. Decide exactly 1. What will be done,2. Who will do it, and 3. Why it will be

done.4. Choose the people

who will get it done.

5. Develop realistic expectations for your colleagues.1,2

1Have you noticed that some people are habitually late?2I have dramatically changed my expectations for my wife.

Hold people accountable.

• Why?– Few of us are

naturally inclined to hold ourselves accountable.

– It creates energizing discomfort.

– It helps to produce results.

– It is a lot of work.– It demands careful

organization and attention to detail.

• How?1. Tell them exactly

what you expect.2. Extract a

commitment from them that your expectation is reasonable.

3. Put it in writing.4. Hold yourself

accountable for holding them accountable.

5. Display individual results publicly.1,2

1Our relationships with physicians are terribly important—and often terribly trying.2We have developed an innovation Physician Relationships Enhancement Process (PREP) to facilitate communication.3The Physician Relationship Team (PRT) projects our PREP notes each month.

Deploy effective leadership teams.• Why?

– Bureaucratic levels are formidable barriers to agile decision making and organizational efficiency.

– Requirements for approval discourage frontline managers and decrease accountability.

– Effective communication is nearly impossible.

– Time and space between participants encourage avoidance and pot stirring.

• How?1. Make a decision to

decentralize leadership.

2. Get all of the decision makers in the room.

3. Focus the meeting on results and tasks and eliminate distractions and small talk.

4. Hold participants accountable.

5. Demonstrate that this is the decision-making group.1

1Let me tell you about our Surgical Services LT.

What have we learned?

• Transforming our Mission, Vision and Values statements into exceptional results is hard.

• But this is why leaders exist.1,2

• Those leaders who succeed will design and deploy key leadership processes.

• Effective leadership processes are tough; they require large, sustained investments of leaders’ energies.

• This is the only way to be the best organization for learning.

1Don’t kid yourself; leadership demands certain sacrifices.2Let me tell you about my introduction to Portsmouth.

Where can you learn more?1

•Google “Common Leadership Mistakes” and you will get more than 15 million hits! (We are all authorities on others’ mistakes).•Explore the Ohio Partnership for Excellence’s Website at http://www.partnershipohio.org/.•Look into the most robust organizational excellence methodology in the world at http://www.baldrige.nist.gov/. •Review a brief but helpful excerpt from Leithwood and Riehl’s, What We Know About Successful School Leadership,(2003) at http://www.e-lead.org/principles/successful.asp. •Read more about how to deploy the tough leadership processes in, The Portable Mentor for Organizational Leaders, (2003).

1Please visit www.KendallLStewartMD.com to download related white papers and presentations.

How can you contact me?1

Kendall L. Stewart, M.D.Kendall L. Stewart, M.D.VPMA and Chief Medical OfficerVPMA and Chief Medical OfficerSouthern Ohio Medical CenterSouthern Ohio Medical Center

President & CEOPresident & CEOThe SOMC Medical Care Foundation, Inc.The SOMC Medical Care Foundation, Inc.

1805 27th Street1805 27th StreetWaller BuildingWaller Building

Suite B01Suite B01Portsmouth, Ohio 45662Portsmouth, Ohio 45662

740.356.8153740.356.8153

StewartK@somc.org StewartK@somc.org KendallLStewartMD@yahoo.comKendallLStewartMD@yahoo.com

www.somc.orgwww.somc.orgwww.KendallLStewartMD.comwww.KendallLStewartMD.com

1Speaking and consultation fees benefit the SOMC Endowment Fund.

SafetySafety QualityQuality ServiceService RelationshipsRelationships Performance Performance

Are there other questions?

www.somc.orgwww.somc.org