How Healthcare Leaders to be 'Great'? They're. They aren't! ....'..!

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The most difficult question in everyone’s mind is what the best leadership attribute will look like to reform healthcare in upcoming days? The reformation is indispensable, if someone disagrees with this transformation, then s/he is far behind of today’s healthcare business. Every healthcare leader including C-suites, even outside leader beyond healthcare recognizes that now, it's one of the toughest times to run a hospital. It is not enough when CEO of a hospital only ‘went to the office and came off the floor.’ The Chief Executive Officer (CEO) needs to set the healthcare system’s goals, both short-and long-term objectives for achieving an overall vision and mission of the hospital in this turmoil time. In line with this strategy, another assignment is ultimately swallowed to develop all procedures and policies providing guidance toward their implementation. In all systems, both organizations as well as businesses, CEO is the top executive position reporting to the board of directors. Hence, this position is the highest authority in the management within hospital or medical facility, with the most time-consuming and difficult responsibilities. Also, it is not a typical kind of KPIs driven job specification, requiring spending additional hours to engage in philanthropy, social activities and fundraising initiatives outside of office hours. And as such, the fundamental assignment is to develop strategic vision and policies for the hospital, be supervising day-to-day operations and being a moral leader who would articulate the hospital’s mission to the patient’s community. Mark Wallace, the CEO of Texas Children’s Hospital, has a good idea of what it takes to lead a hospital. He mentioned that “Leadership is the sum of three things: Vision plus structure plus people, with people by far being the most important ingredient in the equation”. But leading a hospital and leaving a major imprint is no more an easy task.

In 2015, hospital CEO turnover was 18%, fueled in part by merging of hospitals, the emergence of new care models, and movement of CEOs within health systems, according to a recent report by the American College of Healthcare Executives. With the average hospital CEO’s tenure just five to 10 years, what are the keys to success? According to Carrie Hackett, president and managing partner of executive recruitment firm ‘Grant Cooper’ mentioned that leadership is the number one attribute of what quality search teams are looking for a CEO in a hospital. Most inherent leadership skills that are engender the support and confidence of the providers, payers, patients, and surrounding community. While CEOs need to lead in the boardroom and in the C-suite, the best leaders are those who engage at all levels of the organization, who makes daily rounds to get the pulse of hospital operation and front-line challenges. Empathy is another attribute where staffs want to see CEO out in the office, talking to them, listening to them, getting answers from them and showing that CEO cares about them. Every CEO needs to see positive, upbeat culture, mission-oriented staff and focused on patient care and satisfaction. A successful hospital CEO also knows how to cultivate leadership within the organization. The key to success in any organization … is leadership, and its leadership at all levels! Indeed, according to the American College of Healthcare Executives’ most recent guide to effective leadership is the key to the long-term success of a hospital is engaging and empowering those on the front lines of care.

In July 11, 2017 Ayla Ellison is sharing an interesting report under a headline of ‘CEO turnover increases as hospital losses swell’. This report is specifying the windy time of what hospital CEOs are passing in USA. Hospitals across the country have reported their operating margins shrink as they face dwindling reimbursement, regulatory uncertainty and new alternative payment models. Many hospital CEOs are taking the fall for their organization's financial challenges, according to report. Thirty (30) medium- to large-sized hospitals across the country have lost their CEOs in the last six months. Some CEOs voluntarily departed to take on a new position or retire, but many were exiled. That's an increase in turnover, probably a reflection of the current volatility of the healthcare market. Many hospitals are losing money now and the future only looks rockier, with more uninsured and less Medicaid support. Boards want the right person to lead them into such turbulent times. To succeed in today's healthcare market, hospital CEOs need to not only ensure the organization is financially stable but also stay ahead of change and remain engaged in their work, according to the report.

Can you guess what will be the next leadership quality? Yeah, you’re right; today’s CEO needs financial skills. Hospitals are looking for someone who can strategically plan, develop and execute on short- and long-term goals, and who has a solid understanding of all aspects of healthcare financing. The strategic plan must support the revenue forecasting and operational expenditure and clear idea about the profit and loss account. There’s so much related to the finances, the way hospitals are reimbursed or generated revenue, and it’s changing dramatically in today’s scenarios. With the shift to value-based medicine and population health, hospitals have to make sure that care is provided in the most appropriate medical setting. That’s what payers are asking hospital to do. That’s what patients and families are asking hospital to do. That’s what competitor hospitals are going to practice. And the major themes of the Affordable Care Act, to develop this ability of providing a system of right care, right place at the prime time with reasonable cost. Since hospitals are often one of the larger employers in a community, it also helps to have a strong external face. That’s especially more important if the hospital is non-profit hospital. It’s very important to tell stories to the community about hospital, its mission and strategy. Looking at those challenges, what will be the advices for current and future CEOs? Remember, the top issues that are confronting hospitals will be finance, engagement, safety and quality. And to do that, CEOs have to be vigilant of capital resources, operating expenses and FTEs. At hospitals, salaries and benefits represent about 55% of the cost structure.

The CEO of the future will need to be more creative and innovative and think differently about service of healthcare delivery of what the hospital is doing now. They’re going to have to think about what is best practice for healthcare delivery for the patient now and future; and how do hospital get reimbursed or capitalized revenue … because, historically, it was let’s keep our beds filled, counting bed occupancy but the future is not going to in that direction. You’d be surprised to know how many CEOs draw a blank on being able to define leadership and what it means to them personally! Well, it’s pretty tough to be a really effective leader, to be a dynamic leader, to be transformational, if someone hasn’t defined leadership for them. The better way is to encourage young executives and physician leaders coming out of MBA programs and residencies to think about leadership and develop a clear definition that they can share with others. Besides, The CEO needs to feel a real sense of responsibility to all of the employees and making sure that they’re building and sustaining a culture where they feel loved, validated and nurtured.

Few CEOs spend most time in the hospital operation like a COO and fail to achieve the organizational goals. A COO typically will manage part or all of the daily operations of hospital. The CEO will then free to focus more on the long term strategy of the hospital. CEOs are also responsible for making all the managerial decisions and delegate decision among managers. The primary jobs of CEO has to perform include the creation of strategies of how to run the healthcare business successfully. CEO needs to give a particular direction so that everyone stays on board and work towards the same point. Setting the culture within the environment, creating values and examples of performance is another thing that a CEO has to initiate so that there are no doubts among staff on how to conduct their daily activities. Another task is building and training individuals so that they become part of the senior executive team that works towards the betterment of the hospital. Last but not the least; they have to ensure that the money spent within the hospital is to the right people and the right works. Although these are the tasks, the person on this post does not always have to do much since they have set everything in place long before and now just have to stay on the job to motivate people. All the others who are on this post have to work and achieve particular tasks, but CEO gets the fruit of all the hard work done as the hospital keeps on gaining revenue.

If you measure the effectiveness as leaders and conduct a research among emerging countries hospital leaders, you may find that although all are considered high potential, not all are extraordinary leaders. Sometimes potential ratings come from experience, knowledge and expertise as oppose to leadership skills. The best way is to do the assessment of leadership effectiveness using Extraordinary Leader 360 assessment. On average, assessors rate each person, using assessments from managers, peers, direct reports and others. In addition to the 360 assessment you need to gather data from each person on 25 attitude questions. Five of the attitude questions are correlated strongly with overall leadership effectiveness. Leaders who strongly agree with these particular attitudes also have higher overall leadership effectiveness scores. It is possible their attitudes on these items may have influenced their effectiveness as leaders. Mr. Joseph Folkman describes the five attitudes that an extraordinary leader should hold to be a great leader in healthcare.

Number one attitude- Strategic and Future-focused: Have you ever spent most of a day just responding to emails and attending meetings? It’s so easy to get caught up in the grind of your job that you never take the time to ask, “Why am I doing this? What’s really important?” This is a critical skill. In many hospitals, everyone is so focused on their own services that no one is looking at the competition and discovering the cases where the competitor’s services is much better and costs less. One of persistent legends about business believes that Jim Collins is right. As the bestselling researcher-author of ‘Good to Great’ and now, ‘Great by Choice’, Collins is pretty worthy at retrospectively interpreting what worked ‘good’ and or ‘bad’ in the past for some businesses. But he’s not great at forecasting how they’ll do in future. Check it out; if you follow the hospitals Collins called winners, they are now: not so much. It seems like a lot that you’ll be soon reading Collins Book next to him at a holiday dinner. The one who tells you how great General Motors was before its CEO Robert McNamara started the Vietnam War! Okay, that’s unpleasant. But, it’s the truth. Actually, that’s a good measure when judging whether something important is true. The truth probably hurts, or at least causes you to recoil. If someone tells you the so-called truth, and your cheeks are blushing with how wonderful you are? It’s not the truth and it’s not going to help you succeed in this chaotic healthcare environment.

What does work in helping you predict the future, and more importantly deliver the greatest odds of succeeding in the nearly incomprehensible rush of problems and opportunities you face? The predominant quality of great leaders is that they think about the future most of the time. They think about where they are going rather than where they have or had been. They maintain a positive attitude and think about the opportunities of tomorrow rather than focusing on the problems in the past. Only about 10% of leaders have this quality of future-orientation. This small percentage of healthcare top leaders maintains a positive attitude and is long-term thinkers. Average thinkers think only about the present, and about immediate gratification. But great leaders think about where they want to be in five and ten years, and what they have to do each hour of each day to make their desired futures a reality.

Number two attitude- Risk taker: Almost all of the leaders are risk takers. However, there are others who are risk avoiders. Extraordinary leaders have a very strong desire to make a difference and to create value. However, there are many people who avoid risks at all costs. The risk avoiders approach work much like people who go to the hospital round and move around without seeing anything or talking to nobody and come back to office. They go with the flow and never make the effort to walk upstream. Making a difference in hospitals means taking some risks. However, the modern world, the risk is calculative and you have every option analyse data to create future scenarios based on today’s prediction. There are always some clues and inklings present in the present to predict the risk and how to face it. The risk itself always stays in the dormant state and sending message before it really happens. Therefore, if the hospital is making the risk strategy dashboard or risk mitigation process, CEO is the key focal leader who will lead the program. The risk may be the clinical, non-clinical, operational or financial but CEO needs to cultivate risk and be aware of recent risk status of the hospital. Otherwise, it is very difficult to handle the real disaster situation. Taking a risk is not implies that you are jumping into the death trap but how you can save your patient, your business, your staff as well as the hospital and bold enough to take decision for mitigating risk.

Number three attitude- Decision Makers: CEO should take the time to look at all the facts before making decisions. You become a leader when you arise to the challenges of leadership and begin to think the way that other great leaders think, and have thought, throughout history. To think like a leader, you must practice “idealism” in each area of your life. To get the most out of the use of idealization, you should begin by imagining that you have no limitations at all on what you can be, do or have. Imagine for a moment that you have all the time and money that you need. You have all the education and knowledge. You have all the talent and experience. You have all the friends and contacts. You are a “no-limit” person who can do anything that you really put your mind to. If you were the very best professional business person that you could possibly be, what additional knowledge, skills and leadership qualities would you have developed to a higher level? When you begin the practice of idealization, you can then extend this exercise to your family, your capitals and your physical health. If your family life was ideal in every way, what sort of lifestyle would you be living? If your financial situation were ideal, how much money would you have in the bank, and how much would you be earning from your investments each month and each year? If your levels of physical health and fitness were ideal, how would you be different from today? When you begin to develop leadership qualities, you begin to engage in what is called “long-term thinking.” Leaders analyse fact in every moment, they are usually data driven. Here is a good example of how leaders need to analyse data. Over the last few years one person found a few mind-numbingly simple games on his smart phone to entertain himself. Several of the games he plays show the next object coming up in the game. Noticing the next object is incredibly beneficial in getting a good score. He have noticed, however, a tendency he have when he see an opportunity to make a good move to focus all his attention on the move instead of looking at the next object coming, which causes the good move to quickly turn to disaster. This much-repeated experience has gotten him thinking about all the poor decisions he’s made by failing to look at all of the facts before pursuing an opportunity that appears to be great. He admires that people who can pull back, examine all the facts, and weigh the consequences before making a choice.

Great leaders examine the facts before taking any decision. Sometimes, you can see something in-front of your eye but it is only 180 degree vision, you don’t know the other 180 degree of fact; therefore judge anything when you have full 360 degree picture in your hand. Some great leader microscopically examines the fact before they take decision. This doesn’t mean that they take huge time to do that,,,,, nope, as a good leader, you should take 5 decisions in every 5 minutes! Great leaders understand how to balance emotion with reason and make decisions that positively impact themselves, their employees, their patients and stakeholders, and their hospitals. Making good decisions in difficult situations is no small feat because these types of decisions involve change, uncertainty, anxiety, stress, and sometimes the unfavourable reactions of others. Great leaders also know when to move quickly and proceed with the available information, versus when to take more time and gather additional information. When leaders opt to pursue additional information or avenues, they must also know when to stop. While a large amount of data may be desirable in a perfect world, the data gathering process can utilize too much time, and the vast amount of data can also be paralyzing and take attention away from the big picture or key data points

Number four attitude- Wow in Communication: Twenty years ago hospitals wanted to hire “yes” men and women. They wanted people who didn’t ask questions, did what they were told and kept their opinions to themselves. Over time, most hospitals and leaders have discovered the opinions of others are a valuable asset. They’ve discovered that 90% of the time, the wisdom of groups is better than the wisdom of any one individual. It takes courage to disagree with others. It takes even more courage when the person you are disagreeing with is your boss. However, extraordinary leaders appreciate people who speak up (respectfully, of course) when they disagree. Great leaders motivate, encourage and inspire. They also train people, share new ideas and negotiate. These activities have one thing in common: They all require excellent communication. A Practical guide, Glenn Wilson writes: “Where body language conflicts with the words that are being said, the body language will usually be the more ‘truthful’ in the sense of revealing true feelings.” That’s why the most successful leaders are always paying attention to people’s unseen language and nonverbal cues. Is it possible to be a good leader without being a good communicator? How can you engage, inspire and motivate your people if you are unable to communicate your vision, values and strategy? Effective leadership communication is not about talking at your employees but interacting with them. Yes, you will need to deliver key messages and disseminate critical information but it is equally important that you give them the opportunity to be heard, that you listen to what they have to say and that you try to interpret what is really going on.

When leaders listen they gain valuable insights and potential new ideas, they receive useful feedback and they understand better how to engage with their workforce.

Number five attitude- Influential: is it easy to make friends with CEO? Leaders are people who have the ability to influence others. It’s very difficult to influence others who don’t know who you are. Having the ability to make friends and build relationships is a critical skill for all leaders. Most people have worked for another person they had a very positive relationship with and had that person ask them to do a very difficult task. The positive relationship is often the key factor in their ability and willingness to accomplishing a difficult goal. Often people will say something like, “I did not want to let him (or her) down.” This kind of dedication only occurs when people have positive relationships. Extraordinary CEOs always keep a positive attitude. Great leaders inspire other people, their friends, customer, associates and even their children because they are inspired themselves. They are excited about the possibility of creating an exciting future for themselves. They get up every morning and they see every effort they make as part of a great plan to accomplish something wonderful with their lives and push forward with a positive attitude. There can be no leadership without influence, because influencing is how leaders lead. Warren Bennis and Burt Nanus, in their classic book on leadership, ‘Leaders: Strategies for Taking Charge’, echo this point: "There is a profound difference between management and leadership and both are important. To manage means to bring about, to accomplish, to have charge of or responsibility for, and to conduct. Leading is influencing, guiding in direction, course, action, opinion-an essential factor in leadership is the capacity to influence. Managers also use influence, of course, because only a fraction of managerial work can actually be accomplished through control and the use of authority. The aim of both managers and leaders is to accomplish an organization's goals. Leaders lead by mobilizing people around a compelling vision of the future, by inspiring them to follow in the leader's footsteps. They show people what's possible and motivate them to make those possibilities real. They energize and focus people in ways that fulfil their dreams, give them a sense of purpose, and leave them with a profound sense of accomplishment when the work is done. Leaders lead by modelling ways of thinking or acting and by encouraging new ways of looking at situations, and by so doing they give people the words and the courage to make those new ways their own. The best leaders are mentors, and role models--and they accomplish the vast majority of their work through influence, not authority. Remember Henry Kissinger dialogue- “The task of a leader is to get people from where they are to where they have not been”!

Leaders are optimistic. They see opportunities and possibilities in everything that happens, positive or negative. They look for the good in every situation and in every person. They seek the valuable lessons contained in every problem or setback. They never experience “failures;” instead, write them off as “learning experiences.” Most of all, great leaders have a sense of meaning and purpose in each area of their lives. They have clear, written goals and plans they work on every day. Leaders are clear about where they are going and what they will have to do to get there. Their behaviour is purposeful and goal-directed. As a result, they accomplish five and ten times as much as the average person who operates from day to day with little concern about the future. One of the most important leadership qualities is the acceptance of personal responsibility. Leaders never complain, never explain. Instead of making excuses, they make progress. Whenever they have a set-back or difficulty, they repeat to themselves, “I am responsible! I am responsible! I am responsible!” Great leaders see themselves as victors over circumstances rather than victims of circumstances. They don’t criticize or blame others when something goes wrong. Instead, they focus on the solution, on what can be done. Leaders are intensely action-oriented. They are constantly in motion. They try something, and then something else, and then something else again. They never give up. Finally, leaders have integrity. They tell the truth at all times. They live in truth with themselves, and they live in truth with others.

The acceptance of leadership is a great responsibility. It is both scary and exhilarating. Once you decide to become a leader in your life, you cast off the shackles of fear and dependency that hold most people back and pursue life with a positive attitude. With your own hands, you design your own future. You set yourself fully on the path to becoming everything you are capable of becoming. The fundamental attribute is the attitude is what really matters. Not our skill set. Not our network. Not the number of business books we suck back and arm ourselves with – or at least buy to fill up our Kindle or iPad. Here is the nine attitudes that solve any healthcare business problem:

1. Distinguish difficulties as a challenge, an opportunity for new experiences to expand the problem-solving gamut.
2. Focus on the present and future obstacles, and deal with those can do something about. When obstacles appear to be intractable: interrogate about the goal, and if necessary, modify it.
3. Pay attention to the peculiarity among facts, opinions and judgments. First get the facts, and then interpret them. Don’t judge the facts before do the analysis.
4. Listen to experts, authorities and others as if it will be required to take an assessment on what they are saying. Don’t refute or judge what they say when they say it. Ask questions if don’t understand, but don’t argue.
5. Use reason not pride. It will be tempted to distort the facts if someone has to manage ego rather than manage the problem-solving process.
6. Don’t solve the problem too soon. Take every minute to gather and process information from sources. Don’t take more time than can afford, but do not begin evaluation and selection of a solution prematurely.
7. Focus on manageable obstacles that block the way to a solution, any solution. Identify what can’t be overcome, and if a path still exists around those, then pick off the ones that remain.
8. Expect that implementation of the solution will be harder than coming to it. It’ll undoubtedly need other people to implement. Educate them about the benefits of a solution, before tell them what they will need to do.
9. Believe on the control. Even if there are wrong in fact, the perception that has control will promote the ability to perform. If there is a choice, and if someone answer honestly, it is almost always realize that it can be done. Choice is control.

Even if all those attributes are practiced by the healthcare leaders, still there is a gap for improvement. In the emerging healthcare business, where patient’s is paying out of pocket, where insurance reimbursement is not prominent, the competition is much high. The leadership challenges are varied in every hospital, as well as their capacity of working environment. Still these are the main attribute of what a hospital CEO can practice for betterment of the service. Country like Vietnam, Bangladesh, Myanmar, Cambodia, Laos and African where hospitals are struggling with different ball games with developed countries. There is a far difference of environment between public and private hospital, where public hospital is struggling with quality of services, proper allocation of resources and high occupancy, sometimes bed occupancy increase up to 130%, bed sharing is a normal occurrence in public hospital. The CEO of public hospital thus struggles with better service model; motivate staff towards honesty, patient driven service and how to handle corruption. Some public hospital CEO is making innovation to create 'centre of excellence' model in a pilot setting with some specialty and also moving forward some public-private partnership (PPP) model.

In fact, the public hospital CEO is also challenged with revenue generation and quality of service improvement from Ministry of Health. There are not enough budget allocation for doing such quality improvement project, thus these CEOs are expanding their collaboration with private healthcare business under PPP model. On the contrary, private hospital is also struggling with revenue generation, as they have less occupancy. The cost of the service is higher compared to public hospital as they are maintaining highest level of quality of care and some are following international gold standards. Therefore, the biggest challenges for private hospital CEO are to increase revenue by increasing occupancy with keeping the premier costing of services. The other challenges are to motivate staff for keeping the quality of standards, recruiting or engaging physician in the hospital system, recruitment of staff, communicate with community.

Interestingly, in most emerging countries hospital CEO have to look both operation and senior management role, most of the time they don’t have COO in their basket. CFO sometimes helps them to look after the administration but can’t so much experience to take care of operation. CMO is busy with clinical program management; most of the time aligns with MOH or DOH as a point of contact for regulatory compliance. Even some CMO hasn’t performed the day to day operation of clinical operation and thus they invite Medical Director to do so. Ultimately, the CEO is far behind of his/her agenda to formulate strategy and works like a COO for a hospital. This is particularly very prominent picture in the emerging countries healthcare system both in private and public hospitals. Besides, there is a skill and knowledge gap for developing strategy among these CEOs. The background of these CEO are mostly coming from public hospital management experienced where there is definitely deficiency of private hospital service model. With their leadership attitude most CEO quickly learn the service model of private hospital but they can’t come up at the desire level of formulating strategy for the hospital. If they don’t know where their hospital will be positioning in next 4-5 years, then how they will formulate strategy or run the hospital? There is a clear deficiency of such practice in public hospital too.

These pitfalls can be overcome by using the powerful ten steps developed by Clem Sunter. It is now clear that Strategic Conversation with ‘Power of Ten’ is one of the best tools for all types of planning essential to performance excellence by individual department and hospital as a whole in the competitive and rapid paced 21st Century. Strategic Conversation is about creating the strategic intention, setting a realistic and achievable course of action and fluidly monitoring execution to ensure the Intended Results are met.

“Success and strategy go hand-in-hand. A hospital can, very occasionally become successful without a strategy. But in most instances, success is the result of clear strategic intention and concerted effort in execution.”

This era is now in ‘the age of intelligence’. The arrival of the digital age has meant that access to knowledge and facts has increased exponentially over the last 20 years. This has broadened the ownership of information, thereby diminishing control through having a superior information base and throwing further uncertainty into the fray of doing business. The differentiator now is the way people use existing knowledge to create new knowledge and expand horizons by dreaming up ideas that have not been dreamt up before. This is all about intelligence, which comes back to educate people cognitive skills.

Three 'what' questions healthcare leaders should ask before committing to action: 

• What Do we control and
• What do we NOT control?
• What is certain and Uncertain about the future?

Many healthcare leaders have constructed an ingenious matrix around these questions, which assists to identify the rules of the game; assess the key uncertainties; paint scenarios; evaluate realistic options; and thereby make effective decisions. Essentially the matrix will give the edge. Here is the Seven (7) principles of strategy:

1. Strategy is direction. Tactics are how to get there.
2. Strategy formulated without first consulting the context will probably end up being bad strategy.
3. Strategy is as much about ruling in potential paths that fit our scope as ruling out others that don't.
4. Good strategy can be turned into bad strategy by a future change in the context. Scenarios are a way of exploring alternative futures, which might necessitate a change in strategy.
5. Bad tactics can destroy good strategy, but no tactic can rescue bad strategy.
6. Good strategy has a greater chance of being converted into good results if tactics are accompanied by a set of measurable outcomes to which people can aspire.
7. Above all, strategy is about understanding what we do and don't control, and what is certain and uncertain about the future - and knowing when to change direction to avert unintended, and possibly tragic, consequences.

‘ Strategy, the aim of the healthcare business, should not change that often, while tactics to stay on course will vary according to how the game evolves.’

Even there is confusion between the mission and vision statement. The Mission Statement concentrates on the present; it defines the hospital(s), critical processes and it informs you about the desired level of performance. Developing a Mission statement, we need to consider: What do we do today? For whom do we do it? What is the benefit? In other words, why we do what we do? What, For Whom and Why? Your mission statement may change, but it should still tie back to your core values, organizational needs and vision.

The Vision Statement focuses on the future; it is a source of inspiration and motivation. Often it describes not just the future of the hospital but the future of the healthcare industry or society in which the hospital hopes to effect change. Developing a Vision statement, we think about- Where do we want to be going forward? When do we want to reach that stage? How do we want to do it? As your organization evolves, you might feel tempted to change your vision. However, mission or vision statements explain your organization's foundation, so should not change very often, change should be kept to a minimum.

Fundamentally, Great leaders engage C-Suit, Directors, Managers, Board members and the hospital as a whole in critical consideration of 'where they are today' and ‘where they would like to be in the future?’ Great leader assists the organization in planning and executing the actions required in moving from an “As Is” to a “Desired Future Condition” [DFC]. Great leader always designs 'Core Management Systems Model' for the hospital, reflects a basic structure of five, highly interrelated systems. These systems are: the Service Delivery System; the Human Resources Management System; the Support Services System; the Administrative Management System; and, the Financial Management System. Thereafter, Great leader develops a Gap-Bridge analysis, and tools for Action Planning that describes: What needs to change; Why that change is critical; How the change will be effected; Who will achieve the change; Who will be impacted by the change; When the change will be effected; Where the change will be effected; and the Cost of the change in terms of Time, Material, People, and Money (TMPM).

Great leader believes in the very best healthcare organizations are patient-centric and provider-driven. The patient, while perhaps most important, isn’t the only customer. The term “customer” includes what Great leader calls the Four Ps: Patients, Physicians, Public and Payers. The providers include virtually everyone working in the hospital. It takes everyone to provide great ‘patient Service’. At the same time, a hospital cannot meet its Mission if it has no Margin. Everyone working in the hospital must understand and demonstrate a commitment to solid financial performance with respect to revenue and expense. These are the fundamental principles of performance which are reflected in CEO leadership.

Well, when the day is done, healthcare professionals know what their roles and responsibilities are in organization and how they must perform. Given the chance, and a little structure, people will perform. Great leaders simply remind people of their own personal visions and align them with the organizations.

Great leader simply facilitates people in getting to where they really want to go.

The Golden goal in today’s healthcare game is NOT HOW much we care about patient; but is HOW much patient care about us!