‘Peanuts’ and ‘Monkeys’ effect in healthcare! Reforming culture, controlling voice?

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It is certainly unforgettable about Sir James Goldsmith, who a European industrialist known for his flamboyant and outrageous reputation, is attributed with the quote: “If you pay peanuts, you get monkeys.” In Vietnamese it says N?u b?n tr? ??u ph?ng thì b?n ch? có nh?ng con kh?. cau này có ngh?a: n?u b?n tr? l??ng th?p thì b?n ch? nh?n ???c nh?ng ng??i giúp vi?c t?i. But nobody much knows more about his philosophy on how businesses should be run, formed after years of learning and practice. He believed strongly in the decentralization of control, the importance of good managers and incentives and in the wider good takeovers could do in the market place to break up large conglomerates and make their individual businesses more efficient and effective.

Never one to run with the pack, his unconventional and innovative approach was also evident in his extraordinary ability to read warning signs in the stock market – allowing him to make prudent and timely decisions that meant he succeeded when many others did not.

Sir James attracted plenty of attention with his takeover bids for companies, but for him, corporate raids were the engine of capitalism. As he told the Senate Finance Committee, it was a necessary corrective. “Raiders shouldn’t put on a halo. They are doing it for personal gain. The important thing is whether their action is generally beneficial or generally detrimental, not why they are doing it … the dead hand of the bureaucrat does not produce growth. It does not produce innovation. It produces complacency, ossification and decline.”

In the 1980s Sir James applied this lesson to his fight against large corporations and conglomerates he believed should be broken up. In his view, authority should be decentralised, and each part of the business should be allowed to run itself. Companies that had diversified away from their core purpose should be returned to their core business strengths, and anything peripheral sold off, with the proceeds being used to strengthen the central company. His winning letter is still a key secret to run every business.

"My Dear, It astounds me that businesses can continue to pay their best and most hardworking employees little to nothing and still expect genius-scale work from them day-after-day. 

Hiring a large quantity of cheap labor is far less effective than properly hiring and paying for the best. 1,000 monkeys get far less done than three people. And if you barely pay people and they leave, just to find someone else who’s willing to work for such a cheap cost, realize you’re not getting the better deal. What you just did is replace a hardworking person with a monkey – you expecting them to think on the same intellectual capacity is absurd. 

Pay people right. If you pay peanuts, you get monkeys. Falsely yours, James Goldsmith".

Unfortunately and fortunately companies didn’t listen and learn from his lesson, especially in healthcare. Healthcare is turning crucial financial challenges, resource limitation. Actually, the healthcare business starts with philanthropic business motive and now, turning into a for-profit business. And now here the monkeys are coming to healthcare and getting their appointment. Most of the HR practices are very carefully for their recruitment and they always remembers this proverb or James quote about ‘If you pay peanuts, you get monkeys’. Unfortunately, they can’t resist themselves to recruit monkeys in the healthcare. It’s started with low grade entry level position and with a time of spin, now these monkeys are the key opinion leaders in the healthcare and some big monkeys are running the show. Interesting, if you look at corporate private hospital business, driven by profit and always look the bottom line are mostly filled with peanuts and monkeys. The most corporate hospitals CEO loved to stay with Monkey land where they are surrounded by ‘Yes Sir’/ ‘Wonderful Sir’ Monkeys and they make a syndicate into the system. Even the BoD is sometimes helpless to intervene with this syndicate.

Now, the issue is not at recruitment stage where you need to think about peanut and monkeys but now it is in the company culture stage where you’re already handling monkeys! Healthcare is a complex and emotionally touch business, its’ not like production house where production and sales are directly align into revenue and profit. It’s not real state where you sales dream and capture the capital upfront, even its’ not the restaurant or hotel business where entertainment is the main key focal point to generate revenue. It’s totally a different world of business where all are mixed up with emotion, empathy, sympathy, joy, happiness, human touch directly align with revenue. Knowing these facts, BoD or investors are trying hard to make it a for-profit business and engaging CEO from outside the industry to steam up the healthcare. These new CEOs are getting pampered by CFO who is showing unbelieving success by cutting cost and fixing bottom line. And creating a door for monkeys is to join the facilities. Now monkeys are everywhere in the healthcare, And during the course of time, these cheaper healthcare executives turn into a leader and even appointed a CEO. Imaging a big monkey is running your hospital and what will be your expectation!

There is always a difference between cutting cost and saving cost. Cost saving is an art and that needs to learn by CFO. Cutting cost any monkeys can do and they love to do if you give them scissor. Differentiation will be determined how a cutting cost culture turn into a saving cost environment. One of the interesting part is budget practice and how your hospital practice budget is one of the key factor to understand if your hospital is disrupting by monkeys or not! If you have a sharp eye observation, then you’ll find that monkeys have their own culture, they disrupt everything, they are unstable, short focus and sometimes these cultures propagated into BoD and influence them like flu. To make it clear, how it works, here is an example of a hospital. The hospital is commissioned in 2014 and within 4 years, they changed their CEOs 4 times, average lifetime of each CEO is one year and now BoD is looking for another one. They engage one recruiter to recruit a CEO and this recruiter is looking for a CEO who can commit long time engagement, drive for revenue and sales as his/her client is an investment firm and, are looking for profit from this hospital. if average lifetime of a CEO is one year and how a new CEO can commit long term engagement! And also this new CEO doesn’t know how many monkeys are working at that hospital?

To make this long story short, remember the Jim Collins (Good to Great: Why Some Companies Make the Leap and Others Don't) creates a lasting and memorable metaphor by comparing a business to a bus and the leader as a bus driver. He emphasizes that it is crucial to continuously ask “First Who, Then What?” You are a bus driver. The bus, your company, is at a standstill, and it’s your job to get it going. You have to decide where you’re going, how you’re going to get there, and who’s going with you.

Most people assume that great bus drivers (read: business leaders) immediately start the journey by announcing to the people on the bus where they’re going—by setting a new direction or by articulating a fresh corporate vision.

In fact, leaders of companies that goes from good to great start not with “where” but with “who.” They start by getting the right people on the bus, the wrong people (Monkeys!!) off the bus, and the right people in the right seats. And they stick with that discipline—first the people, then the direction—no matter how dire the circumstances.

Long live hospitals, long live hospitals’ CEO and are aware of Monkeys!