EXECUTION FOR DEPARTMENT MANAGERS

1. EXECUTION FOR DEPARTMENT MANAGERS By Dr. Tony Lybarger

2. Fortune 2007100 Best Places to Work • # 9 – Methodist Hospital (Houston) • As gas prices increased Methodist sent employees (not executives) a $250.00 gift card to be used at Chevron stations. • Average hourly employee annual salary (75,776) • 11 hours of training per year • 11% turnover

3. 100 Best Places to Work# 21 • Griffin Hospital (Derby, Conn.) • Over 580 other hospitals have visited to learn how Griffin provides exceptional patient service. • 13% turnover • Average annual hourly salary ($67,619) • 110 hours of training a year

4. 100 Best Places to Work# 35 • Children’s Healthcare of Atlanta • Provides backup care for children, elders & pet insurance • $63,228 average hourly annual pay • 20 hours of training • 9% turnover

5. 100 Best Places to Work# 37 • Northwest Community Hospital (Arlington Heights, IL.) • $3,500 tuition reimbursement (higher for radiology & nursing), concierge service & a $5000 forgivable loan to buy home • $67,246 average annual hourly pay • 52 hours of training • 4% turnover

6. 100 Best Places to Work# 52 • OhioHealth (Columbus) • Provides employees concierge service to assist with personal chores. • $55,574 average hourly annual pay • 103 hours of training • 5% turnover

7. 100 Best Places to Work# 54 • Baptist Health Care (Pensacola) • Leaders are always available with “No Secrets” policy. • $50,860 average annual hourly pay • 60 hours of training • 16% turnover

8. 100 Best Places to Work# 62 • Mayo Clinic (Rochester, Minn.) • Health care coverage includes a comprehensive plan, pregnancy advisor, 24 hour nurse hotline & retirees retain full coverage • 31 hours of training • 6% turnover • Annual pay information not available

9. 100 Best Places to work# 80 • Lehigh Valley Hospital & Health Network (Allentown, Pa.) • Employees pay nothing for healthcare and get bonuses tied to patient satisfaction scores & financial performance. • $58,575 average annual hourly pay. • 88 hours of training • 6% turnover

10. 100 Best Places to Work# 81 • Baptist Health Systems Florida (Coral Gables) • Nearly 70 nurses made more than $100,000 in annual pay • 13% turnover • 16 hours of training • 66,631 average annual hourly pay

11. 100 Best Places to Work# 91 • Memorial Health (Savanna, Ga.) • Hands out bonuses of up to $500 to employees getting high patient satisfaction scores. • $68,297 average annual hourly pay • 60 hours of training • 10% turnover

12. 100 Best Places to WorkHealth Care • # 9 – Methodist Hospital System • # 21 – Griffin Hospital • # 35 – Children’s Healthcare of Atlanta • # 37 – Northwest Community Hospital • # 52 – OhioHealth • # 54 – Baptist Health Care • # 62 – Mayo Clinic

13. 100 Best Places to WorkHealth Care • # 80 – Lehigh Valley Hospital & Health Network • # 81 – Baptist Health S. Florida • # 91 – Memorial Health

14. INTRODUCTION • I created this Power Point Presentation for Department Managers in health care facilities. The content is based on my experience as a manager in health and human service agencies in tandem with philosophical excerpts from Good To Great by Jim Collins, Hardwiring Excellence by Quint Studer and Execution (the discipline of getting things done) by Larry Bossidy & Ram Charan. • My goal is to share information that increases the probability of your success as a Department Manager

15. Definitions: • What is GTG? GTG describes the management practices of 11 organizations that went from Good To Great • What is Hardwiring Excellence? A description of people management practices in hospitals that creates a Culture of Excellence • What is Execution? The discipline of getting things done

16. What is the Value of Leadership Without Execution? • Leadership without execution is incomplete and ineffective. (Ex 34) • That means (to me) that no matter how great you are at leading employees in your Department, if you are not getting things done effectively and efficiently --- who cares! • The test of your leadership/management ability is knowing what work needs to be done, what skills are required to get that work done, knowing which employee can best do that work and getting employees to do that work correctly 90% of the time promptly. (that means on-time)

17. GTG + Execution =‘s HardwiringExcellence: • As a manager I have the ability to create change. For example: • For seven years I was the Director of a 500 bed intermediate care facility with 1500 employees. During my tenure that facilities level of compliance with external (federal) regulations increased from 42 % to 100 %. (42% - 82% in my first 24 months) • During my tenure as Director of a 150 bed intermediate care facility the number of deficiencies decreased from 150 to 2 in during my first 90 days. • For 120 days I managed two 500 bed facilities in two states concurrently with regulatory success.

18. During the preceding vocational odyssey I either learned about or gained insight into the following management concepts that are applicable to Department Managers. There are two types of organizational change (symbolic & systemic). Symbolic (Studer 147) comes first followed by systemic. Right-to-Left Management: Select an organizational destination and operationally strengthen all activities, programs and people that increase the probability of arriving at that destination and discard all others. Hire slow and fire fast. (Studer 81) Recruit, select and retain the 90/90 employee. The 90/90 employee does 90% of her work correctly 90% of the time with little or no supervision. MACRO MANAGEMENTCONCEPTS(1)

19. MACRO MANAGEMENTCONCEPTS (2) • Have the least number of employees possible and pay them as much as possible. • If a job requires 10 employees assign 9. • Pursue vocational equity --- employees love to see people get what they deserve. • Identify the macro success for your Department and based on that success select eight Preferred Work Behaviors (PWB’s). • 70 – 15 – 15 Rule --- 70% of the people working in your organization are vocationally normal (remove demotivating factors and they will give you a days work for a days pay), 15% of the people are genetically happy (they will help you no matter what you do) and 15% of the people are genetically angry. They will be pissed-off no matter what you do. Don’t waste your energy on them.

20. MACRO MANAGEMENT CONCEPTS (3) • The rate of organizational change increases when specific people are held accountable for specific tasks at specific times. • The rate of changes is even more rapid when positive and negative consequences are applied consistently contingent on performance. • A person can only be a victim so long, then they become a participant. • Every adult is responsible for their own behavior.

21. MACRO MANAGEMENT CONCEPTS (4) • Less is more related to the number of supervisors in your organization. • Fix the cause not the symptom (turnover, absenteeism, low moral, low productivity and/or too many errors). (Studer 110) • Your Department is not a Rehab Unit for Negative People! (Studer 36) • You cannot manage effectively from a position of weakness --- confront what you fear most. • The Messiah is not coming for Department Managers. • Learn how to talk like a “Behaviorist” (weird).

22. MACRO MANAGEMENTCONCEPTS (5) • Value Based Alignment Analysis allows more precise resource allocation. (Studer 68) • Commit to 3 – 2 – 1 relationships. (Studer ?)

23. Good To GreatIdentifying Success Templates • Jim Collins completed research on 1500 business (none were hospitals) and identified 11 that went from Good To Great. (Walgreens is a GTG company) • You may be (possibly should be) asking the person next to you --- what does this have to do with being a Department Manager? • The connection is Success Templates. I take the position that good management (the discipline of getting things done) is good management no matter the business. • Learning how to get things done by manipulatinghumans looks much the same no matter the business your in.

24. Level 5 Leadership – Self-effacing, quiet, reserved --- these leaders were a paradoxical blend of personal humility and professional will First Who --- Then What ---A process for getting the right people on the bus, the wrong people off the bus and the right people in the right seats before deciding where to drive the bus Confront the Brutal Facts – An unwavering faith in their ability to prevail accompanied by the discipline to confront the brutal facts GTG COMPANIES HAD THE FOLLOWING

25. WHAT GTG COMPANIES HAD CONTINUATION • A Culture of Discipline – All companies have a culture, some companies have discipline but few companies have a culture of discipline. When you have disciplined people, you don’t need hierarchy. When you have disciplined thought, you don’t need bureaucracy. When you have disciplined action, you don't need excessive controls. When you combine a culture of discipline with an ethic of entrepreneurship, you get great performance

26. FIRST WHO --- THEN WHATThree Simple Truths • GTG leaders understood three simple truths [1] If you begin with “who” rather than “what” you can adapt more easily to a changing world, [2] If you have the right people on the bus, the problem of how to motivate and manage people largely goes away and [3] If you have the wrong people, it doesn’t matter which direction you drive --- you will never have a great company.

27. “FIRST WHO”Easy to Say --- Hard to Do! • This management philosophy requires that your organization differentiate between productive and non-productive employees • That you hire slow and fire fast • That productive employees receive rewards that are significantly different from non-productive employees • Most seats on the bus are reserved for “A” players

28. RIGOROUS NOT RUTHLESS • The only way to deliver to the people who are achieving is to not burden them with the people who are not achieving

29. ARE YOU PAYING PEOPLE TO HELP YOU FAIL? • When in doubt about a job applicant --- keep looking • When you know you need to make a people change, act. • The moment you feel the need to tightly manage someone, you’ve made a hiring mistake (hire slow & fire fast) • Put your best people on your biggest opportunities, not your biggest problems

30. A CLIMATE WHERE TRUTH IS HEARD • GTG leaders understood the difference between “having your say” and being heard. They created a culture where people had a tremendous opportunity to be heard and, ultimately, for the truth to be heard • All GTG companies had a penchant for intense dialogue • If you have the right people on the bus, you should seldom need to assign blame. • GTG companies had the same information as GTW companies. The key was not better information --- but not ignoring the information

31. A CULTURE OF TRUTHFOUR PRACTICES • Lead with questions, not answers • Engage in dialogue and debate, not coercion • Conduct autopsies without blame

32. A CULTURE OF DISCIPLINE • Create a culture of discipline by avoiding bureaucracy and hierarchy • The purpose of bureaucracy is to compensate for incompetence and lack of discipline • GTG companies hired self-disciplined people who didn’t need to be managed, and then managed the system, not the people (Macro Management) • My 90/90 employee • Hire the least number of employees possible and pay them the most possible (me)

33. A CULTURE OF DISCIPLINECONTINUATION • Have the least number of supervisors possible --- they cost money and create confusion • Nucor grew into a $3.5 billion Fortune 500 company with four layers of management supported by a corporate staff of less that 25 people who worked in a rented office the size of a small dental practice

34. HOW CAN YOUR ORGANIZATION GO FROM GTG? • Get the right people on the bus in the right seat and get the wrong people off the bus. (GTG 41) • Recruit, select, train & retain the 90/90 employee. • Good hiring looses values without good firing. • Hardwire excellence by creating a Culture of Execution. • Differentiate significantly between productive and non-productive employees with compensation & rewards. • Create a consequence rich work environment. (Studer 27) • Manage the culture (macro management) not the people (micro management) (GTG 125) • Pay less attention to motivation & more attention to demotivation. (Studer 27)

35. CREATE an ARCHITECTURE of EXECUTION • An architecture of Execution is put in place by leaders who exhibit the following behaviors: • [1] Promoting and rewarding people who get things done. • [2] Assign and monitoring the performance of tasks • [3] Leading and coaching through honest communication and feedback =‘s Robust Dialogue. (Ex 28)

36. What is Execution? • Execution is a systematic process of rigorously discussing (Robust Dialogue - Ex 102) the hows and whats of getting things done, questioning tenaciously and then following through while ensuring accountability. Linking strategy to operations and the people who are going to implement the strategy, synchronizing those people and their various disciplines and linking rewards to performance.

37. What is Execution?A Compressed Answer • In its most fundamental sense, execution is a way of exposing reality and acting on it. (Ex 22)

38. What is an Organization’s Culture? • An organization's culture is the sum of its shared values, beliefs and norms of behavior. (Ex 89) • Another way to describe “culture” is what you as a Department Manager expect from yourself, other leaders and employees. • Culture can also be defined as the unwritten rules you live by at work. • An organization's culture defines what gets appreciated, respected and rewarded. (Ex 92)

39. How do you Change the Culture in Your Department? • You change people’s behavior so that they produce results. • [1] Tell people what results you expect. • [2] Discuss how to get those results • [3] Reward people for getting those results • [4] For those people coming up short, provide coaching, withdraw rewards, move them to another job or fire them. (Ex 86)

40. Accountability Talk! • In a Culture of Execution people talk to each differently. Every conversation is a performance evaluation. Employees hold each other accountable! • You cannot have an execution culture without Robust Dialogue --- that brings reality to the surface through openness, candor and informality. (Ex 102) • Harmony --- sought by leaders who wish to offend no one --- can be the enemy of truth (Studer ?) • Don’t fight your way up the “Pecking Order.” • BS walks & behavior talks!

41. What is a Culture of Discipline? • A culture of discipline is about disciplined people who engage in disciplined thought and then take disciplined action. (GTG 13)

42. What is the Value of a Culture of Discipline? • When you have disciplined people, you don’t need hierarchy. • When you have disciplined thought, you don’t need bureaucracy. • When you have disciplined action, you don’t need excessive controls. • When you combine a culture of discipline with an ethic of entrepreneurship you get GREAT PERFORMANCE! (GTG 13)

43. What is Hierarchy? • Hierarchy is “We” vs. “They.” • Administrative staff securing privileges not available to the people doing the work. • Administrative separating themselves physically & psychologically from customers & employees. • More than four levels of management from the Supervisor (not Department Manager) to the CEO of the organization. • Hierarchy is a demotivating factor.

44. What is Bureaucracy? • The purpose of bureaucracy is to compensate for incompetence and lack of discipline. (GTG 121) • Many organizations build their bureaucratic rules to manage to many the small percentage of wrong people on the bus, which in turn drives away the right people on the bus, which increases the need for more rules to compensate for incompetence and lack of discipline which further drives the right people away --- Do you get it?

45. What are Excessive Controls? • GTG companies paid little attention to managing change, motivating people or creating alignment. (GTG 11) • When you have a Culture of Discipline you do not need excessive controls. (GTG 13) • If you have the right people on the bus, the problem of how to motivate and manage largely goes away. The right people don’t need to be tightly managed. (GTG 42) • The moment you feel the need to tightly manage someone, you’ve made a hiring mistake! (GTG 56) • Rules imposed on employees because you don’t trust them to do the right thing. (Lybarger 3:16)

46. Can Employees Change their Behavior? YES! • People don’t think themselves into a new way of acting they act themselves into a new way of thinking! (Ex 89)(Studer 39) • Identify PWB’s --- then reward employees who exhibit those PWB’s correctly/consistently and coach, transfer or fire those that don’t. • The foundation for changing behavior is linking rewards to performance and making that linkage transparent. (Ex 92) • If you, the leaders, reward and promote people that Execute, the culture will change to match their behavior. (Ex 92)

47. How Do I Motivate Employees in My Department? • You don’t! • (GTG 10 & 42) GTG companies paid little attention to motivating employees. Under the right conditions, the challenge of motivating employees melts away. • When employees (most of them) see PWB’s being rewarded significantly, they will, without being told to do so, exhibit those same behaviors. • Recruit & retain 90/90 employees and the need for supervision and/or motivation will evaporate. • Spotlight the “high performance” employee (Studer 41) • The only way to deliver to the people that are achieving is to not burden them with the people who are not. (GTG 53)

48. Remove Demotivating Factors From the Work Environment • Create a Stop Doing List! (GTG 139) • The fastest way to make a profit is to stop doing things that don’t make a profit. • Four times a year ask employees to identify irrelevant and non-productive work. Then stop doing that work! (Studer 160) • Initiate a monthly “What We Do Worst” meeting. (Studer 147)(Studer 160) • Remove “CRAP” from the work environment! (Studer 81) • If the job requires 10 employees --- assign 9.

49. NUCOR • Executives had fewer perks than frontline workers • All workers (not executives) were eligible to receive $2,000 per year per child for up to four years of post-high school education • All employees shared in profits • All employees shared in the pain of financial loss. However, executive suffered more • Production bonuses of up to 200 percent were available to production employees • Production employees chose the people with whom they would work and deposed of employees costing them bonus money

50. NUCOR • Employees saw the union as another level of management that wanted to take money from their wallet / purse • Destroyed the hierarchy • In 1996 production workers averaged $60,000 per year. To earn their wages the employee had to do two things --- work in teams and produce • We hired five, worked them like ten and paid them like eight • The more they (employees) made, the more we (Nucor) made • Used compensation to give the employees a “stake in the business.”