Lessons From Small-Town Government

The world of politics has some lessons for healthcare.

by Paul Hiltz, FACHE

How can you run an organization when you really can’t control it? If you are the executive of a hospital that is part of an integrated delivery system, that is exactly the challenge you face.

Many common ideas about strong leadership do not apply to system hospitals, and management by edict simply doesn’t work—there are too many stakeholders outside your chain of command. For a better model, you can look to the world of politics.

Based on my experience, integrated delivery systems call for many of the same leadership skills that are critical in small-town government. By implementing these skills into their leadership toolkit, hospital executives can create powerful change even where they don’t have total control.

An Early Lesson
My knowledge of government comes from the 12 years I served on the city council of Fort Wright, Ky., a small community south of Cincinnati. During my tenure, I was also privileged to serve one year as the town’s interim mayor.

During those dozen or so years I learned a lot about working with people. one early lesson stands out: In our town there were two roads with very similar names. It was a dangerous source of confusion for emergency personnel, so the council moved forward with a plan to rename one of the roads. We thought it was a logical solution to a clear-cut safety problem. We were wrong.

Many residents were strongly attached to the name, which had been the same for nearly 100 years. People protested vigorously. What seemed like an easy fix turned into a major fiasco. In the end, we had to drop the plan. This experience taught me that in public service, authority is not as important as influence. Even if logic is on your side, you still need to persuade others to get behind a change.

Over the years, I have come to realize that this same lesson applies to leadership in an integrated health system. Executives of system hospitals need to be able to work with and influence a wide range of stakeholders—physicians, hospital management, staff, system executives, community representatives, their CEO peers and many others. System  executives can meet this challenge by mastering four leadership skills from the world of smalltown government:

Skill #1: Selling Ideas
In small-town politics, nothing happens just because it is a good idea. You need a groundswell of support to make change happen, and that requires selling an idea to a broad range of people. The same is true in an integrated health system—effective leaders are the ones who are able to persuade a wide variety of stakeholders to support a change.

Healthcare leaders who are successful at selling ideas take a few important steps. First, they develop a clear vision, whether it is about quality, safety, financial  responsibility or any other pressing goal. Second, they keep that vision in the spotlight. That means talking about it in every appropriate setting.

Most importantly, successful healthcare leaders connect their vision to people’s goals and priorities. The key here is cultivating personal relationships, both on the job and in social settings. Developing personal bonds allows you to find out what matters most to others and overcome individual obstacles. The ability to  communicate a vision and link it to individual needs is what creates broad-based desire for change.

Skill #2: Making Abstract Concepts Concrete
As we have all seen in recent years, the most successful politicians are the ones who can express dry proposals in vivid terms. This skill is critical in healthcare,  where abstract concepts and theoretical models often dominate the discussion.

The most powerful way to make a message vivid is to present it as a story. In healthcare, this naturally translates into patient stories. Patient stories take an idea to a personal level. For instance, sharing the well-known story of Josie King, an 18-month-old girl who died tragically because of medical errors, is an effective way to communicate about patient safety (visit www.josieking.org for more information). Once people have heard Josie’s story, they would hate to have anything like that happen in their hospitals.

Patient stories help influence people because they make individuals receptive to change. A story helps people see why the organization is moving from old ways to new processes and envision what the new way will look like. Stories can help hardwire operational changes into an organization.

Skill #3: Building Rapport Within Small Groups
Effective politicians thrive in small groups, connecting with constituents in town hall meetings, at neighborhood picnics and around kitchen tables. This skill also is  important in an integrated health system, which can include hundreds of small special interest groups.

For example, say your organization is launching a program to improve patient satisfaction. General pronouncements will not do much to effect change. Leaders  need to make the rounds and meet separately with administrators, clinicians and reception staff. In the case of nurses, the best approach is to visit individually with each nursing unit. With physicians, addressing the medical staff as a whole is not effective. You need to take your message to department meetings.

The small-group approach enables you to build goodwill by meeting people on their own turf; influence stakeholders by appealing to them within their true peer  group; and overcome obstacles by getting a better sense of group concerns and then piecing together a powerful coalition for change.

Skill #4: Thinking on Multiple Levels

The best small-town politicians know what is happening at state and national levels but never lose sight of what makes sense at the local level. System leaders  require this same skill. They need to be able to bridge the gap between high-level priorities and local hospital needs.

Consider current movements in payment reform:

  • An effective system hospital leader is conversant in the various national reform proposals and understands the basic direction of the healthcare industry.
  • He or she also understands the integrated delivery system’s plans for responding to that direction – for instance, an initiative to improve quality of care.
  • At the regional level, the leader is actively involved in coordinating the initiative with other system providers in the geographic market.
  • Finally, at the local level, the executive has to understand how to implement planned changes within the individual hospital.

A key element of this skill is sensitivity to local culture. As integrated systems strive to put new processes in place across multiple hospitals, the risks are friction and rejection. Effective hospital CEOs understand how proposed changes will affect local patients, nurses, physicians and others, and they know how to translate initiatives in a way that works in the local hospital.

The Shape of the Future
Given recent trends, the skills of small-town politics will soon be more important than ever for leaders in all hospitals, system and nonsystem alike. Economic forces are pushing the healthcare industry toward integration. In addition, healthcare reform—whatever shape it ultimately takes—will likely reward coordination across the range of providers. In the years to come, all healthcare executives will have to master the ability to lead by selling ideas, building rapport and tying together a wide spectrum of people and goals.

This is a good thing for both providers and patients. Influencing is more difficult than issuing edicts, but it is a lot more effective in the long run.

Paul Hiltz, FACHE, is president of Mercy Physician Hospital Organization, part of Mercy Health Partners, in Cincinnati.
He can be reached at pchiltz@health-partners.org.

Healthcare is a dynamic industry, in which it can sometimes feel as if change is the only constant. An overwhelming amount of information floods administrators on a daily basis, and there is simply not enough time to take it all in. Nonetheless, it is vitally important for early careerists and more experienced individuals alike to adapt to the transforming environment. Identifying and understanding trends is key, but this is easier said than done. Developing a plan to filter relevant information and utilize appropriate sources is necessary. As the great Peter Drucker said, “Today knowledge has power. It controls access to opportunity and advancement.” Gaining the knowledge most pertinent to personal career goals can help facilitate career advancement.Having a plan
Creating a career development plan outlining future goals must be the first step if you do not already have one. This plan should include strengths and weaknesses to help understand where your talents lie. Being able to use and grow your strengths is a key to success. Having a plan for how to acquire the knowledge you will need to cultivate these assets is easy to overlook, but is just as important. Personalizing how you stay current with your professional goals will help to narrow your focus on the vast array of resources available. Once a plan is in place, you can concentrate on topics related to your areas of interest. Information gathered should be relevant to both your career and your organization. Gaining knowledge that adds value should always be a priority. This will allow you to stay current and informed without wasting precious time on non-essential reading.

Making the commitment
Staying current and up to date must be a daily commitment, which is often a task valued in theory and forgotten in practice. This is why you should devote at least 15 minutes every day to reading about current trends in your industry. It can be tough to allocate any amount of free time due to busy schedules, but it will pay off in the end. Specifying a certain time of the day for reading may help, such during a daily commute or immediately after lunch each day. The key is making the commitment. Many successful individuals spend much more than 15 minutes every day staying current. As you grow more familiar with the process, attempt to increase your daily dosage of reading material. You may also find opportunities to catch up on heavier reading while waiting at the airport or when stuck at the dentist’s office. Maintaining a file of earmarked articles for future reading can aid this process for some. But for others, this may cause reading material to simply accumulate and go unread. Developing a system that works for you is the best strategy. Still, this should be in addition to a daily routine of reading which serves not only as a source of valuable information but also as a reminder to look outward and ahead.

Sources for national issues and developments
Keeping a finger on the pulse of the industry at a national level is important. It is easy to find all of your attention focused on your local market, but this can be detrimental to your organization and career. Looming federal policy changes, for example, can have a direct impact. The reliance of healthcare on constantly evolving technologies mandates continual learning for administrators. Innovation is often inspired from external sources, sometimes even from other industries. According to Peter Drucker, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.” While his statement aptly describes entrepreneurs, it also highlights the importance of foresight and adaptation. Awareness of industry-wide issues and developments is crucial to contending in a competitive market.