How to Avoid The Death of Your Organization

Actual Change Management

INTRODUCTION:
You’re listening to Tiller-Hewitt’s Leadership Lens Podcast. If you’re a leader - or an aspiring leader - who wants to stay relevant and impactful… YOU’RE IN THE RIGHT PLACE. At Tiller-Hewitt we believe it’s faster, smarter -- and less painful -- to learn from leaders who have walked before us. That’s why we invite top leaders to be our guests on the Leadership Lens. Your host is Tammy Tiller-Hewitt – Founder of Tiller-Hewitt HealthCare Strategies. Let’s jump into the podcast.

TAMMY:
You are about to meet my guest Greg McFarland, the Chief Operating Officer of Hillcrest Medical Center – an over 650-bed hospital located in midtown Tulsa, Oklahoma. Greg is a young, no-nonsense leader telling real-life leadership stories that stick, like the difference between a consumer and a patient, and will have you shaking your head in agreement and then something super simple that leaders can do to avoid the death of their organization.

TAMMY:
Greg McFarland, welcome to the Leadership Lens podcast.

GREG:
Thank you, Tammy. How are you?

TAMMY:
Hey, I'm doing great. I was so excited for today. We haven't caught up for a while and I know our listeners are going to find your responses and remarks hilarious like I will. So, thank you so much for being on the podcast.

GREG:
No pressure on the humor, but I'll try and deliver.

TAMMY:
You always deliver it. You're a natural. So hey, maybe stand-up comedies in your future. I typically, during interviews, end with what we call the rapid-fire lightning round questions. But I'm going to flip it around today and I'm going to start with the lightning round questions because clearly, they're my favorite because that's how we typically end. So, we're going to begin just to give everyone a taste of who Greg McFarland is. So, tell me what is your favorite leadership quote?

GREG:
Favorite leadership quote? I had a coach in college and the verbiage was WIN FOREVER, and it permeates through everything in life, right? I've always used this even in a work setting which is, you want to win in everything you do and that sounds aggressive maybe. But it's more than that. It's about culture, right? So, if you are a husband, you want to be the best husband you can be. If you are a leader in the workforce, you want to be the best, most positive, influence and leader you can be. And so, I've always applied that to everything. It's simple, it's sweet. It can be applied to all things no matter what. So, it's win forever.

TAMMY:
Love it. What about your biggest leadership, pet peeve?

GREG:
I didn't know I had this pet peeve until maybe this last year. I hate when people speak anecdotally in healthcare.

Easy examples, “Oh, well, you know, the patients usually stay over the weekend because of a PT eval that didn't get done. Or you know, usually the patients get here at 8 AM and sometimes they're late and we're waiting around…” Those kinds of comments drive me crazy, I'm a data guy and I want to understand the actual information. So anecdotal comments are the killer of progress in my opinion!

TAMMY:
They're the fingernail on the chalkboard for you, eh?

GREG:
Absolutely.

TAMMY:
OK. How about a top value that guides what you do?

GREG:
Yeah, I think it's try and do good. You know, we're in healthcare, we run a hospital. I try and keep it very, very simple on this one, which is I want to work for and lead a place that I want to have my family if they needed care be at. It's a simple guiding force. But you know, if your grandmother or your mother needs to be in the hospital, I want to be confident in the fact that that's my hospital. And so that's my guiding force in healthcare.

TAMMY:
Recently on a leadership webinar, one of the VPs of Operation from a large health system. - he kind of launched it to say, how do you feel, talking to leaders both on the panel and as in the audience, how do you feel when you run into friends or family in social gatherings and they tell you about something that's broken at your organization, and something that you know is broken and something that has been broken for a while, but nobody's taking ownership.

So given the guiding value that you just talked about in a place that your friends and family come to. How would you answer that when you're in a social gathering and someone says something that you knew was broken?

GREG:
You know what, I want all the feedback Tammy, regardless of good or bad. If it's only good feedback, you can never fix anything, right? That means you're perfect and you've reached Mount Everest in terms of goals.

So, bad feedback, I'll take it because it gives us an opportunity to do something better. Whatever the swing and miss is, if you have a friend or family member who came to your ER and they tell you, well you know what, I waited four hours to be seen. I want to know that and I want to go back because I know myself and I'll go back and look at that day and understand what was happening in the ER, see if it was an issue or if it was just a really, really busy evening. But you can't get better unless you get bad feedback that you're, you're never perfect. Right? And so, bad feedback is just a way to improve.

TAMMY:
That's good. I like that your deepest response to that was you were going to go back and look into it. Not just say, I know we have long waits in the ED. What are you going to do? You know, that you're going to actually try to solve for it.

GREG:
Every time.

TAMMY:
I also like that you used the word Mount Everest in that because that same leader was talking about a singular focus. And it's like if we were climbing Mount Everest, if that was our, our singular focus, we wouldn't have the capacity, whether it was our air capacity or strength to really look at anything else, we're climbing Mount Everest. And that's what we need to do as leaders is have the singular focus. And you know, he, he's a very big proponent of the singular focus needs to be the patient.

So, my next question is when you're looking for a new team member, is there a specific quality that you should or that you look for to stand out?

GREG:
They have to know the people. I think that's the one characteristic whether in an interview, if it's someone who's new to a role or if you're coming into a new organization and you're trying to evaluate leaders around you that report up through you. Do they know their people? Right? And what is their interactions with their people?

The easiest way I can identify this is I break it down really simple again, if you're walking down the hallway of your hospital or your health care organization and you walk past five employees, can you name three of the five? Because if you can't name three of the five, you're probably not as connected as you need to be with who's doing the daily work. And so, I really hold that in high esteem as a characteristic I look for in a leader. Because you have to know the people. If you don't know the people and you're extremely confident, you still won't get anything done. But you know, if you're interviewing or you're a leader, the competency has to be there. That's a baseline. But what I look for is someone who is truly connected to people.

TAMMY:
Got you. Hey, do you have a hobby? Leaders need a healthy distraction, curious, do you have one?

GREG:
Yep, I've got 90 minutes a day that are my own Tammy. Everything else is not my own. So, I go to the gym at 5 in the morning. I'm a fitness junkie. 5 to 6:30 A.M. is my time. I enjoy it. I try not to look at my phone whatsoever during that time because everything from 6:45 A.M. on to the evening is typically not my own time. And so, I'm very intentional about carving out my mornings to make sure that that's my holy time. That's my Greg time.

TAMMY:
That's good. Hey, do you have a proudest moment over the last year?

GREG:
You know what I would say is over the last year our healthcare system has done a really great job in earning the Leapfrog A, which is your overall quality metrics bundled together in a really digestible way. You're an A ,B, C, D, F, same thing as grade school grades and you know our health system - for this year - just achieve three hospitals getting a Leapfrog A, which is the most in the region.

Back to what we were talking about earlier Tammy, it's an easy guiding principle when, back to the question of, would you send your mother to your own hospital? It's easy to say yes when you know the quality is behind it.

So, I would say the proudest moment is showing the work ethic and then getting the results on the back end for the quality.

TAMMY:
My last rapid fire at you and then we'll settle down and talk about some leadership stuff. Is there something exciting that's coming up that you're looking forward to in the upcoming year?

GREG:
There's a lot! We've got construction projects. We've got growth projects. We're talking a lot about AI and how it integrates into healthcare. And so, I would say, probably in the next year what I'm most excited about is working with technology that truly helps the efficiency of the hospital. And I think we've got some projects lined up that are going to really help us in that forefront.

TAMMY:
Well, that is exciting. You know, we talk a lot about disrupting yourself and disrupting your organization and so much of it is tied to technology, like are we going to catch up with any other industry in the world?

GREG:
Right!

TAMMY:
I don't know if you've ever heard Warren Buffett's quote where he said “It's good to learn from your mistakes, but it's so much better to learn from other people's mistakes.”

Knowing that in an extremely competitive environment or healthcare environment, what is one thing that you and your organization is doing to set yourself apart from the rest?

GREG:
Yeah, that's a good question. I think that we're getting hyper focused on what we need to be in the business of. If you look at hospitals specifically and you look at the last call it 20 years Tammy, we try to be all things to all people all the time, right?

We wanted to open service lines, we wanted to be, you know, let's do wound, let's do burn, let's do chemo. Let's do all of it, right? And if you're a jack of all trades, you are a master of none. And I think that we're really becoming very intentional about what does the next 20 years look like. Where do we want to be in 20 years? What do we want to be really great at? And then how do we invest and dive into those situations and those service lines that allow us to do that? Because you know, the prices are going up on everything, right? I'm sure everyone feels that in terms of inflation, utility costs, drug costs, all those things are playing a factor now. And so, you have less resources than ever before and you're expected to do more. As we look into the future and we look into what is it that we're really focused on, I would say it's becoming masters in certain service lines and really driving great products and great outcomes for both patients and consumers.

TAMMY:
So that's a really great answer. And how, how do you discontinue things? So if you're going to be a master at the, the certain number, it's not infinite, so how do you get down to this finite core services that you're going to offer?

GREG:
You know me, Tammy, I'm a data junkie and that's half the battle is understanding the scoreboard and understanding what is performing well, right? And there's multiple factors to this. One, do you have a patient population that supports this? Is there a demand for this? And you, you know, I'll give a simple example, outpatient imaging. You can look at it and say, we run the CT scanner for outpatients. We do slots every 30 minutes and we do them eight hours a day, right? What's the wait time to get into that CT scanner? Is it three days? Is it five weeks? What's the demand?

If the demand is there, that's going to be a great opportunity to look at and say, ok, well, let's start to work with this service line and better understand it. Do we need open access? Do we need to become a weekend option as well? Do we need to open up on Saturdays and do more scans? Do we need to extend our hours for folks that can't come in the middle of their workday? What is that?

And then when we tweak with those things and we start to look at, you know, those nuances and we see, oh wow, there's still more people that need to get in, in a timely manner. That's how you decide if a service line is really going to be part of your future book of business, right? Is the demand there? Because again, you have two different categories here. You've got patients and you've got consumers and the patient, that's the person who, you know, has an unfortunate incident out in the community, they get loaded into an ambulance, they come directly to you. That's a patient. That's what we're used to previously. Right. That's our acute care. We're going to stabilize you; we're going to get you to where you need to be.

But the other half of this business is consumer focused. And they're the ones who are deciding their care. They're going to decide, oh, I like going to this hospital or this outpatient clinic or whatever the case is because they treat me like this because my time was respected because I can get in and out efficiently.

And so, looking at it from both perspectives back to your question of how do you decide we are in the balance of who is a patient for us and who is a consumer for us and how do we become nimble in both worlds?

TAMMY:
Wow, that's powerful. I have not heard anyone describe it. They either say one or the other or they're mutually inclusive. So, a consumer includes patients and vice versa. That's good. I like that the patients have to come and the consumers decide whether they want to come or not. That's good. I love it.

GREG:
Yep.

TAMMY:
Knowing that we've worked together before, I know your style. For our listeners, Greg is super-efficient, super diligent and deliberate.

So, for some of the leaders on the line who aren't so efficient, they're wonderful people and get a lot done, but they may spend more time than need be getting it done because they're less efficient. Do you have any secret sauce around your mastery of efficiency and getting so much done each day?

GREG:
I don't know if it’s mastery. I think my wife would disagree that I've mastered efficiency. When I look at, I guess running an efficient day, I look at meetings. I think meetings can be the death of an organization. I truly, truly, believe this! We have tons of meetings on the calendar throughout the day. You've been sitting in them for a long time, you're wondering why I'm in this meeting? You're wondering what role do I play in this one-hour session. And the answer is if you're in a meeting and you're not adding value regularly, you need to cut it out of your calendar. You need to talk to whomever the meeting owner is and get out of it, because that's just time wasted. You got eight hours in the day. You have got to cut that stuff out.

On the flip side of that, if you're the leader of the organization and it's the meeting, you're running, it needs to be a punch list and I think a lot of folks missed the mark on this one. A meeting is not a running conversation. It's not, hey, like here's what we're thinking and maybe we're going to go in this direction, or can we get some input from this group? A meeting is a punch list. So, you have to come in very intentional, here are the three things we need to accomplish in the next 30 minutes. Ok, done deal. Next meeting a month from now, we're going to do these two things. It should be a walk-forward list every single month or every biweekly or however it works. But that's how things get moved forward. Quick punch list and takeaways. We need to move the needle, keep moving the chains forward.

And I feel like a lot of organizations struggle with this because they say, wow, there's just so much to do, there's so much to do. and we've got all these meetings on our calendars and how, where are we going to find the time to actually do this stuff? You know and back to the comment I made earlier, if you're a jack of all trades, you will not be a master at anything. And so, it's really going back and looking, starting in your Outlook calendar and saying I have five meetings today, am I going to be the master of five meetings today? Probably not. Are there two meetings that are really valuable that I feel like if I put all my effort into it, I can contribute and move the needle forward? Yes, then that's what I need to spend my time on.

So, I would say efficiency just comes from being very intentional about if I'm going to be in the room, I need to be a part of the conversation.

TAMMY:
Yeah, that's good. I love the new T-shirts that came out. In fact, I bought one last year for a stocking stuffer. It said I attended another meeting that could have been an email.

What about stand-ups? I know a lot of meetings go faster if people aren't getting all cozy with their drinks and their phone, you know, in a chair. Do you guys do many stand-up meetings?

GREG:
I think I stand in every meeting every day. Umm, but no, we don't do stand-up meetings. I've done a little bit of this recently, I cut back on the times. Unless you're doing a massive-scale project that truly requires 15 people and requires 90 minutes, most things can be done in 30 minutes. I'm a firm believer that you can do most things in 30 minutes. And so, I try and be really respectful of everyone's time because if it's 30 minutes and you know it's 30 minutes and you're coming in with the punch list, there's not much time for anything else. We're going to focus only on those things, you know that going into it. You know, it's going to be hot and fast and we're going to get out. Maybe I'll try that Tammy, I mean maybe I'll just have everyone stand up.

TAMMY:
Yeah, remove all the chairs from the room. I know when we start outreach programs and if there's an existing team in place, we have them make a list of all the current obligations they have, which are mostly “meetings” and when people see it themselves, we don't have to do a ton of persuasion to get out of them. But they'll see how much time they've wasted and why they're not getting things done like they should, so you might try that as well.

And as a business owner, I always am conscious looking around the room at the people who are on my payroll and how much this meeting is costing me and how much I'm going to get out of it. I said that in a group of 12 people yesterday who don't own their organizations and it hadn't occurred to them to think that way. I'm like, we all have to think like we own the business. I mean that's our fiduciary responsibility.

GREG:
I think the exercise you put people through is great. But I think the pieces, we do it right, we clean up our calendars or whatever the case is and then we revert back in a quarter or in six months. And I completely agree with you. I think that's just a standardization of you got to review yourself every month or every quarter and make sure you're using every minute as efficiently as possible.

TAMMY:
Yeah, totally. Well, we know that innovation is the name of the game right now, right? We just need to do things better, different, more efficiently… I'm curious as a leader, how do you encourage creative thinking within your organization?

GREG:
Yeah, it's uh it's a good question, especially kind of what we talked about earlier with AI and new technologies coming to health care for the first time to catch up. It's tough because healthcare is as you know is probably the farthest behind industry right now in terms of innovation, right? We truly are. Some things are incredible, right? Robotic surgery. When you watch a robotic surgery, you think to yourself, I've arrived at the Jetsons. This is the future. So, there's pieces that are incredible.

The flip side to that is what if you're changing a process that has been in place in nursing for the last two decades? That's not going to be digested well, regardless of what it is, right? So how do you get that buy in? I think it starts with front-line staff. I think if, if you have meetings and silos among managers and directors and C- suites, you will never get anything done.

I think you have to start from the bottom up in terms of adaptation and you have to have folks that are really high performers for front-line staff who are excited about it. Right? Who are willing to embrace it, because the reality is if you implement something new, things will go wrong. They just will. There's never a perfect roll out. But if you have folks that are highly engaged, who are looking at this and saying, I see the opportunity down road of how this can help me or how it can help the organization and they understand that going into a new change, they're willing to ride the roller coaster of the highs and the lows. They'll understand why we had a bad day today in this implementation or something didn't go well and they'll be OK moving past it. If you never get that buy-in, in the place, you're trying to create change with the people that are actually going to be doing the work, then all you're doing is setting yourself up for a failure.

So, I would say in terms of actual change management and implementation and getting creative thinkers, you gotta get the front-line staff. Because I might have this great idea, Tammy, at 50,000 ft and I might go and talk to a front-line leader and they might say, oh no look at it from this perspective Greg or, here's what you missed on this. And that's equally as valuable as my thought. I think it's understanding the process but also the people involved who are going to be doing the work.

TAMMY:
I love that. When we stand up outreach programs and the outreach teams, we always have them meet with front-line staff because when you meet with leaders, they tell you how they think it goes works or how they want it to work, not how it really is working. So, I love that music to my ears that you're going all the way to the front line.

Also, later in my career, I wish I would have learned it younger, so I'll give this tip to you as a young executive… people want to be asked, not everyone is like us that raises our hand and want to be involved and want to be a part of it. So many people want to be asked even if they have a great idea or a great innovative idea, they will not speak up until they're asked.

So, what do you do in terms of that, that kind of granular encouragement of involvement?

GREG:
Yeah - this is such a good question, Tammy! So, we implemented something that we titled Team Lead. And team lead was a concept around patient experience. Very specific. And we use outpatient imaging as a starting point and we looked at the high, high, performers in every single modality. So, we grabbed a high performer mamo tech, high-performer ultrasound tech, high-performer MRI, CT, diagnostic, and we started meeting every two weeks. Because again, back to what we just talked about, I have half the puzzle, right? I can see the dashboard that shows where our patient experience is, what the patients are saying, what the comments are, but that's half the equation.

The other half is what they have, the day-to-day and why it's happening or what are the barriers. And so, we put together this group and I'll tell you Tammy, here's how it went. We had them all come into the admin suite, which I don't know if they had ever been in before, we sat them down in the conference room table and we kind of walked through what the concept was and how we want to improve patient experience, but I don't want it from a top-down level. I really want it flat and side to side. I want us to be able to have conversations and talk about barriers. And so, I framed the meeting as, hey, I'm going to open up with here's, you know, the last two weeks of data. Here's what we see. Here's the patient comments from the surveys, here's what they're saying about your modalities and then we would open it up to you. Now, tell me what's going on on the front-line that's an issue? Tell me what the barriers are. And I'll tell you, Tammy, that first meeting, I got nothing. Literally no comments. You know, it was just crickets because there wasn't a level of trust yet, right? I was new to that organization. We're still building this level of trust. And so, there wasn't anything that was offered. I said that's OK in two weeks when we meet again, what I want you to do in the next two weeks is if you run into something that's a barrier that seems like it could have helped on patient experience or whatever the case is, write it down over the next two weeks and then bring it back to this meeting and we'll just talk about it, it'll be very casual.

And that next meeting, we had an MRI Tech and we did the same thing Tammy, where we said, OK let's open it up. You know, tell me what's happening on the front line. Tell me the barriers or anything, and then finally, the MRI Tech said, you know what, we have the out-patients that come in for an MRI and they change in the bathroom, but the bathroom doesn't have any coat hooks or anywhere they can put their clothes. And so could we maybe turn the bathroom back there into more of a dressing room? That is feedback I would have never come up with Tammy. I would have never thought about it. So, I said, boom. Done! We flipped it, you know, in the next two weeks, it was a dressing room.

And from that point forward, the next meeting after they saw the follow through, right of hey, I'm being heard, and I can make a change in the things that I care about. Oh, Tammy, the next meeting ran like 45 minutes over. It was just ideas starting to flow and here's the things that we've been running into and here's the barriers. And so, I think that level of structure you're talking about, the granularity, the granularity on my end, at 50,000 ft is the data, the clean data that I can see. But on the other end of that, on the other end to get to success is being able to have the stakeholders who do the job who say, you know what, that a patient would be a lot happier if they could just hang up their clothes in the bathroom and put on paper scrubs and not have to worry about it.

TAMMY:
Isn't it funny how oftentimes it's not rocket science? It's the little thing, you know my mom always used to say, that we need to major in the minor things, and that is a perfect example.

GREG:
Yep. Yep. Yep. I like that saying, I'm going to take that, Tammy.

TAMMY:
All right, you take it.

I also like two things that you said. I like that your analogy to a puzzle, that you have half of the puzzle or the equation if we want to talk data and executive talk. But the puzzle, I mean that just paints such a nice visual that like, yeah who only wants half of the pieces? And then I also liked how you had a singular focus around this. It was the patient experience. So, people can get their head around a singular focus versus a multifaceted approach. What a great
leadership story.

So, I cannot believe that we are already out of time. See how fast this flies by?

GREG:
That was fast, Tammy. That was faster than I expected.

TAMMY:
Ha! Ha! It's insane but such good stuff. So Greg, thank you so much for being on the Leadership Lens podcast and I just have two words in closing “WIN FOREVER.”

GREG:
I love it, Tammy. Thank you. Thank you so much for having me. This was fun.

CLOSING:
Tiller-Hewitt works with leaders who want to consistently deliver strategic growth and measurable results. The organization is recognized as the leading experts in strategic growth, network integrity, and physician engagement. Thanks for listening to this episode of the Leadership Lens. For more leadership resources and strategic growth solutions, visit tillerhewitt.com.