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Hope Is Not a Strategy

A group of masked surgeons huddling and hugging in their medical uniform

While times of challenge and change are not new, none of us can confidently or reliably predict when the hurricane we’ve been living through for more than six months will end or the exact toll it will take on our personal and professional lives. Without that crystal ball, we plan as well as we can and then hope for the best.

A few years back, I had to laugh when a colleague declared that “Hope is not a strategy” after a thoughtful, proactive crisis plan we put together was killed by a “Let’s just hope, wait and see” leader.

As healthcare providers, we understand the power of hope even as we practice the science of medicine. When hope takes root, our strategies take flight as they are no longer just words on a page, but deep-seated ideas that are lived out in the minds, hearts and actions of our people and organizations. It’s that emotional connection that makes strategies and tactics effective. Facing today’s uncertainty, hope should be a catalyzing element of the strategies we create to keep people positive, resilient and moving forward together.

Consider these seven ways you may be inadvertently signaling that your organization’s strategy and future are hopeless—plus some smart countermeasures to combat the perception.

  1. You stop listening and start assuming. Your patients and employees desire for you to genuinely listen to them. Open the door to dialogue through pulse surveys, virtual town halls and focus groups. Reinvigorate your Patient and Family Advisory Council virtually and encourage managers to conduct one-on-ones with employees using a defined set of questions. Ensure the plans you’ve made align with the needs of your stakeholders.
  2. You lay aside your mission and undermine your values. While hope is necessary, it alone is not a strategy. Before announcing change, ensure your leadership team can articulate how the change will help fulfill your mission long-term. If a decision seems to conflict with your values, lean into the tension and discuss why it’s the right course. Proactively addressing tension helps people respect your reasoning and willingness to make tough decisions, even if they disagree with it.
  3. You underestimate the impact of change. This is a common mistake that can have severe consequences as people in our organizations concurrently face unprecedented (yes, I said it) challenges at home and at work. It’s more important than ever that leaders emphasize partnership over power and demonstrate they genuinely care about employee well-being. By listening, collaborating, making change more manageable and tying it to your mission, you will strengthen resilience and ensure your team has the bandwidth to make change happen. Be upfront about challenges you are facing, ask departments to come up with solutions and remain supportive by following up with a check in on how things are going.
  4. You create a steady drip of negative news. We all know the only thing worse than ripping off a bandage is removing it slowly. Organizations often get too clever in an effort to minimize negative perception and mitigate the impact of tough news. “We’ll announce layoffs next week, benefits changes in two weeks, service-line closures in October, cancellation of our expansion by Halloween…” Drip, drip, drip… Before long, employees come to believe that every communication from leadership will contain negative news. They’ll dread coming to work. When possible, consolidate tough changes into one announcement tied to a compelling strategy and vision – despite the unpleasant process. You don’t have to have all the details to do this. In fact, this type of announcement is the perfect moment to say, “We will partner with our employees, providers and leaders over the coming weeks to implement these changes in a thoughtful way.”
  5. You fuel speculation. Vague or infrequent communication leaves room for anxiety and rumor to grow. If employees or the community sense a scurry of activity among top leadership, chances are they will invent a reason that is likely worse than reality. Instead of pretending that all is well or avoiding communication, be responsibly transparent. It’s usually better to say what you do and don’t know than to let rumors and fear take over. If you can’t answer or don’t know, share what you can answer and do know, as well as what won’t change.
  6. You emphasize money and ignore the recognition gap. Money is usually not the primary reason people want to work in healthcare. The majority want to make a difference and also care for their families. Change challenges morale, so one of the best ways to protect it and foster resilience, trust and pride is by focusing on the recognition gap. Research shows that leaders believe they give recognition far more than employees perceive receiving it. Recognition has to start at the top, and it has to be a priority. Focusing on wins and encouraging those you lead won’t eliminate the sting of no bonus or annual pay raise, but it will help.
  7. You take the community’s support and trust for granted. Beyond your employees, your community is your best asset in solving challenges. And trust is the key to your relationship with the community. If you blindside people with tough news, make decisions that seem in conflict with your values or have a workforce that is actively speaking out in a negative tone, you very well may lose trust and find yourself worse off. Maintain community support by sharing regular updates, talking openly about the implications of external factors like COVID-19 and change in the industry. And, ensure your employees have the information they need to be ambassadors in the community.

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Election 2020…What happened to healthcare?

A roll of "I VOTED" stickers

The election is looming. The first debate was a debacle. There’s so much uncertainty, and yet healthcare leaders need to prepare their organizations for, well, whatever it is that’s coming.

We pride ourselves in looking around corners here at Jarrard Inc., but even we aren’t 100% sure where we’ll all end up. Still, we’ve got a lot of thoughts on the types of conversations that will be taking place around the election and healthcare. That includes some of the hotspots that will erupt but, maybe more importantly, areas where providers could temper their expectations – things aren’t going to happen overnight. (Probably.)

We got our in-house political junkies together to riff on what’s going on. Here, we’ve taken some highlights from that roundtable discussion. The conversation was moderated by our CEO David Jarrard. Joining him were vice president in our Regional Practice Justin Gibbs, senior vice president in our National Practice Tim Stewart, and partner and COO Kevin Phillips.

In a normal year, there would be a lot of discussion about healthcare. Does anyone really care this year?

Justin Gibbs: The short answer is no. Nobody’s diving into the policy weeds of how care is going to be paid for what it’s going to look like in the future. The president is not a policy heavy kind of guy and given Joe Biden the luxury of not having to be a policy heavy guy.

So it’s no surprise that the outline for the first presidential debate included COVID-19 and the economy, but no mention of healthcare?

Kevin Phillips: Kaiser Family Foundation did a poll a couple of weeks ago that rated the most important issues for voters in this cycle. Healthcare came in fifth – and that separated out COVID-19, which came in second behind economy. In contrast, healthcare was the number one issue on voters’ minds in February. And the percentage of Republicans who say that the repeal of the ACA is very important has dropped from around 30 percent in 2016 to five percent today.

Why has one of the hottest issues of the past decade suddenly disappeared? 

Kevin Phillips: Civil unrest, racial justice and the economy jumped into the top spots. They’re dominating. Even COVID-19 is starting to decline.

Tim Stewart: I’m not sure it says anything about healthcare. I think healthcare has probably stayed the same and it just underscores the seriousness of everything else happening across society.

So then where exactly does healthcare fit into the election?

Kevin Phillips: Two things: With Kamala Harris on the ticket Medicare for All could come back up. And with the passing of Justice Ginsburg and the upcoming hearing for Texas v California, repeal of the individual mandate could return as a political issue.

Tim Stewart: If Biden wins, it’s not going to be his first priority. It wouldn’t be even in a world where we didn’t have COVID-19. It would be foolish for a Democratic president, even with a Democratic Congress, to pursue a major overhaul of healthcare as their first priority, because it would end up being their only priority.

Justin Gibbs: If Biden is elected and the Democrats keep the House and take the Senate, it’s plausible that Biden will be pushed to push towards Medicare for All. I agree that it’s not a first priority because we’ve got to get the economy back on track and that’s where I would spend my political capital, but the left wing of the party is going to be pushing hard for this. It took a unified government to get the ACA passed 10 years ago. It’s going to take the same now and they won’t want to miss their chance.

If you’re running a healthcare organization and you understand that most people aren’t thinking about healthcare the way you’re thinking about it, but you’re strapped for funds and you’re wondering what the future is going to be…What do you do? What do you say today?

Justin Gibbs: Providers have to enter the fray but in a way that rises above politics. They need to talk about their mission and delivering on that mission for their employees, for their patients, for the communities that they serve. They shouldn’t get into specifics of a particular plan. Keep in mind Obama was sworn in January 2009 and the Affordable Care Act didn’t become law until March of 2010. So regardless of who the next president it is, it’s going to be a while before there are any big sweeping changes.

Tim Stewart: Take it out of national politics. The bill is going to come due on a lot of this year starting next year. What does this look like when patients are receiving literal bills for COVID-19 tests they thought were covered care? And then all of the care that people have put off this year. It seems like somebody is going to get blamed for the costs that individuals and groups are going to incur.

Like who?

Justin Gibbs: The big insurance companies, all posted record gains over the course of the last few financial quarters. At a time when the economy is struggling, when people are struggling, and out of work, it doesn’t pass the smell test for insurance companies to be making the amount of money they are making and then sticking patients with huge bills. That’s an important narrative for hospitals to continue.

It’s also important to continue outreach to your state and federal legislative delegations to continue the conversation about all of these bills coming due – including the advance payment for Medicare. If we’re looking for a bipartisan issue here, Democrats and Republicans have both been working to make sure that hospitals have the resources that they need to continue.

Where else does outreach need to happen?

Justin Gibbs: Leaders of provider organizations need to be having concerted conversations with their employees about funding because those employees represent a huge voter block and nothing speaks to elected leaders like a base of support from the people who keep them or kick them out of office. They also need to have that conversation with the media as much as they can.

Provider employees are typically pretty diverse – in numerous ways – how do you have those conversations appropriately and effectively?

Justin Gibbs:  There doesn’t need to be anything ideological about it. It’s straightforward: This is the revenue that was forfeited to prepare for and provide care during the pandemic, this is the assistance that we’ve gotten to date and here’s the gap. We’re doing everything we can to absorb that, and in the future, we may be looking to you for help advocating for our organization.

David Jarrard: So you activate that support and you get to turn it into something for it to become a political force that will get you more financial support.

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Lights, Action and the Theater of Safety

The inside of an empty vintage theater

Now is not the time to be subtle.

Fear of the novel coronavirus is as intense as it was this spring. Almost 80 percent of people are afraid they or someone they love will get COVID-19, according to a national consumer survey Jarrard Inc. recently fielded in August.

To be blunt, Americans just don’t feel safe. When we asked how safe they’d feel seeking medical care, the answer was, basically, “Not very.” Whether a doctor’s office, hospital, outpatient surgery center, ER or urgent care center, people rated their feelings of safety no higher than 5.8 on a 10-point scale. (If you’re wondering, urgent care rated the lowest at a 5.0). One in four people rated their feelings of safety at a three or below in our August survey. Not good.

And not much better than the results we received in our first consumer survey back in April.

It seems we have lost some momentum.

Think about it. When providers started reopening services this summer, the entire industry was talking about what people needed to hear from provider organizations. Everyone knew about safety concerns. But what seems to have happened is that too many providers created the safety messages, checked the box, reopened their facilities and said, “We’re good to go.” And with volumes coming back, it seems like it was successful.

Digging deeper, though, that strategy doesn’t appear to have worked. Our August survey asked how long people would wait until seeking various types of medical care. Short answer: Unless they really need it, they’re probably not going to come back for around six months, maybe longer. That’s also no better than in April.

What we need, right now, is a bit of theater.

Theater, not because it’s fake. But because it’s visible, clear, obvious. And it makes you feel something. Because people want to see, hear, smell and feel what you’re doing to keep them safe. We asked people what they need to help them feel safer interacting with healthcare, outside of a major decline in COVID-19 cases or a vaccine. Their top answers were:

  • Screening everyone as they enter a medical facility.
  • Masks on everyone.
  • Enhanced cleaning procedures.
  • Isolating COVID-19 cases somewhere else.

In a vacuum, it would be easy to lean back and think it’s okay to stop your entry checkpoints. The CDC says it doesn’t make much of a difference, so why do it? Two reasons.

First, when it comes to healthcare, we know that people don’t seek out information until they need it. People aren’t thinking about the safety messages you put out two months ago. You have to keep those safety messages top of mind. You have to make sure your website and social channels still have information about what you’re doing to keep people safe.

Second, people want to see activity. They want to be a real-time witness to your extensive precautions.

The key point is that there’s a difference between actual safety and how people feel about safety.

Yes, you have to provide safety – this is theater, not a Potemkin village. That means going above and beyond, not stopping at “just enough.” Whether the CDC says temperature checks are effective or not, seeing those checks provides a feeling of safety. So does seeing environmental services wiping down public areas and front desk staff saying, “Here’s a pen that I’ve just sanitized for you.”

Now take a step back. The theater of safety should start even before someone gets to that temperature checkpoint. Providers need to be showing how they’re keeping people safe, so that they feel safer about making an appointment in the first place. That means resisting the urge to demote safety information on your website. Keep it front and center. And the same goes for social media. Proactively share safety measures when people call to schedule an appointment. Even though it’s added work for your scheduling and nursing teams, there’s a lot to be said for continuing those pre-appointment safety calls. In our observation, those brief calls have helped patients realize, “Hey, they’re thinking about me. They’re working to keep me safe.”

All of those things create the theater of safety.

It’s a little cliché in the “consumerism of healthcare” and “patient experience” worlds to point to other customer-facing industries for examples of what healthcare could/should/would be doing. But other industries are creating the theater of safety better than we are. Consider these examples:

  • Southwest Airlines is doing a fantastic job. They’ve just informed customers that they’re keeping the middle seat open through at least October 31. When you board a Southwest plane today, you can literally smell the cleanliness.
  • Savvy grocery chains like Trader Joe’s have stationed an employee at the store entrance who hands you a cart and says, “This has been sanitized for you.”
  • Even actual theaters – movie theaters – are reopening and publishing extensive plans and guidelines. So far, it looks good on paper. The proof will be when we walk in and can enjoy the full two-and-a-half hours of Chris Nolan’s latest masterpiece. (I’ll be there this weekend.)

Know that this can be done – and really must be done. In the end, it’s a great opportunity for healthcare providers to reframe their thinking and keep a good thing going. After all, the show must go on.

Review the full survey results

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Of tightropes and treading water: Winning strategies of today’s successful healthcare leaders

Man balancing on a tightrope, displaying only below his knees

You’re still performing a high wire act of balancing the needs of your patients, doctors, nurses and staff.

You’re likely feeling deep fatigue and yet, because of your sense of purpose and mission, wanting to do more. That’s a challenging spot to be in. Yet the reality is, you and your teams have done so much.

You’ve saved lives. Many of them.

We know focusing on that daily tightrope of operational demands can make it hard to look forward to tomorrow’s strategies just paces ahead. Or to acknowledge and celebrate the victorious small steps along the way. Or to provide the physical and emotional support your team craves.

It’s no secret that fatigue and stress can lead to tension, even in the best relationships. That’s something we’ve observed at Jarrard Inc. through our client work and our recent national survey. Fact is, healthcare workers and those living with healthcare workers are a bit less trusting of hospitals than the general public, and even feel slightly less safe in healthcare settings. Surprisingly, a notable number (40 percent) is reluctant to get vaccinated when one becomes available.

Sounds concerning. And it is, especially knowing that the fall likely brings a flu/Covid-19 combo. But what this information really points to is a clear, compelling opportunity to strengthen your relationship with your incredible doctors and nurses. Because they need the attention.

Here are four suggestions – two tactical and two philosophical – for doing just that.

Double down on listening.

Ensuring your team feels supported means talking with them about the things they care about most. If you’re trying to decide exactly what’s on folks minds, ask. Bring together your C-suite to lead listening sessions with groups of 10 to 15 people. Ask, “What’s really on your mind? What could help you feel safer at work? What could we do to better support you?”

Those questions move the needle, and systems asking them are seeing a return. You’ll feel better, too. Knowing what people think and having the ability to respond is so much better than speculating.

But you can’t stop with listening. You have to then slow down and tell people what you heard. Once you’ve collected the feedback, process it and come back to people with, “Here’s what we heard you say, and we’re making this change because of it.” Or, if it’s simply not feasible, explain why.

Reconsider your messengers.

One of the most revealing pieces of data from our survey was the continued trust people place in doctors and nurses for healthcare information. The public expects and desires for clinicians to be involved in conversations around healthcare.

But the conversation must be authentic and start internally. Though trust in doctors and nurses is a bit lower for healthcare workers, they still hold clinicians in high esteem. Therefore, you’d be wise to use them for internal communications. Make sure you have respected, well-spoken clinicians as messengers. If you’re not a physician-led system with a physician in the CEO role, there’s real opportunity in featuring your chief medical and nursing officers as you deliver messages about safety or protocols employees need to follow.

With the right messengers offering the right – authentic – messaging, you can convey that you have your team’s back.

Consider what could have been.

Consider that data around the feelings of healthcare workers as a bright spot. The survey’s “scores” on trust and safety for providers have held steady through the roller coaster ride of the past several months – even while there has been so much working against healthcare providers. But you, your team and your organization have hung on. That goes to show you that temporarily treading water is sometimes enough. Even if it’s not the most satisfying activity.

Remember also that in so many critical areas, you’re making a difference. So many lives have been saved. How many people have you discharged from your COVID ICU? Celebrate the caregivers and the administrative teams that made those discharges possible. Some clients are celebrating milestone discharge numbers – 100, 200, 500 patients back home and recovering.  Could your team name with pride how many are recovering? Help them do so.

Imagine what could be.

There’s a lot of work yet to be done—but it’s work that matters. Imagine what it would look like to strengthen the financial position of your organization through additional federal funding and more favorable payer contracts? Imagine what it would look like to allay fear and move the needle on people feeling safer, to provide them an even better experience both in the midst of and after the pandemic. Imagine what it would look like to gain traction on vaccination rates for the first time in decades. Any of those things would be a big achievement…and you can do this. Take that message to your teams, remind them of your shared purpose. Check in and listen to their fears.

And celebrate the work they’ve done and will continue doing.

Review the full survey results

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How will Health Systems Deal with a COVID-19 Vaccine?

Woman lifting her shirt sleeve while a man inserts a medical shot into her arm

As opponents build their case, providers risk reputational damage if they don’t take a point of view.

Early in the COVID-19 era, sometime after Bargaining and Depression, Acceptance began to set in.

With it came the grim realization that we wouldn’t fully leave this era until there was a widely available and reliable COVID-19 vaccine. And we were told that cavalry wouldn’t be rolling in until early 2021 at the absolute soonest. Now here we are, months later, still in suspended animation and confronting another major question:

What if there’s a reliable vaccine, and people refuse to get it?

Our recent national consumer survey shows that just 53 percent of Americans are extremely or very likely to get a COVID-19 vaccine. Now, there’s a lot we don’t know about an eventual vaccine. But we do know two things:

  1. The public overwhelmingly expects and trusts healthcare providers to actively talk about healthcare issues, which includes educating about the coronavirus and encouraging people to take specific actions to protect public health.
  2. The looming war on vaccines will make the masking battles look like tickle fights.

Six months ago, no one cared about the idea of wearing a mask. The idea that it could become a major political signifier would have seemed absurd, even for these absurd times. But as we saw, the issue quickly took on major cultural importance for months before we settled into our current détente. Some of the political air has left the balloon. Most people have accepted their masked fate, while the holdouts remain largely unpersuadable.

There are several significant differences between masking and vaccines, with the most obvious being that one is gently draped in front of your body and the other goes directly into it (via needle, no less…shout out to my fellow trypanophobiacs!). There’s also the fact that suspicion about vaccines has steadily risen over the last several years, long before COVID-19 swept the land. Some groups, particularly marginalized groups with unpleasant histories of medical trials in this country, have every right to be wary. Then there are the Jenny McCarthys of the world, whose rationales are less reasonable but even more, uh, viral.

So, are we telling you that you have to mandate vaccines for all your employees and aggressively promote the vaccine’s efficacy to the public? We are not.

However, as the trusted voice on healthcare in your community, healthcare leaders have an opportunity and a responsibility to educate the public, starting with the people who work within your organization.

Of the 47 percent of the public (and 40% of healthcare employees) who are hesitant about taking the hypothetical vaccine, the overwhelming majority are either worried about the potential side effects or worried about getting infected from the vaccine. These are very reasonable concerns about what is likely to be the most quickly developed vaccine in history. They are also an opportunity for health systems to leverage the trust the public has invested in them in a way that answers the public health concerns they seek.

Broad education on vaccines must start now, while clarifying that specific instruction on what to expect from a COVID-19 vaccine will come later, when we have the appropriate information. Don’t take for granted that everyone understands how vaccines work. Hypothetically, there could be a communications consultant who’s worked in healthcare for years but is just learning today how they actually work. Hypothetically.

Both now and later, explain how your organization will evaluate any vaccine. Make it clear that you won’t just be pulling syringes off an unmarked van and administering them to patients. (You’re not going to be doing that, right?) By explaining the process, we can begin to socialize the idea that any vaccine that comes our way will be thoroughly reviewed for safety and efficacy – “Operation Warp Speed” notwithstanding.

This is a major challenge, and it’s one that many health systems would prefer to avoid. It is an instantly political issue which will be further politicized and weaponized in our dismal national discourse. While it may not feel like it, the far greater reputational risk lies in health systems not doing everything they can to get responsible, timely and accurate information out to the public. As we continue to confront the greatest public health crisis this generation has seen, shrinking from the moment is a guaranteed way to lose the trust you’ve built.

What is your plan? You don’t have an option to sit this out, so you best start preparing one now.

Review the full survey results

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