By Michael J. Reiswig, FACHE, President & Chief Executive Officer – OCI Holdings, LLC,

Texas and others are grasping at understanding Medicaid. They’re hesitant about the changes to come and the impact on beneficiaries and the bottom line. The law created in 1965 to balance the scales of equal access and care between those who can afford healthcare in the open market and those who cannot appear to be a distant dream. The fog has been thick of late. It has impacted providers serving children, their families seeking care as well as regulators, managed care and legislators attempting to find the right answer. Some believe this fog is the result of accountability brought on an industry ripe with problems such as fraud. Some see this as the result of failure to be self-accountable on the values it delivers while pursuing financial returns. Some schools of thought find it is nothing less than political shifts seeking to spend less of the public taxpayers funding on Medicaid, supported at the voting booth and the public. All of these views are right. The sting of accountability is painful to accept, and the recipient always attempts to justify their actions while pointing blame. We hold our children accountable as well as our politicians, public figures who fall from grace and of course, our employees. Do we as owners and leaders in healthcare hold our organization’s accountable to the industry and beneficiaries we serve? Do we embrace change, accept responsibility and move to be part of a solution?

Hitting the Guard-Rail

Accountability is necessary for life and business. Stephen Covey reminds us that “Accountability breeds response-ability.” On its face, accountability is a difficult word for many. It conjures up memories in our past experiences that are not so pleasant: Failing to tell the truth and getting caught, bringing home bad grades from school and losing privileges, getting fired from a job, failing acceptance to a desired college or university or falling short in a sport. All of these are bad memories of the “A” word. Accountability sometimes results in us accepting the result and taking ownership of it and other times, avoiding it by pointing blame the other way and avoiding responsibility. As a leader of a healthcare organization, I have faced a lot of instances of accountability regarding employee matters. Many have turned around successfully while others resulted in forced or self-exclusion from employment. In the end, what I have experienced is a trend that accountability is the hard guard-rail to move us back into the mainstream of an actionable culture, if you have one. None of us like hitting the guard-rail. It’s painful, and yes, sometimes it leaves a mark physiologically that is difficult to heal. As leaders, do we allow our organization’s strategy and decisions to mimic the same consternating effects and resulting blame pointing that we see in individuals? Absolutely.

Me, Me and Me

Self-absorption is many times the cause of hitting the guardrail. This applies to organization’s, their business strategy and their leadership as a group as well as to individuals. Self-absorption is a preoccupation with one’s (including organization’s) emotions, interests or situation to the exclusion of others. As described by Leon F. Seltzer, Ph.D. in his article “Self-Absorption: The Root of All (physiological) Evil,” he describes self-absorption as “..synonymous with self preoccupied, self-centered, self-obsessed—and even egotistical and selfish.” Individuals, as well as organizations, can be self-absorbed and the result can be painful. The self-absorbed mentality is ever present in healthcare by many providers at the direction of their owners and principals. It is the concept of protecting what has been done for years without appreciating or accepting the opportunity to move into an era of innovation, alignment with others and accountable outcomes. Fee-for-Service, a common reimbursement methodology in healthcare, has warped the minds of many provider owners for years, focusing on volume vs. quality while failing to measure and share the latter. It is a catalyst for a ME attitude of self-absorption. There is a saying that characterizes the result of this reaction: Pigs get fat, Hogs get slaughtered. The healthcare industry is striving to find partners to collaborate with and align. In a recent meeting with a team of top state regulators, it was clear to me that this group is attempting to clear the fog once thought fostered by them. Their purpose is to encourage innovation, alignment and drive quality and accountable outcomes. A mandate, forcing those in charge of the Medicaid dollars to transition from volume based to quality-based alternative payment models, is the first clue that economic and clinical alignment is no longer merely a suggestion. The reaction by many will be the same as in the past. The ME attitude with some providers will go unchanged; they will fight this change at every step to their eventual exclusion – Hogs get slaughtered.

Everyone Likes ICE-T

Business leaders create the guard-rail of culture to ensure employees believe in a set of values that are acceptable to all. Those values also define the organization’s intent as well. In 2009, I experienced first hand, the opportunity to lead a group owning a negative culture. It was bad. I almost quit after the first month. One would think that an organization serving a pediatric population with health needs would be naturally driven by a suitable culture. Individually,caregivers were culturally sound. As a company, it failed. The guard-rail was hit weekly bouncing from one side to the other without finding a purpose or universal values to anchor it. It appeared that nothing could reverse the trend. Since 2010 and with new leadership along with excellent support and mentorship from partners and select stakeholders, I committed myself to change this terrible culture trend. As a team, we formulated a set of core values as a foundation to a new expectation. We intentionally set in a specific order the core values: INTEGRITY, COMPASSION, COMMITMENT, CARE, EXCELLENCE and TRUST (ICE-T). Now, these values were not easy to come up with, and the importance of order was paramount; You cannot earn TRUST without first being recognized with INTEGRITY composed of COMPASSION, COMMITMENT, CARE, and EXCELLENCE. Our initial guidance on culture as a leadership team relied heavily on a book written by Chester Eaton and Adrian Gostick, titled; “All In – How the Best Managers Create a Culture of Belief and Drive Big Results.” Centered initially on a study of how some of the country’s top companies navigated the financial meltdown between 2006 to 2009, the authors uncovered the lessons of organizational and financial failures and success directly related to organizational culture. A second and equally important book also solidified our approach to culture by J. Randall Keene and Timothy J. McKibben titled, “A Better Way: Four essential elements for creating a values driven culture in your business.” You
can’t go into any of our leadership’s offices today and not see these books. They are everywhere. Our leadership rely on these books and for a good reason: It provides excellent examples of the culture link that contributes to success and failure individually and organizationally. Everyone in our organization loves ICE-T.

The Clearing Fog

Navigating through the fog requires a set of shared values that everyone can believe without compromise. Our core values have endured and in fact, become stronger along with our Purpose, Beliefs, Burning Platform, Brand and Path to practicing our culture daily. Culture is far more than just core values, but core values are where it all begins. These values have influenced a global strategy to align ourselves with insurance organizations, regulators, physicians and other health organizations with a goal to be a trusted partner/provider. This started soon after our cultural reformation in 2010 seeking ways as an organization to prove and share our clinical outcomes. Today, our research and data mining has led to significant answers and more questions. It has created recognition by industry and professional groups. It has created innovation. It has confirmed our path of knowledge directly benefiting our patients and our partners. Our values have brought a positive differentiation to others who offer similar services. As one prominent healthcare expert told me recently, “you’re very different than most – keep it up.” Our efforts have opened doors for unique opportunities and growth. Most important, our culture has directed a responsible and accountable attitude and the opportunity to manage through a maze of uncertainty avoiding the self-absorbed ME psychosis. We’ve turned our culture into action, embraced accountability and created shared solutions. The healthcare fog is slowly clearing for our organization. I trust whatever fog you are in will be lifted, and my experience will shed new light on you individually and your organization.

Copyright 2017 – All Rights Reserved
Michael J. Reiswig and OCI Holdings, LLC