Health System Case Study

Catholic Healthcare Partners (CHP) is a growing multi-hospital system operating in 10 cities in four states. Like most large health systems, CHP's size, complexity, and the uncertainty of today's healthcare environment make it very difficult to manage and lead. After assembling a top-flight executive team, Michael Connelly, President & CEO of CHP, was resolute in making sure that all these challenges did not get in the way of accomplishing the goals of the System.

"I wanted to take advantage of the richness and diversity of my executive staff without letting the meetings slow down the important work that needed to get done," notes Mike Connelly. He also wanted to find a better way to manage the issues and opportunities surrounding local hospital priorities versus what was better for the System as a whole.

In place for over a year, the coaching process has instilled a set of leadership practices that has had a dramatic impact on how the entire health system is being managed. Summarizes Connelly: "Our team meetings are now focused on getting real work done—all with a higher level of trust and engagement. We have learned how to better manage the polarities of both the mission goals and operating goals and the needs and priorities of the System versus the needs of the local hospitals. We now know how to have more productive executive dialogues. In the final analysis, the coaching approach was perfect for taking really smart, competent people and making them even better."

The Engagement: Coaching the Team and Individual

CHP engaged the O'Brien Group (OG) to coach the organization's top senior executives: the CEO, three Executive Vice Presidents, six Corporate Vice Presidents and 10 regional CEOs. The leadership coaching used the actual business issues currently on CHP's plate as a way to immediately begin applying key leadership principles. Working on the team level, OG observed issues, breakdowns and opportunities right on the spot during regularly scheduled meetings. OG was able to see and help the executives remove roadblocks using the actual issues as the platform for teaching a new leadership concept.

OG and CHP focused on four key areas to improve leadership relationships and executive conversations at the senior executive level:

1. Managing polarities
2. Managing the executive meeting structure
3. Managing breakdowns
4. Managing yourself

A common management issue in large multi-hospital systems —what we call a polarity—is how to balance the needs of the System with the needs of the operating entities, i.e., we must either impose the System's best practices onto the local hospital or let the Region do what is best for its local market.

What typically happens in these situations is the polarity is thought of as a problem to solve where there are winners or losers—an either/or situation. When others weigh in on the issue, they feel the need to first pick sides—and then each side digs in. Communication degrades, progress is slowed and leadership tends not to happen.

As part of the coaching process, O'Brien Group worked with CHP executives to show them better ways to view these issues in order to achieve more innovative thinking and enhance the quality of the executive dialogue around these kinds of decisions. More specifically, by reframing the polarity with a "both/and" statement, ("How can I take advantage of BOTH the System's best practices AND give the local hospitals control and autonomy?"), leadership and high quality executive dialogue began to take hold. Conversations became more creative and open. Teams began to find ways to reap the benefits of both poles as they were no longer locked into their views and the final solutions became more fully supported by all stakeholders.

Through heightened awareness and real-time observations during the OG engagement, CHP is now better equipped to manage these polarities. "More work gets done, because we are able to discover the positives associated with both sides of an issue while avoiding many of the negatives when making a decision," says Connelly.

2. Managing the Executive Meeting Structure

Given that most top executives spend 95% of their time in meetings, one of the key areas of focus for CHP and OG was on improving the quality and structure of executive meetings.

"OG felt, and we concurred, that the senior team meetings collectively had too many people. They discovered that there were sub-groups within those groups that existed that could meet in separate forums to get actual work done. They helped us see that. In the old way, our discussions got distracted because lots of things weren't applicable to everyone," says Connelly. "Now we are meeting in the right groups, at the right time, and to discuss the right things. Just reconfiguring our meetings seems like such an elementary adjustment, yet it's paying dividends each week. I see the improved productivity and more candid dialogue." Meetings are now about producing work—not just about sharing information.

3. Managing Breakdowns

Breakdowns and conflicts are a natural and ordinary part of business. They usually occur when someone did not do something that you thought they should do. Or when something "should not" be the way it is. Discussing these conflicts feels risky. You could be wrong or you could make matters worse. It is during these breakdowns where leadership is the hardest—and the most needed.

As part of its coaching process, OG worked with the executive teams to teach them a new set of skills that helps turn these breakdowns into breakthrough thinking. At the core of this approach is showing individuals how to accept someone else's concern and, just for a few moments, make that concern your own. To become genuinely interested in another's viewpoint and to hold your view of the situation as only your opinion and not the truth.

OG taught the executives how to view a personal opinion and those opinions of others as "grist for the mill" and are not the same as a conclusion. Opinions are not the whole truth. Whoever speaks the loudest, latest and longest should not necessarily prevail and cause others to disengage from the topic.

O'Brien Group coached the individuals and the teams on the art of good dialogue—which is central to turning breakdowns into breakthroughs. Good dialogue occurs when executives are willing to:

• State their opinion and ask others for their reactions;
• Be wrong;
• Be curious about why others think what they believe is correct and true;
• Accept the fact that you may not be aware of certain facts and be open to new information that may change your mind.

4. Managing Yourself

Effectively participating in and leading teams is, in part, about paying more attention to one's own psychology—to begin to take notice of when you feel withdrawn, afraid, threatened or resentful. When executives operate with high stress and uncertainty—which, again, is a normal part of managing any large organization—we shift into a self-protection mode and our contributions begin to run counter to our personal and organizational values. This shift is emotional and automatic. This protection mode typically manifests itself in recurrent problems going unsolved or important work not getting done.

As part of the individual coaching process, OG worked extensively with each executive to teach them a new skill set that allowed them to better manage the upsets or breakdowns that prevent them from being "their best selves" and therefore not contributing and performing at a high level. The process began with getting the executives to see that all upsets and fears are based on a story that one has created about why things are not the way they should be. Its full of "they shoulds" and "I shouldn't haves."

OG introduced a set of tools that enables dramatic new pathways to purposeful action. It starts with naming the upset or breakdown and then reframing it—or shifting your thinking—in order to open up new possibilities. For example, saying to oneself:

• "I don't know the whole story"
• "I don't know what else is on their plate"
• "How do I want this to end up?. . .What is my hope?"
• "What is Life calling for?"
• "What can I contribute?"

"By asking myself 'What is Life calling for' in a particular situation, I've learned that I sometimes need to shift from change agent to information provider to challenger to one who raises the bar — whether I'm in a one-on-one with a hospital CEO or I'm presenting to a group of 100," explains Jane Crowley, Executive Vice President of CHP. "By recognizing that leadership needs those constant shifts, I can now tap into my own unique talents even more and be a better leader."

The Art of Teaching Very Bright, Very Busy People

Enhancing leadership behaviors and actions in the adult mind in a sustainable way requires a unique methodology combined with highly skilled coaches. What helped make these leadership principles become a way of doing business is that they were "taught" during the daily meetings and rituals already on CHP's calendars. Observations and feedback were being made within the context of the issues and projects that were already on the table. Thus by dealing with these "live" issues in real-time, change and momentum were gained from day one. The observations and feedback were better ingrained in the minds of the executives because they were challenged to work through the very issues they face on a daily basis — thus reinforcing the teachings so they could be used again and again.

The examples put forth in this case study demonstrate how improved productivity, richer dialogue, better regional buy-in and improved meeting management have led to a more cohesive and focused executive senior management team. Connelly concludes that increased efficiencies are one of the more important outcomes attached to the coaching program: "These principles and teachings have freed up our team's ability to work through issues faster with better outcomes. But the ultimate benefactor is the health ministry as the executive team and I are better armed to accomplish even more of what the mission intended."

The Benefits Of Coaching: "Now" Vs. "Then" At Catholic Healthcare Partners

Below is a snapshot of how business used to get done at CHP — versus how it's happening today. How breakdowns have yielded to breakthroughs. How unconscious behaviors have now been identified and reshaped on both the team and individual front. How hindrances have been removed to allow the real business at hand to move along more efficiently and with greater intent.

Old Way	New Way
Executives immersed themselves in content in order to become a subject expert on the meeting topic.	Executives put trust in the agreed-upon experts so they can focus instead on asking the right kinds of questions to move things forward.
Meetings were heavy on agenda items but light on pre-defining whether topic was for information only versus dialogue versus action. Capturing meeting minutes was the primary written protocol.	Meeting agendas are sent out to attendees prior and each topic includes type of input and level of involvement desired. Documenting action items is now the primary written protocol.
Passionate dialogue prompted countless opinions during meetings. The same vocal leaders prevailed. The more reserved ones remained reserved. Sometimes decisions were based on who spoke the longest and loudest.	Executives now voice their opinions as personal "assessments" (and not necessarily the truth) to breed inclusion and welcome others to do the same. Richer dialogue and more well-rounded decisions have resulted.
Organizational structure determined meeting structure. Sometimes meetings would cover topics not relevant to certain members. Lack of candid feedback due to sheer size of meetings.	Meeting reconfiguration now yields smaller, more focused meetings. More candid conversations. More time given to important senior-level topics.
Decision topics involving both the System and the Regions were unconsciously categorized as one side winning and the other side losing. Inherent polarities were seen as problems that needed to be solved. Pros and cons of each were rarely discussed.	Pros and cons associated with each side are now weighed evenly. Cons are included now in decision-making. Polarities are viewed as issues to be managed - not problems to be solved.
Local hospital executives are sometimes dispassionate about their System leadership role due to System biases and not having forums to contribute. Lack of buy-in and dissention high due to not being included in home office decisions.	System now involving local hospital leaders in more home office meetings and decisions. More buy-in and consensus, since Regions are now helping shape System initiatives.
Executives using a single leadership style to lead. Unconscious that they aren't being flexible enough to change style based on what is really needed from them leadership-wise at the time.	Executives now conscious that they can and should shift their styles and role based on what the situation is calling for at the particular moment. More of the right decisions are made and more issues resolved.