From HFMA: Five Ways Leaders Fail

Philip Betbeze, for HealthLeaders Media , June 16, 2009

Greetings from sunny Seattle where we're experiencing the HFMA Annual National Institute—among other things. I know, up is down, white is black, and it's sunny in Seattle. The 27th straight dry day, in fact. If we don't get rain by Wednesday, we'll tie a record, apparently. This is not what a first-time visitor has been led to expect from the Emerald City, but it's a pleasant surprise.

Speaking of which, it gets late early out here, to borrow a saying from Yogi Berra (and if he didn't say it, he should have). By that I mean I returned from dinner last night thinking I was going to catch the end of the NBA Finals, only to discover that a little after 8 p.m., the game was nearly over. I got to catch the last 30 seconds, anyway.

On to the conference.

My colleague Michelle Ponte and I have been attacking the conference with vigor this year. It's so nice to have two of us reporting from the conference, because I don't know if you know this, but HFMA has only two educational sessions per day, so it's easier to attend more of the valuable sessions with two people to break it down. One suggestion for improvement: shorten the sessions and create more of them throughout the day so people can attend more. Are you listening, HFMA? You don't have to recruit more speakers, you just need to spread them out a little more. That minor criticism aside, we're learning a lot.

Today's keynote speaker, Patrick Lencioni, kicked off the day, speaking about Leadership. Since it's my new beat, I was interested in what he had to say.

Lencioni often works with hospitals to adopt ideas around teamwork. Now, it's more important than ever in these difficult economic times, when everyone is expected to do more with less. He gave us five ways leaders often mess up their teams. Pay attention. I've definitely been on some bad teams and some good ones, and this guy has it right:

1. The absence of trust: Most think about predictive trust, which means we have known each other long enough I can predict your behavior. But that's not what makes a team great. The team we need is based on vulnerability. Vulnerability-based trust happens when human beings on team say things like "I don't know the answer," or, "I think I need help; I think I screwed this up," or even "I'm sorry." When you have that dynamic on team it creates powerful competitive advantage. Vulnerability can never be faked.

2. Fear of conflict: Why don't people like to engage in conflict? They say they don't want to hurt people's feelings. Organizations that think conflict is bad crush people because it ends up as a conflict of people and not issues.

3. Lack of commitment: When we can't get people to debate, people won't commit. If people don't weigh in on a decision they won't buy in on a decision. Truth is if we want to get people to commit we need to make sure we are hearing people and their opinions. My job as leader is to make sure I know what everyone thinks, and if that takes time then so be it and if there is not consensus then it is my job to break the tie. When you can do that, hear everyone, and factor in their input, 99 times out of 100 they will support the decision even if they disagree.

4. Avoidance of accountability: This is the most common and most dangerous of all the dysfunctions. When you walk out of meeting and know that person next to you didn't commit, how much courage will you have to hold them accountable? The thought of letting down a trusted colleague is the biggest motivator. They love their teammates. You find it in firefighters and police. The best teams play for one another.

5. Results: Pay attention to results of team rather than individual needs. You have to make sure you do the best for the hospital, not the department. When there are silos at the top of the organization, they suffer the most. The most important priority is the collective results of the organization.

Meanwhile, while the American Medical Association got the president, we're stuck with Al Gore. Perhaps that's an unkind statement about my former senator, but I have a good reason.

Why am I bitter? Well, you won't read anything about the former vice president's talk here, because we've been unilaterally banned from the speech. By "we," I mean representatives of the media. Now is that any way for a former journalist to treat the media? I think not.

Wonder if he'll be discussing some top-secret inside information about healthcare reform? Perhaps he'll castigate healthcare for how ungreen it is. Since we can't listen, it's fun to speculate.

Until tomorrow, so long from Seattle.

You can follow Philip Betbeze's HFMA updates on Twitter throughout the conference at

Philip Betbeze is senior leadership editor with HealthLeaders Media.

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