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Six dimensions of leading organizations forward [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Dr. Britt Berrett, Director of the Center for Health Care, Leadership and Management at the University of Texas to discuss six dimensions necessary to lead organizations forward.

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Highlights of this episode include:

  • How Dr. Berrett went about identifying the six dimensions of leadership
  • Confidence and competence
  • Authority in action
  • Fairness and awareness
  • Reputation and record
  • Kindness and caring
  • Integrity and trust

Mike Passanante: Hi, this is Mike Passanante, and welcome back to the award-winning Hospital Finance Podcast. COVID-19 affected every health care organization. As we move past the immediate effects of the pandemic, what skills and behaviors will be required by health care leaders to move their organizations successfully into the future? Today, I’m joined by Dr. Britt Berrett, director of the Center for Health Care, Leadership and Management at the University of Texas at Dallas to discuss Six Dimensions necessary to lead organizations forward. Dr. Berrett, welcome to the show.

Dr. Britt Berrett: Delighted to be with you, Mike. Thank you for the invitation.

Mike: Well, we’re happy to have you. Dr. Berrett, why don’t you talk to us a little bit about how you went about identifying these six dimensions of leadership and what got you interested in that topic?

Dr. Berrett: It’s interesting. I come from the hospital administration background. For 25 years, I was an executive with health care, 20 years as a hospital president. Most recently, I was the president of Texas Health Dallas, which is a 900-bed facility. And I was the executive vice president for Texas Health Resources, which is an integrated delivery system in the Dallas-Fort Worth, North Texas area, 24 hospitals. So I served in that role. Prior to that, I was with HCA. And if you’re familiar with that great organization, I was the president of their largest and most successful hospital, Medical City Dallas. And as I was navigating through my leadership role, my responsibilities, it got kind of complicated. And the more the additional responsibility was placed upon me, I had to transition from what I call shooting from the hip on how I lead, to having a very structured approach. I felt like in the past, I just did what I thought was right. I built teams, I delegated responsibility, I required people to return and report. And I was just shooting from the hip. A lot of it I learned along the way. A lot of it I learned from books I had read. But I had to put into play some very tangible and specific leadership tenets that I adhered to. There’s a great article from Harvard Business Review. It’s called Why Do Hard-Nosed Health Care– or Why Do Hard-Nosed Executives Need Theory. And what they’re advocating is the times of shooting from the hip, they’re over. And I’m sure a lot of your leaders are where they are because they’ve been inquisitive, they’ve been curious, they’ve been exploring, they’ve been asking questions. But there comes a time you have to write down on a piece of paper, “This is what I believe.” And so that’s what I did. And then I was asked by the American College of Health Care Executives to write an article on those tenets. And that is what was published.

Mike: Well, that’s a great setup and I’m excited to learn more about the tenets that you’ve developed here. And so the first to mention that we’re going to talk about is confidence and competence. Why don’t you tell us about that?

Dr. Berrett: Confidence is an interesting word. When you hear the word confidence, then it’s, “Okay. Look at me. I’m confident.” I walk into a room and everybody, “Here’s the CFO and blah.” I think confidence is knowing who you are. Confidence is understanding your skills, your traits, your strengths, your weaknesses. Confidence is knowing who you are, and you couple that with competence because, “This is what I’m good at.” It also says, “This is what I’m not so good at.” My example is I am very good at speaking in large groups to large groups of people. What I struggle with is getting into the detail, and checking the boxes, and getting the paperwork done. So throughout my career, I had a couple of team members that were absolutely fantastic on the ladder. So Ross and Frankie and John and the list goes on of individuals that I would hire that understood and would adhere to the details so I could do what I do very well. And there are things they didn’t want to do. I mean, they didn’t want to lead a board presentation. They did not want to have to talk about why we needed to expand our ortho and neuro strategy but they would provide the back up. So I think one of the first elements is this confidence of knowing who you are and what you’re good at and being able to also know what you’re not good at. There’s some great tools out there, Mike, assessment tools on your leadership skills. DCI, DDI’s got some programs. I don’t ascribe to any of them. All I plead is that leaders understand what their competencies are and have the confidence to declare who they are and what they’re about.

Mike: That’s very interesting. And the second dimension, I think, goes hand in hand with that in some ways. And I think people sometimes confuse authority with confidence. And so your second dimension is authority in action, which goes hand in hand, I think.

Dr. Berrett: Well, when we talk about authority, it’s, “What’s my scope or my sphere of influence?” I’ve spoken at board retreats. I’ve spoken at national meetings. And I’ll have individuals come up to me and say, “Hey. Listen, I hear what you’re saying about building culture but I’m just a small brick in this big wall, just a little cog.” And my question for them would be, “What is your sphere of influence? What can you touch?” “Oh, I’m just a director in revenue cycle,” or “I’m over accounting but I’m not the CFO.” And my response would be, “Okay. Stephen Covey wrote a book, Seven Habits of Highly Effective People, and he talked about your sphere of influence. So figure out what your authority is, what you can impact, what you can change, how you could evolve and build that team. Build that team and you have the authority to do so and prove that you can create change.” So action. I work with an executive and his comment to me is, “Hey, I am doing all this and I’m doing all that.” And then my response is, “Great. Are you creating results? Are you creating results? Are you moving the strategy forward?” If you’re not, that’s just a lot of talk. How many times have we worked with someone who just talks and talks and talks and doesn’t get anything done? So, declare your area of authority, your sphere of influence, the things that you could touch, and then get things done with that group.

That, to me, has led to fairness and awareness. And it’s kind of a little play on words there. But the third and fourth is, are we– I’m sorry. The third dimension would be, are we fair and are we aware of all the members of the team? When we talk in employee engagement, there’s this raging conversation about can we improve an employee’s engagement by compensation? And my experience has been and actually the statistics validate this, people have to be paid fairly. If there is not fairness in compensation, you’ll see dissatisfaction. You don’t have to overpay. You just have to be fair. You also have to be fair on a number of things like work schedules, vacation time. Can you create an environment where everyone believes that there’s fairness associated? And when there’s a pop-up, when there’s an event– look at COVID. People kept on saying, “Well, am I an essential worker? Can I work from home? That doesn’t seem fair that Bob can and I can’t.” When you can address those on a team basis, you create a sense of organizational harmony. And aware of what people are saying. When I was running this 900-bed hospital, I would, once a month, get trays, carts full of cookies and cupcakes, and I would just wander through the hospital and visit with people. I got more information by that management, by walking around, than I ever could in a survey or a report.

So not only be fair but be aware of what the critical issues are in the organization. That is proven to be very, very important as we transition from remote and online to “Okay. We’ve got a new set of rules now. We’ve entered into a hybrid environment.” What’s fair and does everyone feel a sense of fairness? And are we aware of maybe some elements that might not be fair that you and I as leaders must address?

Mike: That’s fantastic advice and the next dimension, the next set there, which I think it’s both individual as well as institutional, is reputation and record.

Dr. Berrett: Yeah. Yeah. Yeah, reputation and record. Everyone wants to work for a winning team. Everyone wants to work for a winning team. So how do you tell the story? “Woo-hoo. No casualties on hand.” Okay. Maybe that’s not a big deal for the nurses but it might be a big deal for the finance team. John Kotter wrote a book, it’s one of the most prominent books, seminal work on leading change. And he talked about how you’d lead an organization from one state of being to the next. And he said something interesting. In addition to all the other elements that I highly recommend the listeners consider looking at John Kotter, K-O-T-T-E-R. He said, “Celebrate small wins.” Celebrate small wins. And what he’s saying is celebrate the successes that point you in a specific direction. Of course, there are things like there’ll be birthday celebrations and there’ll be – I don’t know – gatherings. But celebrate the successes that align with your strategic initiatives. If the cash days on hand is a big issue, then celebrate it. And celebrate it in a unique and fun way. Build on the reputation that you’re creating by celebrating individual’s performance. And keep track. Keep track of it.

Clinical folks are always interesting. We don’t really connect with some of their measures of celebration but you got to. If you’re in the finance space and you’ve got a lot of clinical folks, sometimes they look at the world differently than you and I. So when I talk about reputation and record, what do they celebrate? It could be something as simple as the patient satisfaction scores. It could be advanced and professionally by their peers. It could be– when we did magnet certification in nursing, we were the first hospital in North Texas to receive this, the highest achievement that any nursing service could receive. Magnet certification in nursing. We were the first in North Texas to receive it, the 92nd worldwide. It was a big deal. My finance folks were like, “Yeah. Whatever. No big deal.” No, no, no. Figure out what the clinical folks are celebrating and celebrate with them. And so we got pens and I wrote big pins and I encouraged all the finance folks to put those pins on their name badges. And we had a big party. And we invited everyone. Ancillary, support, admin, nursing, clinical doctors to celebrate together those wins. So reputation and record gets back to that. Everyone wants to work for a winning team. So find those successes, both big and small.

Mike: The next dimension, I don’t know if you find this in every management book, but I think everybody learned more about it in the last year during the pandemic, and that’s kindness and caring.

Dr. Berrett: I wrote an interesting book. So I pursued my doctorate later in life. And my dissertation was on the convergence of strategy and leadership. So how you lead. Does it have an impact on your strategic outcomes? And the answer is yes. We really had researched in health care. Finished the dissertation, Mike. No one read it. I was so disappointed. I thought it was genius. So a buddy called me up and he says, “Hey, you want to write a book with me?” And I said, “I’d love to.” So we took all these statistically proven theories and we put them into a book called Leading Change By Changing How You Lead. And at the last minute, we retitled it Patients Come Second. And the plea in this book was be kind and caring, understand your team, build your team. Because once you build your team, then you can create exceptional results. You can’t beat people into submission. You’ve got to build that team. We published in 2013. It became a New York Times bestseller or Wall Street Journal bestseller, a USA Today bestseller. It was phenomenal. Actually, it’s one of the reasons that led to me to retire from hospital administration, go into teaching and just enjoy hopefully inspiring people. And it really talks about understanding your team. There’s so much to be gained by kindness and caring. There’s so much value in understanding where your team is coming from. How often do we assume, Incorrectly, the reason for performances? How many times have we been anxious with the performance of an employee only to learn that they’re going through a life changing experience?

I’m working with a chief financial officer in Midwest and he hired an accounting, the professional. And she was phenomenal. Absolutely spectacular. One day she walks into his office and says, “I’m leaving.” I mean, it was devastating. He had no idea that she had some personal challenges in her life that, honestly, she was unwilling to share. Now, we have been working with him and with her, and she finally opened up and revealed where she was coming from and the challenges that she had and resulted into a very, very kind and caring separation from the organization. But I got to tell you, she might be back. And if she’s not coming back, she’ll talk to other people who are considering that job and realize that there was goodness in the organization that cared about her personally. And you just can’t undervalue that. And when we’re coming out of this pandemic, there are going to be a lot of very strange behaviors that you and I just won’t be able to understand. And it’ll take a lot of kindness and caring to deal with it.

Mike: Huge part of leadership. Finally, your last dimension is integrity and trust.

Dr. Berrett: There’s an author. His name is Dan Lencioni– is it John? John Lencioni. He wrote a book called The Six Dysfunctions of a Team. And Lencioni talked about the foundation being trust. And I put this at the end of my list, not because it’s the last, but more importantly it’s the one we need to talk about the most. We’ve got to build trust. We’ve got to build a sense of confidence and comfort, one with another. And great leaders and great organizations trust one another. There’ll be times when the inexplicable will occur and you and I will react, perhaps correctly, perhaps incorrectly. Perhaps we get part of the information. Sometimes people don’t understand the full ramifications. Does your team trust you? That your intentions are for the betterment? Think about the worst boss you ever had. Did you trust them? Absolutely not. Think of the worst leader you’ve ever had to work with. Think of adjectives to describe he or she. I’ve done this tens of thousands of times with leaders throughout the United States. Words come to mind like horrible boss, micromanager, thoughtless, mean, vindictive. Those are all words to describe an environment that lacks trust. So, Integrity ties into that. I would encourage leaders to allow the team to know who you are.

It goes back to the first one. Understand yourself. Why are you doing what you’re doing? What do you bring to the table? And having the integrity to reveal yourself becomes very, very important. Getting back to this issue with this individual, this senior accountant that left the organization. They really had not built the trust that was necessary to have a conversation that might have mitigated or perhaps prevented her departure. So lesson learned. Integrity. Trust. Those are efforts that are worked on every single day. And great organizations, great leaders use integrity and trust as a foundation on how they organize and lead a team. So there are six dimensions. They are all applicable. I’d encourage your listeners to ponder them. I’d encourage your listeners to maybe create their own. What are the six tenets of my leadership style? I’ve given you a couple of ideas that I think would be of value. I think integrity and trust, though, should be foundational in any of those efforts.

Mike: Dr. Berrett, great discussion today. If someone wanted to find out more about you and the work that you do, where can they go?

Dr. Berrett: I’d be delighted. I’m at And quite honestly, Mike, I’m honored to be invited to this podcast. You’ve got some great, great broadcasts in the past. I’m honored to be part of it. My life’s mission is to prepare the next generation of health care leaders. So if you shoot me a note, I’d be glad to respond. I do work with teens. That I’ve enjoyed immensely. I do that on a limited basis. The fees that are charged go all into the University of Texas at Dallas Scholarship Program. So I’m working with a group of physicians up in the Midwest and the fees I charge, those are all going towards scholarships for our students. That’s my gift to the next generation. So I’d be happy to engage in a conversation in any way, shape, or form with the listeners of this podcast.

Mike: Well, we appreciate that. It was an honor having you on today. Thanks for coming by the podcast, Dr. Berrett.

Dr. Berrett: Pleasure to be with you. Thanks again.

The Hospital Finance Podcast

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