Leaders Want Their Followers to Ask, Answer and Share Their Own “What’s in it for me?”

Leadership and management theories, principles and applications are universal constructs. They aren’t just for one industry or sector; they apply anywhere and everywhere. This week I have read not less than ten articles on Population Health Management (PHM). In every one, and I mean without exception, there has been some allusion to the difficulty of getting various constituencies that have not work well together to do so going forward. In the health care industry, it is common to hear that physicians and hospital administrators do not get along, much less work together to accomplish goals of mutual interest. The reason? I have always heard that their agendas are too different, that the system incentivizes each differently. Arguably, for sure, the consensus is one only cares about patients, the other only cares about money. Under the new imperative both must be concerned equally for the management of the patient and the management of money. To create this opportunity, each constituency (many more than physicians and administrators) must identify and realize “What’s in it for me?” The question and the powerful “Why” that will emerge from asking it will uniquely incentivize critical players to get in the game. 

Whether you are in healthcare or another industry, your mandate is the same. To effectively lead, you must align your incentive (“WHY” you play) with the incentive (“WHY” they would play) of each of those you wish to lead or expect to follow you. If you don’t, you will not have their sustained commitment; you will not experience success. 

Creative Incentive Building 

The Merriam-Webster Dictionary defines Incentives as “Something that encourages someone to do something extra or to work harder.”

We’re not talking about incentives or incentive programs typically found in company salary and benefit packages. Here we are talking about the fundamental and intrinsic incentives which live in every person and cause them to act (or not) in any situation.

So the question was asked of me this week, “Why would hospitals ever support PHM? They make their money providing acute care. They need to see sick people. The gateway to their Inpatient activity is the Emergency Room. That article you shared with me says that PHM will emphasize preventative health and care planning that keeps chronic patients away from hospital acute care services. Decisions on the accessing of acute care services through a hospital are proposed to be made by a primary care physician who “captains” a multidisciplinary Care Team. They will minimize hospital admissions to maximize their profits. Hospitals will stonewall any PHM initiatives, and right now they have the power to do so.”

Insanity is doing what you have always done the way you have always done it, expecting different results.” – Albert Einstein

My answer to this statement more than questions was, “Yes, and so what?” I love asking this question because at first people think I am being sarcastic and it intensifies their focus. “So, what can we do to align incentives where they do not appear to be aligned?”

The current US health care system, really the fundamental business model, actually pits the 4P’s (Providers (hospitals and physicians), Patients, Payers and the Public) against one another. It is a system that has reached the terminus of its functionality. It must radically change. For that to happen, each of the 4 P’s must step outside their box and seek new ways to be who they are, to do what they must now do (that might mean being the same to do something different or it might mean being different to do something different). It is time to think in terms of new models for doing business. These new models must reflect an awareness that we are not only adjusting to a new economy, we are adjusting to a whole new world.

Be clear, I am not just talking about the health care industry and PHM. To be effective leaders in the 21st Century I think we must all be prepared to step outside our boxes to create new leader-follower incentive models in our respective industries. I have truly come to see that what has incentivized me in the past, what incentivizes me today, is not the same as what incentivizes the millennials with whom I find myself working more and more at the owner and C-levels. When I talk to business owners and C-level leadership and management Teams today about incentivizing those working within their organizations, we are not talking about aligning on one common incentive. Rather we are talking about creating unique incentive programs that manage to incentivize each constituency within the complex organization of the modern matrix company while maintaining overall fairness and equity. We are talking about a deeper multi-faceted model for aligning different incentives toward a common primary objective. This is a contemporary challenge for all leaders, everywhere. 

The best 21st Century leaders, certainly the most valuable, will be those who understand the problem and can build responsive incentive models and programs. 

About the author


Dr. Ed L. Hansen

This blog is written by our guest author – Dr. Ed L. Hansen. He has C-Level leadership experience and expertise (as CEO, COO and CFO) in government hospitals and health systems; not-for-profit community hospitals; and corporate, for-profit hospitals. He has been the CEO of an international multi-facility hospital group.

As an employed hospital executive and as a consultant, Ed has led major construction activities, hospital and clinic service development activities and new healthcare business start-ups, including an award-winning international air ambulance company. He is particularly strong in the areas of operating systems design, implementation, maintenance, re-engineering and evaluation. He has addressed the Bond Covenant violations of several struggling hospitals. In these cases, he and his teams effectively turned-around their operational and financial performance.

Read more at Part 3


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