Kubica LaForest Newsletter, Jan. 2012
Newsletter: January 2012
Internal Talent Integration
How well does your organization select and integrate talent for internal promotion? If you are like many organizations we've seen — not very well.
When promoting from within, do you select the person who is doing the best job in their current role? Do you promote the person you like the most, the person who has the most seniority, or the person who gives you attention and deference? It is not unusual to promote a good technical person or a good clinical person into a management position. Technology companies and healthcare organizations do this frequently.
If this is your current practice, then you are missing out on the opportunity to improve business performance. You may also be dramatically and unnecessarily increasing your cost of operations. This is hardly a good strategy in the current economy.
Look at the cost of a bad (mismatched) promotion:
While cost is obvious, time is a valuable and non-renewable resource. A poor promotional decision is expensive.
Internal promotions should be approached the same way you approach external hires: formally. There are distinct advantages when promoting from within. The candidate knows the business, knows some of the politics (politics at the managerial and executive level, however, are different), and is familiar with the culture. But this knowledge alone does not qualify them for promotion. What qualifies them for promotion is a positive performance track record and a demonstrated ability or high potential (versus just interest) to take on additional responsibilities and succeed.
Here are five actions that organizations can take to prepare internal candidates for promotion:
Once the candidate is selected and promoted, their transition must be supported. It is reckless to assume that a candidate promoted from within the organization will automatically succeed and needs no further attention. Yes, they know the organization. But do they know how to manage and perform at a new level within the organization? Promotion doesn't result in instant competence. A mentor or a coach are excellent ways to support the transition and prove to be a good investment.
Some candidates, however, will not have had the advantage of participating in a management development (i.e. "grooming and growing") process. Some may never have held a management position. Some may have agreed to a promotion reluctantly.
Creating a formal Talent Integration process for newly promoted managers is a wise business practice.
Talent Integration involves:
Recently highlighted in the Wall Street Journal, 26% of managers aren't trained to manage, according to the Rasmussen Report. Now consider the even greater likelihood of this when technical people are promoted to management. For internal promotions to be highly successful, a rigorous internal promotion process must be established and a formal transition integration process must be put in place. The cost of not doing so is simply too great. Unless your funding and talent are abundant and not a concern, you can't afford not to.
Preventive Healthcare Visits May Not Be Free
If you are following the information coming out of Washington and the Affordable Care Act about preventive care visits, you would come to the conclusion that certain preventive care visits are free. Well, you would be coming to the wrong conclusion.
There is an interesting interpretation that all healthcare consumers need to be aware of. While screening visits are free, diagnostic treatments are not.
Why does this matter? On the surface it appears obvious. Of course diagnostic procedures are different than screening procedures. But it’s not as obvious as it may seem.
An Associated Press article (that got wide coverage in December 2011) identified a man who thought his colonoscopy would be free. But when the bill arrived, his insurance company billed him $1,100. Why? Because when the doctor was doing the colonoscopy, he found two non-cancerous polyps, which he removed. What started out as a colonoscopy screening procedure turned into a diagnostic procedure (removal and determination that the polyps were non-cancerous). And the insurance company can bill for a diagnostic procedure. Interestingly, the patient went under anesthesia thinking he was getting a screening procedure and woke up to find he just had a $1,000 diagnostic procedure.
The article reported on another patient who went for a mammogram. (or, mammography exam)She thought she was going for a preventive screening procedure (which her doctor ordered). The hospital staff, however, told her it would be a diagnostic test (because a previous mammogram found something suspicious, which turned out to be nothing) and would cost $700. She held her ground and got the screening free.
There are also issues with co-pays (amount certain insurance policies require the patient to pay out-of-pocket). Some providers are charging co-pays even though the preventive care procedure should have been free – such as immunizations. The Associated Press article reported that the physician told the patient that “no one really comes in just for a flu shot – they inevitably mention another ailment so he charges”.
So it appears that the patient is in a “buyer beware” position. It looks like it’s legal and the charges, based on what happened and the explanation, appear to be justified - just as the actions taken by credit card companies are perfectly legal. Just read and fully understand the fine print on the back of the credit card application!
The providers and insurers need to get ahead of this one. Regardless of what they may think about what they are doing and what they are charging, it does come across as “bait and switch”.
And here is an easy way to do it. Talk to the patient. Explain what can happen during the preventive screening procedure and explain what it may mean in terms of co-pays and insurance bills.
And from a political, provider, and payor perspective, let’s not be silly about it. We hear that patients should know and should be able to make decisions about their healthcare. Well perhaps, but this is truly a naïve and unrealistic assumption. If you asked 100 male consumers about getting a preventive colonoscopy and ask them to explain to you the potential options and outcomes that they need to consider, how many would talk about the difference between preventive screening and the possible diagnostic procedure that could happen if polyps are discovered? Our guess – none.
The responsibility to inform rests with the providers. The responsibility to ask clarifying questions rests with us, the consumer. But we have to know what questions to ask or that there is even a question that needs to be asked.
Regarding preventive screening, there are many questions to ask. We encourage each of you to: ask questions, challenge the system and be your own patient advocate.
Preventive Care: A Complicated Situation
Preventive care will identify medical conditions early, it will extend life, it will prevent a more complicated disease presentation when caught earlier. But there is a significant challenge: the current cost and the future economic benefits are out of sync. Many providers and insurers think in terms of short-term economics while they espouse long-term benefits.
The economic benefits resulting from preventive care are long term. The healthcare system, as it exists today, is designed (and rewarded) to deal with the disease – not the prevention of disease. In fact, the prevention of disease, at least in theory, could decrease the current need for healthcare. This would create an economic hardship for the care system.
So what we appear to have is what Clayton Christensen has termed The Innovator’s Dilemma.
The situation reported above is one example of the complication that results from changing the incentives within a system. Could it be that organizations not associated with the current provider system (i.e. Wal-Mart, Target, CVS) will lead the change effort toward more preventive care? If history is prologue, we believe it will.
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