Excellence in Leadership“From the Dark Side to Beyond the
Comfort Zone”Scott Hill, Ed.D.
Executive Director for Community [email protected]
Norman Spain. J.D.Professor Emeritus
Program Takeaways• Insights into the:
– concept of “dark side of leadership” in legitimate organizations, risks it posses; need to and thoughts on ways to address it.
– comfort zone performance model; problem of employee entitlement; and benefits and risks for increasing employee stress/anxiety to achieve an earning culture and healthy environment.
– Multiple proven leadership principles and practices, and a challenge to help you grow personally and professionally.
Part 1
The Dark Side
“refers to inner urges, compulsion, motivations, and dysfunctions that drive us toward success or undermine our accomplishments.” Pg. 29
Psychological Patterns of Dark Side Leaders
Compulsive
Narcissistic
ParanoidCodependent
Passive-Aggressive
Organizational Risks of Leaders Dark Side Behaviors
Illegal
Abusive Unethical
Dark Side Leadership in HealthcareIs it a Problem?
Case Study: Misleading Marketing
• Johnson & Johnson ordered to pay $572 million for an aggressive misleading and dangerous marketing campaign that use of opioids was safe. It exponentially increased addictions, overdose deaths, and babies exposed to opioids. 2000 cases still pending. – Jan Hoffman, at
https://www.nytimes.com/2019/08/26/health/oklahoma-opioids-johnson-and-johnson.html
Case Study: Ignoring Evidence• Federal criminal charges were filed against Rochester Drug Cooperative,
one of the nation’s ten largest distributors, its president and compliance officer.
• Despite numerous red flags including internal warnings, senior management persisted in continuing to supply pharmacies with addictive opioids for illicit use by customers with “no legitimate medical need.”
• Between 2012-2016 RDC sales of oxycodone grew from 4.7 million to 42.2 million tablets, and fentanyl dosages from 63,000 to 1.3 million. The president’s salary increased 125% to $1.5 million.
• RDC signed a consent decree accepting responsibility, to pay a $20 million fine, and enhance its compliance program. If it complies for 5 years the government may recommend to the Court the charges be dismissed.
– https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-and-dea-announce-charges-against-rochester-drug-co-operative-and April 23, 2019
Case Study: Failure to Supervise • Michigan State University entered into a $500 million settlement
with 332 women sexually victimized by a college team physician employed for about 2 decades. MSU failed to appropriately investigate complaints and supervise the physician. $75 million is reserved for victims who might still step forward. https://www.chicagotribune.com/sports/college/ct-spt-michigan-state-larry-nassar-settlement-20180516-story.html May 16, 2018
• 100 women are stilling suing MSU and it was fined $4.5 million by U.S. Dept. of Education for Clery Act and Title IX violations. https://www.insidehighered.com/news/2019/09/06/education-department-fines-michigan-state-45-million-not-reporting-nassar-crimes Sept. 6, 2019
Case Study: Referrals & Kickbacks• William Beaumont Hospital, part of Michigan’s largest health system …, paid $85 million to settle
government allegations that it gave physicians free or discounted offices and subsidized the cost of assistants in exchange for patient referrals.
• A month later in Montana, Kalispell Regional Healthcare System paid $24 million to resolve a lawsuit alleging that it overcompensated 63 specialists in exchange for referrals, paying some as full-time employees when they worked far less.
• Both nonprofit hospital systems did not admit wrongdoing in their settlements but signed corporate integrity agreements … requiring strict oversight.
KHN, Jordan Rau, May 31, 2019 https://khn.org/news/hospitals-accused-of-paying-doctors-large-kickbacks-in-quest-for-patients/
Note: the Anti-kickback Statute [42 U.S.C. § 1320a-7b(b)] prohibits offering “remuneration” to induce patient referrals or generate business for items or services payable by the federal health care programs. The Physician Self-Referral Law (42 U.S.C. § 1395nn) prohibits physicians referring patients to receive healthcare services for which the physician/immediate family has a financial relationship.
Case Study: Patients-for-Cash• The CEO of both Amity Home Health Care, largest provider in the
San Francisco Bay Area, and Advent Care, a hospice provider; 15 doctors, 5 nurses and 9 others were indicted in $115 million tainted Medicare fraud scheme. The CEO and healthcare organizations paid 8 million in bribes and costly gifts to doctors, nurses and healthcare staff to provided referrals and references.
– Evan Sernoffsky, San Francisco Chronicle, Sept. 5, 2019. https://www.sfchronicle.com/crime/article/30-charged-in-115-million-Bay-Area-Medicare-14416892.php#photo-18213004
– U.S. Department of Justice, N.D.CA, Sept. 5, 2019https://www.justice.gov/usao-ndca/pr/bay-area-s-largest-home-health-care-agency-and-28-health-care-industry-workers-charged
Case Study: Upcoding Medicare• A former nurse at Regional Medical Center in San Jose, Calif., filed a
federal lawsuit alleging the hospital and its owner, Nashville, Tenn.-based HCA Healthcare, submitted false claims to Medicare.
• According to the complaint, hospital administrators also directed staff to upcode claims to inflate reimbursement.
• "Placing the ER patients in fraudulent rooms allows defendants to upcode as many revenue codes and revenue code units on the UB04 forms and make the final bill as high as possible," the complaint states. "Defendants then benefit by receiving additional outlier reimbursements that they would otherwise not qualify for under CMS' standards.“
– HCA accused of billing fraud, 3 things to know, Ayla Ellison (Twitter) –Monday, Feb. 25, 2019 at https://www.beckershospitalreview.com/legal-regulatory-issues/hca-accused-of-billing-fraud-3-things-to-know.html
Case Study: Medicare Overbilling• One Of Nation’s Largest Hospital Systems Agrees To $65M Settlement Over Medicare Overbilling
Allegations• Prosecutors had alleged that Prime Healthcare Services unnecessarily admitted Medicare patients
who were being treated at the emergency rooms of several hospitals in its system. Medicare pays more for patients who are admitted to hospitals than those who are treated as outpatients.
– The Associated Press: Hospital System Pays $65M To Settle Medicare Billing Claims– Prime Healthcare Services, one of the nation’s largest hospital systems, agreed Friday to pay $65 million to
settle allegations of Medicare overbilling in California. The company and CEO Prem Reddy agreed to settle a whistleblower lawsuit alleging that 14 of its hospitals unnecessarily admitted patients and also “upcoded” patient diagnoses, exaggerating their illnesses in order to receive more Medicare money. (8/3)
– The Wall Street Journal: Hospital System, CEO To Pay $65 Million To Settle Lawsuit Alleging Medicare Fraud– Prime Healthcare Services Inc. will pay the bulk of the settlement, while Chief Executive Prem Reddy will pay
$3.25 million and the system’s nonprofit affiliate will pay an undisclosed small amount, … Prime also agreed to a five-year corporate integrity agreement with the U.S. Health and Human Service Department’s inspector general. The agreement requires Prime to have an “independent review organization” scrutinize its Medicare bills. Under the terms, the settlement resolves allegations against Prime and its nonprofit affiliate Prime Healthcare Foundation without a determination of liability. (Evans, 8/3)
• https://khn.org/morning-breakout/one-of-nations-largest-hospital-systems-agrees-to-65m-settlement-over-medicare-overbilling-allegations/
Case Study: Collection Practices?• Virginia Governor Northam and University of Virginia President
Ryan committed to revising UVA Health System’s collection and indigent care and financial assistance program. Despite state law mandating hospitals pursue collections, this action came a day after a scathing report of its aggressive practices by Kaiser Health News investigation, published with The Washington Post. (“UVA has ruined us: Health system sues thousands of patients, seizing paychecks and putting liens on homes”) Over 6 years UVA Health Systems sued 36,000 patients for $106 million.
• Jay Hancock and Elizabeth Lucas, Kaiser Health News, Sept. 10, 2019 at https://khn.org/news/virginia-governor-and-uva-vow-to-revamp-practice-of-suing-patients-as-ceo-exits/
• Note: Was it good business, unethical, or politically unacceptable?
Discussion
• With all the existing laws, regulations, and organization policies, what new or more can healthcare organizations do to develop a strong organizational culture to identify, prevent, detect and reduce leadership dark side misbehavior?
Part II: Danger in the Comfort Zone
Entitlement Habit
• “Entitlement … an attitude, a way of looking at life. Those who have this attitude believe that they do not have to earn what they get. … they are owed it… they get what they want because of who they are, not because of what they do.” – Judith M. Bardwick, Ph.D.
Executive Entitlement?
Executive Entitlement/Abuse• Misuse of company
airplanes for personal and family travel
• Provided expensive company vehicles for mostly personal use
• Misuse of company credit cards for personal expenses classified as business
• Using specific hotels, airlines, etc. that are more expensive to earn free travel points for family
• Unnecessary club memberships for pseudo-business purposes
• Executive salary increases/bonuses when employees are losing jobs, taking salary cuts and freezes.
• Use of sole suppliers and contractors without competitive bids who are friends, family, and …
Maximizing Productivity
• The Comfort Zone is a psychological model for employers to raise employee stress/anxiety to move away from an entitlement culture to an earning culture. While there are recognized health and performance risks with high stress levels, substantial workplace stress/fear may be necessary to jar employees at all levels out of a deeply rooted sense of entitlement.
The Comfort Zone Model
Earning Zone
• Comfort Zone has been misinterpreted …• Comfort Zone does embrace progressive
employee management concepts and practices in the earning zone where employee share common purpose.
• Nonetheless, gravitational force of the entitlement attitude will always be pulling on employee behavior at all levels. Leaders need to be aware of and resist the temptation.
Part III: Beyond the Comfort Zone
• Leadership concepts in general that are based upon a belief in human dignity and capacity to perform at its best when people at all hierarchal levels are respected and valued.
• Leadership based upon intentional relationships founded on trust and shared purpose .
• Does not mean a problem free existence. It means problems will be identified and corrected in a fair manner that benefit the shared purpose.
Covey
Covey
How to operate day to day?
• Do it?• Delegate it?• Trash it?• Schedule it?
Covey’s Maturity Continuum
Who determines your weather?
Be Proactive! Focus on what you can control!
You make your own weather from now on!
What would happen if you always did your absolute best?
Balance
Intrapersonal Leadership
Before you can lead others you have to be able to lead yourself!
Quotes to Apply
• Esse quam videri
• And above all else to thine own self be true….
Quotes to Apply
• Esse quam videriLatin Phrase meaning “To be, rather than to seem to be” Motto of a lot of places/institution including state of North Carolina.
• And above all else to thine own self be true….Shakespeare - Hamlet
Holistic Model for Human Development
• Physical • Spiritual• Emotional• Cognitive• Social
Are they related? Are each important? Develop a plan to further develop?
Interpersonal Leadership
Interdependence
• Mutually dependent on each other
What kind of leader are you?
• Transformational Leader – inspires others to follow by force of personality, creative, energetic, attractive.
• Transactional Leader – in many ways opposite of Transformational, transactional directs more and focuses on supervision, organization, performance, rewards and punishments.
• Servant Leader, or I Leader/We Leader
Servant Leadership
• Robert Greenleaf coined the phrase in 1970.
• The servant leader is a servant first…..It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. This person is sharply different than person that is a leader first.
Practical Examples Servant Leadership
• Meetings• Rounds• Share your time• Supplies• Remove Barriers• Treat others the way you ……• Thank them• Serve Them
More practical examples of servant leadership
• Listen• Respond• Fix it• Address it• Follow-up• Be genuine• Build relationships
Are you as rich as you want to be?
More resources
Part 5: Leadership and Change
• Leadership is an essential element of social order, be it for the worst or better.
• Change is inevitable. It is a natural and on-going element of life and human history.
• Striving for a better life and environment is a natural desire of all people.
• Getting there is a direct result of the quality of leadership, by one’s self and others.
• Positive change is not guaranteed.
Have you Changed?
• Have you learned new leadership skills and principles?
• Are you growing personally as a leader, growing professionally?
Most everything has changed!Ø Sentinel Event Alert #59 – April 17, 2018The Joint Commission, 2018
Ø Mass Shootings – 270 2014 to 346 2017http://www.gunviolencearchive.org/past-tolls
Ø OSHA – 3148 1996, & 2016
“The rate of change is not going to slow down anytime soon. If anything, competition in most industries will probably speed up more in the next few decades.”
Have to have a sense of urgency?Complacency is dangerous.
Model for Positive Change
Questions?
[email protected] and [email protected]
What is one thing you need to change in your life to be more effective, to make more of a difference? Poll-maker.com
https://linkto.run/p/K0S5FQIT
• Email me in two weeks on how you are doing?List one thing you have changed, has it helped? Do you think it will? How can I help?
