Leaders of health care organizations risk obsolescence or getting lost in the “middle management” aspect of their work – unless they follow ethical principles designed to root out toxicity. This is according to SCAN Group CEO Dr. Sachin Jain. SCAN Group is a non-profit Medicare Advantage organization and parent company of SCAN Health Plan, a […] The post SCAN Group CEO On The Principles That Prevent Health Care Obsolescence appeared first on Home Health Care News.
Leaders of health care organizations risk obsolescence or getting lost in the “middle management” aspect of their work – unless they follow ethical principles designed to root out toxicity.
This is according to SCAN Group CEO Dr. Sachin Jain. SCAN Group is a non-profit Medicare Advantage organization and parent company of SCAN Health Plan, a $2.4 billion organization that covers more than 435,000 members and several clinical programs. He previously served as CEO of palliative care and senior services companies Aspire and CareMore, both subsidiaries of Elevance Health (NYSE: ELV).
Jain recently outlined his new principles for leadership in an article in Forbes. There, he outlined the importance of saying and doing hard things, recommitting to health care exceptionalism, speaking for people who don’t have a voice and elevating the people who actually do the work.
He also posited that leaders should end side projects that drain resources, keep a small organization mentality, combat ethical erosion, build strategies for addressing patient discontent, be honest about the company’s impact and root out internal toxicity.
In an interview with Home Health Care News’ sister publication, Hospice News, Jain expounds on some of these calls to action for health care leaders.
How can leaders strike a balance between consideration and respect and toxic positivity? Where is the line?
It’s important for us to take a big step back, and the best way to navigate a situation is to define it clearly in the first place. If you don’t accurately define a situation or a circumstance, it’s impossible for you to actively, to effectively, navigate that circumstance. And I think those of us who work in health care are in constant pursuit of trying to make health care better, but the only way we’re going to actually make it better is if we define the current reality with a high degree of resolution.
That doesn’t mean you have to demean others. It doesn’t mean that you have to be negative about your organization. But it does mean you have to kind of call things what they are, and I think that in a Hospice News context, you could be like, “Oh, you know, we’re really good at this, or we’re really bad at that.”
Then, because we’re good at this, it allows us the room to be better at the things we’re bad at. But if you just say, like, “Oh, everything’s great,” it doesn’t actually create the room or space for people who do see defects or deficiencies to actually fix them.
I’ve now seen this as a general kind of cultural phenomenon across multiple organizations, multiple proud organizations who have good reasons to be proud of themselves, but sometimes that pride can crowd out constructive feedback or a constructive perspective on future direction. That’s frankly, how organizations oftentimes find their ways to obsolescence. They don’t necessarily meet the moment when they’re not when they’re not defining them clearly, and they’re defining their circumstances clearly.
How can leaders best articulate the concept of health care exceptionalism?
First, they need to stop with casual comparisons to other industries. I think for decades, it’s been like, “Oh, well, if I could just build the Amazon of health care.” It’s been, “If I could just make healthcare as safe as the transportation industry.” Or people say, “If we could just make going to the hospital as easy as going to Avis or Hertz.” You just see these kinds of loose analogies. The other one that everyone loved for a long period of time was like that, we need to build a Toyota of health care.
Analogies can be clarifying, but they can also be distracting, and oftentimes they’re incompletely articulated. So I’ll just use the Toyota example. What’s interesting is, if you go back into the history of Toyota. It took the Toyota corporation like 60 years, maybe 70, years of continuous evolution to become the thing that I think most people know as the modern Toyota Corporation. There’s a glibness that kind of befalls us when we start to use cross-industry comparisons.
There’s also just abstracting away the human element. You work in hospice; this is literally about life and death every single day. You have to be thoughtful and careful, and respectful of people’s preferences and people’s humanity and the diversity of humanity. Oftentimes, these industrial comparisons, Blockbuster-Netflix is another one that people love to kind of just pull out of their wallets.
Candidly, even I’ve been guilty of this historically, overdoing the analogies. I used to compare buying health care to buying a mattress, and the kind of opacity of the purchase. But the truth is, a lot of consumer analogies fall apart when you realize most people don’t actually want to shop for health care. They’re not in a position to shop for health care, they just need it. They sometimes find themselves in a circumstance where they need it, and in those moments, they just need everything to work.
I think the analogies really do fall apart sometimes, and so I think health care leaders need to really lean into what makes health care different, the human connection, the life and death nature of so much of what we do and the relative importance of health care to people.
All that leads to a view that health care is exceptional, not like any other thing that we do in our lives.
How can a large organization with multiple levels of hierarchy ensure that they’re hearing employees based on their impact rather than their proximity to power?
You’ve got to always be close to the real work. So you always have to be close to the people doing the real work. And it’s so easy for health care leaders to get lost in this middle management view of the world.
In many organizations, you’ve got corporate officers who then have senior vice presidents who report to them, who have corporate vice presidents who report to them, who then have vice presidents, and then have directors, and then have managers, and then have senior managers. Then they have specialists, and then they have frontline people.
It’s important to remind yourself that most of what we get is a highly sanitized view of the world when we engage with people through all these layers. So one of the things that’s always been important to me is to be close to customers, close to the people who actually receive our services, so I can hear the unfiltered view of how it’s really going.
It’s one of the reasons I give my email address to literally every one of our 435,000 members. I also give my email address and my phone number to every one of our 3000 employees. So that if somebody really needs to get a hold of me with a kind of a unique and distinctive perspective, they can.
Now the truth is, most employees never text me or call me, and members only reach out to me when they’re having an extremely difficult or challenging situation. I get probably one letter a day from a member, candidly, so I’m only seeing the extremes. But, I do things like have office hours where any employee in the company can sign up and just come to meet with me. I do all-employee forums. I do ride-alongs with some of our clinical staff, all of which gives me closer insight into what’s actually happening.
There are occasions where sometimes I learn of something that middle management has no idea about because they haven’t actually gotten close enough to the relevant unit, which is the place where our services really interact with a consumer in the real world.
How should health care leaders be advocating for the most vulnerable among their patients or the beneficiaries that they serve?
First off, it’s just remembering that that’s why we’re here. In many ways, implicit in our work as health care leaders is to address injustice and to address some of the disparities that we see. A
Sometimes, health care organizations fall into this loosely developed ethical framework of, “We treat everyone the same.” And the truth is, that’s not what “good” looks like in health care. We have to actually treat people according to their unique circumstances and situations, and the most vulnerable people amongst us need more from us — period, full stop. And I think we forget that sometimes.
What are some potential signs of ethical erosion?
I’ve seen it over the course of my career. It’s when you start out in health care and you’re like, “I’m here to help people.” And then 5, 10,15 years in your career, most of what you’re talking about is maximizing the share price or optimizing your bonus for that year, or you’re spouting corporate platitudes like “no margin, no mission,” without even a moment’s reflection on whether the mission that you are defending is the right mission.
I see it all the time. You see it with clinical staff; you see with non-clinical staff; you see it with leaders. It’s when our priorities have meaningfully shifted, almost imperceptibly shifted, to ourselves.
Another way to think about it is, “What would myself 20 years ago say to my current self, and what am I really thinking about today versus what I was thinking about 20 years ago?
How do you identify and root out toxicity?
You’ve got to be really careful about it. And I think you know you have to look for both micro and macro behaviors that lend to toxicity.
A lot of organizations have an implicit acceptance of toxicity, particularly implicit acceptance from people in important positions, or people who are seen as being particularly valuable from a customer perspective or a revenue perspective. But one of the things we don’t ever acknowledge is the deleterious effect that toxic people have on everyone around them.
Toxic people will do things like take credit for work that’s not their own. They will normalize having one face in front of one group of people and a completely different face in front of another group of people. Too often we accept that kind of behavior.
Everyone else sees that behavior, and everyone else thinks that you’re okay with that behavior because you’re not doing anything about it. Lots of people who work in health care, lots of leaders in health care, are actually massively conflict-averse. They don’t want to take on these hard situations, and so they fester for years and years.
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