The 18-Month Rule

I have found that whenever you start something new, it takes approximately eighteen months to effectuate change and realize the positive impact of the hard work you will put in.  In healthcare and ambulatory surgery centers, the staff can be very tough on leadership.  It takes grit and thick skin, but it gets better….even though at times it won’t seem that way.  You will feel unappreciated and undervalued, but that’s usually because most surgeons have no clue about running a business and everything that goes into the day-to-day operations.  It’s not personal.  Tell yourself that every day!  I’ll go into more detail, but here is the basic outline of the 18 month rule (which is something I made up, but has proven to be true with each transition I have made).  

The first three months should be spent building credibility and assessing the workplace; taking a careful look at people, process, technology and culture.   Once you have your finger on the pulse of what is working and what is not, you will spend the next three months putting a plan together and starting the slow process of moving the needle.  SLOW being the key word!  It is never a good idea to come in guns blazing.  Once you have a plan, you will spend about six to nine months making your plan come to fruition and continuing to build respect and credibility.  Be careful not to use up all of your good will with the surgeons/owners; you’ll need it later.  By the end of months 12 to 15, you will be in the home stretch.  The next three months will be spent continuing to implement your plan and seeing the results of your efforts in action.  There’s still plenty of work to do, but hopefully by this point you will have plenty of support and a stronger team.

The first 90 days of transition

One of my mentors, Rob, used to give out two books to each newly hired leader in the organization.  One of them is titled “The First 90 Days”.   This book has important information related to success strategies during a transition.  The first 90 days on the job are critical to building credibility and outlining the path for success.  It is the most important period of time as it will define how you are perceived and set you on your path to success.

Unfortunately, too many leaders do not take the time to assess the current culture and systems prior to forcing their own ideas and process on the staff.  In my experience, more often than not, there will be issues with culture.  That said, you should not go into it assuming you will need to make big changes.  You should also be leery of drawing conclusions prematurely.  Learn what IS working in addition to what is not.  I’m a fixer.  Solving problems is in my DNA.  That can be a problem in and of itself.  Not everything needs to be fixed.  Stick with the old adage “if it ain’t broke, don’t fix it”.   Learn, learn learn during your first 90 days.  Soak it all in.  There will be plenty of time to work on necessary improvements and to put your brand on the place.

When I started my current position, I made an outline of everything I needed to learn about the organization.  It served as my guide to ensure I was staying on task and not leaving anything out.  I made sure I included plenty of communication during that time so that the owners knew what I was working on and could start to see that I am bringing value.  I don’t mean a detailed list of everything I was doing on a daily basis.  It was more of a general summary of the areas of focus and opportunities as I identified them.  Trust me, surgeons do not want to hear about the day-to-day.  The credibility I keep referring to has to be built among surgeons as well as staff.  Respect and credibility are earned, not mandated.  Even though the owners demonstrate a certain amount of faith in you by offering you the position, you still have to work hard to prove your value and earn their respect.  Making them profitable will always make them happy, but there is far more to it than money.

The second 90 days

When you enter the second 90 days, you should have a solid sense of the organization.  This means the people, culture, mission, processes, and technology (in use or needed).  You’ll use this time to formulate a plan and prioritize.  Make sure you aren’t doing this in a bubble.  Engage your leadership team and solicit input and opinions.  Don’t go down too many rabbit holes.  The rabbit hole will get ya every time.  Determine the two or three things that need the most attention and then focus.   Whatever you do, try not to lose focus!

I always recommend making it a top priority to ensure the right people are in the right seats.  If the people filling the roles are either in the wrong role or in the wrong place altogether, you will never be able to make progress.  Tough decisions will have to be made at this juncture.  You cannot avoid it.  If you don’t know your conflict resolution style, I highly recommend you take an online test to find out.  The Thomas-Kilmann Conflict Mode Instrument (TKI) is a very effective tool to identify your style.  You are going to be faced with a lot of difficult and challenging situations and many uncomfortable conversations will need to occur.  Understanding your style will help you approach these situations with confidence.

The next 6-9 months

Now you’re entering the second half of your first year.  It’s feeling a little better, or it should be.  It’s getting a little easier (maybe very little, but a little nonetheless).   Your feet are firmly planted and you’re making progress.   Your stress level is still high, but that comes with the territory.  It’s time to make things happen.  You’ve figured out who the toxic people are, you’ve gotten to know staff and surgeon personalities, and you’ve learned the politics of the workplace….EVERY workplace has politics.  This is the point an athlete would think of as “game time”.  You spent the first six months getting game-ready and now you’re on the field and going to give it all you got.  Leave nothing on the field during this time.  

Confidence is key.  Some decisions won’t be your best, but be willing to own that and learn from it.  Don’t be afraid to admit your mistakes.  Humility is an important quality in leadership.  Acknowledge what you don’t know and seize the opportunity to learn it.  Back to having the right people in the right roles; you will need this to be successful.  Your leadership team needs to be a TEAM.  They need to be unified and working together with you.  If you have managers/leaders who are new to leadership, give them the support they need to learn and grow.  If you have seasoned leaders, don’t shy away from learning from them.  Empower your leadership team.  Communicate well and often.  

Be ready for some push-back.  It is inevitable.  Change is something most people struggle with, some more than others.  Be empathetic about this fact.  Recognize it and try to figure out how to help others embrace the change that is coming.  Transparency will be important as you are figuring this out.  I have found it is a little bit easier when people know the “why” behind what they are being asked to do.  One thing that is absolutely critical is that the leadership team must support your efforts.  Before even attempting to get staff or surgeons on-board, make sure your leadership team is on-board.

To refer to an old commercial slogan for anti-perspirant (I’m aging myself now) “never let ’em see you sweat”.   There are times when you will want to scream, or maybe even cry……DON’T DO IT!  There was one Administrator I know who actually went on the balcony of the building and screamed at the top of her lungs.  The walls were glass, so I’m not quite sure why she thought this was a good idea.  I think she was only employed for about one more week after that.  Not only did she lose the respect of the staff, she lost the respect of her peers and her bosses.  Save that kind of therapy for home.  You cannot lose control, or the appearance of being in control.  There have been plenty of times where images go through my head that I am ashamed to even admit, but I don’t let that crazy come out.  I keep my crazy on lock-down because, believe me when I say, all of us will likely have moments of crazy that will want to manifest and you have to avoid that at all cost.  (Please note, that’s not intended to be a commentary on mental health, I take that very seriously).

Reaching the end of the first 18 months

So at this point, you were most likely starting to wonder if you would ever get the benefit of the doubt when staff are incessantly complaining to the surgeons.  You were probably questioning when, or if, it will be smooth sailing.  You should be seeing that there is a deeper level of trust and understanding starting to surface.  The difficult and toxic people should be fewer.  The needle should have moved, even if only a few degrees.  

That said, the “real” work is just beginning.  Up to now, the work has been meaningful, but the purpose was to clear the path so that the focus could shift from fixing individual problems to a more continuous improvement approach.  The impact will start to be greater as will the rewards!  I am reaching the 18 month point in my position in two months.  My theory has proven true in this role and I am truly seeing a difference.  The surgeons are more engaged.  The culture has started to shift, although there are still a few toxic employees.  The leadership team has grown and we are working together.  The thing I am most excited about is having more support from the surgeons/owners.  They are finally redirecting staff and seeing that they only get a partial picture or story when they are here.  I have a lot more to do as we prepare for our AAAHC survey, but I see the light at the end of the tunnel and feel good about where we are going from here.

I want to hear from you!

If you’ve been in your position for more than 18 months, think back and comment.  If you haven’t been, reflect on where you are.  Does my rule hold true in your experience?  If it does not, please share what is different.  I’d like to learn from you as well.

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