April 2009 Archives
R&D Spending Holds Steady in Slump, appearing in the April 6 Wall Street Journal, chronicles the benefits of continued corporate investment in research and development during down economic cycles. In this page one article, authors Justin Scheck and Paul Glader observe that: "Big R&D spenders say they've learned from past downturns that they must invest through tough times if they hope to compete when the economy improves." This may hold a lesson for health care leaders.
Mssrs. Scheck and Glader report on the difference between companies that maintained R&D spending in poor economic times and harvested substantial returns from new products and technologies (Apple's investement between 1999 and 2002 resulted in the launch of its iPOD) and those that cut back in those periods and subsequently lost market share or competitive edge (General Electric and Motorola in the same period). I suspect these lessons, and others from the corporate experience that are cited by the authors, likely apply to health care products and devices as well. We just don't usually think of health care providers and payors as major investors in R&D. Think again. We do invest, albeit differently. Our investments in new medical technology, infrastructure, personnel, and training may not be research but they certainly qualify as product development and innovation in the programs and services that are the core of our businesses.
So the lesson for health care leaders is that when under pressure to cut "unnecessary cost," continued improvement of quality, safety, IT, and customer service - investments crucial to our reputation and therefore our revenue base - should be last rather than first on the cutting block. Perhaps it even makes sense to increase these investments in pursuit of competitive advantage at a time when others are reticent to invest.
Left untended and stagnant in a shifting and highly competitive environment, health care delivery organizations are at risk of losing advantage. And as an industry that must regularly adopt new scientific and technologic innovations, we must continually reinvent our ability, our systems, and our people to receive and effectively implement the fruits of innovation efforts in other health related industries. Which qualifies us as investors in R&D in my book.
How Toxic Colleagues Corrode Performance is a short sidebar article with a big impact by Christine Porath and Christine Pearson in the April 2009 Harvard Business Review. The authors also wrote the upcoming book: The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do About It. The article is a 3 minute read, at most. But it provides data that drives home a haunting point for health care leaders - and more specifically physician leaders. Namely that the misbehavior of physicians, executives, and managers extracts a far greater toll on organizations than the pain felt when complaints are made.
Porath and Pearson have made a study of incivility in the workplace for years. The results of their poll of several thousand organizations revealed that common "benign" misbehaviors such as rumor mongering, berating management, unfairly taking credit for the work of others, blaming others for one's shortcomings, etc. take a severe toll on co-workers. The article states the following results:
- 48% decreased their work effort,
- 47% decreased their time at work,
- 38% decreased their work quality,
- 66% said their performance declined,
- 80% lost work time worrying about the incident,
- 63% lost time avoiding the offender, and
- 78% said their commitment to the organization declined
As we all know, health care workplace settings are far from immune from these. We see incivility by physicians, nurses, and clerical employees in office, hospital, and corporate settings. The bar for intervention into benign misbehavior is high. It is largely seen as the result of "personality quirks" that are grey areas for managerial intervention since they fall outside of the ethical and professional guidelines set up to deter and correct "malignant" misbehaviors such as dishonesty, sexual harassment, overt intimidation, falsification of data or documentation, discrimination, etc.
But these results suggest that "mere" incivility is far from a benign condition. Given the increasing pressures we are under to maintain an efficient and productive workplace, it is critically important for health care leaders to be aware of the measurable collateral damage that can result from these behaviors.
Then comes the challenging task of developing awareness, behavioral guidelines and both peer and managerial intervention strategies that result in a culture of civility. And doing this in a fashion that avoids two undesirable situations: (1) the creation of a juvenile code of behavioral rules; and (2) failure to clearly set limits on destructive "benign" behaviors.