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Manny Linares turned around North Shore Medical Center by building momentum Featured

8:00pm EDT September 25, 2010

North Shore Medical Center was in a tough position when Manny Linares took charge. The hospital was falling behind in its effort to maintain equipment and technology, and patients were beginning to take notice.

The lack of capital improvement was particularly evident at the hospital’s cancer center, says Linares, the hospital’s CEO. It was once the place where North Shore sent many of its cancer patients for treatment. But that wasn’t the case anymore.

“It was a radiation therapy center that had equipment that was really antiquated,” Linares says. “It had really lost its name and presence in the community. The medical staff had stopped referring any patients to the center.”

It certainly wasn’t the only area that needed an upgrade at North Shore, which is owned by Tenet Healthcare Corp.

It may not even have been the most urgent need in the eyes of some people. But fewer patients ultimately means fewer dollars, and Linares needed to turn that trend around. He decided the cancer center was a good place to start in making a statement to those who had grown concerned about North Shore’s future.

“The morale of the staff was lacking,” Linares says. “Motivating and inspiring the staff to understand their role as a community hospital and in the community we’re serving was important.”

It would also provide a financial boost by getting patients moving through the center’s doors once again to use its state-of-the-art technology and equipment. But Linares had to convince his people that the restorations wouldn’t end there and that he was serious about doing what it took to get North Shore back on strong footing.

“It’s really talking that vision, expressing that vision and ultimately executing on that vision that is very important,” Linares says. “You start to gain consensus and momentum, and once you deliver that, people start to believe in you and work harder.”

The project did, indeed, deliver results, as visits to the cancer center increased 282 percent from the time of project completion in 2005 to 2009. Digital mammography was added in 2007, followed by a new digital imaging system and a new stroke center in 2008.

The success helped restore the faith of both the community and the staff and helped lay the groundwork for a merger with Florida Medical Center, which brought the organization’s total work force to more than 1,800 people.

Here are some of the steps Linares took to identify the changes that would help North Shore turn things around.

Get people talking

You need to find a way to tap into the hearts and minds of your employees when plotting a major change. They are the ones working in the trenches every day who understand how things get done in your business.

You can get the ball rolling by just being direct about what it is that you’re looking to do and what you want from them.

“This is what’s going on,” Linares says. “These are the areas that we need to improve on. This is the goal. Effective communication really goes a long way. Letting them know, ‘Hey, I need your help. I need your input.’”

But what if that’s not enough to get employees to open up to you? What if they can’t overcome the fear that you’ll hate their idea?

In that case, Linares suggests trying this approach.

“What’s been effective for me is basically telling them, ‘Look, we don’t have an open checkbook,” Linares says. “But if we had an open checkbook and if you could ask for anything, let’s list it.’ It’s being very up front. ‘Is this a must have? Is this really a necessity?’ You talk it out with the staff.”

By erasing that financial obstacle, at least for a moment, you can open the door to ideas that might otherwise never be mentioned.

“It’s a hypothetical situation,” Linares says. “But at least it will let us write everything down on a piece of paper. Then we can together say, ‘Look, we can’t do all 10 of these things because we can’t afford it. It’s not realistic. But guess what? We can do three of these things. So let’s agree on the three that are the most important for the success of this department or the success of this service area.’”

This approach helped Linares learn about a potential opportunity to help people suffering from diabetes. Fortunately for diabetics, this was a problem he could solve.

“We had an employee here that was diagnosed with onset diabetes,” Linares says. “We had talked to a lot of our medical staff and they said they were seeing more and more instances, particularly of onset diabetes. That kind of triggered our thought process to look at the demographics of our community. We said, ‘Perhaps we need to create a diabetes outpatient center for these new onset diabetic cases.’”

North Shore opened its diabetes treatment center in 2009, and it has proven to be quite successful, with a first-year 86 percent growth rate.

The key to getting this kind of useful feedback is for you to be open and let your employees dictate the tone of the conversation. If they seem to want to talk about something other than your primary topic, don’t be afraid to let it go off topic for a bit.

You can always bring it back to what you want to address, but don’t rush the conversation. Do what you can to help people feel comfortable and you can learn a lot from them.

“It’s talking to employees on a more personal basis, opening up a dialogue that’s more informal” Linares says. “Then, at that point, start to ask questions: ‘What’s going on in your area? What are the challenges that you had? What are some things we can do to make your job better?’

“I will make myself available to speak to an employee. That has provided very good feedback almost instantaneously about things that are going on in the hospital and things we can do to improve in the hospital.”

Start building a plan

Linares takes a lot of notes when he’s putting together a plan. When you’re plotting a major change and talking to a variety of people, you need to find a way to keep it all straight in your head.

“You are constantly communicating and constantly writing down thoughts and ideas,” Linares says. “Then you come back to your office and you have all these thoughts and different ideas.”

So what do you do at that point? You get those thoughts and ideas together into a rough plan and get ready to move into the next phase of how you and your team are going to make the plan a reality.

“Put it all together,” Linares says. “Then you go back with more of a defined path. ‘This is what we can do. This is how we can make this a reality, and this is why I think we’re making the right decision.’ You’re almost providing feedback that says, ‘What you told me is important, and I’ve created something around it.’”

While putting together your rough draft, be sure to involve your team in the process and walk them through your ideas to help shape the final draft of what you want to do.

“Everybody has to have that shared vision that this is the product that we’re going to provide, and we all need to be part of this team in making sure that this product is successful,” Linares says.

At this point in the process, you need to be laying out concrete ideas to show that you are moving toward real action and how that action will lead to achievement of the goal.

“You basically lay out that road map,” Linares says. “‘The first thing we’re going to do is upgrade all of the equipment. This is the equipment we’re getting,’ and you detail the equipment. ‘This is what the equipment can do. These are the bells and whistles that we can bring on today.’

“You provide timelines. It’s very important that you consistently communicate throughout that process and ensure that they know what the timeline is for that final product and when that final product is going to be available.”

You’re showing leadership and initiative to get a project done. You’re also respecting the knowledge base of your people in the field to offer their thoughts on how to make your ideas even better.

“In this hospital in particular, there is a lot of tenure on the medical staff,” Linares says. “So I certainly tapped into that. At the end of the day, they are also part of the execution to make sure we’re successful. They are a group of constituents that are very important for a solution to the problem. For me, that was certainly key.

“At the same time, there was a lot of tenured staff that had seen things that worked in the past and that had failed in the past. Tapping into that experience base and that knowledge base was very helpful to me to navigate which direction we wanted to go.”

You should enable these department heads to serve as the point people for their own direct reports during a project. When your department heads clearly know what’s going on with the plan, that lends a lot more credibility to your cause.

“The director of that service line or that area is probably the day-to-day communicator with the staff and fields most of the questions on a day-to-day basis,” Linares says. “We certainly keep all the staff up to date. Communicating and making sure that everybody understands everything that has gone on is critical. … You just have to be religious in making sure that you block those times and you go there and you talk to them.”

Build momentum

Success in the first phase of a project can create valuable momentum to help you get the rest of the project completed.

“The momentum and energy it brings spreads rapidly through the organization,” Linares says. “People get geared up. The feeling is a positive feeling when you create a vision and everybody has input in this vision.”

Make sure you explain why a particular aspect of the project was chosen for the first phase if there are other components that will have to wait in line.

“It’s a phasing plan,” Linares says. “We have to be, first, successful here, and once we’re successful here, we go to this. If we’re successful in those service lines, the hospital will become financially viable and financially stable, and at that point, we can look at other processes and other departments and upgrade other areas.”

Make all employees feel like part of the plan, even if their respective department is not part of the initial phase.

“It’s part of the inspiration and motivation you provide to the staff,” Linares says. “It’s letting them know, ‘The hospital can’t function without you.’ Making sure you communicate that effectively and consistently and making sure they understand that the piece of the puzzle that they play in completing the puzzle is key to success.”

Be aware of your reputation in your company and whether it’s one of a leader who gets things done or just talks about it. If you fit the latter, you may have your work cut out for you in convincing others that you’ll have time for their part of the project.

“I’ve delivered in my promises and there’s a high level of respect [for that],” Linares says. “Really fortifying and solidifying relationships and making clear what the expectations are that I have of you and you have of me and then delivering on those has been a winning formula.”

How to reach: North Shore Medical Center, (305) 835-6000 or www.northshoremedical.com