Vision plan Featured

8:00pm EDT April 25, 2009

Lisa Rubino loves a good joke.

Asked about spending 30 years in her profession, she’s quick to point out that makes her 35 — since she started working when she was 5.

OK, that’s probably not doing the joke justice. The point is Rubino has used humor throughout her career to help make everyone’s job a little easier.

But when she moved into the role of president of Molina Healthcare of California, a subsidiary of $3-plus billion Molina Healthcare Inc., in 2008, even she turned off the laughter for a minute. What she saw at the company was 370 employees moving in about 370 different directions. And though she’d had success in another leadership position at the managed care organization that delivers health care services to people eligible for government-sponsored programs, the California subsidiary had been through nearly a president per year from 2004 to 2007.

“That was hard because there was an absence of leadership, not only in the president and CEO but throughout middle management,” she says of her unit, which posted 2007 revenue of $379 million. “And when you have an absence of leadership, people will decide for themselves what’s right, and everybody was doing what they thought was right, it just wasn’t coordinated. So it was really shifting working hard to working smart and creating what I call a culture of accountability — aligning their work against a vision and delivering on it.”

Creating and laying out a vision is tough, but Rubino’s plan at Molina was straightforward. Before she dove in, she used her humor and social skills to build some credit, working with employees of all levels to get feedback and talk shop. When she had a handle on that, she created a rough outline for her vision and worked with senior leaders and managers to tweak it. Once she rolled it out, she used it as a road map through all the good and bad that Molina faced.

Create comfort in your leadership

Before Rubino could get too deep into setting out her vision, she had to deal with some of Molina’s ghosts. Previous visions had come and gone, and there are always concerns from employees when leadership sets out a new path. What Rubino has learned is that step No. 1 is to build confidence in your leadership. Whether you’re a new leader or just laying out a new path, help people understand you and your thinking so you’ll get feedback that will hone your vision and start earning buy-in.

“People come to leaders when they feel comfortable and they feel that folks are approachable,” she says. “The people closest to the work, they know stuff and they’ll tell you stuff, and they state the obvious sometimes.”

For Rubino, being approachable means she gets to use her well-honed sense of humor to help knock people’s guards down. But before you decide to start every meeting with your best “So-and-so walks into a bar line,” you need to realize being a funny boss is about tastefulness and putting the joke on yourself or the external pressures you’re facing.

“In my presentations, I have cartoons, and we call our budget crisis ‘As Sacramento Swirls’ starring Arnold Schwarzenegger,” she says. “You just weave that into the dialogue, into the conversation, you weave it into your presentations, and it just gets people to relax. … You have to not take yourself that seriously — and humor, I’ve found, in any circumstance, is a way to help people be comfortable.”

Further building up your approachability can come from giving people a comfortable setting. Rubino does “Lunches with Lisa” where anyone in the company can join her for lunch. The meetings are purposefully designed with no formal presentation or agenda, they just start with regular conversations and people are allowed to ask any question. Her ability to answer those honestly builds credibility. So does her follow-up. At one luncheon someone asked why Molina didn’t have a contract with a certain hospital. Rubino said it was probably too expensive.

“And she said, ‘Well, our patients go there anyhow,” Rubino says. “So I came back and ran a report, and we had spent millions of dollars at this hospital as a noncontracted provider, and guess what, we have a contract with them today.”

Rubino circled back and told the woman how the information helped. Don’t always expect that much help, but your open mind encourages participation and starts buy-in.

All this doesn’t mean you’re getting invited to Friday happy hour, of course.

“It’s probably safe to say they never see you not as the boss because you’re (always) the boss,” Rubino says. “… No matter what you do people aren’t going to be completely comfortable, but I just put myself in position to have people come to me. I’ve been here less than two years and I’ve already seen the culture shift. All it took was talking with people, setting a vision, steering a course, being visible, being honest and admitting that I don’t know everything.”

And even if you don’t have any good jokes, putting effort toward having people come to you will be helpful. Rubino watched one former boss who couldn’t find a way to let his guard down become a lonely general.

“Colin Powell said (that) you know as a leader in the military that you are in trouble when people stop asking you questions, stop coming to you with information, and I saw that so vividly with this guy because no one wanted to talk to him,” she says. “People wanted to get out of the room as fast as they could, and when you create that, you’re in trouble. So I’ve done everything in my power in my career to not have that.”

Build leadership-level buy-in

Once you’ve built some credibility with employees, it’s time to change your focus to collaborating on a vision. Rubino started with her thoughts and then involved her leaders in stages.

“I crafted what I thought were the key priorities for the organization and ran that by the (senior leadership team),” Rubino says. “So I said, ‘It’s ’08; by the end of ’09, we’ll have created this culture of accountability, which means we are using data-based decision-making, we have engaged employees, and by doing this — and I’m paraphrasing — we’re going to have repeatable, sustainable performance and that means top-line growth and bottom-line growth.’”

Rubino let her senior leadership team massage her original thoughts and then let that version take alterations at the director level. The core things Rubino wanted — accountability, data-based decision-making and the like — had to remain intact, but she wanted thoughts on everything from time frames to the necessary personnel.

Once everyone had a look, Rubino blew up a big copy of it and sat down with all those involved. She hung the document on the wall of the meeting room.

“It’s sort of like the Declaration of Independence,” she said. “We put it up on a big board, and I said, ‘We started with some thoughts from me, you’ve all had input, if this is what we believe, throughout this meeting I want you to sign this. … And if you can’t sign today, I don’t want to strong arm you, but you have to come tell me why you can’t sign and if we have to do something different before you can sign.’”

There were 30 people in that meeting and more than 70 percent signed it that day.

Rubino was surprised by the two objections those leftover still had. First were minor alterations they simply hadn’t mentioned previously. Solving that was easy.

“I’d say ‘This is our Declaration of Independence, so we’ll add it,” Rubino says.

The second had nothing to do with the vision.

“The people that came to see me were the people who had been in the company the longest,” she says. “They would say, ‘We’ve seen people come and go, you’re probably going to go, too, and this agenda is not going to matter.’ And I said, ‘I hate to tell you, but I’m not going anywhere. I’ve only had four jobs in 30 years; I intend to stay.’ It was more older folks, skeptical, they didn’t think that the corporate entity would support us. … There was not a lot of course correction to the statement of vision but just hearing them out.”

A few final dissenters still didn’t sign after those private meetings, so Rubino put the declaration on the outside of her door and had her assistant keep a casual eye on it. Days later, all the names were inked. Rubino says her takeaway lesson was sometimes people put up an objection just to be heard individually. The solution is patience and a format for them to be heard.

“Eventually, we got everybody to sign,” she says. “You’ve got to put a framework in place and people have to feel that they’re giving input to that.”

Revise as needed

Before Rubino could sit back and enjoy successfully rolling out her vision she hit the same bump you did in 2008: The economy fell apart. Suddenly realistic expectations were meeting a new reality that included a $42 billion state budget shortfall. Rubino handled it with her usual humor — it was a great storyline for ‘As Sacramento Swirls’ — and also used the strength of the agreed-upon vision.

“As a leader, you’ve got to be able to create clarity out of chaos because there are so many things that could cause people to get out of focus,” she says.

Instead of turning her back on the vision, Rubino began to use it as the original road map that now had detours in it. She explained those detours with instructions on how to get through them instead of having her people worry about the whole path.

“We get in front of people and just tell them the brutal reality, there is a $42 billion shortfall in the budget, it is a $50 million problem for Medi-Cal in this state, and for us in California, it was a $3 million problem,” she says. “Break it down from the macro to the micro, to how it impacts us and what it means to have a $3 million problem. We said, ‘Here are the things we’re doing about it.’ So it was just taking the outside, bringing it in, and then focusing on what answers we have for a $3 or $4 million problem.”

The fact that there was an active vision gave everything that Rubino did a backbone. When she laid out a slight course correction, she was able to lean on the original vision to show how the adaptation put the team back on the path.

“Before, we didn’t have a plan, now we have a plan, and once you have a plan, you can go back,” she says. “I look at it as a recipe. I’m not a cook, so I’m going to mess this up, but if I’m going to make a cake and it’s for six people and instead it’s going to be for 24, I’m just going to add more ingredients. So it’s just what ingredients do you add, what ingredients do you take away.”

The end result is that Rubino’s people are using her vision to grow the company. While many companies were crying for help, Molina grew to $417 million for 2008, an improvement of more than 10 percent from 2007. And while that was celebrated, Rubino is even more interested in how the vision continues to unite people.

“We grew in a flat market, so that’s exciting,” she says. “But what I’m most excited about is the cultural shift — really seeing people focused on the business, understanding the details of the business, starting to use data more easily to solve business problems or coming up with business solutions, hearing people say, ‘It feels different; I’m glad you’re here. It’s not the same company.’”

How to reach: Molina Healthcare of California, (800) 526-8196 or