Adam D. Singer, M.D., says the doctors whom he oversees are living Shakespearean plays.
“There’s happiness and new birth, and then there’s tragedy and death and everything in between going on in these hospitals,” says Singer, the founder, chairman and CEO of IPC The Hospitalist Co. Inc. “They’re comrades-in-arms because they’re dealing with so much human emotion every day they’re at work. So it’s very important that they find the right people that are going to live that tragedy with them.”
Singer puts a lot of effort into hiring employees who will mesh with the rest of their team, but it’s not just for the sake of a cultural fit. Because he manages more than 1,000 affiliated health care providers in more than 150 private practice groups, he can’t be constantly looking over their shoulders. So his employees need to be able to fend for themselves and each other.
“I want people that are out there self-starting, self-motivated, self-correcting,” says Singer, who also serves as IPC’s chief medical officer. “That’s how life becomes a lot easier for us in management.”
Instead of telling employees what to do or how to do it, Singer is more intent on providing the tools they need to make those decisions themselves.
That empowerment means he has to be prepared for mistakes, but Singer says you’re better off allowing those flops.
“You have to be prepared to allow those mistakes to happen in order to move forward,” he says. “You learn a lot more from your mistakes than you do from your successes. The more [mistakes] that you have, the more people are trying to stretch the environment with new ideas, the better I think your company is.”
Singer manages a mobile dispersed work force across more than 500 facilities in 21 states by giving employees the power to manage themselves and their teammates. Their self-improvement also drives the company’s success, taking it from 2007 revenue of $190 million to $251 million in 2008.
“We try to empower our employees to have a lot of autonomy in the way that they function and deliver results to their clients,” Singer says. “We don’t have a situation where you just come here and we tell you what to do. … You really just have to lead the horses to the water. They figure out how to drink it themselves.”Finding a fit
The first step to empowering employees is finding ones who can handle the power.
For Singer, finding the right employees goes beyond interviewing candidates over dinner to learn about their interests outside of work. In fact, you don’t want them to stay too relaxed because you want to see how they’ll handle the stress of the job when you’re not sitting across the table.
“One of the challenges is that people act differently in an interview than they do when under stress, and in our world, they’re under stress a lot,” Singer says. “And so, in some ways, it’s very difficult to interview someone if you don’t put them under stress during the interview. How they’re going to respond in an interview may be very different to what happens to them when they’re in the heat of battle of saving someone’s life.”
To see how they might react under stress, you can ask candidates about stressful situations they’ve handled in the past. But a candidate can say anything, and it might not be indicative of his or her actual behavior. Singer takes it a step further by simulating stress in the interview.
“In the middle of the basic questions Where are you from? What kind of schooling did you have? I’ll all of a sudden launch a question like, ‘By the way, why did they make manhole covers round?’” he says. “And then you watch how they respond to that. Do they creatively come up with some goofy answers? Do they just say, ‘Look, I don’t know,’ and fail to respond?”
The point is that you won’t always be around to hold employees’ hands. You want to see how they handle the unexpected whether they think through the problem calmly or freak out.
“All of a sudden they’re thrown a question that they never anticipated getting, so they’re under a little stress,” Singer says. “So finding some kind of question that’s totally out of the blue that throws someone a little bit of a curveball will allow you to see how do they think, how do they process, how do they problem solve. The point of the exercise isn’t to get to the right answer. It’s to watch them struggle.”
You also want to see how candidates acted independently in the past. If they’ve taken risks by making autonomous decisions, they’ve likely made mistakes. So Singer asks them about their failures and more importantly what they learned.
“I ask a lot more about people’s failures than their successes,” he says. “It’s really interesting because in an interview, the interviewee never wants to talk about their failures. They’re trying to pump themselves up and talk nice of themselves, of all the things they’ve done. I’m almost not interested in that.”
So you’re making progress with a candidate if he or she answers the question at all. Singer spent two years interviewing 65 candidates for the position of chief operating officer before he hired one the only one who was willing to discuss his failures.
“I could spend an entire interview dissecting why someone failed at something and, at the end, think they’re the best candidate for me because they won’t make those mistakes again,” he says.Empower with policies
A few years ago, IPC employees complained about the increasing complexity of their incentive plan in both surveys and exit interviews. So Singer simplified it in 2006 by aligning incentives with the company’s success. But the catch is that the incentive is tied to each practice group’s performance as a team.
The plan also came with the power for teams to make their own changes in order to earn their incentive. Singer learned that even details like the structure of your incentive plan can foster an environment of empowerment.
“What it does is it forces the high-productivity individuals of the team to work with the lower-producing members of the team to improve their productivity so the overall team does better,” Singer says.
At IPC, 40 percent of each employee’s income is incentivized. But individual incentives ride on the team’s success.
“Either the group hits its target and then they get their bonuses, which are individually based,” Singer says. “Or the group doesn’t hit its target and nobody gets a bonus.”
You make your job easier by giving employees the power to control how they achieve goals. When the plan dictates that each employee’s success depends on their team’s success, everyone is motivated to pull each other up to par so you won’t have to.
“If there is someone in that team that’s not pulling their weight, it comes out of the bonus of the higher producers,” Singer says. “The higher producers get penalized for a lower-producing person on their team. So it has the team working together to get eve rybody profitable, as opposed to the company coming down on an individual.”
The structure of your plan can inherently empower teams to help each other, but you have to give them permission. Singer’s groups which typically consist of four to six doctors can divvy up workloads and rearrange work shifts to give lower performers the right amount of work in order to reach their goal. They’ve even asked underperformers to lower their base salaries so they don’t create a loss.
“The beauty is that the compensation plan itself (empowers people),” Singer says. “If I’m losing money because you’re not producing, I’m motivated to make changes to identify what the problem is and fix it.”Encourage idea-sharing
Maybe underperformers are reluctant to lower their salaries or take on more shifts for the team. Or maybe top performers are frustrated because a low-performing teammate is keeping them from their incentives.
It’s one thing if you order those changes, but when employees are empowered to control their own and, to a degree, each other’s success, they might not be certain about the best way to achieve it. Empowerment is not just giving employees the opportunity to set their own path but also the tools to navigate in the right direction.
It might be easier for you to just tell them, but that doesn’t necessarily produce the best results.
“In some ways, I want them to be frustrated because that frustration leads to better performance. It leads to changes in what they’re doing, to figuring out how to excel, and how to be more productive and more effective,” Singer says. “I think it’s OK to allow some frustration to enter into your company. It can be very revealing and motivating.”
The best way to nudge employees in the right direction is to show them their progress. Singer calculates how much incentive each team member earns by looking at individual productivity through a lens of metrics including encounters per day, week and month, revenue per encounter, length of stay, readmission rates and client satisfaction. In other words, monitor both quantity and quality of performance.
The key is that those metrics should always be visible to employees. You can’t hover over them to provide step-by-step directions on meeting their goals, so you need to give them tools to make those adjustments themselves. Singer publishes dashboards monthly for each employee, which are benchmarked against the practice, the region and the overall company.
“They can see how they stack up,” he says. “If you’re an outlier on any of these measures, you start figuring out strategies to not be an outlier.”
Singer recommends paying bonuses monthly, too, rather than annually, so employees see a more immediate reward to their productivity.
That transparency will foster self-correction. But it’s also important to have a forum for open communication so employees can share ideas and struggles especially when team members may spar over the best corrections to make.
Thanks to technology, you have several options that can allow employees across the country to serve as each other’s immediate sounding boards. Singer uses Yammer, an “intranet of Twitter” that lets employees post questions for the entire company to ponder and respond to.
“If I’m having trouble with my team leader or my practice partner, I have the ability to say, ‘You know what, let’s find out what the other thousand doctors would do,’” he says. “Either I’m right or I’m wrong, but I’m going to hear about it from lots of people. It allows a massive jury to be put into place to help resolve my conflict.”
Singer also uses videoconferencing systems to allow entire practices to share their struggles and ideas.
“If you’re having some unique issue and not able to get consensus, we [find] a practice that’s either further along or equally struggling on a topic, and we videoconference them together. We have them brainstorm their issues,” Singer says. “As much as possible, you want your employees empowered to figure this stuff out themselves. What you don’t want is to come in and tell them what to do. That’s the least effective way to enhance your business.”
Besides allowing that open communication, Singer also provides plenty of data about other employees’ results. If you provide people with the financial performance and experiences of others who have faced the same issue before, they tend to make similar decisions without you dictating what to do.
And if they disregard that data to make a decision out on a limb, they’ll learn from it.
“A large part of that empowerment is let them take some risks; let them try something that maybe you wouldn’t agree with,” Singer says. “What that does is really engenders a better trust between you and your employee one, that it’s OK to take risks, but also maybe next time, they want to listen a little bit more to our experience.”
How to reach: IPC The Hospitalist Co. Inc., (888) 447-2362 or www.hospitalist.com