Second opinions Featured

8:00pm EDT September 25, 2008

Seven years ago, Peter F. Bastone and his management team atMission Hospital were putting the finishing touches on plans fora $150 million, state-of-the-art critical care tower.

“We thought we had really touched all the bases,” Bastone, thehospital’s president and CEO, says. However, at the boardretreat at which Bastone and his crew presented their final recommendations, several physicians expressed their reservationswith the plan.

Their concern was that with the steady growth of the community that Mission Hospital served, expanding the hospital’sovertaxed emergency room should be its No. 1 priority. Afterall, what good is a brand-new critical care tower if patients arebeing diverted to other hospitals because Mission’s emergencyroom doesn’t have room for them?

The physicians had been involved in the planning process,but they were so focused on their own specialties that they didn’t see the big picture. The discussion at the board retreatsaved the organization from making a huge mistake.

“This thing almost had a bow on it,” Bastone says. “We wereready to send it up to the health system for their approval. We hadto go back to our architects and our master plan and our budgeting process after that board retreat. We had to pull it apart, and wehad to delay our tower until we expanded our ER.”

Soon after the board retreat, Bastone had to chair a ball duringwhich he fielded several questions about the organization’splanned expansion.

“I was embarrassed,” he says. “I’ve already spent millions of dollars on this project, but it won’t make any difference if people can’tget into the hospital.”

Bastone’s discomfort was only temporary, because although itcost a significant amount of money, disaster was averted, and theright decision was made.

Now, Bastone emphasizes communication among every area of the2,000-employee hospital, which posted net revenue of $334.5 million in 2007. Effective communication between departments canmake or break any organization. Here’s how to make sure it doesn’t break yours.

Be willing to say you were wrong

One way Bastone encourages communication is by being a proponent of executive and management vulnerability.

“There have been a couple of times when I’ve had to stand infront of my managers and say, ‘Bad decision; we shouldn’t havegone in that direction,’” he says.

“All of the decisions and all the things we do in terms of leadingthe organization may not be the right thing. It may be the wrongpolicy, wrong investment or wrong focus. But if we make a mistake and we’re not making the impact we need to have or if it’scontrary to where we want to go as an organization, I’ve taughteveryone here that it’s important to stand in the middle of theroom, in front of everyone, and say, ‘I goofed.’”

Once you accept responsibility for a mistake, Bastone says takea step backward. Look at other recommendations that weremade at the time of the decision, and re-evaluate them. Mostimportantly, ask for help. Your way of doing things didn’t work,but maybe someone else in the organization has an idea thatcould fix what went wrong.

By promoting the idea of executive vulnerability, Bastone has lifted the illusion of management infallibility. When your staff understands that the boss isn’t always right — and that it’s OK that theboss isn’t always right — the barrier between management andstaff breaks down. The staff members know it’s OK to disagreewith their managers, because their managers might be wrong.Bastone says his emphasis on management vulnerability hasstrengthened the interdepartmental bonds at Mission Hospital andintegrated the management and staff into one entity.

Let employees know they are important

If there is one lesson to be learned from Bastone’s success withMission Hospital, it is to never undervalue the importance of youremployees’ opinions.

In fact, Bastone makes it clear that each employee has a responsibility to share his or her input. To make sure the importance ofthat message sinks in, he treats each employee as a key asset.

It starts the first day of employee orientation. Bastone personally speaks at each orientation, and during his presentation, hedetails the commitment each new employee must demonstrate tothe organization’s improvement.

Then, after the new employees have gone through their three-month probationary period, Bastone checks back with them. Bytouching base with them again after they’ve settled in, Bastoneestablishes that treating employees as assets isn’t just a line froma welcome speech.

During the second meeting, he asks the new employees if thethings he told them three months ago match up with what theyhave been seeing on the floor as they work.

From that point, Bastone shares the organization’s vision in quarterly department meetings. Those meetings are his top source ofdirect, from-the-source employee input, which he uses to supplement his view of the big picture.

“The input I get from them may be detailed specifically to theirarea of focus, which is great, because I’m flying at 30,000 feet,” hesays. “Sometimes, people on the ground have to tell me what’sactually going on. I’m giving them the broader picture, but I wantthem engaged in terms of, ‘Here’s the broader picture, but how canyou as a department help us get to where we need to go?’”

Sorting through all the input is a daunting task. Depending onwhat the input is regarding, Bastone farms it out to the people whoare affected by it. If it is regarding technology, the information willgo to the organization’s technology committees. If the input has todo with a specific service line, those recommendations go backnot only to the particular department’s strategy meeting butstraight to the involved physicians, as well.

Bastone has a few keys to getting the most beneficial inputout of your departmental meetings. The No. 1 way to get useful feedback is to establish a process through which your employees see how their ideas are moving through the organization.

“Once you engage them, and once you ask a question and theygive you input, you have to assess that input and get back to thepeople,” he says. “You say, ‘Great idea. We’re going to pursue this.We’re going to go through this process in terms of the organizational structure of how we process ideas.’”

Even if you don’t see an idea immediately being stitched into thefabric of the organization, you still need to show the employeewho originated the idea that their thoughts were carefully considered.

“If that’s the case, we get back to them and say, ‘Great idea, butwe don’t have the infrastructure,’ or, ‘This is a systemic issue, butwe may be able to do it in the future,’” Bastone says. “It’s a matterof cataloging, being an active listener to the people who are inthose meetings, assessing the value of the recommendation andgetting back to the group or individual who made the recommendation with a yea or nay.”

It’s also the CEO’s responsibility to explain the reasoningbehind his or her decision. That goes a long way toward buildingemployee satisfaction, because it shows the employees that theiropinions matter.

Whether you reject their idea outright or simply place it onthe organization’s back burner for the time being, your reasoning doesn’t matt er nearly as much as the fact that you took thetime to consider their idea. Bastone says that if you show thatyou value their thoughts, not only will you improve the quantity and quality of the feedback you receive, but you’ll reap therewards of having happier, loyal employees.

“When you go through that kind of a process, people say, ‘Hey,you know what, they’re listening to me. Even though they’re notdoing what I want them to do, or they didn’t take my recommendation, at least they went through a process that placed value onmy recommendation.’ That, in itself, develops a high degree of loyalty and engagement with that employee, which is very important.”

Finally, you have to seal the deal. Make sure you follow throughwith your feedback evaluation process. If you don’t follow through,the barrier goes back up and your employees will lose all sense ofthe importance of their role in the organization.

“If you ask a question and if you engage people to be part of theprocess — they have to be part of the process,” Bastone says. “Itcan’t be lip service. It can’t just be someone taking minutes at ameeting. You can’t just send the minutes back to the employeesand say, ‘OK, we’ve talked about it,’ and they don’t hear from youfor two years. Then all of a sudden they see the walls coming downand new technology coming in that they didn’t even have inputinto. It may not be reflective of what their recommendations were.So you have to be not only an active listener but an active participant.”

Listen up

The hardest challenge Bastone faces in communicating with hisstaff is being an active listener. As an executive fueled by ideas, itcan be difficult for him to stay quiet while another staff member ispresenting his or her own ideas.

“I’m always pitching,” he says. “I love to be a mover, shaker andinnovator. Sometimes when someone gets on track and wants toshare something with me, it’s like they’re giving me the OK to lift offbecause I’ll take the ball and run with it even though the person isstill talking to me.”

Active listening is Bastone’s self-admitted weakness, and he hasdeveloped some ways to become a better listener.

First, be respectful. Don’t just nod your head, biding your timeuntil you can talk again.

Second, don’t assume you know everything. Pay attention to whatthe person is saying and allow the person to completely finish statinghis or her thoughts. It may be tempting to cut him or her off, buthijacking the discussion is a sign of disrespect. Besides coming off asoverbearing and arrogant, you also risk missing his or her pointentirely.

“Sometimes, you just have to be quiet and listen,” he says. “Eventhough you may have an idea of what the answer is, you’d be really surprised at how resilient people are in providing you with a different perspective.”

Patience is a hard skill to master, especially for executives whohave been lauded throughout their careers for their innovativeideas. But Bastone says it is a skill all great executives need tolearn.

“When I was a young administrator, there was no way that wasone of my attributes,” he says. “After more than 20 years in thisbusiness, I’ve learned there are times when you have to listen. Youmay have to listen to things you don’t agree with or you don’t liketo hear.

“You may not like it, but it does make you a better executive —especially when you acknowledge the difference and when youfind yourself going in a different direction than you normallywould go. That’s how you realize the importance of being an activelistener.”

HOW TO REACH: Mission Hospital, (949) 364-1400 or