Good to Great author inspires reflection

Do you have the right people on the bus’?

Although he did not make a physical appearance at the 18th Management and Leadership Conference of the Alexandria, VA-based National Hospice and Palliative Care Organization (NHPCO), held Sept. 7-9 in Phoenix, management expert and author Jim Collins nonetheless exerted a powerful presence. Having consulted previously with NHPCO and with a number of leading hospice executives, Collins seems to have been adopted as the unofficial management guru for America’s hospices.

Collins’ 2001 management guide, Good to Great: Why Some Companies Make the Leap and Others Don’t, has become a publishing sensation, directly inspiring several presentations at the Phoenix conference and helping to shape NHPCO’s strategic planning process. Collins also addressed attendees through a videotaped conversation with NHPCO president J. Donald Schumacher, recorded at Collins’ management laboratory in Boulder, CO.

Good to Great builds on research for Collins’ previous management bestseller, Built to Last, and summarizes common traits of 11 elite companies that made substantial, dramatic, sustained improvements in financial performance. The book emphasizes a few key themes from these elite companies, including the role of the "level five" leader in guiding the transition. According to Collins, level five leaders are personally selfless but have an indomitable will to achieve the organization’s goals.

Each Good to Great company also established a culture of discipline built around its "hedgehog concept," which is a single, simple, unifying organizational mission that can be found in the overlap between the company’s passion, what it can do better than anyone else, and what drives its "economic engine." Great companies were willing to confront the "brutal facts" of their environment and to make sure that they had the right people in the right seats.

Not another management fad

Given the varied management trends, fads, gurus, and organizing principles that have swept through America’s business community in recent decades, it is striking how thoroughly Collins’ concepts have come to dominate the conversations of leading hospice executives. David English, CEO of the Hospices of the National Capital Region in Falls Church, VA, offered personal testimony regarding the appeal of Collins’ ideas in a presentation on how his agency applied the principles in Good to Great to its operations.

"The passion I have for Jim Collins and the concepts in Good to Great are so important to me that they have become a significant part of my life," English said. Based on a careful reading of the book while on vacation in 2001, he came to realize that three of the six members of his agency’s executive team were not the right fit for where the hospice needed to go in pursuit of its hedgehog concept. But before he could act on that realization, English needed to go to his board of directors and ask them if they thought he was the right person to be driving the bus and if they were all in the right seats.

"The Good to Great concept allows you to ask that question," English related. "One of the most significant things I learned from the book is that as an organization evolves, a person may be the right person today but not the right person a year or two from now. We had developed leaders with vision, passion, and enthusiasm. Unfortunately, that doesn’t mean they were the right people on the bus."

In early 2002, the Hospices of the National Capital Region adopted a strategy of creating an internal Good to Great culture. Its hedgehog concept, found at the confluence of the "three circles" — what the agency is passionate about, what it can do better than anyone else, and what drives its economic engine — is now used by the hospice in making key strategic decisions. "Anything that doesn’t fit our hedgehog concept, we will not do," English said.

This approach also required empowering staff, encouraging vigorous debate, planning for leadership succession, and improving metrics—what the hospice measures to help shape its strategic decisions. The concept can also be applied within individual departments as well as across the organization as a whole.

"We have actually changed the culture of our executive team, although implementing it across the organization has been a longer process," he said. The reshuffled executive team put together a position paper outlining the agency’s reorganization with Good to Great concepts and is developing a "Three Circles Institute." "We’re going to retrain every person in our organization around our culture, values, mission, and what the three circles mean. We also told our staff we expect them all to have the same passion for the work they do," English said.

Confronting the brutal facts

In his videotaped presentation for the NHPCO conference, Collins summarized the challenge facing the hospice industry as the need to clarify the distinction between its why or core mission and how that mission is carried out, which is subject to modification as needed. The industry also needs to define "an economic engine that leaves hospice in control of its own economic destiny."

Collins urged attendees to fearlessly confront the "brutal facts" of their present circumstances. One of those brutal facts is the Medicare hospice benefit, which Collins says has been more of a burden than an advantage to the growth of hospice. "It has allowed you to be intellectually undisciplined about your economic engine," he explained. "I would challenge hospice to figure out how to make its economics work such that you can take or leave" Medicare’s reimbursement for any given patient.

Based on a personal hospice experience in his own family, Collins said the core mission of hospice care is "to add humanity, meaning, and graciousness to the experience of dying." Hospice’s why, he added, is "to make the process of dying a fully human, engaged process that, in and of itself, has its own redeeming value for all concerned."