Larry Scanlan

When I was raising my kids, I would try to teach them that the best word they would ever learn in any language is the word "no."

They did not embrace that concept as toddlers or especially as teenagers. However, I now hear them teaching the same concept to their children. (The nerve of them picking on my grandchildren.)

In today's culture, there is a negative connotation to saying "no." You see it frequently in politics when one party accuses the other of being a party of "no," as if something is morally wrong with such a stance. Then the other party accuses its opponent of the same. Today, federal and state budgets are extremely challenged to come even close to being balanced. Yet when we put our citizenship hat on, although most people appear to be concerned about our country's national debt, proposed solutions are often met with a loud "no" when such remedies appear to affect our personal lives.

Clearly, discernment is needed on what issues call for "yea" versus "nay." What managers of hospitals, physician practices, nursing homes, or consulting firms have not been caught up on the wave of a trend or some position that appears to be a "no brainer"? Sometimes we take a position on an issue that appears to have its own virtue or logic and that may also be a popular position to endorse. We become vulnerable to not weighing sufficiently opposing views, or perhaps equally important, failing to come to grips with the potential unintended consequences of our own "yes" position. History is replete with individuals and organizations that took an opposing position and later evidence showed it to be a rational, if not a better, position.

The Challenge of Saying No

How does this conflict relate to us professionally?

A hospital CEO and management team feel pressure to improve volume and profitability. The CEO signs an agreement with a specialty physician group that will help meet strategic and financial objectives. Later, a whistleblower spawns an investigation that alleges unnecessary medical procedures, ineffective peer review, and questionable referral patterns. The result: Several members of the management team are dismissed, and the hospital finds itself at the top of the news for months. Fiscal pressure made it hard to say no to what seemed like a slam dunk to increase utilization and profitability.

A CEO may pressure his CFO to be "cooperative" in presenting more favorable assumptions and estimates in the monthly financial statements. The CEO believes the CFO is being too conservative and holds the power as CFO to present a "better picture" to the board. The CFO said "no," and it cost him his job!

What would you have done if you were in either of these positions? Who would you rather work for, the CEO or CFO? Who do you think will be the more successful executive in the long run?

Financial executives and other leaders must be discerning on when to say "no." Not every challenge, issue, or question requires consideration of a "no," but leaders and aspiring leaders cannot be afraid to say "no" in carrying out their fiduciary responsibility to protect the assets, mission, and well-being of their organization. As leaders, we also carry a community obligation if we believe in the relevance of our organization's mission.

Tony Dungy, the former Super Bowl football coach and now pregame broadcaster, has a child who does not possess feeling in any of his nerves-a disease called congenital insensitivity to pain with anhidrosis. This young boy can put his hand on a hot stove or even jump out a window, and he would not feel the pain, despite the inherent danger. Dungy has to teach his son the value of "no" for his own safety.

Sometimes executives need to say "no" for the overall protection of their own healthcare enterprise.

What Finance Leaders Should Do

Whether you are in hospitals, health systems, nursing homes, or consulting firms, our industry needs leaders who:

  • When facing profound strategic, operational, and financial challenges, say "no" to temporary solutions that are invariably incremental (easier, less career-threatening, politically acceptable) interventions when clearly such actions do little to solve underlying, long-term systemic issues
  • Say "no" to choosing high-price IT venders because government stimulus money is available, without regard to value, ROI, or the need for practical, effective, and affordable technology solutions instead of buying what their organizations really need
  • Say "no" to sugar coating difficult issues in speaking with board members, physicians, and employees because they understand that the knowledge, cooperation, and contribution of these people will be needed to help resolve such issues
  • Say "no" to the CFOs and other managers who consistently put unreasonable demands and deadlines on their staffs, because they understand that overworking and demoralizing staff does not serve the short- or long-term well-being of an organization or department
  • Say "no" to unreasonable forecasts or projections of financial statements to meet budgets or other targets when actual performance discloses a variance that calls for an action plan, not "accounting artistry"
  • Say "no" to "falling in line" with highly publicized, popular industry trends without critical due diligence on the organizational and community impact because they know that such trends all too often turn out to be fads that evaporate over time
  • Say "no" to projects and initiatives that compromise management time and talent and distract from meeting the organization's critical success factors, because they always take time to review priorities (e.g., weekly) to make sure they are congruent with their organization's overall priorities and objectives

Saying "no" to peers, bosses, physicians, trustees, shareholders, employees, and others may be difficult and perhaps not even politically correct at times. Successful leaders understand the priorities and critical success factors that protect the well-being of the organization. Furthermore, when their own values correlate with those of the organization, their ability to say "no" reflects discernment and sound
judgment. These leaders are not steered off course by the latest challenges, organizational and industry storm clouds, or political threats. Such leaders provide stability and wisdom to their organization.

When is the last time you said "no" in situations like those described above and took a stand that had you swimming against the wave of opinion or expediency?

Larry Scanlan, FHFMA, CPA, is president, Insight Health Partners LLC, St. Petersburg, Fla., president of his own executive coaching practice, and a member of HFMA's Florida Chapter (lscanlan@insighthp.com).


Publication Date: Friday, July 01, 2011

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