Larry Scanlan

Walking through the business office of a hospital where I was serving as interim CFO some time ago, I overheard an unusual comment.

As the hospital controller and I made our way through the narrow corridors to a meeting, I heard an accounts payable (A/P) clerk say, "Why is this department head always asking for check requests?" She did not look at me as I walked by; in fact, she was looking at her desk. I did not know her, but her tone and words caused me to think she had wanted me to overhear her comment.

I asked the controller to meet with the A/P clerk to explore with her why she had made the comment. I joined that meeting and learned that the A/P clerk's comment was indeed intended for me, but she had spoken casually because she did not want to risk directly approaching an interim CFO she did not know. Her comment related to a well-respected department head who she thought was initiating too many check requests.

A thorough document search disclosed that the department head had been directing checks to her personal mail box-for more than eight years. I confronted the department head, who admitted to the crime. Being alert to a seemingly casual comment and acting on it allowed the hospital to stop an embarrassing internal control miscue.

Lest readers think I have perfected the skill of listening, be assured that far too often such is not the case. During the first half of my career, I worked in hospital management, primarily as a CFO or CEO. On one occasion, I was dragging my feet about renewing a hospital-based physician group contract. The contract renewal date was approaching, but was not an immediate issue to me. I was annoyed that before my arrival, the group was permitted to open a competing outpatient center even though the hospital was paying for an exclusive contract. The hospital's commercial patients frequently took their business to the physician-owned center. This competing center was possible in part because the group's leader sat on the hospital board, which helped him favorably position his group's business for the board's consideration. In addition, one of the group's physicians was extremely rude.

For some time, the physician group kept reminding me about the upcoming renewal of its contract. The physicians were eager to get it behind them, but I still procrastinated. They finally gave me a strong tongue-lashing-and they were right to do so. I was not listening. The contract was important to them-and to the hospital. I was wrong to allow my own bias to interfere with a timely, proactive approach in contract renegotiation for an important clinical service-a valuable lesson indeed on listening, to which I should have been attuned much earlier.

Why Listening Matters

Improving listening skills is not a project or a journey. It is both.

One needs to be conscious and deliberate about listening, and make it a priority-not easy to do in a world where multitasking carries a badge of honor. As other professionals with whom we work, or even our family members, likely could attest, listening is hard work.

During the second half of my career, working as a consultant, I learned early on the value of listening. In addition to reviewing numbers and processes, consultants interview people. The feedback I received after my first few engagements indicated that people felt I was listening, so I decided to pay particular attention to this aspect of consulting. After 20 years of consulting, engaging with people is my favorite part of the process. I have found that people want someone to listen carefully to their point of view and to take their viewpoint seriously.

Early in my career in hospital management when I was an assistant controller, a surgeon who mentored me taught me that although analyzing numbers is necessary, it is in many ways more important to get out of the office and observe and listen so you can learn how these numbers actually come to be. That is the most important advice I ever received.

Consultants sometimes enter hospital or physician practice engagements in which they are told that few people will want to be interviewed. Because other consultants have worked there previously, the CEO or CFO believes that management and staff are fatigued from such (futile) exercises. In reality, the opposite often happens. As word gets around, those not on the interview list ask to be interviewed, so a project in which perhaps 30 people are scheduled to be interviewed could end up with more than 100. Why? Because people discern when someone cares, and word gets out that the consultants seem to really be listening. In fact, consultants almost always ask to interview the most negative manager and physician because we need to hear other points of view. Listening does not equal agreement, but it indicates a fundamental consideration of a person's view and acknowledgment of the value of that person's professional experience and opinion.

Improving Listening Skills

Healthcare finance executives can take practical steps to enhance their listening skills in many areas of activity, including decision making, networking, and attending education seminars.

Decision making. When deliberating key strategic, operational, and financial decisions, obtain the insight and opinion of others who will or could be affected, or who have to manage through key decisions. Listen carefully to their point of view, even if it is an opinion you would rather not hear. This point hit home for me when I witnessed the impact of a management team's announcement that it was making a major change in the strategic direction of two hospitals. The news shocked the medical staff, and significant numbers voted with their feet by taking their business to another hospital. The health system's cash diminished quickly, requiring a turnaround firm to put together the workout plan. Remember the proverb: "Plans fail for lack of counsel, but with many advisers, they succeed."

Networking. Speaking of advisers, build your network not only for professional contacts, but also include in your social connections a network of advisers. Be open to new ideas and different points of view, and weigh each suggestion carefully. Your decisions and your career will be better for it.

Attending seminars. HFMA chapter, regional, and national meetings are great venues for building your network and provide outstanding opportunities to listen to the experiences and challenges others are facing. Attend classes and seminars without checking your cell phone for messages. Listen attentively to the presentation, and engage in discussions as appropriate. We are so caught up in electronic messages that we don't give people our undivided attention anymore. A genuine commitment to improving your listening skills would be to stay for the entire session-no leaving early.

What CFOs Should Do

In addition to improving listening skills, CFOs need to appreciate the experience and challenges others face within their organizations.

Spend an hour or two each week-or one day a month-in another department. Understand what others in your organization do and how their work and processes might fit into the area where you work. Listen for opportunities to make your organization and the patient care experience even better.

Eat lunch at a different table or on a different campus. Find out what others are thinking about and talking about, and appreciate another point of view while expanding your own internal contact network.

If you are a manager, periodically spend time in an informal setting, and just listen to your associates and staff. Find out what is working and what is not. Don't be defensive. Mainly listen, and then follow up on items needing action and communicate to the group in a timely manner what has been done since the last meeting.

CFOs should hold a monthly lunch with a small number of staff-a half dozen or so people. Each month invite a different group of people. Allow most of the meeting to be their agenda, ask how things are doing, and then listen, listen, listen. Follow up as appropriate on items needing further action, and communicate back to the group as appropriate.

A Project and a Journey

Sound decision making requires three steps. First, obtain as many facts as reasonable for a given situation. This requires listening. Second, be open to new ideas. This also requires listening. Finally, make sure you hear all perspectives on an issue before drawing a conclusion. This is challenging work. After taking these steps, you will appreciate that improving listening skills is indeed a professional and personal project and a journey.

What ideas or plans do you have to improve this most essential skill-listening? I would love to hear what is working for you.

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


Publication Date: Monday, October 03, 2011

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