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Leading in Healthcare with Passion
and Compassion
Interview with Jan McNally,
President, Covenant HomeCare
By Mary Eggers and Stas' Kazmierski
Working spiritually smarter means
creating an organization that operates as one-brain
(all knowing the same truths) and one-heart (all connected
around common, articulated yearnings and commitments
to next steps action.)
-- Mary Eggers
. . . . .
Jan McNally is the President of Covenant
HomeCare, a relatively large regional homecare company
located in the southeast that includes a home infusion
division, a Hospice program and a staffing services
company. HomeCare is one of many affiliates of a regional,
not-for-profit healthcare system. Prior to the sweeping
changes of the Federal Balanced Budget Act of 1997,
they provided approximately 250,000 home health visits
annually. HomeCare has seen dramatic declines in patient
admissions and visits and as a result no longer provides
home medical equipment and some specialized homecare
services. Jan McNally's abiding belief in the wisdom
and power of the voices of the people in the organization
stood out from our first contact with her.
LEADING
IN HEALTHCARE WITH PASSION AND COMPASSION
At the heart of Jan's leadership philosophy
is this tenet: "You have to expect always that
people are doing their best…if you expect it you
get it." This was also at the heart of author Douglas
MacGregor's well known Theory X and Theory Y - the belief
that people are good and want to do good. The other
cornerstone of Jan's philosophy is respect. As Jan said,
"I have learned you have to start with respect,
true respect, valuing that people have important things
to say…You can't fake this, you have to be sincere."
These two beliefs form a leadership framework to create
an organization that operates as one-brain (all knowing
the same truths) and one-heart (all connected around
common, articulated yearnings and commitments to next
steps actions). Connecting the minds and hearts of all
of the members of an organization is the only way to
work with openness and certainty. For Jan and HomeCare,
this meant involving 450 managers and employees in the
decisions that affect their future. These decisions
ranged from what the company strategy should be to how
to redesign the core processes that are used to run
the business. Peter Drucker talked about bringing out
the best in human beings and organizations this way;
"Leadership is about creating an alignment of strengths
and making people's weaknesses irrelevant."
Jan shared this story of bringing out the best in someone.
"Someone in our senior leadership team had been
struggling with her role and, in the last year, it had
become clear that she wasn't working to potential. After
giving her feedback, I realized I needed her to act
like a senior leader. I decided to split one of my upcoming
activities and have her lead a series of what we called
'road shows'; large-group meetings to get feedback from
everyone in the organization on the proposed new designs
of our core processes. I'd partner with her on the first
few 'road shows' and then let her take the remainder
solo. I realized in the process that I'd been one of
her barriers to being a successful leader because I
would step in and help too often. At the conclusion
of the road shows I suggested that she do two things
before we spoke again; first, get feedback from two
other people who were part of the presentation team
on how she had done. And then reflect on these questions:
- Think back to a day that really went well and what
contributed to that day.
- Think about a day that didn't go well and was frustrating
and what contributed to that day.
When we talked next, we explored ways she could capitalize
on the characteristics of the positive day. And she
came with a suggestion, a new job that she really wanted
to do. It was also a critical job that we needed to
have done. I gave her the opportunity to try this new
job and she's done more than I or she expected. She
is now meeting a tremendous company need, with 15 folks
reporting to her that love her and the work. She was
not feeling good about herself in the old position.
Now she is contributing at an exceptional level because
she's created a positive image of herself."
Leaders have to know when to step in and when to hold
back. Jan helped the person succeed through her realization
that she had become a barrier to success for this person
by stepping in too often. It also helped Jan leverage
her time and energy by not having to "do it all,"
a trap that all too many leaders fall into. As Jan describes,
one of the challenges leaders face is "finding
ways to feel challenged without destroying your health,
or feeling guilty about the choices you're making."
Jan is counter-cultural in her approach to leading
HomeCare. She doesn't work 12-hour days and she doesn't
take the technical work home with her. The only work
she takes home is reading which she considers her own
development. She reflects on a time when she was "low
on the totem pole." Leaders that sought her out
at that time shared information with her, asked for
her opinion, and gave her special assignments. The beauty
of these relationships was that they were "informal
-they were just conversations where I really felt trusted
and had an opportunity to learn." These were "turning
points" in her leadership journey as she began
to "think outside of the vision of what I thought
I could do," much like the story of how she guides
younger leaders.
Jan has created an environment at HomeCare where everyone
truly has a voice. She believes, "If you have the
right environment and situation you really can have
rich conversations between the 'big boss' and the rest
of the folks." During their first large-group meeting,
members of the organization heard unique perspectives
from various stakeholder groups: patients and their
families, senior leaders at Covenant Health Systems,
and the leadership team of HomeCare, including Jan.
Each stakeholder group was invited to respond to several
questions that were developed by a cross functional/multi
level team and given to them ahead of time. After each
group presented, the whole room of 400 had the opportunity
to probe deeper to understand the speakers' view. Building
a common database is critical to creating "one
brain and one heart." When we all know what we
all know, then as a whole we can make wise decisions
about the future of the organization. As Jan noted,
"[This process of] two-way conversation about what
we're doing and learning, and what we can do differently
has been tremendously effective. It's been incredible
what I've learned from feedback to me."
Building and maintaining authentic, appreciative working
relationships calls for "respect, mutual trust
and total honesty." Jan has learned over and over
again though her career, "You can't get the work
done without these. People have to believe you will
tell it like it is even if it's unpleasant." What
we know about adults is that when they are treated like
adults - given all the data in a respectful way, they
can and will make wise decisions regarding the organization,
in addition to making wise decisions about balancing
their work and personal life.
It became apparent to Jan that she would need to lay
off several managers. The question was how to do this
in a caring, honest, and supportive way. In all of her
communication and interaction with staff, Jan was always
conscious of sharing her truth and the uncertainties
of the future. She'd been telling everyone that this
was a possibility from the very beginning of the change
process. She also supported inviting those who were
to be laid-off to help redesign the organization. Yes,
that meant giving them a "pink slip" at the
same time you ask for their help in reshaping the organization
they were leaving. Of the 20 or so folks that were laid
off, all but two said yes to helping in the redesign
process. The message in this is that the lay off is
a business decision and not a personal reflection on
their contribution to the organization. We believe that
the "yes" was based on Jan's having been totally
open and honest with everything. She had treated people
with respect, given them a meaningful voice in the major
decisions facing the organization, and built a significant
amount of mutual trust.
Dynamic and compelling images of the future come from
two places - the power of the collective and the voice
of the unusual or different. Jan shared a story of a
manager at a hospital she had worked at prior to taking
the president's position at HomeCare. "In the past
we've had the crutch of 'we're healthcare, we save lives'.
We've got to seek out those that intuitively dance to
the beat of a different drum. We had this manager that
was extremely bright and had a million ideas. She made
us all crazy - she wouldn't follow the dress code, she
wore Birkenstocks and long dangly earring to work, and
she brought something to the organization that we needed.
We need to look to the young people, those that are
different from us. Maybe we won't ever get comfortable
with them; at the same time, we need to value their
ideas." Jan has never thought she "needed
to have all the answers". In fact, she believes,
"Leaders and leadership teams must resist the temptation
to believe that we think we know the issues. We don't
and we must challenge ourselves to sit together and
discuss the undiscussables."
Jan would like to see the whole healthcare profession
learn about hope and inspiration from the protocols
being used to care for the terminally ill. The most
powerful piece of the protocol, she believes, is the
power of hope - meaning and hope even for patients with
only a few hours to live. She recently heard a physician
share a story of a patient saying, "I want to live
through this weekend when my son comes home" -
and the energy of that hope actually carrying them though
the weekend. Jan sees powerful possibilities in this.
How, over time, do you maintain the energy needed to
sustain the individual and the organization? It's not
enough to just have hope. Over time, without meaning
and power, hope can turn into cynicism. Meaning comes
from having a sense of an ennobling purpose for the
organization and for the work of the individuals. Hope
is connected with our deepest yearnings, and power derives
from participating in the decisions that affect the
individual. Author Margaret Wheatley has said, "So
I've been working with the idea that a leader is one
who has more faith in people then they do in each other,
or in themselves. The leader is one who courageously
holds out opportunities for people to come back together,
to be engaged in the meaningful work of the organization,
whatever it is. The leader is one who relies on people's
creativity and their desire to do something meaningful."
That's Jan!
. . . . .
JAN
MCNALLY | Jan McNally is President
of Covenant HomeCare and Senior Vice-President of Covenant
Health in Knoxville, Tennessee. Jan has 20 years of
experience in healthcare and is a Certified Healthcare
Executive. She is a graduate of the Fellows Program
in Management for Nurse Executives and was the 1994
Outstanding Alumnus, University of Tennessee College
of Nursing. Jan lives in Oak Ridge, Tennessee and can
be reached at JmcNally2@CovHlth.com.
MARRY EGGERS
| Mary Eggers has been in the field of Organization
Development since 1985 and practices the Whole-Scale™
change process in the areas of healthcare, education,
government, information technology, not-for-profits,
and manufacturing. She lives in the Washington, D.C.
area and can be reached at eggersm@ix.netcom.com.
STAS'
KAZMIERSKI | Stas' Kazmierski's background
is in Education and Organization Development. He joined
Dannemiller Tyson Associates in 1992 and has consulted
in healthcare, manufacturing, extraction industries,
finance, food service, education, and numerous not-for-profit
organizations. Stas' lives in Ypsilanti, Michigan and
can be reached at staskaz@aol.com.
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