Tuesday, May 23, 2017

an ending to the Open Ped experiment

So the semester is finally over - what an adventure it was trying to implement Open Ped, to be an unteacher. I feel like it's not quite right to say I taught the course. I'm coining this concept of unteaching right now, in the spirit of an unconference (according to Wikipedia, an uncofnerence is "a participant-driven meeting").

Nothing is perfect, and no plan is ever executed exactly as conceived. There were some parts that definitely need work, and some parts where I might need to have a heavier hand than I did this year. But overall, what a great experience.

Here is a link to the class's final project, The Primer:

https://docs.google.com/document/d/1htA3wCSMs4Q0aruXykFhKEoNsb7IWDizC49jvH6YFNM/edit?usp=sharing

I was so impressed with the overall quality of this document, particularly the effort they made to standardize across the whole document - not an easy feat.

I am really looking forward to sharing it with next year's class and seeing it grow and mature.

For those of you who followed the progress of my class this past semester, I think The Primer is all the proof I need of how well my students performed. Is it perfect? Is it ready for publication by a major publisher? That's not really a fair standard. Keep in mind the authors of this document had never had an organizational behavior class before this one. And yet this is what they were able to do. I'm very proud of what they did.


Monday, April 17, 2017

Student Presentation: Organizational Ethics

Regan and Caroline are presenting on organizational ethics for our organizational behavior course. Here's the pre-work they assigned for the class today:
Hope everyone is having a great day with friends and family! Please watch this quick video and think about these questions for our presentation tomorrow: 
https://www.youtube.com/watch?v=izXuboAZzCM

what does ethics mean to you? what is one scenario in your life where ethics have come into play ?what ethical problems do you see being a challenge in the workplace? what are some ethical challenges in a healthcare setting? 
My thoughts:

what does ethics mean to you?

For me, ethics is a system of guiding principles that provide boundaries for acceptable behavior. Organizations often have formal ethics rules that provide guidance for employee behavior, and those rules are often enforced by formal and informal sanctions. But an ethical system transcends formal rules, and each of us has inside ourselves an internal set of ethical standards, though those internal ethical standards are sometimes not well defined and sometimes not consistent.

A common sentiment about ethics is "it's the things you do when no one will know". That is an appeal to the internal ethical system. If you know you won't get caught, and yet you still obey certain beliefs about boundaries of behavior, you have found your internal ethical center.

The military spends a great deal of time talking with service members about ethics precisely because service members are often put into stressful situations where it is highly likely no one will know what they did.

I wrestled with finding an internally consistent set of ethics until I was introduced to the work of Adam Smith, an 18th century moral philosopher and the founder of modern economics. Smith divided individual ethics into two categories: commutative justice and distributive justice. Commutative justice can be summarized in terms of absolute rights: the right to life, liberty, and property. These rights were best articulated by John Locke in his 1689 Second Treatise of Civil Government. Smith sometimes refers to these rights as "perfect rights", but more modern moral philosophers refer to them negative rights. They are negative rights in the sense that you have the right to stop someone from taking any of these things from you. You have the right to respond with violence if someone attempts to violate your perfect rights. If someone tries to hurt you, you have the right to repel them with violence; if someone tries to take your things, you have the right to repel them with physical violence. I have the right to protect my person and my property from you, and I have the right to go about my business unless I am violating one of your perfect rights. A key characteristic of commutative justice is it is independent of your position in society or your relationships with other people. These are fundamental human rights that extend to all people. There is nothing praiseworthy about obeying the principles of commutative justice; it is negative in the sense that you can satisfy its requirements by doing nothing.

Distributive justice is characterized by relationships and individual obligations, and in this sense, it is positive where commutative justice is negative. It is "the becoming use of what is our own, and in the applying it to those purposes either of charity or generosity, to which it is most suitable, in our situation, that it should be applied." The principles of distributive justice deal with what we should do to be praise worthy individuals. Calling a friend and wishing them well when you know they are sick, or going to visit them when you know they are sad are examples of distributive justice. You take a resource of your own - in this case your time - and you share it with someone with whom you have a relationship. It is often a sacrifice of some sort on your part in order to make someone else better off. If you know your friend just went through a painful break up and you take the time to take them out for coffee, you are meeting the requirements of distributive justice, especially if you could have been doing something more fun than listening to their sorrows. This behavior is praiseworthy. However, if you don't take the time to visit with them, you are not meeting the requirements of distributive justice, and now your behavior is blameworthy. A key difference between commutative justice and distributive justice arises here: not visiting a sad friend is blameworthy and deserves to be looked down on, but never rises to the level of a violation of commutative justice, which justifies physical intervention and potentially physical punishment. Distributive justice is always relative. If you are sick or sad, but you are not my friend, I do not have an obligation to visit with you. Depending on the circumstances, it might be kind of me to do so, or it might be just weird. That is the key to understanding distributive justice - the circumstances and relationships matter. Under commutative justice, the circumstances and relationships don't matter - everything is pretty much black and white.

what is one scenario in your life where ethics have come into play ?
what ethical problems do you see being a challenge in the workplace?
 what are some ethical challenges in a healthcare setting? 


I'll lump these three questions together...

I find the commutative justice/distributive justice system internally consistent, and it helps me think through ethical problems. For instance, I happen to have a number of LBGT friends. But I also grew up in a time that was relatively conservative, and the rights of LBGT people were not as well respected as they are now. In the mid-2000's, gay marriage was being hotly debated, and starting to be legalized at the state level. My initial, gut reaction was not one of support. This was despite the fact that I cared about my friends and wanted them to be happy. I applied my ethical analysis based on the Smithian framework above and decided that marriage was a fundamental right of liberty - it was a commutative justice question. If two adults wanted to be married, my discomfort with the idea was not an appropriate justification for preventing that. I was not in a place to either stop or allow this policy, but having a clear framework helped me work through a thorny ethical question.

More specifically on a professional level, healthcare administrators deal with ethical issues all of the time. Decisions about what kind of care should be delivered and to whom is a problem we deal with. How do we deal with the uninsured, especially if we are a charitable organization?

Again, more specific to my experience is how we deal with coding. It is very easy to up-code patient records to generate higher levels of billing - and consequently higher levels of compensation for the organization and the individual providers. While there is a risk to this, it is possible to game the system in various ways. As a former CFO, I was always looking for ways to improve the compensation my organization received for the work it was already doing. This is an important function for a finance executive. The mechanisms for compensation shape the way organizations operate. This is not in itself unethical. The compensation systems are often designed explicitly to get organizations to change the way they do business - MACRA and MIPS are examples of policy changes that are intended to force healthcare organizations to reorganize. The ethical issue organizations face is as they reorganized to take advantage of changes in the marketplace is whether their behavior is consistent with the law (commutative justice) and the mission, vision, and values of the organization (distributive justice). If a non-profit, charitable organization begins to give priority treatment to commercially insured patients over those with either Medicaid or no insurance, that organization may not be breaking the law (violating commutative justice), but it may not be staying true to the spirit of its purpose for existing (violating distributive justice).


Wednesday, April 5, 2017

Student Presentation: Listening

For today's class, Shayna and Logan are talking about listening. Here's the pre-work assigned:


Hey guys this is the pre work for tomorrow's class on listening that Shayna and I created.
Read these two articles before class:
https://hbr.org/2016/07/what-great-listeners-actually-dohttps://hbr.org/2015/01/how-to-really-listen-to-your-employees
Also, think about these questions to discuss before class:
1.) Have you had any instances in the workplace when a problem occurred due to the lack of listening?
2.) In your opinion, how do you effectively communicate with someone who tends to struggle with listening?
3.)In your opinion, what factors affect the ability to listen the most?
My thoughts:

Good articles - I'm borrowing How to Really Listen for this week's RWL Newsletter because I liked the mini-cases at the end.

1) Have you had any instances in the workplace when a problem occurred due to the lack of listening?

Absolutely. I've been on both sides - I've been a bad listener and I've not been listened to.

When I was in the Army, I had a civilian employee who came to me to tell me she had received a job offer with another Army facility that included a promotion. I congratulated her and was genuinely excited for her. She was deeply offended and eventually told me I had hurt her feelings. Why? Because she didn't actually want to leave and her goal had been to get me to give her a bonus or salary increase in order to retain her. In the end, I didn't offer her anything and she left. But even if I had decided to offer her some incentive to stay (which would have been against DOD policies because we are not supposed to compete with other DOD offices, and the GS civilian system is closed to outsiders precisely to enable insiders to move up), I don't think she would have stayed. 

The thing that makes me sad about this situation was I genuinely liked her and after she left, she bore a grudge about the whole thing. 

Similar to the case in How to Really Listen with Got Junk? I was a hospital CFO and my bosses didn't listen to me when I tried to tell them that we shouldn't hire additional personnel. The result was we hired too many people and a year or so later we had to go into a hiring freeze and fire a bunch of contractors in order to make budget. I regret not having been more forceful because my failure to convince them resulted in a number of people losing their jobs.

Very often failures of listening are the result of our having a desire not to hear. 

2) In your opinion, how do you effectively communicate with someone who tends to struggle with listening?


I don't know that I have a great answer for this. I've had employees who were really hard-headed, I've had colleagues who only listened to themselves, and I've had bosses (see above) who didn't want to hear what I was saying. I find most senior managers learn to hear pretty well because it's a critical leadership skill, and people who can't learn to do it often get stuck. 

I recall an Army general I worked with who was very smart. The problem was whenever he had a meeting, he wanted to make sure everyone knew he was the smartest guy in the room. It was exhausting working with/around him. What I saw was in order for him to hear you, you had to demonstrate deference to his enormous ego, after which he would finally start to listen to what you had to say. So sometimes getting hard-headed people to listen involves figuring out how they want to hear your message. In this case, once you achieved sufficient obsequiousness, he would start to listen to you.

3) In your opinion, what factors affect the ability to listen the most?

I think it's a desire to have a certain world view maintained. Bad listeners very often want to maintain a certain world view, and they often want to force that world view on you. It's not physical interference, it's that they are so busy with an internal dialogue that they can't hear what you are saying, especially if it does not re-enforce their own world view (e.g., the general I mentioned above - he couldn't hear you until you helped re-enforce his world view that he was the smartest guy in the room).

Monday, March 27, 2017

Student Class #9 - provider/administrator conflict

For today's student led class, the students are going to be talking about the conflict between providers and administrators. This was the pre-work:


Hi guys for our pre work please watch this short video and read this article. Think about why conflicts occur between physicians and administrators and how these issues can be resolved.
https://youtu.be/QHfan71zHKk

http://vitalworklife.com/blog/2012/06/06/conflicts-among-physicians-and-staff-the-high-cost-of-not-getting-along/

**

My thoughts:

First, I LOVE this video. ZDogg does some funny stuff, but this is by far my favorite of his videos. Mostly because Doc Vader sounds like my father, a retired pathologist, and his attitude toward administrators.

This is a good article. It has a good, short case study.

I see the conflict between physicians, nurses, and administrators coming from a few different origins.

First, as an economist, I think about incentives. Physicians have historically had a loose relationship with hospitals. They were (and still are) courted by hospitals to practice there. But whether the hospital made money or not was not a particular concern to the physician, so long as the physician could maximize his/her own revenue. There was a strong incentive for the physician to bend the hospital to maximize the physician's utility (revenue, ease of practice, etc.). Physicians may have received pleasure from being domineering, or could potentially be at least indifferent to the hospital's employees.

In a similar vein, administrators have historically had a strong incentive to focus on the well-being of the hospital. There are some good articles on non-profit management that imply non-profit managers do not have strong incentives to work especially hard. At a minimum, the separate revenue streams - physician vs. hospital - has historically laid the ground work for conflict.

Second, as a student of management, I think about identity. Physicians and administrators have different identities. Physicians perceive themselves, rightly, as belonging to an elite group with particular professional/vocational ethics. Ideally these ethics are patient focused, meaning especially focused at the individual patient level. Administrators also have an identity, though it is a bit more flexible. They also have a professional set of ethics, but their focus is primarily at the system level, rather than the individual patient level. The difference in foci lays the ground for conflict. When a physician follows his/her professional identity and ethics to care about the individual patient, s/he may want the system to accommodate individual patient needs, without considering the cost to the system/organization. This also ties back to the issue of incentives, particularly because the physician sometimes conflates convenience for him/her with the well being of the patient. The opposite also can be true - and this is typically one of the most common complaints i hear from physicians: administrators only think of the inconvenience to them of flexing the system to accommodate the needs of the patient. Both physicians and administrators can fail to be patient centered, while both claim to be.

What can be done to fix this? The fix for incentives has been going on for a few decades, though accelerated recently. Physicians are merging into group practices, and group practices are merging with hospitals. The conflict between revenue generation is starting to be better aligned.

The fix for the second is harder, but I see some interesting adjustments happening. One adjustment is the inflation of educational credentials in the healthcare environment. Almost all providers are getting "doctorate" level training. We have doctors of pharmacy, physical therapy, and nursing. To quote the bad guy in The Incredibles, "When everyone is super, no one will be." But also the nature and culture of medicine is changing. There is a reason, greater than ego, for the increase in credentials among non-physician providers - non-physicians are taking on more and more technical roles that require greater levels of training. The physician cannot do everything like s/he once could as medicine becomes more complex. But it also does not make sense to have the physician do everything. The physician is becoming more embedded in a team, often as the captain of the team, but still as a member of the team. The lone ranger, solo practitioner cannot take full advantage of the resources available to him/her in the modern hospital setting. S/he has to assume a position on the team.

This culture is changing slowly. A lot of people gravitated toward careers as physicians in decades past because it offered a safe and stable, self-employment arrangement. The culture of physician training supported the lone provider. That training is changing, and the culture is evolving as the old guard retire.

Saturday, March 25, 2017

why I teach


People come to academia for a lot of reasons. For me, it's all about helping the students grow.

Yesterday I accompanied a bus full of students from my program down to Boston for an alumni networking event at Boston Children's Hospital. We also had alumni from several other organizations, including MassGen and MEEI. Our alumni are really great. They do so much for our students. It's really nice to see, and it is a big part of what makes our program so special. It's such a privilege to be part of an inter-generational process.



I have these students for a few semesters, and of course I do what I can to share with them as much of my knowledge and experience as I can when they are with me, but the classroom is just one touch point. Becoming a professional in our field requires much more than just completing some classwork. That's why I try to help give them opportunities to explore and experience things beyond the classroom. I can't claim Boston Day as my work - it's been going on for a number of years - but I help with it. And I help bring a lot of other opportunities.

Being a teacher for me is about providing opportunities. Whether a student grows or not is not really up to me. I can provide the opportunity, and I can provide the support, but the student has to choose to grow. I teach because I get to watch when they choose to reach for that opportunity. None of these students had to come on the trip. They chose to take that opportunity. Some of them were nervous about networking, but they came and they gave it a shot. Watching people try to do something they've never done before, and giving them a boost when they need it, is what makes teaching so rewarding, and getting to watch them grow and succeed is why I teach.

Wednesday, March 22, 2017

Student Class #8 - performance evaluation

Students continue their leadership of the Organizational Behavior class with today's entry being performance evaluation. Here's the pre-work:
Hey Guys!
Please read the article, watch the short clip, and answer the following questions below for tomorrow's class.
https://www.thebalance.com/employee-evaluation-1918117https://www.youtube.com/watch?v=KcGhX7Htk9U&t=67s1. What characteristics do you think would make a good performance evaluation?
2. What characteristics do you think would make a poor performance evaluation?
3. What type of categories do you think would be found on a performance evaluation?
4. If you have had any experience with performance evaluations, come prepared to discuss your experiences in class.
Thanks,
Caroline, Carly, & Regan
 **

My thoughts:

The video is a good introduction to MBO and fits well with the article.

My personal experience in the Army was that I always had to do a self-evaluation prior to receiving my supervisor's evaluation. It was questionable how much that self-evaluation actually played into the evaluation I received, particularly the feedback from my senior rater, but it was an exercise I think was worth doing regardless. It forced you to think about how you were going to contribute to the organization.

Calibrating evaluations is difficult for everyone. The article offers two extremes,
Some managers dislike giving negative feedback and will inflate their workers' ratings to avoid difficult conversations or to make his department look good up against his peers...
Other managers feel that unless you were awarded a Nobel prize, you're nothing more than an average performer. These managers rate their employees lower than they should. This can demoralize employees and lead them to seek out new employment.
My experience is that this challenge is enhanced by the culture of the organization, and how much senior leaders hold their subordinate managers accountable for giving accurate evaluations. In the Army organizations I worked in, 90% of the civilian staff received top block ratings (e.g., on a 1-5 scale with 5 being the best, 90% got 5's). That makes the system meaningless.

Officer evaluations were subject to forced ranking, where the senior rater had a limited number of top blocks to give to officers. Forced ranking is good for the organization, I think, if there are enough rated individuals in the senior rater's span of control. When a senior rater has a small number, good people can get less recognition than they deserve.

One of the most heart breaking evaluations I received was when I had been working very hard and knew I had had a lot of success, and the senior rater gave me a "center of mass" or average rating. Just to give a flavor, the senior rater said, "MAJ Bonica is in the top 7% of majors that I senior rate. His intellectual and leadership skills allowed him to effect several critical command-wide changes, which will have a positive impact for years to come..." And yet I received a middle-of-the-road rating.

I like the leader who gave me that rating, but I was in a pool where he didn't have the spare ratings to give, and he felt he had to save a top block for someone else, and I was going to be the bill payer. That's the kind of thing that happens in a forced ranking system.

In small organizations, formal performance evals are sometimes not done at all, or might only serve as HR CYA. In large organizations, like the military or Fortune 500 firms, performance evaluations can take on real power and can have lasting effects on someone's ability to be promoted. In the military this was very true. You needed to have a percentage of your evals be top blocks (the larger the percent, the better) or you would not be promoted and would not be given leadership opportunities. Forced ranking can lead to unhealthy competition among officers who know they are jockeying for the limited number of top blocks, especially when they know their careers depend on the top blocks.

I believe the forced ranking system has both positive and negative effects on officer culture. On the positive side, it puts real pressure on people to come up with initiatives that have significant impact. However, it has two powerful downsides: 1) It has the effect of officers pursuing short-term, flashy projects that appear to have significant impact - short run appearance being more important than actual effect; and 2) it has negative effects on team work - it makes officers think about how they can stand out as individuals, rather than support colleagues who are working on real projects.

In my interviews with senior executives, I've only run across a few who have willingly participated in 360 reviews. They have all said they were painful, but valuable to their development. I would have liked to see a 360 evaluation system implemented in the Army. While most senior leaders are decent people and good leaders, there is a large enough minority of really nasty individuals who make their way into senior ranks that left a wake of destruction in their path in order to look good to superiors that I think some input from subordinates would make a difference. Input from subordinates into these leaders' evaluations might have forced them to behave differently.

As a pre-tenure college professor, I get something close to a 360 evaluation. I get evaluated by my chair, and I get evaluated by my students. My colleagues have some input on my evaluation as well.

Every evaluation system creates a set of incentives. Without forced ranking, superiors are likely to take the easy way out and give everyone a top block. With forced ranking, you see dysfunctional competition. With a 360, you might get leaders who are afraid to discipline their subordinates and push them to do unpleasant tasks. Finding the right balance is a difficult challenge.


Monday, March 20, 2017

Student class #7 - communication

We're back today from spring break and continuing with our student-led organizational behavior course.

Today begins the second of three parts of the course. This part is "Two", and will focus on interpersonal behavior. Jess and Sarah are leading today's class and below is the prework:

Jess and I will be talking about effective communication.Here are the few things you need to do:
1. Think about how you talk to your friends vs. how you talk to a person you see as your superior? What changes do you make to your body language and wording in each situation?
2. Come prepared to discuss a story about you! Can be about anything you feel comfortable sharing with others.
3. Read this article: http://www.nationalforum.com/Electronic%20Journal%20Volumes/Lunenburg,%20Fred%20C,%20Communication%20Schooling%20V1%20N1%202010.pdf
 **

My thoughts:

1. I know I talk to friends and family quite differently than I speak to superiors. Many years in the Army instills a strong sense of social distance. I think good leaders know when to use social distance and when to remove it. Social distance is not always a bad thing, and is not the same thing as not caring. With a superior I am more formal and reserved, and I try to show deference to the position in order to show that I will support the superior. Perhaps because of my background, both in the military and before, I was raised to believe that you show deference to a legitimate superior, so it does not trouble me. I know not all people feel that way and I know not all people act that way. Some of the ways we showed deference to a superior in the military were to stand when a superior enters the room, to be quiet when the superior is speaking, and to stand in certain ways when addressing a superior (attention or parade rest depending on the situation and your respective ranks).

2. Coming to UNH I've run into a number of funny situations where my previous experience caused me to miscommunicate with my colleagues. One circumstance arose when I was dealing with a service provider who had to send invoices to our department to get paid for a project I was working on. The contractor wanted a second e-mail address to send the invoices to as a back up, in addition to mine. I gave the contractor the department chair's e-mail, but clearly instructed them to send the invoices to me. The contractor immediately started sending the invoices to the department chair. She very politely passed them on to me so I could deal with them. This made me mad because I had told them not to do that. So I wrote the contractor an e-mail with the chair cc:'ed, telling them to send the invoices to me, as I had told them, because they chair would just be sending them to me anyway, and it would make her mad. The chair was taken aback by my assertion, and sent me a separate e-mail saying effectively that she would prefer I not speak for her and that she would never get mad about such a petty thing. She and I exchanged a few e-mails and it became clear we were not communicating, as she continued to get more upset with me.

To understand this miscommunication, you have to understand that had this happened in the Army, my supervisor would have let the invoice non-sense go once, but would have expected me to fix it. If it continued, an Army supervisor would have gotten mad - not at the contractor, but at me. There is a strong ethic in the military that subordinates are supposed to take care of superiors by preventing distractions from getting to the superior. Eventually I had a face to face conversation with my chair and explained that when I said she would get mad, it was actually a compliment in that I was acknowledging her position and authority, not an insult to her character (she took it to mean that I thought she was thin-skinned). Once we were able to clarify the communication, we were able to have a laugh about it.

I continue to occasionally run into little confusions like this because, although many things in my environment look like the did in the Army, in fact they are quite different. Academia is a very different culture than the military. Even academia in the military is different from civilian academia.

3. I thought the assigned article was quite good - it is succinct and well organized, and has some solid points. It's primary audience is education professionals, but it's easily applicable to any workplace.

I particularly liked the discussion of barriers to communication - I hope we discuss those. The article references "psychological distance" as a barrier - I more often think of "social distance".