CEO如何用好“时间管理”

本篇文章由资深顾问Quint Studer所撰写，作者以时间管理的理念，指导CEO的绩效管理工作落地。除了推荐医院行业的高管阅读外，也非常值得HR工作者与职业经理人借鉴，以时间管理理念来。 本人翻译水平有限，请读者批评指教。

The HospitalCEO's Ultimate Dashboard: What to Check Daily, Quarterly and Yearly

医院CEO的职责，实在是包罗万象。CEO必须监督各种不同性质多的工作领域，同时做出决策和解决问题。如果你稍有轻忽，你将整天忙于响应各种实务，而不是像激光般聚焦在能有具体产出的问题。

等到你发现自己的时间管理不对劲时，早已是猴年马月了。你最宝贵的时间一去不复返，都花在了“头痛医头、脚痛医脚”上，而不是根本解决问题。

构建正确的管理体系，是避免上述混乱的解决办法。如果你坚持且刻意地聚焦在最重要的指标上，那些让你浪费大量时间的表面问题，通常反而会迎刃而解。

那么，CEO到底该聚焦在什么指标上？根据我的经验，有四大类指标，分别是的生产力、数量，临床医疗品质、服务。

但是，我发现如果你打破上述的四大分类的指标分类法，重新以从时间轴的视野来进行管理工作，更能帮助自己将宝贵时间用在刀口上。时间轴可以帮你把任务重组为三种类型：年度、每季和每日。

我建议CEO采取以下的管理模式：

（1）每日监督的指标与议题

在我往下介绍之前，简单提醒读者：在已经导入精益LEAN管理的医院，CEO可能已经把以下这些行动当作自己的标准工作清单。

1.没有出现门诊病患

没有门诊病人，医院的生产力就无法发挥，这个问题浪费医疗行业数亿美元的成本。如果你注意到医院的数量高涨，也许就是你改善提醒机制的时机，以便让你更好地监控每日门诊数量。

2.首个门诊的起始时间

监督第一个门诊启动时间的及时、即刻很重要，可以预防各种延误和瓶颈，保持医院平稳的运作。

3.病人数量

每天有多少病患来到医院？

4.急诊病患从进门到医生治疗，需等待多少时间

急诊患者要等待多久，才能在急诊室看到医生或等到治疗？这结果将影响你的员工水平、病人生命的安全、病人和员工的满意度。

这个指标与以下指标，以及病患在其他医疗程序中的等待时间，将在“Medicare Hospital Compare ”上公开比较。病患会比较你和竞争对手医院的等待时间，再决定去哪个医院看病。

5. 从允许转移急诊病患起，到实际完成转移的时间

当急诊科医师准许病患从紧急照护ED病床转移到一般床位后，需要多少时间才能实际完成转移？

6.急诊患者没有被治疗就离开的人数

有研究表明急诊患者没有被治疗就离开数量（LWBS），是急诊室超负荷的指标，并与急诊等待时间较长有关。病患如果在急诊室内没有被治疗就离开，更容易发生健康恶化的问题。

7.劳务外包和加班费用

持续关注外包费用是很重要的，因为当你使用外包时，你付出的劳工成本更高（译者王威：同工同酬之外，还要支付机构费用）。如果外包劳工是派遣到特定期间的项目，高成本只是暂时性的。但通常的问题是，高外包成本反映了医院有人员流动率问题（译者王威：净人力资源流动率是补充人数除以工资册平均人数。所谓补充人数是指为补充离职人员所雇佣的人数）、招聘问题、或我认为最常见的留才问题，这三个问题与员工的敬业度密切相关。

由于劳务外包的员工通常对彼此不认识，对医疗专业体系也不熟悉。所以，通常医院付出更高的外包成本时，病人体验也就越差。

8.核心服务的议题

有没有患者对你们的核心服务感到失望？如果有，也许最好的方式就是你亲自去处理。

9.核心敬业度的议题

有没有任何医师或员工，对医院感到失望？提振员工或医师的士气必须及时，因为员工敬业度直接冲击患者的生命安全和治疗工艺的提升，甚至，敬业度能够影响各种事情。我建议把员工和医师的满意度，纳入部门主管及医疗执行委员会的议程大纲上，定期监督与检讨。

（2）每季度跟踪的指标与议题

虽然以下大多数的议题需要持续关注，我建议每年进行至少四次的深入检讨。

1.品质指标

我们医院的HCAHPS满意度调查结果如何？（译者王威： HospitalConsumer Assessment of Healthcare Providers and Systems是目前美国最为主流的医院满意度测评方法）如何衡量过程中的品质？如何衡量产出的品质？依据效果付费的趋势，导致了这些指标成为大家特别注目的基准，同时，这些议题也与医院经营边际利润的好坏，直接挂钩。

2.员工指标

员工满意吗？员工流动率如何？（译者王威：分析净人力资源流动率时，可与离职率和新进率相比较。对于一个成长发展的企业，一般净人力资源流动率等于离职率；对于一个紧缩的企业，其净流动率等于新进率；而处于常态下的企业，其净人力资源流动率、新进率、离职率三者相同。）

员工敬业度对于高绩效的组织而言，是必不可少的。所以，我建议每季举行员工座谈，让员工有表达心声的机会。

3.医师指标

包括了转诊模式以及满意度评价。重要的是要确保医生深度致力于医院的营运，也确保我们医院在医生的眼中，是个绝佳的行医场所。

4.慈善事业

虽然大多数的组织一整年也未能办一次慈善活动，但是，我仍建议即使医院仍在生存边缘奋斗，还是最好每季次举办一次。

随着政府的社会补助越来越难申请，慈善事业越显重要。关注慈善募款活动，掌握捐款增减情况及原因。此外，保持沟通渠道的畅通，尤其是为捐款人定期提供慈善款项用途的反馈信息。

5.董事会沟通

虽然我把它放入“每季度”的跟踪，但实际上董事们应该更加频繁地沟通，尤其是关键董事会成员应该经常地、积极地交流。年底进行一年一次的会议，往往为时已晚。大多数医院的CEO们，从未正式衡量董事会的沟通。他们认为，只要能按时参加董事会会议就足够了，但事实并非如此，星星之火，可以燎原。CEO应该与每一位董事单独商讨，询问董事们如何定义一场有效的董事会会议。能够澄清董事会的期望和进行有效的沟通后，CEO面对任何议题都能处变不惊。

（3）每年度必须采取的步骤

1.执行严谨的领导力评估

如何有效整合组织内领导人才的心态和人才资源？对于持续改善的需求，管理层是否有一致性的紧迫感？目前你所采取的正确行动，迅速而准确吗？您的系统和流程如何确保任务执行者，都有自觉的责任心？

2.审计领导力评估体系

你的领导人才评估体系，是否能有效反映领导人才的实际绩效？如果你多数领导人才的领导力被评为“大幅超过预期”，表示你的组织目标，也应大部分成功达标。但我发现事实上，往往企业的领导力评估似乎与管理者的成果无关。如果你的领导力评估采用主观且缺乏评价基准的方式，而不是采用客观的明确衡量指标，我建议你应该立刻检讨现有的领导力评估方法。

3.评估供应商合同

仔细从两方面检视供应商的关系：成本和效益。前阵子，我与一位正在进行成本精简的医院CEO交流。我拿起他医院的HCAHPS一看，发现该组织的清洁得分排在倒数12%内。他的环境整洁采用外包形式。我建议他立刻重新评估这份外包合约。监控你的采购成本：不仅是市场价格，同时考虑供应商的性价比。记住，医院的绩效表现取决于供应商合同，虽然这是常识，但是影响超过你的想象。

结论

当我写这篇文章时，我思考着“每日”与“年度”的跟踪项目，哪一个应该放在文章前面的位置。我决定先谈每日跟踪项目的原因是，只要你每日真正监督了这些关键议题，并且根据你所看到的证据做出明智的管理决策，季度和年度的任务将会变得迎刃而解。整个一年中，做好每日与每季监督工作，你会为你的年度任务打下坚实的基础，深入掌握所有关键议题。

总之，把这些项目整理成一个“仪表板”（译者王威：做成视觉化的工具），将有助于医院CEO满怀信心地领导自己的组织，穿越各种让行业颠簸的剧烈变化。

我极力建议你要密切关注你的仪表板。有时，医院CEO不想来衡量这些议题的原因，是因为他们早已预料将看见很差的结果。例如，如果CEO感觉到医生的士气不佳，就可能不想衡量这个项目，以避免去验证自己的担心。或CEO们不愿意把指标明确固化下来，以避免与董事会有所冲突；有些CEO为了保住自己的工作，会避免让董事会成员，去接触那些他们所不会满意的衡量结果。

医生出身的医院CEO们，更需要看看这些指标。医师不会简单地向病人说：我不想量你的血压。医师的诊断工作必须完成；组织健康的诊断工作也一样要必须落地。

无法避免地，你得忍受一些新习惯所带来的不适，但是当你体验到伴随组织健康而来的长期收益时，你会很高兴你做到了。

王威 20130725 翻译于杭州

The HospitalCEO's Ultimate Dashboard: What to Check Daily, Quarterly and Yearly

Written by Quint Studer, Founder of StuderGroup | July 01, 2013

The job of a hospital CEO can be overwhelming.There are so many areas to oversee, decisions to make and problems to solve. Ifyou aren't careful, you'll spend your whole day responding and reacting insteadof laser-focusing on the issues that drive results.  

Before you know it, those days turn into weeksthat turn into months that turn into years. Eventually you come to see thatyou've spent most of your valuable time addressing the symptoms of problemsinstead of the problems themselves.

The solution toreducing chaos is creating structure. When you consistently and deliberatelytake aggressive action on the metrics that matter most, many of the peripheralproblems that would otherwise take up your day will solve themselves.

So what are the bigissues a CEO should focus on? In my experience, they fall into four"buckets:" productivity, volume, clinical quality and service.

I find it's helpfulto break these categories into specifics and put them into a timeline. Thereare three categories of tasks — those to do yearly, quarterly and daily. Irecommend the following checkpoints:

Metricsand issues to monitor daily

One quick note beforeI dive in: In a LEAN environment the CEO might make these actions part of hisor her Leader Standard Work list.  

1.Outpatient no-shows. Patient no-shows hurtproductivity and cost the healthcare industry billions each year. If you noticeyour hospital's numbers are running high, it might be time to tweak yourreminder system or switch to a better one.

2.First case start-times. Prompt start times arecrucial for preventing delays and bottlenecks, and for keeping the OR runningsmoothly.

3.Patient volume. How many admissions are inthe hospital each day?

4."Door-to-doc" time in the emergency department. Howlong do patients wait to be seen by a physician or advanced practice providerin the ED? This has implications for staffing levels, patient safety, andpatient and employee satisfaction. This metric, those regarding the followingtwo items and those regarding wait times for certain other care processes areavailable to the public on Medicare Hospital Compare. Patients will compareyour wait times with those of your compe*s to decide which hospital tovisit.

5."Decision to admit to departure" time in the ED. Howlong does it take from the time the emergency physician decides to admit apatient to an inpatient bed to the time the patient actually leaves the ED forthat bed?

6.Number of patients who leave without being seen in the ED. Studieshave shown LWBS visits are an indication of ED crowding and are associated withlonger ED wait times. Patients who leave the ED without being seen are morelikely to report worsened health problems.

7.Agency and overtime costs. It's important to look atagency costs constantly, because when you use agencies you pay a premium pricefor hospital labor. This may be a temporary cost if labor is assigned for acertain project, but most of the time, high agency costs mean the hospital hasa turnover issue, a recruitment issue or — most often, in my opinion — aretention issue. All three of these are strongly correlated with employeeengagement issues. Those who have high agency costs, might also have lowerpatient experience costs because there are employees who don't know each otherand aren't familiar with the health system.

8.Major service issues. Are any patients upset? Ifso, it may be a good idea to handle these situations personally.

9.Major engagement issues. Are any physicians oremployees upset? This is the time to address major issues in employee orphysician morale. Employee engagement affects patient safety and processimprovement. That one number can impact all sorts of things. I would suggestemployee and physician satisfaction be regular agenda items at your departmenthead and medical executive committee meetings.

Metrics and issues to monitor quarterly

While most of theseissues need to be looked at continually, I recommend an intensive review ofthem at least four times a year.

1.Quality metrics. How are the hospital'sHCAHPS results? Process of care measures? Outcome measures? Pay-for-performancechanges make these benchmarks particularly "hot," as they are directlylinked to the health of hospitals' operating margins.

2.Employee metrics. Are employees satisfied?How are turnover rates? Employee engagement is essential to high-performanceorganizations. I suggest holding employee forums quarterly to give employees achance to be heard.

3.Physician metrics. This includes referralpatterns as well as satisfaction ratings. It's important to ensure physiciansare deeply engaged in hospital operations and that they see your organizationas a great place to practice medicine.

4.Philanthropy. While most organizationszero in on philanthropy once a year, quarterly is better in a time when so manyhospitals are struggling to sustain themselves. With government funding gettingharder and harder to obtain, philanthropy grows more important. Keep an eye ondonations. Know when donations increase and decrease, and understand why. Also,keep the lines of communication open. It's important to provide the people whodonate money with regular feedback on where their funds went.  

5.Board communication. I put this one in the"quarterly" bucket, but it should probably happen more frequentlythan that. Communicate with key board members vigorously and often. The end ofthe year is too late. Most hospital CEOs are never formally measured on boardcommunication. They assume that going to board meetings is enough, but itisn't: if there's a problem, it festers and will one day explode. The CEOshould meet with every board member individually to ask what he or she definesas healthy communication. This is about clarifying expectations and measuringthem so the CEO is not surprised when an issue comes to head.

Stepsto take annually

1.Hold an intensive leadership assessment. Howaligned are your leaders in terms of mindset and resources? Is there auniversal sense of urgency regarding the need for constant improvement? Are youtaking the right actions quickly and precisely? What about your systems andprocesses — do they hold people accountable for executing well? Studer Groupoffers the Straight A Leadership Assessment to evaluate leaders, but if youdon't use this tool, find another way to measure these vital leadership issues.

2.Audit your evaluation system. How well do leaderassessments match up to the results they're responsible for? If most of yourleaders receive a "substantially exceeds expectations" rating, yourorganization needs to be hitting most, if not all, of its goals. I find this isoften not the case. If you're using a subjective evaluation tool, rather thanan objective one linked to hard goals, it may be time to re-think yourapproach.

3.Evaluate vendor contracts. Look closely at theserelationships in two areas: cost and performance. A while back, I was talkingto a hospital CEO who was preparing for a reduction in force at hisorganization. I pulled up the hospital's HCAHPS results and saw theorganization was in the 12th percentile for cleanliness. Its environmentalservices were outsourced. I would have reevaluated that contract in a minute.Monitor the vendor costs — not only the market price but the cost in terms ofperformance. Remember, hospitals can tie performance into their contracts withvendors. It's common in certain areas, but could be common in more.

Conclusion

As I was writing thisarticle, I struggled with whether to put "daily" items or"annual" items in first position. I decided on daily, and for areason. If you are truly monitoring these crucial issues every day — and makingsmart decisions based on the evidence you're seeing — your quarterly and annualtasks will be much, much easier. Throughout the year, you will build a solidfoundation for your annual tasks, and you'll be deeply familiar with theissues.

Together, thesechecklists make up a "dashboard" that will help hospital CEOs steertheir organizations confidently through the hurricane of change that'sbuffeting our industry.

I urge you to payclose attention to your dashboard. Sometimes, hospital CEOs don't want tomeasure these issues when they anticipate a poor score or outcome. For example,if they sense poor physician morale, they may want to avoid measuring it andvalidating their fear. Or CEOs don't pin down the metrics in order to avoidconflict with the board. They anticipate that board members will not be pleasedwith the results, and they want job security.

CEOs need to look atthese metrics as if they were physicians. Physicians do not simply tellpatients they don't want to measure their blood pressure. It has to be done.Keeping tabs on the health of your organization has to be done, too. It maymean enduring some discomfort up front and learning a new habit — but when youexperience the long-term gains in your organization's health, you'll be gladyou did it.