Interview

Leaders who light the path

The principles of
organisational excellence

Kathy Letendre is an organisational excellence advisor. By tapping into her own experience as a healthcare executive, she creates transformational experiences for her clients and catapults them to unprecedented levels of organisational excellence.

She’s a passionate agent of change which was crucial for a bold move in 2020, when she decided to donate massive amounts of her time to enable healthcare organisations to make the leap from in-person to telehealth care. There’s only a handful of people I know who are as passionate, competent, and at the same time generous as Kathy is.

Learn more about Kathy at her website: https://www.letendreassociates.com

Michael Gerharz: Shortly after we’ve met each other about a year ago, you were in the midst of transforming your own business when suddenly the pandemic hit the globe. To me, it felt like, at that moment, you knew exactly what you needed to do, which was to focus less on yourself and your own business and focus on what the world needed most at that time. You decided that the right thing to do would be to donate large amounts of your time pro bono to teaching organisations the procedures that they needed the most at that time. Could you tell us a little bit more about what that transformation was and what enabled you to make those organisations see that and implement them?

Kathy Letendre: Yeah, absolutely.

A year ago in March, it was quite a big shift for me in my life. And in my business. I have a background in public health but I’ve spent my whole career in healthcare administration and organizational leadership. I’m an advisor to lots of organizations around organizational excellence.

When the pandemic hit, most organizations were not talking about organizational excellence. They were focused on how to just simply take care of patients who weren’t showing up for care because they were afraid of coming in person. I knew that there was a tremendous amount of misinformation and lack of information out there to go from a largely in-person mode of healthcare delivery to an almost exclusively virtual care delivery.

I was fortunate – and am fortunate – to be part of a consortium with about a dozen of actually the world’s experts in tele-health. And so what I did, as you described, is I literally spent every waking minute helping this group of tele-health experts. Get the message out to the world through podcasts and webinars and call-in sessions that we had at all hours of the night with these experts.

My role was sort of bringing them together, catalyzing the tremendous amount of information they had to share and getting it out there into the world. In the month of March and April, I think we reached thousands of medical practices and providers. It’s hard to know where that messaging went exactly because lots of it was recorded in the form of webinars and podcasts that just live on.

So, one of the things that changed for me a year ago was really generously sharing information – with organizations that had never thought about how to do virtual care as a major part of their way of taking care of patients.

I literally spent every waking minute generously sharing information.

The medical industry, at least as I understand it, is a highly formalized and structured business – which is a good thing because, I mean, we are trusting them with our health and we want the procedures to be in place so that they take the best possible care of our health. But last year, there probably wasn’t just the time for these highly structured processes and an industry which is used to following procedures needed to move fast. How did you manage to get them moving?

It’s interesting that a lot of people in the healthcare industry found that they just had a tremendous amount of time on their hands because patients weren’t showing up, they simply weren’t there. I remember a client I was working with together with my colleague Christian and literally, on a Wednesday morning, the medical director walked into a meeting and said: “The waiting room is empty at 10 o’clock on a Wednesday. What can we do?”

And by Friday, at that medical practice they had trained up dozens of medical providers in order to make this shift.

Now, many organizations who didn’t tap into expertise simply focused on the technology. But the last part about tele-health is about the technology. There are many organizations that attempted to make this change to virtual care by focusing solely on technology. But the real essence of doing tele-health is about focusing on the workflows and providing training and patient support, thinking about this as a clinical service offering, having the doctors involved in the workflow design.

These are all the parts that make telehealth work well. And I think this year has really shown a light on the organizations that simply approach tele-health from a tech only point of view. They’re the ones that are saying: “We’re going to give that up as soon as possible!” versus the organizations that saw this as a way to provide extraordinary health care, not just as a stop gap measure.

So yes, they ramped up the technology quickly, but they quickly added the workflow design and the patient support and the check-ins with patients prior and after the tele-health visit to helping the doctors and the nurses feel comfortable on camera to still make a meaningful connection with patients.

Helping doctors and nurses feel comfortable on camera to still make a meaningful connection with the patient is crucial to telehealth.

That’s an important factor and probably a point that’s often under-appreciated in the work of doctors, that communication is a huge part of their job. The way they communicate with their patients is a huge building block in how patients find the trust in the doctors and in their care – which gets a lot harder in a time where everyone is a bit uncertain because nobody knows what the pandemic will bring long-term. But also in that new form of interaction where we don’t sit in the same room but the doctor is just an image on my computer or even on my phone.

How can that trust relationship be transferred to that new environment, this unusual way of making patient care happen?

There’s a couple of parts that come to that. I mean, one is addressing the concerns of the physicians. Upfront acknowledging that this is different and helping to support them to make this transition through personalized individual coaching and training.

I mean, it’s 15 to 30 minutes of spending the time to help them to understand the importance of occasionally looking into the camera. You know, taking the time for that. Personal conversation before and after the visit, all of those pieces, supporting the providers to understand how to take what they’re incredibly good at and do it in a virtual fashion.

Again, organizations that just quickly made this transition without listening to physicians’ concerns and without providing training, for them it’s not too late. These are many of the organizations that my colleagues are working with now to really optimize, to circle back and say: “Yes, we started this quickly, but here’s how we can now formalize and make you more comfortable.”

The third part that I would mention is around the patient piece. Organizations that have done this well don’t expect the physician to troubleshoot the tech issues that a patient might experience but have staff that is there in advance of the appointment, reaching out to the patient, making sure the patient is in, has good lighting and has a good connection. And they try it out in advance.

We call it the tech check. Getting all of that fit before the visit so that when a physician walks in the room, if you will, the patient is there, the patient is comfortable, the patient has worked through these challenges.

I can remember a physician group we were working with and the doctor saying to us that in her organization, they were expecting the doctor to do all that tech troubleshooting. Not a good use of their skillset. It just creates anxiety at the start of that visit. It takes away that relationship based care.

You’re painting really vividly that shift from a technology problem to a solution that actually sees the humans using the technology – the needs of the doctors, the patient that’s faced with a different and probably difficult environment for them, the staff and the organizational procedures that are required to make that system run smoothly in a time and environment where everything else isn’t going smoothly. It seems that empathy plays a major role in the consulting that you are doing in that area?

Absolutely. And my colleague Christian who I collaborate with on many projects talks about how this is really about change management, helping the staff and the physicians and the patients to work through this major change, this major overhaul of healthcare delivery.

I believe the pendulum will swing back again where the really high performing healthcare organizations will find a really critical blend of in-person and virtual care. They won’t go back to the old way because they’ve seen the benefits for their patients to be able to do a virtual visit for certain types of care.

For instance, there’s a pretty high no-show rate patients that don’t show up for the appointment. You can imagine that the no-show rates for virtual visits is remarkably lower because now I don’t have to make arrangements for childcare and leave work and drive, you know, 30 minutes each way, either in a busy city or across the rural America, right?

My visit is the visit. 15 minutes. Not a two hour endeavour for me as the patient.

Really high performing healthcare organizations will find a critical blend of in-person and virtual care.

There seem to be lots of benefits and it looks like we’re not going back to where we were before, but to a hybrid world.

You mentioned high performing healthcare organization. Could you define that a little bit more? What makes a healthcare organization a high performing one?

Yeah. This is really the realm that I’ve worked in for the last number of decades. To me, a high performing organization understands who their customer is and understands that customer extremely well. It focuses on providing the greatest benefit towards their customers. So, they’re outward looking, not inward looking.

High performing organizations also are those that when they set plan or set priorities, they consistently implement them. There are so many organizations that develop plans and only some small fraction of those plans ever come to fruition. High performing organizations set a plan, they execute it, and they watch the results. They see it in the numbers.

And I would say the third hallmark of a high performing organization is one that knows with metrics, knows with numbers, how well they’re doing, right. It’s not just: “What do I think we should do? Where do I think we should go?” But they are fact based – in setting priorities, in monitoring results and ensuring plans. Improvements lead to actual change in those key metrics.

Those are a few of the hallmarks of high performing organizations. And again, coming back to whether it’s implementing tele-health or completely changing your organizational leadership structure or designing and implementing a new service, high performing organizations hit the mark on all these aspects.

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I guess it’s quite easy to see how in chaotic times – and I guess much of last year qualifies pretty much as chaotic times – how in chaotic times, organizations who have those principles of organizational excellence in place are much better positioned to face those difficult times. But not all were. A lot of organizations didn’t have those practices in place. Could you probably give some hints or tips or a few thoughts on some effective steps that an organization can take to better prepare themselves for times like these or deal with the situation when it comes up?

Absolutely. I mean, I think first and foremost is taking the time to reflect and learn from what just happened and then implementing and integrating what I call a disciplined approach in the organization going forward. My favorite client has been a client of mine for eight years. This past year, they have implemented more of their strategic priorities in half the time.

So they have already fully accomplished their years’ worth of action items at an accelerated pace. Many organizations that I talked to, they put everything on the back burner. The CEO of this organization had the process in place. He had his leadership team fully aligned. Managers and leaders at all levels fully understood how to develop plans and implement plans and they had measurements in place.

All of these pieces they had been working to put that in place from last March until now. The amount of strategic implementation that this agency has been able to accomplish is mind boggling. And so when we were meeting in November, instead of saying: “Oh my gosh, should we take a break?” their entire leadership team sayd: “Well, what can we accomplish in the next six months? In the next year?” Just saying that we’ve got all the building blocks, we’ve got measurement, we’ve got leaders who know how to plan and implement. We continue to support them. We continue to prioritize. We continue to paint a path forward about where we’re headed.

Disciplined organisation were even able to implement more of their strategic priorities in half the time through this difficult last year.

That’s an interesting connection that you draw to lighting the path. I mean, without knowing that CEO, just from listening to you, I suppose that the way he’s managed to focus his organization in that direction wasn’t exactly by telling everyone what to do. And it probably also wasn’t by providing incentives that try to motivate the team. But – I suppose – he managed to light the path … so that everyone in the organization was aligned on the mission and knew what to do – without the CEO having to tell everyone what to do. What role does that attitude play in that organization?

You’re absolutely spot on. He simply became the cheerleader this year because there was such clarity.

This is a mental health agency. If we’re going to continue to reach our clients and our patients, we all know what to do, right? There was no need for a command and control structure at all because they were clear about the need for continuing extraordinary care to their clients. The clinicians, the counselors, the support staff really led the charge.

He simply removed the barriers. He simply allocated funding when they asked for it: “You know, we have this particular patient population that telehealth isn’t working for” and he went out and applied for grant funding and brought in some simple solutions by listening to some barriers that were preventing some clients from being able to access services.

So the path was clear and he just kept shining a light forward. In a crisis there are some people that do become paralyzed. But he was sort of watching and continuing to signal. No, this is the right thing to do. This is still where we’re headed. Full speed ahead. Just removing roadblocks on the path. That really became his focus.

And where did that clarity come from?

This is an organization like many organizations I work with who’ve spend the time to ensure that they’re clear about where they’re headed and they reevaluate that routinely. They do that through strategic planning.

Organization for whom strategic planning or planning of any sort is just an exercise and something that sits on the shelf, you know, that doesn’t create clarity. You need a robust process that creates the environment where the senior leadership can debate and arrive at a common direction that paints the path. That doesn’t come through one planning cycle. It doesn’t come through one retreat. It comes through the hard work of the senior leadership team debating and choosing both what we’re going to do and what we’re not going to do.

Strategic clarity comes through the hard work of the senior leadership team debating and choosing over and over again both what the company is going to do and what it is not going to do.

And it’s also not coming from a marketing agency that just hands you over your mission statement that somehow is supposed to just make it clear. It has to come from inside. And, if I listen correctly here, that isn’t just luxury time. You’ve seen the proof how taking that time to actually repeatedly reflect upon whether we are still headed in the right direction is helping you in critical times – probably to be able to even accelerate. Because you’ve not let the urgent hunt you in the times where there was no urgency, but got the important things done so that you can focus on the urgent when it is actually urgent.

Absolutely. I have this graphic that I use with organizations that I work with and this particular CEO always has it right over his shoulder, on his bulletin board. This graphic shows how leaders in high-performing organization spend about 30%of their time on strategic thinking and execution. Not the norm but it’s not an activity to do occasionally. It’s a hallmark of high-performing organization.

Let me circle that back to your own situation because it certainly was a huge strategic shift that you were taking for yourself. And it came out of – at least what felt for me – total clarity about what you do. I was wondering whether you can pinpoint that situation. Was there some inciting incident that suddenly made you realize that that’s where you’re headed and that’s where you must go? Or was it a process? And where did that clarity that made you so confident in that path come from?

Wow. That’s a question. It’s a bunch of things that just came together as we were in the pandemic. I was, as you said, working on making some changes in my consulting business, sort of redefining my deafness and all of a sudden I found that the world was in a crisis. My background in public health, combined with my hands-on experience as a healthcare administrator and my access to clients who were just confused as to what to do next –it just clicked for me.

All of these parts of my life were coming together at this moment in time to redefine how to spend my time. I don’t know whether all of this pro bono work will ever be returned to me in any monetary sense. I measure my success in number of lives saved. And it just was that clear for me.

You know, people’s lives were at stake and I had the combination of these experiences in my life where I just knew that I could do something different to save lives.

I remember this one evening, it was about nine o’clock at night and we were doing one of these call-in sessions. I had four of my colleagues on the call and there was the CEO of seven gyn practices in the Midwestern United States. At the end, we were going around asking if folks had questions and he said, after this one hour on the call: “I know what to do to keep the pregnant moms safe.” I just had tears streaming down my face. I was so glad we had all these little small zoom boxes. We never worked with him directly but to think that in one hour, because of these free call-in sessions, he now had a plan out of how to keep these pregnant moms safe, it just motivated me to keep going. What a reward that was.

I measure my success in lives saved.

We never know what will come back but I’m a big believer in karma in the sense that the more we give the more will come back – in whatever unexpected and surprising ways. Yet, were there moments of doubt for you? Or resistance? Were you sometimes questioning whether you are even entitled for that sort of work?

No. I never had doubt. The only doubts that came was that, you know, all my paid client work went away, right? So, I just wasn’t focused on that because rganizations weren’t hosting in-person strategy sessions and leadership training events. I just had all this time because organizations were putting things on the back burner.

And so I never had a doubt in terms of how to spend my time and energy. You’re right, I knew, I know the karma from that work will come back in some way and I never doubted it was the right thing to do.

What a great example for a leader who lights the path! Who just sees that there is an opportunity – even a necessity – to lead and that the things that I am capable of doing are exactly the things that people need at that exact moment of time.

Let me close with one question that I’m really curious about. What was a leader that lighted the path for you. And in what way?

Hmm, I think of a physician leader who’s really lighted the path for me. This is a physician that I’ve known for 25 years and he is a leader who is constantly looking out into the future. He has this incredible ability to see things years before they materialize. Most people can’t follow where he’s going because he can see things and when he describes them to people they just don’t see that coming to fruition.

He’s a leader for me who I always stay close to. We have had many successful endeavors together in many parts of my career because he’s always innovating. He’s always asking what if. He’s always seeing possibilities well before other people see them.

So, he’s a leader who lights the path for me and who has really been a light for many people within the community where he works.

And so I never had a doubt in terms of how to spend my time and energy. You’re right, I knew, I know the karma from that work will come back in some way and I never doubted it was the right thing to do.

That’s truly inspirational. Thank you so much. It was a real honour to talk to you and that you let us into this exciting journey that you’ve been onto in the last year, lighting the path for so many organizations in their journey to making the leap from in-person to telehealth in such a difficult situation.

Thank you, Michael!

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