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Trust, Politics and US Health Care Policy

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The ability to trust is not an unalloyed virtue. It opens one up to the possibilities inherent in a relationship. It can also make one scam-candy for the unscrupulous. Yet trust without risk is not trust.

So we have evolved to make snap judgments and hold them strongly, even in the face of contradictory evidence. We also extend trust, via a trusted agent, to new arenas.

Which is why it’s so hard to de-politicize big policy issues. We tend to trust one party line or another on major issues. Answers to “Do you hate Hillary’s health care proposals” are highly correlated with “Do you hate Hillary?” Thus, when it comes to complex issues, our blind ideological trust serves us badly.

What we need in such cases is a Nixon-to-China personage; someone to shake and confuse our ideologies in ways that lead us to look afresh. May I suggest Regina Herzlinger in the field of US health care policy.

Ms. Herzlinger is a Harvard Business School professor whose career focus has been on non-profit organizations—particularly health care. Her third book on the subject, Who Killed Health Care? , has just been written, and she’s interviewed in Is Health Care Making You Better; or Dead, part of the HBS Working knowledge series.

Depending on which quote you take out of context, you’ll think you’re reading either Michael Moore or Milton Friedman. Put them together in context, and you’ll think you’re reading blindingly obvious commonsense. It’s that good.

She succeeds in using the tools of capitalist analysis to create an indictment of our health care system—as a system that is bad for health and bad business at the same time. She pulls no punches, as she outlines the chillingly bad-business practices of the five health care “killers” (her term); health insurers, the US Congress, employers, hospitals and academics. (Pharma catches a break finally).

Another Nixon-to-China component of Regi’s approach is that she demonizes very few individual human beings; in fact, she clearly respects the devotion of many in all five “killer” systems. Yet this doesn’t detract from her indictment of the system. She also offers specific suggestions which, unlike Michael Moore, are quite hard to label as one or another ideological –ism.

I’ve never understood why Regi Herzlinger’s health care work hasn’t gotten the attention that went to, say, Michael Porter or Ira Magaziner. Perhaps it’s because they were easily classifiable into trust-proxy ideologies; she is not.

Joseph Califano, after the Clintons’ ignoble shot at health care in the 90s, said that health care reform wouldn’t come until after campaign finance reform, because of the same power-sustaining characteristics that Herzlinger points out. Perhaps her health care work may actually contribute to campaign finance reform, the new Supremes notwithstanding.

Sometimes our trusting instincts get complacent, and we need someone like Herzlinger to shake them up.

Full disclosure: Herzlinger was a professor of mine, I’m very proud to say.

Soliciting Customer Service Feedback: Motives Matter

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Ginger Conlon, over at The 1 to 1 Blog,  writes about an excellent midtown New York meal tainted by a flawed customer service feedback process.

When the check arrived it came with two comment cards, encouraging our feedback. [But] the only way to give your feedback was to give the card back to the server. I could walk up and hand it to the host; but perhaps I would like to have mailed it in? There was no address (or email address)…

… if I was to have given negative feedback (I didn’t, the food and service were terrific) and drop that card back in with the check, what’s to stop the server from tossing it in the trash? If this restaurant, or any other establishment, really wants feedback – good or bad – it should make it easy and comfortable to give it.

In this particular case, I think the comment card was really more of a way to get satisfied customers to opt in to the company’s email list.

Agreed, Ginger, and let me pile on.  Not only is this a bad service evaluation process; it also ruined your dining experience (badly enough that you’re blogging about it, and I’m amplifying it).  It made you think about:
 

a. a mildly uncomfortable and totally unnecessary interaction;
b. the possibilty of gaming the system
c. the (possibly nefarious) motives of the restaurant.

And the worst of these is the last.

Let’s go from bad to worse, to worst.

Bad:  when was the last time you filled out a paper service evaluation form at a hotel, airline, restaurant? Probably only when something went really wrong?  Data quality with such low and skewed participation rates is low.

Worse: such low participation rates cause cynicism in customers and employees alike. Bad data can’t support quality decisions.

But the worst—bad motives—can sound very much like good service improvement theory. The theory goes:

• Carefully measure what’s wrong
• Figure out the desired new behaviors
• Reward people on the basis of improved data.

This is management 101, right?  Tell people what you want, then reward them for doing it.  (It’s also Pavlov 101 and Skinner 101, but never mind…)

Unfortunately, when you put such weight on the rewards, you can ruin the motivation for good service. It becomes about money, not pride.

The really good waiters, servers, etc. know how to subordinate the goals to the process—they succeed in spite of, not because of, those following service improvement theory.

But its worst, this approach produces begging. “May I put you down as having received excellent customer service on this call?”  Try saying “no” next time and see what happens.

Here’s what happened with me.

CSR: May I say I provided excellent customer service for you today?
ME: No.
CSR: But—what did I do wrong?
ME: You didn’t do anything wrong, but you weren’t able to solve my problem.
CSR: (Sputtering) But, that wasn’t my fault; it’s the system.
ME: Whatever.  I still didn’t get my problem solved, so I didn’t receive “excellent customer service.”
CSR: But I tried.
ME: Thank you. But is this about your trying, or about my results?
CSR: But this could hurt my ratings and cost me!

This is a bad customer service feedback process, providing bad data.  It ruins the service as well.  And it creates cynicism about bad motives.

But when it turns decent employees into pathetic beggars—abjectly beseeching the very customers they are supposed to be serving—then the process has achieved something truly twisted and dehumanizing.

And all in the name of measurement and reward.

Hey Ginger—any reason not to provide the name of the restaurant?  It’ll be our little blow for improved service analysis.

Call for Submissions for the July Carnival of Trust

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Carnival of Trust Logo

The second Carnival of Trust is fast approaching and will go live on Monday July 2nd.  The deadline for entries is this coming Thursday,  June 28th.

As I wrote when announcing the first Carnival of Trust my hope and ambition for the carnival is to begin establishing a home base, a center of gravity, for people who are interested in fostering greater trusted relationships in various realms of the world.

While my own material is primarily business-oriented, the Carnival of Trust will be explicitly more broad than business alone. Trust is heavily personal in nature, and I hope the submissions will reflect that—postings that deal with personal trust, business trust, and political trust are welcome, as well as pieces on the nature of trust.

I’ll be setting a hard limit of 10 postings per Carnival. The host will personally make the decisions about inclusion, in an inevitably subjective manner intended to push the thinking ahead in those broad areas of trust. I’ll be hosting the first few carnivals, and while quality is the main criterion, I’ll be looking for breadth at the outset as well.

I invite, encourage and urge you to submit pieces for the Carnival. Send them to http://blogcarnival.com/bc/submit_1693.htmll .

I look forward to hearing from you!

Attract and Retain: People Strategy, or Roach Motel Ad?

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The phrase “attraction and retention” falls naturally off the lips of HR people. It’s also common with the customer relationships crowd.

Yet it’s also perfect ad copy for selling flypaper or roach motels; “they can check in—but they can’t check out.”

So which is it? High-minded strategy for people and customers? Or unfortunate parallel with the extermination business?

The phrase “attraction and retention” grew out of McKinsey’s 1990s “war for talent,” crystallized in the 1997 book of that name.

Excerpt:

…a company’s ability to attract, develop and retain talent will be a major competitive advantage far into the future. “The only thing that differentiates Enron from our competitors is our people, our talent,” said Enron Chairman Kenneth Lay recently.

Ouch…score a few points for the insect hypothesis.

Let’s have a look at how the phrase has evolved in ten years. Today:

It’s still about employee attraction and retention—in the HVAC contracting business.

For the 7-county Milwaukee area, Deloitte Consulting offers a 5-step process for attracting and retaining new business and industry residents.

It’s about website visitors

And it’s definitely about customers

But just how does one attract and retain?

Well, for customers, you could use one-to-one marketing:

Remember all of those advertising brochures you’ve found in your mailbox over the years from them? Those are the results of a one-to-one personalized marketing strategy. Most likely your relationship with Radio Shack began when you walked into one of their locations and purchased a stereo.

Yup, that’s probably where it started, all right. Though I haven’t been back in years…wonder why…

To attract and retain employees, you could create a retirement plan .

You could also “attract and retain more supporters, members, and donors, through a BrandXcellence consulting relationship.”

Here’s how Brunswick does it:

• Business and financial leadership development programs
• Products managed and engineered by local and regional talent
• Performance management process

You could do it through CRM.

You could read about the Five Key Elements of A&R.

But wait a minute—why is it that are we doing this? What purpose does attraction and retention serve? Ask that question, and we get some consistent answers:

the long-term sustainability of an organization’s business strategy and market differentiation hinge on effective recruitment, talent development, and retention.

Human capital continues to be the single-largest investment a company makes, and now management can quantify the return on investment of its human capital and connect it to business results…"

We use tools such as the Watson Wyatt Human Capital Index ® – which links the effectiveness of human capital practices to shareholder value creation

A primary challenge facing almost every organization today is quantifying human capital investments and their effect on shareholder value.

Ah, yes, that’s it—the reason we want to attract and retain employees and customers is so that we can raise shareholder value. People and customers are the means;  business success  is the end. Therefore the value of employees and customers can be measured by their contribution to financial value creation.

Does it not dawn on these people that they’ve gotten it backwards?  That financial performance is a result, an indicator, of success in serving employees and customers?  That companies should serve people—including shareholders—rather than the other way ‘round?  Causality flowing one way doesn’t mean it flows the other too; people who like things hang around for more, but just because people are hanging around doesn’t mean they like things (prisons, for example, have high retention rates).  

The sin of the roach motel approach is that it focuses on symptoms, not causes—and in so doing, perverts means and ends.

It all comes down to motives, and motives can be slippery. Even the same person, moments apart, can treat customers like ends—or like means.

One of the best—and most vacuous—recommendations is to engineer your entire company culture around doing things that attract people and encourage them to stay. Best, because it’s absolutely correct. Vacuous, because if you don’t start with a profits-exist-for-people mindset, you’re never going to get there by pursuing X-step processes in support of increased shareholder value.

You either live it or you don’t. People are attracted by genuine motives—not by some technician measuring their attraction levels. People stay most if they genuinely want to stay—not because of a program that locks them in in order to increase shareholder value.

The roach motel crowd is dominating the dialogue. In our pursuit of minute measurement of the effectiveness of flypaper, we’ve forgotten motives.

People come if we really, really like them and treat them well. Period. People stay if we really, really like them and treat them well. Period. Not for the sake of shareholder value. For their sake. Period.

Then—and only then—the shareholder value thing works best too.  As an outcome—not as a goal.

Random Canadian Acts of Kindness?

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Yesterday started badly for Ian Welsh in Toronto. His computer crashed—no response from the power button. After the taxi dropped him at the computer repair store—he discovered he’d left his backback in the cab.

Then—it all ended well. The question is—why?

Says Ian:

Turns out it was just the power supply. I thought it wasn’t, because enough power was getting through to keep the power light on the motherboard on, but it turns out it was damaged enough that there wasn’t enough power to boot.

Since the techie did more than he had to and wouldn’t let me pay him "under warranty" he said, and seemed offended when I offered, I gave his business (family owned) a plug at the Agonist.

And the cabbie whose cab I left my backpack in, returned it to the store he dropped me off at.

A banner day for "people can be really decent sometimes" and a nice anti-cynicism dose.

A banner day indeed. Possible explanations:

1. People in Toronto are just nicer than the rest of us

2. Ian’s a decent fellow, and you get back what you put out

3. The weather was great yesterday, which makes people act well

4. Ian was lucky; sometimes you get lucky, sometimes you don’t

5. What’s the big deal? People are generally nice—this is the norm.

I think those are pretty much the big generic explanations, unless you’ve got some I missed.

So—what’s your take on it? Did Ian have a good day? And if so, why?

Flipping the Company or Flipping Beliefs?

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I heard two young spirited entrepreneurs, working their butts off creating a new and wonderful company, totally devoted to clients and to their technology—talking about how they were going to flip the company in a few years.

Is this entrepreneurship at its best, creating and then moving on to let others manage?  Or are these a couple of cynical short-termers?

I think it’s something deeper.

I think it’s a fundamental shift in how we see things—and in what we believe in.

What if this is the new mainstream?

It’s easy to caricature it as a selfish, short-term oriented, monetize-everything approach, to be contrasted with the social good of building a lasting organization.  By that view, it rhymes with abandonment of employees, looking for the fast buck rather than the ongoing value. And let’s thrown in skepticism about the loyalty and dedication of whatever employees are left after the original founders are left.

Passing judgment is generally what generation now-minus-two-or-three does when faced with change.  We condemn the moral decay the change represents.

But—what if “entrepreneurship” becomes the norm?

You’d end up not being able to flip companies for very much, because they wouldn’t last long.  But the people who worked in them after the flip wouldn’t be working very long there either, since they too aspire to flip—their own careers.

Is this a recipe for cynicism? Must it be incompatible with customer service?

Not necessarily—not if you love learning and building a business and helping customers. Which is what I heard going on.

Sometimes, it is our beliefs that drag us down, hold us back. The beliefs from a generation or two ago. What are they? Let’s take stock:

1. Employee retention is good, to be maximized. Not really—the goal is engagement. Retention was always a second-order indicator that’s now fraying.

2. Sustainable competitive advantage is the goal. Sustainable for a bit is all we need; welcome to disposable businesses.

3. Built to Last. No thanks, it only has to last long enough.

4. Boundarylessness. Yes—but not limited to within the corporate walls.

5. Loyalty.  Companies can’t be loyal, only people can. People who are loyal to companies are in one-sided relationships.

If we’re going to critique trust in new businesses, we need to be careful to distinguish the core elements of trust from the ways in which trust happened to be manifested in the past.

YourCo Trust DiaBlog: Trust HelpMe

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Welcome to the YourCo Trust Dia-Blog. There are four categories of discussion: see red links at top of page.

  1. New participants—gives pre-session instructions for those about to attend a BTBR session; You are Here
  2. Post-session debrief—for discussions after a session is completed
  3. Alumni—for ongoing dialogue of BTBR "graduates," and master-class attendees
  4. Trust Help Me—for discussion of trust issues in general. << You Are Here

Following are a series of cases about trust in business relationships. They have been designed to reflect realistic trust-related business relationship issues within Shell. The intent is to encourage dialogue about such situations.

We encourage you to comment on these cases, and to read other people’s comments. It is a way to share perspectives. At the end of any case, just click the "comments" button at the bottom of the post, and add your perspective.

The Resistant Client

I’ve got a client who should be a client; needs to be a client; whose boss wants him to be a client; and who himself probably wants to be a client—but who is resisting.

He’s got weak interpersonal skills. He “plays” badly with peers, gets weak 360s from subordinates, and is prone to giving orders and losing his temper. In speaking with him, I get signs that he knows the effect his behavior is having on others, and doesn’t like it. I think he knows it could hurt him big time, but is—I think—very embarrassed to admit it.

Worse, I have been recommended to him by his boss and by one peer. I think he may feel that working with me is a public acknowledgement of his failings, and that gives him problems.

I have tried to politely approach him, but he does not seem to be taking the hints.

Any suggestions on better approaches to take to get him involved with me?

Trust Advisor Associates Team

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Welcome

To the Trusted Advisor Associates Team page. We can use this to plan and get better acquainted.

Note: at the bottom of the comments page, you can check a box that will automatically notify you via email if a new comment has been posted. That way you do not need to waste time checking for new comments. We recommend you use it.

T

Welcome to YourCo Trusted Relationships DiaBlog

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This is the New Attendee section  of discussion in the DiaBlog, accessed by the red-font links at the top of this page.

    Please, join in. Start by clicking on "comments or question" below, and adding your responses.

    Do You Trust Your Boss?

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    My assistant, Trish, asked me, “When are you going to blog about employee trust?”

    I asked her what she meant. She explained that she trusted a great deal in me and her other boss—to do the right things for her, to provide job security, to create a rich experience.

    Now, I’ve had a boss, and I’ve been a boss. And if I knew then what I know now—well, then I’d have known a whole lot more.

    I think that my experience working for people was probably typical. I liked most of my bosses. Those I liked, I trusted a lot; those I didn’t, not so much.

    To those I liked, I imputed wisdom. I would ask them questions if I didn’t know the answer, and I asked a lot. The best boss answered socratically.

    (The best single employee lesson I ever got was from a terrible boss; he couldn’t articulate what it was he wanted, and I was finally so frustrated that I did what I thought was right. Which turned out to be what he had been trying to tell me. Lightbulb.)

    I thought they were older (true, in my case) and wiser (so I thought; not true in the rear-view mirror). I argued with them, just to engage and to find out their logic. Sometimes, this would piss them off. It didn’t dawn on me they didn’t know.

    From the rear view mirror, I see now they were hardly different from me. One was wildly insecure. Another, insecure and alcoholic. One, quixotic. Another, sometimes wrong but never in doubt. Most had charisma. All were genuinely nice people, and all could make some Really Stupid Moves.

    I suspect my experience is the norm.

    (Though for about 6 months, Jamie Dimon, President of J. P. Morgan Chase, one of Time’s 100 most influential people in 2006, reported to me. Well, administratively anyway; not quite the same as being his boss. Jamie didn’t have quite the awe for his bosses that I did. I suspect Jamie figured he was smarter than all of them, and just lacked seasoning and data. I imagine Jamie still believes that, and by now he’s more than earned the right to say nyah, nyah, he was right, too!)

    Jamie aside, the rest of us have met the enemy, and it is us. I am my old bosses, at various times, in various ways. I’m just another sentient idiot on the planet trying to make sense of it all and keep the back foot movin’, hoping the front foot it’s following is generally hewing to a forward-wise di-rection.

    A study once queried students and faculty, asking each what they thought of the other group, and how much time they spent thinking about that group. The results: faculty spent little time thinking about students, but figured the students thought a lot about them. The students spent little time thinking about the faculty but figured the faculty spent lots of time thinking about them.

    Moral: In the real world, empathy consists of staring at the other guy’s feet almost as often as at your own.

    And Trish trusts me. Hoo boy.

    But you know, when people trust you, it has an ennobling effect. Yes, I tell her to think for herself, and not to be dependent on others. But, I still try to do right by her. I do want to be a good boss.

    After all, she trusts me. Waddya gonna do?