I have the least amount of skill in the organization

“I have the least amount of skill in the organization”.

We might expect to hear this from a new employee, but how would you feel if you were to hear this from the CEO of your hospital? Would you be inspired or think “he should be fired”? The answer to this question says a great deal about your understanding of the role of today’s most influential leaders. It does not matter if you are a new employee, experienced leader, medical professional or volunteer board member, the lessons shared in this short interview with Roland Knox, CEO of Northern Cochise Community Hospital could literally change your life. They are already changing the lives of patients, employees, families and friends in beautiful Wilcox, Arizona, population 3,822.

I started the interview by asking simply Why? Why leave the comfort and security of a great job as COO of Mt. Graham Community Medical Center. Roland had been with Mt. Graham for eight years, loved his job, his team and the community. Taking on a new role at a stage in his career when many would prefer to coast would require giving it all up to start again. The answer lays not in money, title, or even less hassle; in fact quite the opposite. Based on the rigorous series of interviews he endured it was very apparent that taking on the responsibility for this struggling enterprise was going to be a burden that most would be unwilling to bear. Without being critical of the people or place, I tried to write an objective job posting and think it would look something like this:

That may not be exactly how the advertisement read, but I have no doubt that Roland knew full well what he was getting into when he accepted the job. When I asked him why, he said “I like puzzles”. Now don’t get the wrong idea; Roland is not some nerdy left brain bean counter. During our interview I was shocked to learn that he was once a banker and had spent 20 years in the business. Roland is smart, and he does know numbers, but his gift is people. Maybe the most revealing insight about Roland is found in one of the lessons he recalls being taught by his mother. “Don’t let a word come out of your mouth without passing through your heart first.” But having a big heart in an organization that has big problems can be a recipe for ulcers.

Here is the short version of how he addressed some of their issues:

How did you earn trust in an organization that was trained to distrust, I asked? In short, he said, “I shared everything”. He started his first meeting with a visual that everyone could understand, a teeter tooter. Quality on one end, finances the other, and people as the fulcrum in the middle. This became the symbol around which all decisions were made. Next he shared all the financials in detail, the good the bad and the ugly. He knew there was a chance some would become demoralized and jump ship, but this was his “Mirror, Mirror” time. (Use the articles search bar on the right to search “Vineet” for more examples of this truth telling process).

Most stayed, a majority were stunned. When the meeting was over many said they were never shown this before. Roland thought his act of transparency would trickle down to the sharing of financial information to all employees, but they had been so conditioned to an environment of command and control that managers thought the information was for their eyes only.

So to lead by example Roland began holding regular town hall meetings where anyone who wanted could attend, and EVERYONE got a printed copy of the financials. The same information was shared online, updated monthly, and the buzz started to happen. People were starting to wonder if this new guy was for real. But Roland knew he still had a long way to go. Talk was cheap, he had to not just share the problems, but INVOLVE them in solutions.

Now the town hall meetings took on a new dimension. Roland stopped talking and started asking. There was “A LOT” of quiet space. I wish I could have been there because this part is viscerally painful for me. What do you do when you ask a question and nobody says anything? Vineet Nayar did the same thing in his “Directions” meetings. He asked questions and he waited. One minute, two minutes and then eventually somebody said something and the gates began to open. Slowly and tentatively at first, but anytime anyone had a suggestion he immediately met with them after the town hall and ASKED them how they might accomplish what they had suggested, who would they need to give it a try? Teams were assembled and now the buzz got serious, which brings up a new set of problems – managers.

Up until this time it was pretty much business as usual as far as managers were concerned. The problems were “out there”, but once employees had the information and now the opportunity to act on that information they started to ask hard questions. Managers with strong personal power tend to thrive in an environment of full disclosure and ubiquitous information, but those whose power is derived from the aggregation of information were absolutely out of their comfort zones, and to the benefit of all some found comfort elsewhere and left the organization.

This brought me to the biggest challenge of all. People who work FOR you, if not willing, at least feel some level of obligation to consider self reflection; but what about those people you work for? We have worked for and with boards for more than the last dozen years, and the greatest challenge we have faced is the unwillingness of board members to hold each other accountable. This is the ultimate recipe for mediocrity.

In one of Roland’s interviews he was asked what he would do if a board member told him to fire an employee, so I knew that there was at least one board member who didn’t understand their role. I was profoundly curious. His reply was simple and straightforward, which I should mention is how he responds to everything. He doesn’t want anyone to think they are being sold or cajoled, so he always repeats the question and responds in two sentences or less leaving no doubt exactly where he stands on the issue.

On this question he said, “I told them the truth”. In fact he recalled one meeting where a board member stood up and said almost in exasperation “Roland, you are going to have to stop telling us so much truth”. Beyond wishing Roland would run for any office where I could vote, I want to ask every one of you reading this now – How many of you have too much truth in your organization? If not, why not? If not now, when?

Everything Roland shared with me, from his first interview considering the job to now one year and two days after becoming CEO, was based simply on telling the truth. I asked him then if the truth is so powerful why is it so uncommon, and how he learned to speak truth to power.

He talked about his twenty years as a banker and how he had watched clinicians over the years that in the most difficult of all situations had to tell the truth for the lives of their patients.

I am sure that all of those experiences helped Roland understand why he is the way he is but they did not make him that way. I think it was his mom who always told him that “everyone is a person first”.

Roland could not have said it better when he said he had “the least amount of skill in the organization”. I think it is a powerful statement mostly because it makes you think. Certainly Roland is tremendously skilled, but the statement makes you look for your own explanation of why someone in his role would describe himself in such a way. I think he defines the value of his skills as they are diluted in each of the layers it takes to reach his customers. From a customer or patient perspective it is that person’s skills who are closest to them in that moment that makes the biggest difference.

Roland does not see his role as one of privilege but one of responsibility. He said the biggest surprise in becoming a CEO was the weight of the responsibility. Every decision impacts so many lives. His focus on truth, transparency and accountability is simply an acknowledgement that from a patient’s perspective he is on the lowest rung of the ladder. It requires every member of his team to have the information, resources and opportunity to serve each patient in the way that patient deserves to be treated. As he saw it, not telling the truth was never even an option.

I doubt the Roland has much time to put his feet up these days, but if he does find a moment or two at least he has the right shoes for the job.