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The Art of Physician Courtship: Five Things Healthcare Leaders Can Do to Lay the Groundwork for Physician Integration

April 4, 2011

Click the link for a video going into more detail on this topic. Blog Response

It seems we in the healthcare industry constantly hear about the upcoming “marriage” between hospitals and physicians. And while it’s not yet clear exactly what form this partnership is going to take—ACOs, physician employment, or something else entirely—the people in suits and the people in white coats are about to get a whole lot closer.

This raises a very logical question: How can you ever get married when you’ve never enjoyed dating?

No one knows what will happen as pay-for-performance really gets rolling, but it doesn’t matter. Organizations need to get focused on building strong, healthy relationships with their physicians, however they work together right now. (If you don’t lay the groundwork for a solid partnership, can you imagine how unhappy the marriage will be—and how much the divorce will cost?)

The idea is to become the kind of organization that physicians want to partner with. Even if the “marriage” ends up not happening, everyone will be a lot happier in the present.

At Studer Group®, we work with plenty of organizations that get physician integration right. These organizations do very specific things that set them apart:

They understand that, in the hierarchy of physician needs, great patient care comes first. Physicians care about clinical outcomes. Other things matter, too (workload, reward & recognition, the ability to make a living), but knowing patients are well taken care of has to come first. Providing exceptional quality care—every patient in every department every time—can happen only when you have the right culture. And that “culture of always” can happen only when you get the foundation right.

It’s Evidence-Based LeadershipSM—a foundation that gets their goals, behaviors, and processes aligned and working together—that allows them to reduce variances in leadership skills and processes and helps organizations achieve predictable, positive patient outcomes.

They measure physician satisfaction. It’s very simple: If you want to know whether your physicians are happy with your relationship, ask them. It’s amazing how many organizations don’t take the obvious step of diagnosing physician satisfaction. And what’s even more amazing is how many do diagnose it but then fail to act on the results—or even switch vendors rather than look for ways to improve the situation.

If it’s really important to you, you measure it. You diagnose. And you don’t run from the answer.

Once they’ve measured it, they take action to improve it. Rochester General Health System in Rochester, NY, is a great example of physician integration. RGHS took its physician satisfaction results from the 11th percentile to the 90th percentile in a very short amount of time. It did so by measuring one domain at a time—administrative response time, communication, tools and equipment, ease of practicing medicine—and by working with physicians to create a game plan on improving each one.

Their leaders keep in close touch with physicians. Leaders cannot engage their medical staff from an office. To build solid relationships, they need to establish sincere, face-to-face, two-way communication with physicians. This doesn’t just happen. Leaders have to make it happen. That’s why we recommend that leaders build time into their schedules to round on physicians.

We’ve found that when leaders round on physicians once a month, satisfaction results will be in the 87th percentile for likelihood of recommending the hospital to a colleague or patient. If you round quarterly, satisfaction is in the 75th percentile. If you round every six months, or never, it’s in the 50th percentile. So if you’re going to round, you have to do so at least once a quarter to make an impact.

They look for ways to make physicians’ lives easier. Two simple tools we recommend are Got Chart and physician preference cards. The first is a checklist nurses use when they need to call a physician about a patient. It lays out the information the physician wants to know (and in what order) and makes these interactions more efficient (and safer for the patient, too). The second is just what it sounds like: a card the organization creates for each physician to let staff members know which rounding time he prefers, how he prefers to be contacted, and so forth.

As you can see, both tools are very low-tech and easy to use, but they make a big difference in physician satisfaction.

Physician integration isn’t really about ACOs or any other financial structure. It’s about making sure hospitals run well. It’s about making sure patients are given exceptional care, not just some of the time but every time. It’s about creating solid relationships with physicians, so that they want to join forces with you in whatever form the partnership takes.


Quint Studer

Quint Studer, CEO

Studer Group


Effective Meetings: Two Powerful Communication Tips to Try Right Now

March 16, 2011

(Don’t miss the link at the bottom to a video clip diving deeper into this topic.)

What separates high performing individuals and groups from lower performing ones? Often there’s a simple answer: communication.

Because leaders are human, it’s unlikely we’ll ever communicate with 100 percent clarity and efficiency. The great news is there are things we can do that will lead to vast improvements in this vital area.

Here are two techniques we suggest leaders try. Both of them involve adjustments to the meetings you’re already holding:

  1. Synchronize meetings between senior leaders and direct reports. During your next senior leader team meeting, ask each leader when he or she meets with direct reports. It will become obvious why there is inconsistency in performance. Let’s say the senior leader team meets weekly on Tuesday afternoons. It is not unusual to learn that some leaders meet with their direct reports on Wednesday, Thursday, or Friday. Some may wait until Monday. Chances are very few hold their meetings late in the day on Tuesday (right after the senior team meeting).

    There is also inconsistency in how often senior leaders meet with direct reports. Some meet each week; others at least once every two weeks.

    So, what we have is a situation in which important items are being shared at different times (and at different frequencies) with key stakeholders. The result is that some staff members are taking action immediately. Others aren’t. And the staff members who haven’t yet had their meetings hear things through the grapevine from the others—which leads to confusion and misinformation being passed around.

    A good solution is to ask everyone on the senior leader team to hold their direct report meetings on the same day and (if possible) at the same time. This simple change will greatly reduce the time leaders spend reacting to people wondering if what they are hearing is correct. It will also ensure that everyone is taking the same actions consistently.

    Finally, holding all leader department meetings at the same time will make it much easier to pull the entire group together, if needed.

  2. During meetings, clarify exactly what will be communicated afterward. I find that in both senior leader meetings and department team leader meetings, very seldom is time allotted to discuss what needs to be communicated, when, how, and by whom. Taking time to do this will result in all leaders, and thus the organization, being on the same page.

    Experience has shown me that in most organizations it’s not the decisions that are the problem, it’s the communication around them. We spend all of our time and energy reaching decisions, then miss the opportunity to assure the best way to communicate those decisions. It’s this last 10 percent that makes the previous 90 percent pay off.

I urge you to try these two simple techniques. I think you’ll find they go a long way toward ensuring the optimal execution of the decisions you make.


Quint Studer

Quint Studer, CEO

Studer Group

Click the link for a video going into more detail on this topic. Blog Response

Six Days of Suggestions to Keep the LOVE in February

February 14, 2011

I love February! Want to know why? Well, first off, it means we’ve made it through January—and thank goodness, because January is always a tough month with the end of the holidays, putting away the decorations, paying the bills, ugghh…And then of course there is the January weather! Wow, this year has been awful with the record cold temperatures and terrible winter storms. I landed in Atlanta one day and saw big piles of snow on the runways…What’s up with that? So when February 1 rolled around, I said good riddance to January; now we are in the home stretch of winter.

But that is not the only reason I love February: I also love February because as we make our way to spring, we get our shortest month…28 fast days. And to top it all off, smack dab in the middle of those 28 days is Valentine’s Day, the day devoted to love. How magnificent!

I am urging all of you to really celebrate the holiday of love this year, and to use it as the perfect catalyst to chase out any negativity that crept back in during January after the fun of the holiday season or even stuck with you during the first part of February. When I was working at Holy Cross Hospital, we celebrated Valentine’s Day for an entire week, and when you do that, you can’t help but chase away the winter blahs and the negativity that goes with it.

So here are six days’ worth of suggestions to choose from:

  1. Coworkers. Remember how fun it was to get those cute valentines in those little envelopes at school? Guess what: It still is! Can you imagine looking in your mailbox at work and finding ten tiny cards? Encourage your colleagues to pick out valentines that best suit them, like Bob the Builder from the person who’s always remodeling their home, or Snoopy from a pet lover, or Strawberry Shortcake from a petite team member.
  2. Customers. These can be patients or internal customers. For patients, you could give red pens with pink hearts on them along with the hospital’s or department’s name. You also could have something printed on the pens such as, “We love our imaging patients.” Internal departments could do something sweet for their customers: IS/IT Departments could spend time out on the units cleaning keyboards, and Marketing Departments could coordinate a poster contest for support departments to acknowledge the internal departments that they serve. The posters could be displayed and voted on in the cafeteria.
  3. Colleagues. How about those folks in other departments who make your life easier? For example, simple cards signed by everyone in your department given to the cafeteria folks who always wait that extra minute when you are running late to catch the last serving time, or to the housekeepers who know what your floor needs even before you page them are sure to be appreciated.
  4. Physicians. We know that Doctor’s Day is in March, but how about a little preview? You could do baskets of those conversation hearts or Hershey’s kisses in the physicians’ lounge or at the doctors’ entrance if you have a separate one. An amusing heart-shaped sign above each basket (I mean, you want them to know where the treats came from!) could read, “At ABC Medical Center, we love our physicians,” or, “Memorial physicians are really sweet”…Okay, maybe that’s a little too much, but you get the idea.
  5. Families and visitors. Imagine how great it would be if one day during Valentine’s week, visitors were surprised with free coffee and heart-shaped cookies. The treats don’t have to be extravagant or costly—just a cart with some decorations and perhaps a placard that reads, “We love our families and friends.”
  6. Staff. If you are a leader, now is the perfect time to let your team know how much you appreciate them. My all-time favorite, which also became a tradition, were heart-shaped pink bagels…Yep, I said pink bagels. A local bagel place did them every year, and of course they were served with strawberry cream cheese. Baskets of candy also work, as does sending flowers because they last for several days (meaning several shifts).

I promise you, with all this love and celebration going on for a week, it will chase negativity right out of the place. The next thing you know, it will be February 21…Then, poof, only one more week ’til the end of the month. And we all know what that means: March and, hallelujah, SPRING!

Liz Jazwiec is a recognized national speaker and author of Eat That Cookie!, winner of the AJN 2010 Book of the Year Award.

Analyzing HCAHPS: Two Resources on a Hot Topic

April 14, 2010

In the past, hospitals have used a variety of mechanisms to measure patient satisfaction. That is about to change. The reason? HCAHPS scores. This standardized patient survey tool is the only one that a) provides a true “apples to apples” comparison, b) overtly connects to clinical outcomes, and c) shares its results with the public.

More and more hospitals are taking notice of HCAHPS—and since the results are posted online for the world to see, so are more and more consumers. If you want to know how your organization is really doing, this is the only patient survey tool you need.

Recently, I had the honor of being interviewed by Becker’s Hospital Review on the subject. I invite you to read the resulting article: “Quint Studer: Using HCAHPS to Drive Patient Satisfaction.”

Also, last month on my radio show I interviewed Karen Cook, RN, on HCAHPS results, how they connect to quality and clinical outcomes, and what hospitals can do to effectively use this data.

One of the nation’s leading HCAHPS experts, Karen has more than 20 years of clinical nursing and management experience in healthcare. She has been particularly successful in helping organizations reduce turnover and empower nurses to participate in creating great work environments.

Click here to listen to my interview with her (it’s broken into three segments). As you can see, HCAHPS is a “game changer” for our industry. I hope you will take advantage of these two resources to learn more about it and what it means for our industry’s future.

Eight Roadblocks to Moving Best Practices

January 20, 2010

Have you ever noticed certain leaders or departments in your organization are really, really good at doing one specific thing? Maybe they consistently get great patient satisfaction scores, or their employees have very low levels of absenteeism, or their infection levels are consistently lower than those of similar areas.

It’s clear that these high performers are doing something different, something that sets them apart. And whatever “magic touch” they have, you’d love to bottle it and distribute it to other areas of your organization. In fact, you may have done some digging and figured out what they’re doing right. But when you tried to get others to follow their lead, there’s a good chance you fell short of the goal.

Harvesting “best practices” and transferring them to other leaders and departments is a wonderful way to achieve organizational consistency. And yet, many organizations just can’t seem to get it done. Have you ever wondered why?

We have discovered there are eight common “roadblocks” that keep organizations from identifying and moving best practices. They are:

  1. High performers can be modest. They minimize what they do. “Oh, it’s no big deal,” they’ll say. To figure out what they’re doing that’s different, you need to dig deep. In fact, digging deep with a high performer is how we initially discovered the impact of hourly rounding—which was later found to reduce call lights, falls, and skin breakdowns and to increase patient satisfaction.

  2. A leader may fear losing his edge. If he tells everyone about his best practice, he will be unable to keep up his success. This does not happen frequently, but it does come up.

  3. Sometimes the high-performing leader balks at taking on a “teaching role.” Maybe she doesn’t want others in the organization to think she is showing off or that she is the boss’s favorite. And when she does present, she will even give reasons for why she could successfully implement the best practice but it may be hard for others.

  4. Success is attributed to the leader and not the best practice. People think it’s the leadership and not the practice itself that’s getting the great results—so the actual best practice is missed or underestimated.

  5. Leaders want to keep their autonomy. Implementing someone else’s way of doing something makes them feel they are giving it up. It moves them out of their comfort zone. (This is especially true in the C-suite.)

  6. “Terminal uniqueness” can hamper moving best practices. Leaders are quick to point out how they are just a little bit different and that’s why a certain best practice won’t work for them.

  7. Egos get in the way. By the time some people get to the C-suite, they are better leaders than followers. Or at least they think they are!

  8. There is too much change and not enough time. There simply isn’t enough time for a best practice to be mastered—and it’s dropped before it’s given a fair chance.

The good news, of course, is that there are solutions to all of these roadblocks. Smart organizations will work to overcome them. Best practices are the ticket to great results—and isn’t that what we’re all looking for?


Quint Studer

Quint Studer, CEO

Studer Group

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Who is your spark?

January 13, 2010

I came across this quote awhile back and have always included it in my Inspired Care and Inspired Nurse presentations. Reflect upon this for a moment…“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” – Albert Schweitzer

For all of us there has been or is someone who kept or keeps us going. As healthcare folks I think this is even truer. Think back on times, in your healthcare journey, when you thought, “I can’t keep going!” For some of us it was in school. Remember those days? Maybe some of you are in school right now. There was that friend, or peer, or instructor that said, “You can do this. Don’t give up.”

Think back on any time when you felt like throwing in the stethoscope (or tool of your trade!). Maybe it was when you were training for a new job, your first job, as a charge nurse, an assistant manager, Senior Technologist, manager….it goes on. There was someone there for you. When your light was fading, they “rekindled” that flame. Sometimes it was with words. Other times it may have been through a helping hand. Whatever it was, it made a difference in your life. Maybe that person continues to play that role today.

The question I have for you is; “Do they know”? Do they know the impact that they have had on your life? Do they know that, maybe, you would not be in healthcare if it weren’t for them? If they don’t, here’s your challenge. Tell them. It is simple. Let them know! Write them a letter. Send them flowers. Drop them an email. Call them. Go and visit them. Let them know that they were, or are, the spark that lights your flame when you feel like you’re going to fade. This gratitude that you extend will serve two purposes. It will help their flame to burn brighter and it will fill your heart and increase your inspiration. After you’ve done this ask yourself one more question: “Who am I a spark to?”.

Be well. Stay inspired.

Rich Bluni, RN

Rich Bluni, RN
Studer Group National Speaker
Studer Group

Read a complimentary excerpt from Rich Bluni’s book, Inspired Nurse, at

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Keep Performers Close…and Document Relentlessly

January 6, 2010

Our research shows that, on average, every supervisor of staff —from the CEO to front line supervisors—reports 1.78 employees who are not meeting performance expectations. When one considers how many leaders an organization may have, you quickly realize that this translates to hundreds (maybe even thousands) of low performers.

Also, of the “not meeting expectations” crowd, between 40 to 60 percent of those identified are not in any form of disciplinary or performance counseling. For that matter, they also have no documentation. This is not fair to them, to their co workers or to the organization. I will get to that in another blog entry.

The point is most organizations need to let some people go. There is no way around it. And this brings up two important points: 1) alleviate the worries of your middle performers, and 2) get really serious about documenting performance issues.

Last week I was talking with someone who told me when they let a person go from their department it caused what they felt was a higher than expected level of anxiety with others in the department. I asked if they had stayed extra close to the other staff as the departure process was taking place. In retrospect, they said they had not.

My advice is this: when you know you will be taking action on a person who has performance issues, first make sure you are close to the other people who do not have performance issues. While the very high performers on your team may not worry, if other staff members are not feeling safe they will have anxiety—and that anxiety will impact both their quality of life and their productivity.

I’m not suggesting that you say, “You are fine, so when you hear that so and so is leaving, relax!” However, you do want to make sure the others in your department know you want to retain them. It’s important to go over what they do well and to clearly state your commitment to development. This way when a change is made they will not feel unnecessary anxiety.

Now for the second point: It used to be that many staff members with performance issues would self-select out when they were held accountable. Not anymore. Why? Quite simply, there are fewer jobs to go to.

Many times, lower performing individuals at the leadership level would relocate when self-selecting out. Today, that’s less likely to happen. Even if these people can find other jobs, they probably cannot sell their homes. So for supervisors this means more relentless documentation.

In summary, each day is a day for leaders to retain those staff members that are performing at or above expectations, which is most of them. And it’s also a day to keep a close watch on those staff members who aren’t meeting expectations—and to make sure you’re keeping careful records on them.

Both actions will help ensure that you have a calm, focused, productive staff today and in the future.


Quint Studer

Quint Studer, CEO
Studer Group

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The Power of the “Why” behind the “What”

December 16, 2009

Often after I do a speaking presentation, people will come up to me to ask questions and share steps they are taking to improve performance. Some of the saddest moments are when it’s evident that someone is working very hard to serve patients and it appears many of the right steps are being taken—but the objective results are not there.

I’ve identified a common theme in these situations. Even when many of the correct steps are being implemented, one critical step often is not: explaining the why. Sometimes explanations have more impact than behaviors.

Here are several examples:

Example 1: A hospital wanted to improve the patient’s perception of speed of direct admissions. Through process improvement it had reduced the average time to around 20 minutes from a previous average of over 40 minutes. Yet, patient perception of the speed of admission process stayed the same. The issue was that the change was not explained to patients—so they had no basis for comparison. It simply seemed slow.

The recommendation was to say to each patient: “The admission process you are going to go through used to take an average of 47 minutes. However, we’ve worked hard to speed up the process and now it should take less than 25 minutes. When you’ve completed the process, we’d like your feedback on it.” The hospital implemented these key words and ratings went up.

Example 2: An Emergency physician told me the story that while he tried to make all the patients comfortable he was not explaining the actions he was taking. For example, “I want you to be as comfortable as possible—would you like a blanket?” or “I have ordered pain medication to make you more comfortable.”

While he and the other physicians had always done these behaviors, they had not connected the dots for the patient. Once they started doing so, the patient perception of care (satisfaction results) improved.

Example 3: A hospital’s HCAHPS result on noise was not good. To remedy the problem, the organization had put softer wheels on carts, eliminated paging, and even purchased quieter keyboards and put up signs asking people to keep noise levels down. Unfortunately, no improvement was experienced in the HCAHPS.

Here is what took place next. The staff explained to the patients and family members that they wanted the unit to be as quiet as possible so the patient could get rest. They even explained the steps they had taken, such as the softer wheels and the elimination of paging. They added: “While we do all we can, we are a hospital and some noise is inevitable as we’re caring for patients. Still, if it’s too noisy, please let the staff know and we will do all we can to keep things as quiet as possible.”

Guess what? Perception of quietness went up and noise went down.

I see healthcare professionals working very hard, taking many of the right steps, and I see their disappointment when those results are not there. Often, they end up trying even more actions—which may still not make a difference.

My suggestion is this: before you make even more changes, first take the time to better explain the why of the current actions. The patient’s perception of care will improve. Sometimes, words actually do speak louder than actions.


Quint Studer

Quint Studer, CEO
Studer Group

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“I won’t say I’m sorry if it’s not my fault.” (“And by the way, don’t script me!”)

December 9, 2009

The other day I received a note from someone with a copy of a letter sent to him by a staff member regarding a conversation with a patient who was upset with the care she had received. The note basically read, “I won’t say I’m sorry if I didn’t do anything wrong. And I won’t use tools that have been provided because I don’t want to be scripted.”

I am sure many of you are thinking of some “key words” you would like to use right now! But instead, let’s attempt to help this person see the value of handling a complaint in a value-driven manner. I’ll address his concerns one point at a time:

Point #1: “I won’t say I’m sorry if I’m not at fault.” Saying you are sorry does not have to mean you’re admitting a mistake. It is fine to say, “I am sorry we are not meeting your expectations.” This does not mean that you or anyone else did something wrong.

The Fire Starter Publishing book “I’m Sorry to Hear That…” Real-Life Responses to Patients’ 101 Most Common Complaints About Health Care (by Susan Keane Baker and Leslie Bank) offers numerous examples of ways to say you’re sorry. The main goal is to get patient care back on track.

When I was president of a hospital, I wanted to help the patients and families get to the point in which they followed the treatment plan and worked with the staff, not against them. So when a patient complained, I would say, for example, “I am sorry you are disappointed,” or, “I am sorry we’re not meeting your expectations.” I followed this up with, “What would you like us to do?” Probably 95 percent of the time, it was something that could be done.

Sure, there were times when an issue was not able to be resolved. But most of the time things got back on track. In fact, our litigation all but disappeared—and much of the credit was due to those simple words.

Point #2: “I will not be scripted.” We prefer to use the term “key words” instead of “script.” (It seems healthcare people can be so upset with the word “script” that they miss the outcome.) Whatever you call it, scripting works. The goal is to use words, phrases, actions, tools, and techniques to help the situation and to achieve the best possible outcome.

Parents love scripting: “Say please,” “Say excuse me,” “Say thank you.” Spouses also use key words: “I love you,” “Thank you,” and “Let me get that.”

In healthcare we use scripts—or key words—with patients all the time. “Press this button if you need anything,” “Tell me if this hurts,” and “Let me know if you have questions.”

During each patient visit, physicians use the phrase, “Can I answer any questions?” When I ask them why, they say that it lets patients know they are interested and that there is time to ask questions. It also reduces calls back to the office. I believe that when the reasons why are correctly explained to them—and when they understand there’s a way to do it without admitting error—people don’t have a problem with saying sorry. (Of course, if it is an error, we need to say it is and fix it as best we can.) I also feel most people understand that key words can reduce anxiety, improve compliance with the treatment plan, and offer many positive benefits.

As for the person who inspired this blog post, let’s hope he did not understand the why of saying “I’m sorry” and of using a script. If he said these things out of his own discomfort, let’s hope that once training is provided, he will come to understand the why of de-escalating the situation. Patients, families, physicians, and employees have enough stress in their roles without letting situations that can be calmed down get heated up.

And if after learning the benefits of saying “I’m sorry” and putting powerful key words into practice, the person still can’t get it, he just may not be right for healthcare.


Quint Studer

Quint Studer, CEO

Studer Group


Is respect given or earned? (How to not be micro managed)

December 2, 2009

In a meeting I recently attended, a leader shared that she felt her department was not respected. Her statement led me to look into the department in question. What I found was the department had poor results in expense management and physician satisfaction—and it also had low patient satisfaction.

Perhaps the lack of respect is not surprising.

Real respect is earned. And the best way to earn respect is through good results. Don’t get me wrong: the role of the department and the duties of the individuals that work there are always respected. But if the department as a whole is not respected, chances are the reason has to do with performance.

Liz Jazwiec’s book, Eat THAT Cookie, points out how easy it is to fall into victim thinking, and how easy it is to reinforce that kind of thinking when it develops in an organization.

When someone comes up to you and says he feels his department is not respected, or is being bashed or is not being treated well in some other way, he is exhibiting victim thinking. Here are a few suggestions on what to say:

  • Ask the person to share specifically why he feels that way.
  • Ask him what he is looking for.
  • Then, close in on performance.

My experience is that good leaders do not make “victim” statements about not being respected. Generally, it is the leaders whose results are lagging who voice these complaints.

Often, these low performing leaders will report that they are “micromanaged.”

This reminds of me of another story. I was meeting with 12 hospital administrators and some key senior leaders from the system’s corporate office.

At the first break one of the hospital leaders came up to me and said he was pleased the system was moving in this direction. He also asked if perhaps I could influence the corporate leaders to stop micromanaging him.

Later on, right before lunch, I went up to another hospital leader at the session and asked if he felt corporate micromanaged him. No, he replied. In fact, he added, the main thing he liked about the system was that they did not micro manage him and that he liked the autonomy he was given.

Now, these two leaders worked in the same system. They had identical roles inside the organization. Yet, they had two very different perceptions.

I had lunch with the corporate leaders. During lunch I brought up both individuals, without making any specific comments about them. When I mentioned the first one, the immediate response was, “We are concerned about this leader. He is not meeting goals.” When I mentioned the second one, they said, “We never have to worry about Tom. He hits the goals every year.”

In summary, the better leaders achieve their goals, the more respect they and their area will have and the more autonomy they will receive.


Quint Studer

Quint Studer, CEO

Studer Group

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