It’s been 45 years. I’ve had that long to consider health care in Douglas County. What we do well. What we don’t. Time to observe the impact of technology on health care for both good and bad, and to assimilate the cultural changes in physicians and society that influence how we relate to one another. I've had time to think about what matters most and what control I have over other people’s health and happiness. It’s been a humbling experience.
I plan to retire at the end of 2025. It’s time. Evergreen has excellent leadership that allows me to be confident that this group we have built together will continue to burn a legacy into the fabric of our community. My highest priority for the year is to finish well.
When you review the goals I set for this year, the first two are what matters most to me. The other goals are just doing what we do. But the first two goals are ones that I own. The first part of finishing well. The second part is to pass on principles that have carried us to this place.
I do have some fear surrounding retirement, but it isn’t about you. The fear is one of becoming irrelevant. For 45 years, medicine has been my passion. I’ve had good days and horrible ones. But I’ve never doubted our mission. And I liked myself better when I was with you.
Part of what I need to pass on to each of you is a sense of that relevance that emerges from a shared purpose. When work becomes a passion, it ceases to be work. It becomes part of one’s identity. The relationships and memories we develop while we work together can form a legacy that will bless our lives in a manner nothing else will. I invite you to make it so.
I want you to know how proud I am of what we have built and who we are. How proud I am of you. These are four principles that have guided my thoughts through the years:
Mission:
Only a clear, focused, and shared mission can unite the organization and enable it to produce results. The EFM Mission Statement is this:
"EFM strives to provide high-quality, cost-effective, compassionate medical care through a cohesive primary care-based organization. Our obligations are to our patients, community, families, and ourselves. We strive to establish trust and mutual respect with our patients and to advocate our mutual interests within the healthcare system. "
If that mission isn’t clear in our own minds, we have no hope of achieving it. Even as truth is for knowing what’s not, understanding our mission allows us to avoid endeavors that aren’t integral to that mission, no matter how noble they may seem in the moment.
We are a healthcare delivery system, not a teaching facility. Our educational focus is directed toward our providers and staff to enable our mission.
Our “product” is not achieving compliance or meeting metrics but a changed human being. It is a human being whose condition is cured or managed, whose pain is lessened, or whose quality of life is improved even when their condition is not.
Our mission extends to one another. It requires we consider the work experience of each employee who contributes to the mission. Each member contributes something different, but each must contribute toward a common goal.
Leadership is responsible for preserving this mission focus. Charisma isn’t to be confused with leadership. The three most charismatic leaders in this century—Hitler, Stalin, and Maso — inflicted more suffering on humanity than almost any trio in history. What matters is not the leader’s charisma but the leader’s mission.
Good intentions are no excuse for incompetence. The executive who believes that social consciousness is a substitute for managing his hospital or clinic so that it procures the results for the sake of which it exists is foolish, unscrupulous, or both.
Efficiency alone is insufficient. Nothing is so useless as doing efficiently that which should not be done at all. Every value, every program, and every innovation must support the mission or be disregarded.
Management is doing things right; leadership is doing the right things. Working on the right things is what makes knowledge work effectively.
Culture:
Culture is more important than strategy in achieving our mission. It begins with choosing the right people to work alongside. Those people must instinctively embrace our values as character will unlikely change under our employment.
Integral to our culture is the ability to execute ideas. Strategy is a commodity, and execution is an art. History has been written not by the most talented but by the most motivated. Brillant men are often ineffectual because they fail to realize that brilliant insight is not by itself an achievement. Insight is effective through determination and hard systematic work. Intelligence, imagination, and knowledge are essential resources, but only effectiveness converts them into results. In themselves, they only set limits to what can be attained.
I’ve heard it expressed that ideas move mountains. They don’t. Bulldozers move mountains. The most incredible wisdom not applied to action and behavior is meaningless data. Execution shows where the bulldozers should go to work.
EFM culture embraces our values of working as a team and equality of both opportunity and sacrifice. Working with those you trust and enjoy can buffer the most difficult days. Working alongside a self-centered or ill-tempered colleague ruins the best day. One cannot hire a hand – the whole man always comes with it. Executives owe it to the organization and their fellow workers not to tolerate disruptive or nonperforming individuals.
Personal relationships are the only thing that prevents the breakdown of the system structure. There is a constant need for arbitration between system members to adjudicate disputes, jurisdiction, direction, budgets, people, priorities, etc. The most important people, regardless of job description or assigned tasks, are those who keep the machinery running.
Much of our life and memories are connected to work. When that work provides purpose and supportive relationships, the work experience is as necessary as the compensation for motivation. Managing a department requires taking responsibility for relationships.
The executive team must be the keeper of the company’s culture.
Management:
The best leader is not a searcher for consensus but a molder of consensus. Effective leadership is not about making speeches or being liked; results, not attributes define leadership. Results require an approach consisting of planning, organizing, integrating, motivating, and measuring.
The number of functional managers should be kept at a minimum. The preference is to emphasize general managers who oversee an integrated department and are directly responsible for its performance and results.
A well-managed department is a quiet place without drama. It seems boring because the crisis has been anticipated and converted into routine.
Too frequently, what we call management consists of making it difficult for people to get their work done. This especially applies to meetings. People who enjoy meetings should not oversee anything. Meetings are a concession to deficient organizational preparation. One either meets or one works. One cannot do both at the same time. Until we can manage time, we can manage nothing else.
Meetings are necessary but need to be purposefully directed. An undirected meeting is not just a nuisance; it is a danger. Two common ingredients for successful meetings are preparation with a clear purpose in mind and disciplined follow-up. Every participant should have no question about why we are having this meeting.
Good managers can see both the forest and the tree and have learned to connect. They understand when a decision must be based on principle and when it should be made on the merits of the case and pragmatically. Understanding the difference between the right and the wrong compromise is wisdom.
Good managers understand that efficiency is doing better than what is already done. They also understand when the problem is not the person but the system. Any job that has defeated two or three people in succession, even though each had performed well in previous assignments, is unfit for human beings. It must be redesigned.
Good managers are always conscious of the mission and priority. Their focus is first things first and last things not at all.
Innovation:
Any existing medical clinic or hospital will go down fast if it does not innovate. Any new organization collapses if it does not manage. Today is always the result of actions and decisions taken yesterday. It is yesterday’s actions and decisions, that become today’s problem. It is more productive to convert an opportunity into results than to solve a problem- which only restores the equilibrium of yesterday.
Innovation may be perceived as a focus on the future. That is a mistake. We should not try to innovate for the future. Trying to predict the future is like driving down a country road at night with no lights while looking out the back window. We should innovate for the present. That innovation may have a long-term impact and not fully mature for 20 years. The present-day realities will guide the evolution.
It is rarely possible- or even particularly fruitful- to look too far ahead. A plan can usually cover no more than 18 months and remain reasonably clear and specific. The best way to predict the future is to create it. While we can’t predict the future, we can organize it to compete with the present.
The questions we must ask are these:
What results can I achieve that will make a difference in the next 1 ½ years? These results should be difficult but within reach. The results must be meaningful and measurable. Greater results will come by exploiting opportunities rather than solving problems.
Evergreen’s mantra should be to abandon what is about to become obsolete, develop a system to exploit our strengths, and retain a systematic approach to innovation. People tend to overestimate what they can accomplish in one year. But they greatly underestimate what they could accomplish in five years.
Finishing Well
Despite my fears, I will retire without regrets. I know it is time. And I have the greatest confidence with whom I’m leaving our mission. It’s been such a privilege to share this space with you. I wish the best for this clinic and each person who gives their life energy to meet the health needs of our community.
Let’s make 2025 a year to remember.
Tim Powell MD