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Friday, November 20, 2009

Skip the Social Media Staff

In the past few weeks I'm hearing discussion in our company and elsewhere about the potential need for social media specialists of some sort. I believe we should heed the history of technological innovations, get ahead of the curve, and skip this expensive and soon to be outdated step. Social media is on its way to becoming a required and ubiquitous skill set in several job families, not a position or department.

I see similarities between this technological development and two others I've experienced in my career; the use of interpreters and the adoption of the personal computer.

In international business the model was often that people of different cultures transacted business in some neutral third language or utilized interpreters to facilitate communication. It may seem a quaint notion if you're under 50, but there was a time in business where executives working in foreign countries actually travelled with a person who was paid to help them communicate. Early in my career, about the late 70's or early 80's, we saw a shift in that companies began to train staff members in foreign languages, or hire bi-lingual or tri-lingual graduates. The last interpreter I hired was in 1991; after that it was required that you speak more than your native language for almost any foreign assignment, and no mono-lingual staff members were considered promotable to positions with international responsibility. The bar was raised and has never lowered since. Companies then had to cope with the unwinding of interpreter staffs through layoffs or reassignments.

We saw a similar situation with the personal computer. Again, a quaint notion for younger readers is that we used to pay people just to type memos and other documents. Skilled staff and managerial positions required no typing skills. When the PC broke on the scene it was embraced by skilled knowledge workers first as a way to improve all manner of graphic and calculating work (engineering, design, architecture, etc...) and a way for the average office worker to escape the control of the Data Processing department (another quaint notion) who controlled the main frame computer.

Within a very few years the idea that a company would pay someone to type for you became as ludicrous and paying someone to speak for you. Typing became "keyboarding" and became a requirement for practically any office job. Later the integration of spreadsheets and presentation software with word processing led to the "office suite" concept of prepackaged integrated software. Now the price of admission into any career working in an office was working knowledge of Microsoft Office, Word Perfect Suite, or similar product. Within a staggeringly short period of time about half the "secretary" positions in the country disappeared as the bar was raised for skills required to work in office positions. Today you don't think of hiring someone for a knowledge-worker position who can't keyboard and use office software.

This brings us back around to Social Media. This new technology continues to develop and morph into whatever it will become. When it finally matures the communications between people who share some affinity or commonality will never be the same. Positions like marketing and recruiting, those that connect a company with those outside its own walls, will require the people working in them to have social media skills. Those companies who decide right now to hire social media staffs to help them leverage this new technology will, by the time they build those staffs, find themselves with an expensive and outdated apparatus. They will be unwinding and disbanding their social media gurus like the interpreters and secretaries of past technological periods. I won't have a social media specialist to help my recruiters search LinkedIn, Facebook and Twitter for talent; I just won't hire a recruiter who can't do that for themselves.

What makes the most sense now is to discern the essential skills necessary to communicate and mine for information on social media, and then teach that to our staffs. We should not consider for entry-level employment anyone in marketing, PR, publicity, recruiting, and business development who does not know how to navigate social media. If done right we'll be hitting our stride in mining on-line communities for business while others are expending energy downsizing or disbanding their social media groups or departments.

Saturday, November 14, 2009

Live Events Division Office On the Move?

It is highly likely that we will move the division headquarters of Thomas Nelson Live Events sometime this summer. While that's not guaranteed, that seems to be the direction in which we're heading. Some might wonder why, in the current economic climate, we would do such a thing. After all, isn't that inconsistent with our measures to cut costs and preserve cash? Here's what we're doing and why.

Since the merger of the Facilities and HR departments I've been getting an education on commercial space. New space is often referred to as "Class A" space in that its new, well apportioned with a good location and solid management. Class B space is Class A space that has aged well, but no longer has the first class look of new top-quality space. Class C space is run down and tired, old and/or poorly maintained.

The Live Events division space in Plano occupies offices that its been leasing for 9 1/2 years of a 10 year lease. That space was probably Class B when it was leased by the previous owners of the company. The lease rate was very reasonable, but was a la carte. Everything is an add-on, including maintenance, janitorial, security, etc... We also get assessed for common-use major maintenance, such as when the HVAC system had to be replaced for the building. Over the years that we've occupied this space the actual "all-in" occupancy cost has been the equivalent in the Plano market of low-end Class A space.

During the period of our lease the absentee landlord has declined to put requested repairs and upkeep into that space. Last week I noticed that almost every wallpaper seam in the one larger conference room was loose. A letter sent by our broker 2 1/2 years ago requesting over a dozen "immediate" repairs has resulted in none of those repairs being made. The result of this neglect is that, according to our brokers, this space has now become Class C space at a Class A price.

Because of these factors, and a half-hearted renewal proposal from the landlord's property manager, we began looking for space a few months ago. What we discovered was that the vacancy rate in the north Dallas market (Plano, Richardson, Allen, etc...) is extremely high with some buildings having space that's been empty for 2-3 years. Our first round of price quotes indicates that we can upgrade these offices from Class C to upper-end Class B space for 30 - 40% less lease. We're also insisting on a comprehensive lease so that our division with the smallest percentage of male employees is no longer responsible for their own maintenance.

Over the next few weeks we'll issue a Request for Proposal (RFP) to and receive responses from six finalists. We've arrived at these six from an initial review of 80 commercial buildings in the Plano area. The current landlord is welcome to bid as well and its not inconceivable that they could wake up. Given past history, I seriously doubt it but anythings possible.

So that's the inside scoop for those of you in Plano who asked me if you're "really going to move this time." That's also the facts for anyone wondering if we've lost our mind. Our goal is a significant reduction in cost and simultaneously a significant increase in the quality of the work environment and workplace satisfaction. We'll be pushing hard on this for an April/May decision and a possible move in late summer.

Wednesday, November 11, 2009

Listen to Your Uncle Julio

Earlier tonight at the recommendation of friend and colleague Lara Dulaney I stopped for dinner at Uncle Julio's in Allen, TX. Knowing that the rest of the Nashville contingent had gone home a day earlier, and that I was dining by myself, she told me that the food was good and that I could get a full meal at the bar. I thought that was a good idea because you're not so noticeable as "dinner for one" eating at a crowded bar.

I drove the extra exit up from my hotel in Allen and found the place on an out-parcel in a shopping center that had TJ Maxx and Dick's Sporting Goods among other stores. It was mid-priced/low-upscale so nothing that felt like a waste of money. Unlike the eerily deserted restaurants I saw during lunch in the Plano area Uncle Julio's was busy at 8:00 p.m. and had the appearance of winding down from the dinner rush.

So I sit at the bar and here is where the story really begins. One of the two bartenders stuck out his hand, said, "I'm Jeff what's your name?" and asked me where I was from and had I dined there before. I told him I hadn't and he made several recommendations. What I had isn't important, but it was good. Jeff came around and made conversation. When I asked for the check he said he'd bring it but that he had something for me.

When next I looked up there was a manager standing there with plate of soppopias and honey. He also stuck his hand out, introduced himself (Josh, I think, but I may not have heard him correctly). He said, "Jeff tells me you're here for the first time. We wanted to give you a little something special and ask you to come back." I tried to share this plate with everyone at the bar because there were enough for four people.

As I'm leaving I thought about what had just happened. A fully engaged and well-trained employee made a special effort to connect with me on a first-name basis and identify me as a potential new customer. He passed that along to his manager who similarly made a first-name connection and gave me way more than I had expected. I don't believe for a minute that its coincidental that Uncle Julio's parking lot was full while others were empty.

Business is about people and human connections. Business people tend to think its about finance, but finance is to business what a score board is to the football game. It doesn't play the game; people play the game. What a company's financials tell us is what happened between people in the act of commerce. When restaurants in this area are having the same predictable Board of Directors reaction to slash expenses and cut their way to prosperity, Uncle Julio's is reaching out and taking their fair market share, and then some, by engaging employees and connecting with customers.

If your parking lot is empty, either the customer lot or the employee lot, maybe your should listen to your Uncle Julio.

Friday, November 06, 2009

While We're Reforming Healthcare Let's Talk About Doctors

I'm writing this over lunch having spent the better part of my morning going to and coming from an appointment at the Vanderbilt University Medical Center Hand Clinic. I never saw a doctor; I walked out after an hour and a half and I'll decide later if I go back. This morning reminds me of a study done in 2007 on the hidden cost of physician inefficiency.

This study, available on studied Americans 15 and over during 2007 to see how much time is spent in physician waiting rooms. That number...and maybe you should sit down, is 847 million hours in one year. In 2007 the average wage for American workers was $17.43/hr, so the total cost to the economy was $240 billion. The average American that year spent the equivalent of 1.1 hours per week in a doctor's waiting room. So, take your average hourly wage x 52 weeks a year x 1.1 and see what you or your employer are spending each year.

In all other commercial transactions in a capitalist system the person to whom you pay money is working for you. Medicine is an exception. Only in medicine do the people and institutions to whom we pay money (either directly, through our health insurance, or both) dictate the environment in which we'll wait, how long we'll wait, and what care we'll receive (you can assert your rights as a patient to guide or refuse the care offered which is not always appreciated by your physician). Timeliness, it is safe to say, is not a metric used to assess the performance of most physicians practices.

Let's draw a distinction for the rest of this discussion between routine care, which most of us receive, and life-threatening care such as rendered via oncology, cardiology, emergency medicine, etc... I never minded waiting in the Breast Clinic with my wife while her doctors were treating cancer. That's way different.

Now here's the big "ah ha." Practically all non-life-threatening care is routine. When was the last time you had an experimental treatment? If you're like most patients, its never. Anything that's routine can be analyzed and measured.

Whether you're treating a common cold or rebuilding someones knee, with a modicum of study you can determine how long that takes. You can then schedule your appointments around those needs. You don't have to know the diagnosis if you're an ear, nose and throat specialist; those coming to you are making appointments because they have an ENT need. Same with orthopaedists and double for primary care physicians.

In other words, there's never a good excuse for over booking your practice and making people wait unnecessarily.

This is a paradigm that we should shift while we're reforming American health care. If more patients demanded timely care, and took their business elsewhere when they didn't get it, then timely care would become a measurable performance metric in physicians and clinical practices. Those operations, for all the good they do for humanity, are also businesses and are sensitive to customer pressure. As patients we just usually don't think to exert it and we should.

Tuesday, November 03, 2009

Push Back When Medical Bills Seem High

One of my family members recently had an endoscopy procedure. It was recommended at this stage of life and was purely preventative. According to our UHC insurance that procedure is covered at 100% when its a preventative screening. After the test the physician met with us and told us the results were "unremarkable".

Note my surprise, then, when I received and EOB for the procedure asking me for $800 as my portion of the expense. We called UHC who explained that physician's office had coded the procedure as "General Illness" and so our plan would only pay 80% after a $500 deductible. I tried to explain back to them that the procedure was covered at 100%, to which they replied that as long as the bill was coded anything other than "Preventative" there would be a deductible and co-insurance.

Next I went to the physician's practice at Vanderbilt Clinic. After three phone calls over four weeks and ever-elevated blood pressure, I took an unusual step. I jointly emailed our UHC rep, the physician, and the VUMC billing dept rep explaining that someone had made a mistake; either the physician was wrong when he told us that he found nothing, the coding was incorrect when an unremarkable test result was coded as an "illness", the billing was incorrect if a preventative screening was billed as an illness, or the claims processing was incorrect if a co-pay and deductible was applied to a preventative service.

Well, none of them were amused and I did have to make a phone call to Vanderbilt Patience Advocacy. Eventually, on 9/23 (8 weeks after the service date) the physician's bill was reprocessed and paid at 100%.

So all was well. Until it wasn't.

Two weeks ago I received a $297 bill for the hospital's portion of the billing for this same procedure. My wife called while I was at work and Vanderbilt Patient Billing explained to her that this bill had already been reprocessed and that UHC would only pay 80%. We did indeed owe this. Two days later, this last Saturday, I received a final notice from Vanderbilt on this same balance.

Monday morning I called Patient Billing. I found that their customer service calls are taken by their accounting staff and I had a 40 minute conversation with a lady determined to tell me I was going to pay the bill. One supervisor conversation later and this bill is now in coding for review, which is what has to happen before it can be recoded and billed properly.

This long narrative is meant to make these points.

1. Vanderbilt's medical coding and billing has stumbled in recent months. I'm not sure what's wrong over there, but you should look at your bills and make sure that what they're charging you squares with what you understand your benefits to be.

2. You should question any charge to UHC and to your provider that is for more than you think you owe.

3. Make sure and get a printout of your scheduled benefits off or from HR, as the first time we asked UHC about our benefit they misquoted it until we faxed them our benefit schedule.

4. Keep your cool. The people who take these calls are accustomed to yelling and screaming and you make yourself refrigerator noise when you do. Get your facts together and beat them with kindness, calm, reason, and superior facts.

5. Medical billing staffs are not terribly well trained or well qualified. This profession is like Education and Human Resources. Anybody can get into the field so while you can have professionals of high quality and integrity you can also have under performers make a career out of making mistakes. Don't ever assume that your bills are coded correctly.

6. Ask HR. Before you let any of this make you crazy, come see us. We deal with these types of issues all the time.

Whenever I deal with my own insurance I get really concerned for everyone else. I've been administering benefits for 25 years, I know bad work when I see it, and I'm not afraid to call it out. If I have this much trouble, what does everyone else do? My concern is that you pay it and move on.

Before you pay something you don't believe you owe (because the providers and insurers will certainly let you!), come see us.