Stress up the Ladder: Wellness Management is Key for C-suite Execs, Whose Stress Can Affect Entire Organizations
Publication Name: Modern Healthcare
Published Date: 01/05/2009
When hospital executive Jim Casanova gets stressed, he likes to think about a little refrigerator magnet he received as a gift a few years ago. The top of the tchotchke is imprinted with the phrase, "Control what you can," while the rest of the magnet is a mirror reflecting the viewer's face. "It's a little corny, but I think it's a good lesson. You can't control things, but you can try to control your reactions," said Casanova, who is chief executive officer of 195-bed Aurora Sinai Medical Center in Milwaukee. "It's not that we shouldn't try to solve problems. But you can control yourself and your approach to things and your plans and attitude. Not always, not easily, but you can."
Stress control is becoming an important issue in healthcare provider C-suites, experts say, as the tough months that ended 2008 give way to gloomy prospects for at least the first half of 2009, if not beyond.Such times demand good leadership. CEOs and their executive teams could face some of their thinnest balance sheets and most challenging decisions in recent memory as they contend with issues of financial performance, market share, customer satisfaction, and difficulties in the credit and securities markets, said Jim Gauss, president and CEO of Witt/Kieffer. "We are clearly operating in a time of diminishing resources," Gauss said. "Executives are going to have to be smarter, faster, more thoughtful than they were before."
It might be easy for an executive to downplay his or her own stress level when down the hall patients lay in operating rooms and emergency rooms with their life or death hanging in the balance.But there's good reason for executives to resist that kind of thinking and take care of themselves. Thomas Dolan, president and CEO of the American College of Healthcare Executives, said researchers have ample evidence linking prolonged stress to a host of negative physical and mental side effects.
"It's hard to feel bad for people who are making six-figure salaries," Dolan said. "But it's important that they deal with stress effectively, because their stress can affect the whole organization. It's well-documented that stress affects your focus and decisionmaking."
One of the most direct ways to alleviate stress is to fix the problems causing it. And despite the dour financial picture at many organizations, several observers said a bad economy can create opportunities for organizations that are prepared to act, from staff training to joint operating agreements to renegotiated deals with suppliers, physicians and banks (See story, p. 7).
But sometimes that's not enough. "Obviously we can do very little about changing the stress itself, the economic problems, etc. What people can do is protect themselves from the effects of it," said Herbert Benson, an associate professor at Harvard Medical School and director emeritus of the Benson-Henry Institute for Mind Body Medicine, Boston.
In addition to the basics like getting exercise, eating right and doing relaxation exercises, executives turn to stress-relief strategies like building strong teams to share the load, focusing on the benevolence of a hospital's mission and striking a realistic balance between home and work life. (For tips on relieving stress, see story, p. 14)
Above all, leaders look to project the sense of calmness and confidence that they want to see in their workers. When stress levels are at their peak, executives have to perform at their highest level."That's part of the job. Suck it up-that's the job you have," said Beth Krehbiel, president and CEO of 149-bed Fairview Ridges Hospital, Burnsville, Minn. "There's enough stress without the leader being in a frenzy and worried."
Lee Huntley is facing stress, but so is his whole management team.Huntley, president and CEO of 309-bed Leesburg (Fla.) Regional Medical Center, said his team's stress derives not from individual challenges so much as the act of adapting to shifting circumstances in order to stay financially solvent. "Change, just the sheer rate of change, creates stress for the team," Huntley said. It was a topic much on Huntley's mind in late December, as he and his senior staff attended an all-day planning retreat and came to terms with the challenges facing the healthcare industry. Though the scale and rate of the changes is steep, Huntley said his team is less likely to fragment when everyone works together and shares the strain, which takes the pressure off him personally.
Huntley said he's a great believer in the power of attitude and positive thinking, and he was not afraid to use a phrase like "Taking us to the next level of team" to describe his staff-building efforts. "This is really serious work, and this is a great time for us as a senior team to really pull together. Not just for growth, but to show support," Huntley said. "I don't mean to get all mushy. But it's important that we care for each other."
Dolan said employee cohesiveness is especially important at times when workers are looking to their leaders for even the smallest clues about an organization's performance-situations that can often lead to miscues and inaccurate conclusions. But reaching out to co-workers-even socially-tends to become harder as office tension rises, even though it's also more important at those times.
"In times of stress I know I become insular," Dolan said. "I get strength from interacting with my staff and friends. I think it's a time to reconnect."
Focusing on mission
Like many executives, Krehbiel, also a nurse in addition to being CEO of Fairview Ridges Hospital, said she deals with the stresses of work by focusing on the good things that drew her to the field.
She said it's important for leaders to recognize that it's not just them and their staffs, but also the patients, who are facing the crushing pressures of the recession. They come to the hospital to have babies, receive chemotherapy and mend bones after car crashes. But they may also be unemployed or otherwise economically affected by the downturn.
Staying in touch with their needs helps Krehbiel stay grounded as her personal levels of stress rise. "I feel very strongly about the work we do here. It's important, and we are making a difference in people's lives," Krehbiel said. "I try to every single day be talking to staff or a patient. It's easy to lose touch."
Quint Studer, CEO of consultancy Studer Group, said the tight focus on finance in hospitals may threaten to overshadow their good missions, especially in times of financial strain. "It's not because they're money-hungry, because they're not. But they want to make enough money to provide patient care," Studer said.
When Debra Sukin is not busy raising her two young children, spending time with her physician husband, or working as CEO of a 91-bed hospital, she likes to train for marathons. Yes, marathons. "For the past 10 years I have been running For my peace of mind, it is my time that I get to spend. I find it to be probably the best thinking time for myself," she said. Sukin is CEO at St. Luke's Community Medical Center-The Woodlands, outside of Houston. She said that many people ask how she finds the time to run marathons, or even train for them, in between her bustling personal and professional lives, without buckling under the stress.
Juggling act
"Personally, I do juggle. I have two young children...and I am married, my husband is a physician. And I run a hospital," Sukin said. "Its important to work toward making sure your priorities personally and professionally are straight, and that they are very much at the forefront of all the decisions you make."
Achieving that much ballyhooed goal of "work-life balance" is not a matter of making sure that your time is evenly divvied up under a rigid set of guidelines, such as leaving work at exactly the same time each night. She said she makes ad hoc decisions every day based on her relative needs and available resources. "The reality is, it is a 7/24 job. If you see it as I do, as my passion, I don't see it as a beginning and an ending of the day," Sukin said. But "if you constantly remind yourself that your children and family are a priority, they will be."
For Sukin, that means accepting that she cannot attend every single athletic event her boys are in, while making sure her employees understand that they will not see her at work if one of the kids is sick at home. If she wants to make time for running, that comes before the kids rise or after they go to bed. And when everyone else is sleeping, she does not hesitate to pick up her BlackBerry and make management decisions at night.
So what things are left undone? "I made a personal decision that I was not going to work hard Monday through Friday and then wake up Saturday morning and clean the bathroom. I made the decision to quote-unquote 'outsource' that work," Sukin said.
Don't ignore it
Whatever strategy an executive chooses, Sukin said, ultimately they must decide how to deal with stress instead of ignoring it. "If you're in this because it's your passion and you're in it for the long haul, then you have to pace yourself. If you burn out early on, you won't be there for the end," she said.
Roger Armstrong, who has held several CEO and chief financial officer jobs at hospitals over the past 25 years, has no trouble thinking of an example of an executive who failed to control his stress. He was on a conference call with one particularly busy CEO who had been having trouble dealing with his stress. None of his superiors or subordinates had really seemed to notice the problem, until one of his bosses fired a pointed question at the executive. "The CEO just kind of blew up. He stood up and started throwing papers all over," said Armstrong, who is interim CFO at 230-bed Indian River Medical Center, Vero Beach, Fla., through search firm B.E. Smith Inc.
"That's an extreme example. But I think it's happening more in this environment," Armstrong said. "Most people in organizations look to their CEO and leaders for signs that we can handle this-that this too will pass. If they can't exude that calming influence, they cease to become effective leaders."
Here's what experts say is probably going on when a person is confronted with a changing situation: The hypothalamus causes the release of two hormones, adrenaline and norepinephrine, that produce changes in the body to prepare to deal with a fight-or-flight situation, said Benson of the Institute for Mind Body Medicine. In this state of arousal, metabolism and heartbeat increase, breathing becomes shallow, perspiration forms, and the flow of blood to organs and limbs decreases.
While it may have been a boon for ancient hunters, it's not always great in modern societies, where stress-inducing threats are frequent, uncontrollable and often last much longer than a foot chase would. Among the negative side effects are excessive anger, insomnia, high blood pressure and the worsening of pre-existing pains. Benson cited studies that have found more than half of all visits to the doctor are related to the side effects of stress. "Fortunately we have within us a force opposite the fight-or-flight response, and that is the relaxation response," Benson said. The relaxation response makes the body more resilient to the harmful effects of stress. "In Western society, it counters the contention of Descartes that mind is separate from body," Benson said.
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