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We are not entitled to have a job.  There is no legal or constitutional guarantee of employment.

We are paid to do a job.  Typically we work as part of a team — either in senior leadership, management or as an hourly employee.

The big challenge for leaders is to get the highest of the highs and the lowest of lows within an organizational structure to share mission, vision, values and  achieve measurable goals for the success of the enterprise.

Along the way, we often tend to lose sight of the ultimate judge of our efforts — whether the organization was successful in achieving its performance targets. The trouble begins when employees, those who punch the time clock and those who are exempt, begin to believe that the compensation they receive is for the hours they worked, versus the results they produced.

As we  begin to move forward with new payment, care delivery and service models, everyone who works in healthcare, from the executive chairman to the housekeeper, we need to be honest with one another:  no one is entitled.  We have to earn what we are paid.  The more we earn, the greater the responsibility to generate value but in the end, no one should get a free pass.  We can’t afford to carry people who do not produce value.

If the housekeeper cannot keep the bathrooms to the patient rooms clean or if the CEO cannot provide empowering leadership to his or her team, then there must be consequences.

We like to look down our noses at those “with their hands out, with a sense of entitlement expecting someone — the government or private citizens —  to offer a free ride.”

The same rules for free rides should apply to employees and executives.