In this podcast we remember high school extemporaneous speech contests and how most of us lack that skill in answering dicey questions in job interviews. We will finish with some observations on how our industry will survive another attempt at healthcare reform.

Everyone has a story to tell about their career and like many people, your story may have a glitch or two that, if not handled appropriately, may reduce your chances of being the successful new job hire.

Some of these little career hiccups may be potentially serious, others not. Regardless, we all tend to treat these issues like the proverbial sore toe. We go into the interview trying to protect that toe from getting stepped on and, more often than not, that defensiveness just makes matters worse.

There are generally four areas that fall into this sore-toe category:

  1. A personal issue: a DUI, hospitalization for an addiction or a messy divorce that made the papers which also means that details of your personal life also made Google.
  2. A major professional mistake: This could be a major error in calculating contractual adjustments against revenue, a major misstep in negotiating a union contract that proved to be very costly, or not paying attention to the details of a construction project that then goes off the rails.
  3. Short job tenures: These may have occurred through no fault of your own but you know they will attract the attention of the interviewer.
  4. Bad choices in career management: This is probably the most common of the four. Executives, either in a hurry to achieve their career goals, or those who failed to conduct adequate due diligence of a prospective employer, have resumes that reflects a careening career. Short tenures, step-back jobs — ones that you take following a termination or layoff that have less responsibility and probably lower pay — or even those ill-advised “I thought it would be interesting” jobs that, while interesting, amount to be a big career detour. In all likelihood, these are the types of issues that will have to be explained.

The first key to success in dealing with these issues is to assess the risks with your mentor, career coach or outplacement consultant. You may find that what you think is the biggest threat because of your own internal sense of anxiety or guilt, is actually not one to worry about. Regardless, the second key to success is to be prepared to answer any and all questions that address those issues.

The most important thing I have said thus far is: be prepared.

Some of the most amazing people I know are skilled in the art of extemporaneous speaking. For them, it is like a walk in the park. But they are in the minority of the general population. For those who lack these skills, standing in front of a group of people without the benefits of notes, can be a painful public experience, something akin to having a root canal without Lidocaine.

As most of you remember from your high school and college academic competitions, extemporaneous speaking is the art of speaking without special advance preparation; an impromptu talk. My first topic in a high school debate/speaking contest was to deliver a seven minute talk on my life inside a ping-pong ball. If you saw my other options for the speech you would immediately understand why I opted for this one. As a sophomore in high school, I don’t think I even knew what the term geopolitical meant, and I certainly did not want to attempt to talk about the economic impact of unfair trade practices on the lesser Antilles. But that is beside the point.

Some people excel. Most do not. So why go into an interview to talk about some potentially sensitive subjects – in extemporaneous fashion – and not be prepared? This is not some high school academic competition that no one will remember in two weeks. It is your career, the lifeblood of your financial and emotional security.

We spend considerable time on this subject in our career management boot camp that I teach to healthcare and other service industry executives, but today I am going to share a couple of strategies to help you move from being in the uncertain extemporaneous mode to be confident and prepared.

  1. First, assess your risks with a neutral source, someone who knows you but will be honest with you. Someone with the enough industry experience and maturity that they can help you see the real threats as opposed to those raging in your own mind.
  2. Second, once you have prioritized these issues write your answers to the possible questions you might receive. Do this on large index cards for practice purposes. Stand in front of a mirror and read them back, then go back to the drawing board and revise. Remember, how you respond to these questions could be critical to your success or failure in the search. So, even if you are a great writer, the first draft is rarely the one you ultimately use. After rewriting, try them again. And then continue the fine-turning process. This is not quick or easy. So be prepared for a little pain.
  3. Third, learn the answers, don’t memorize them. There is a difference. When you are asked about one of your issues, you do not want to lay an egg with a stilted delivery that sounds as though you are reading from a prepared script. In other words, have the message and the delivery style down pat. Make it conversational and engaging. This takes a lot of work. Interview preparation IS a lot of hard work and trying to take shortcuts can be risky. Just consider the time and angst you spend in preparation as an investment in your career and for that next position you land.

Next on SelfPerspective, preparing for value-based reimbursement and the emergence of population health management initiatives in an era of proposed reductions in federal spending on healthcare. This is one of the major leadership challenges facing healthcare strategists in today’s topsy turvy political world.

Cutting federal spending for Medicaid is hardly strategic. It is more like a political tactic covered with a scarf of deficit reduction. The problem is that the least among us in society will be the first to feel the pain, followed closely by the 4,862 hospitals across the nation. For even the most politically conservative of hospital CEOs, these cuts are problematic for the fiscal well being of their hospitals.

The problem with Washington-based healthcare reform is that it is long on political tactics and short on meaningful reform, all the ideologically driven cries for market driven healthcare notwithstanding. It is short on strategy.

Listen, most of the senior healthcare leaders I talk to, off the record, agree that the only way to get our costs under control is not through payment reform, which is what we currently have in Obama care and what we will have if anything that remotely resembles the House-passed healthcare bill is approved by the Senate, but through sweeping strategic reform. And if you think that ACA was difficult, just try building a new business model with a completely new set of economic incentives and reimbursement systems.

Economic pressures are building. For hospitals, it is the reduction of critical reimbursement programs that cover costs for the uninsured or the underinsured. The former could grow by 23 million people over the next 10 years if you have any faith in the Congressional Budget Office’s projections and lately that level of confidence depends on which side of the political aisle you pay rent.

These reimbursement cuts are coming at a time when hospitals are being asked to take on more risks. With long-term debt, large numbers of inpatient beds and continuous declining inpatient admission rates since 1994, hospitals, which have invested in building new beds over the last 25 years, will have to retool their factories in order to stay in business, and at a time of declining reimbursement, that will take additional investments in facilities and equipment.

The real challenge, strategically speaking, is to deal with those ancillary issues while, at the same time, assuming more risks for the patients they treat. In other words, payment for value, not volume together with growing numbers of consumers with no insurance, or plans that cover only the most major of expenses.

From a career management perspective, there will be a decline in the number of executive leadership positions in healthcare. As the industry continues its contraction, those who can figure out how to deliver care in a financially sustainable way will be heroes, highly recruited and well compensated. Those who lack these next-level leadership, strategic and execution skills will face tougher career choices.

I do not consider myself much of a futurist although I did forecast in early 2015 that Community Health Systems, the Franklin, Tennessee-based investor-owned hospital management company with a business model firmly entrenched around inpatient admissions, would be toast within two years.

While they are not toast — yet, they face significant financial challenges. Today they are continuing with their massive cost-cutting by announcing a definitive agreement to sell five more Pennsylvania hospitals to a regional health system in that state,. Previously they agreed to sell four of their Central Pennsylvania to one of my clients, another regional health system. Their debt load remains staggeringly high and they face significant repayments over the next two years. Will they survive? Only their bankers and note holders know for sure, but there is one thing that is certain — their financial and operational free-fall reflects the challenges all hospital operators will face if they think that sticking with the current business as usual model will allow them to survive.

By the way, CHS’ share price opened this morning at about $9.25 . When I first made my projection of their demise, CHS shares were trading at about $60 a share. This company is now a stark reminder that the for-profit healthcare wonder kings are not invincible.

In the end, it may be the not-for-profit health system executives who save healthcare in America. This assumes they can balance their way through reduced reimbursements and a push to drive down the cost of through a capitated payment structure for specific population groups.

But a few innovative, daring health systems, hospitals,. medical group practices and insurance companies cannot restructure healthcare in America. This is a task that will take a village and then some. It is time to get all the healthcare providers and insurers to the table to develop a new business model. As for the politicians, they should  just take a seat in the hallway. We will call you if we need you.

Now that is wishful thinking.

Thanks for listening. Remember: Leadership exists because there is trust. Without truth, there can not be trust.

Truth is not a word of convenience.

New Blog Post, Career Management Video Scheduled

Join us on Thursday for another blog post.  On Saturday, another career management video will debut on John Self TV via YouTube.