Eric gets people excited. About healthcare. About technology. About Geonetric. It only takes a few moments of being in his presence to feel his passion and see his vision. A healthcare reform junkie, Eric can usually be found uncovering new ways to show healthcare executives how to leverage technology investments and develop patient portals that will improve care delivery. After earning his bachelor’s degree in business administration from the University of Iowa, he began his career in technology, founding Geonetric and never looking back. Through his leadership, Geonetric continuously receives honors and recognitions, including being named a Best Place to Work by Modern Healthcare, Software Company of the Year by the Technology Association of Iowa, and an Inc. 5000 Fastest Growing Company for five years running. When he’s not sharing his vision for the future of healthcare or accepting awards on behalf of his company, he can be found having lunch with his daughter at a local elementary school or donning lederhosen and entertaining his team at the Annual Engelmann Oktoberfest.
Mission statements are usually written early in a company’s history, then put on a plaque and promptly forgotten by everyone.
At Geonetric, we use ours a little differently. For example, the mission statement is the very first slide of every monthly company meeting, because it’s just that important. I put it there to remind us every month why we are here, as a company, doing this – rather than something else.
Up until last week, Geonetric’s mission statement was:
To build an exceptional team of experts to do revolutionary work for our clients.
That may not sound very exciting to you, but we thought carefully about those words and the placement of those words. As you can read in the statement, we focus first on the idea of building an “exceptional team:” amazing, smart people that work well together. It is pretty common for new team members to be a bit dazed the first few weeks as they adjust to the idea that there are so many brilliant people under one roof. The people here care about where the company is going. They’re engaged. They want Geonetric to succeed. If the new hire just arrived from the typical corporate world, it’s a bit shocking, actually – and that’s the point. Building an exceptional team is hard, and it’s the most important reason we’re here.
“We’ve totally lost control of the plane! We don’t understand at all!”
– David Robert, co-pilot, Air France flight 447, June 2009
“I’ve had the stick back the whole time!”
– Pierre-Cedric Bonin, co-pilot
A few weeks ago, the final report (PDF) on the tragedy of Air France flight 447 – that plane that disappeared inexplicably over the Atlantic in 2009 – was revealed. The key factors leading to the disaster were failure of air speed indicator instruments followed by pilot error – “the pilots were overwhelmed.”
But CBS News, interviewing famous former US Airways pilot Chesley Sullenberger, notes an apparent design decision that appears to have been a critical contributing factor: the cockpit design is different on an Airbus aircraft (Flight 447 was an Airbus A330) than on Boeing aircraft, with a tragic result.
This video is very worth 8 minutes of your life to watch as it illustrates the importance of design affecting decision-making under stress. Go ahead, I’ll wait:
Every company has them. At Geonetric, we call them “huddles” – a chance to sit down, one-on-one with your manager to discuss your performance, your role, your goals, and areas for improvement. They usually happen every few months, or in some cases, annually. Overall, they foster great conversations, and often bring about resolutions to problems that have festered for a while. They’re the perfect time for managers to deliver a “thank you” for a job well done.
And that’s why we’re getting rid of them.
With about five years of consistent data from huddles across the company, I can say pretty confidently that they don’t directly improve organizational performance. In fact, I would argue that performance appraisals are detrimental to a high performance culture. They’re a crutch for managers, and an enabler of poor communication.
This image is the output of the retrospective done by the team, in this case, at the end of the regression period just before we release the next version of our software to our clients. Retrospectives are a critical component of Agile software development and at Geonetric, they happen every two to three weeks.
I belong to a number of CEO peer groups, and I have the opportunity to learn from some brilliant small business owners, and they learn from me. Last week we had a fascinating conversation about a fairly well-known concept called The Saltshaker Theory, which apparently inspired a book called Setting the Table.
The Saltshaker Theory goes something like this: it is the role of the business founder/CEO to apply constant, gentle pressure on the organization to set the standard and vision for the company. The author illustrates this point by clearing a table, and asking his friend to put the saltshaker in the middle of the table. The author moves it slightly off-center. The friend must move it back. Again, the author moves the saltshaker, and gives this sage advice:
“Your staff and your guests are always moving your saltshaker off center. That’s their job. It is the job of life. It’s the law of entropy! Until you understand that, you’re going to get pissed off every time someone moves the saltshaker off center. It is not your job to get upset. You just need to understand: that’s what they do. Your job is just to move the shaker back each time and let them know exactly what you stand for. Let them know what excellence looks like.”
At first blush, this seems elegant and obvious. Of course the leader’s role is to define the level of excellence for the organization and continually demonstrate it by nudging the organization back toward the target.
While I concur that the leader’s role is to articulate the vision, there are two things subtly wrong about the analogy:
It reinforces a cynical view of the team and treats them as children. Apparently, it is the “law of entropy” that your team will fail to live up to your expectations. “That’s what they do.” Always. Without you, as the magnificent leader, to put the saltshaker in the right place, your team will clearly perform poorly.
It perpetuates a culture of reliance on the leader to define and continually reinforce the standard. Why is it that you must move the saltshaker back? Is your team apparently incapable of understanding your intent – that the saltshaker should be in the middle of the table, and move it back there, should it somehow get off center? They must rely on you to tell them it’s not right.
So, in my view, the Saltshaker Theory is an interesting concept, but ultimately it doesn’t work for a high performance, professional team.
In addition to celebration, our monthly all-hands company meetings focus on incredible levels of transparency.
We’ve been very deliberate about weaving transparency across the company in ways that are rare in corporate America. In my view, that reflects our belief that we treat our team members as responsible professionals. Most companies keep even basic data about performance a secret – as if executives are the only people qualified to hear and understand it, or do something about it.
There are six categories of information we share at company meetings:
Client satisfaction survey data. Every company pays lip service to the importance of their clients or customers, yet most companies don’t even ask, or care, about feedback from them. And of the ones that do ask, how many share the results with the entire company? Client satisfaction is so important to Geonetric that every quarter we survey all clients – either electronically or by phone, for feedback on how we’re doing. The cumulative scores and summary comments – good or bad – are then shared with the entire company. Sharing this information makes it crystal clear to everyone that our jobs are ultimately focused on meeting our clients’ needs and making them happy. Without that – profitable or award-winning as we may be, we’ve failed. It also reinforces the idea that we’re all in the same boat together – our clients’ success is dependent on everyone at Geonetric performing optimally.
Employee satisfaction survey data. Twice a year, we ask our team members for feedback and input on what’s going right, and what’s not. The survey gives us a way to push team members to effect change by identifying areas that need attention. Being a fairly outspoken group, the feedback we get is often enlightening and eye opening! I would like to think that, as a small business CEO, I have my finger on the pulse of the company every day. But sometimes the survey identifies areas that I might not have realized were in need of attention. Or maybe something I don’t want to acknowledge is an issue. Sharing the aggregate results of the survey publicly reinforces accountability for me – I can’t exactly duck an issue I’m not comfortable with if it’s presented publicly for all to see.
Financial data. Some executive leadership teams seem to think that it’s OK to incent employees to accomplish financial goals (e.g. profitability) but then hide all of the pertinent information from them of how to get there. Especially when it’s bad news! In my view, this is a failure of typical American management. At Geonetric, every month we’re pretty much doing Open Book Management, sharing revenue and EBITDA information with the whole company. And yes, everyone is expected to know what EBITDA is – not necessarily how to calculate it, but what it represents to the business.
Sales data. Because we’re growing so fast, it is critical for us to keep everyone on the same page. We find that we need to regularly scale up new processes as new clients or types of work are added. Keeping everyone apprised of the various “waves” we might hit is one way we’ve absorbed a constant growth rate and maintained excellent client satisfaction rates and a 94% client retention rate for the past 13 years.
Process improvement metrics. Sometimes we’re working on challenges with a particular process, and so we focus on “what hurts” by highlighting an appropriate measure in front of the whole company – a painful exercise! For example, two years ago, we had significant challenges in having too many defects in the software released into the finished product each quarter. We undertook a painful but very successful effort to utilize Behavior Driven Development and other techniques to eliminate defects; we showcased defects per release in company meetings – until the number got so low it wasn’t important enough to include any more. In other words, acknowledging and focusing on problems company-wide works to steel the resolve of the team and keep problems front and center until they’re gone. It also forces accountability – we don’t have the option to simply ignore difficult problems when they’re publicly known and visible.
Community efforts. Unlike many large companies, we have our entire staff headquartered in one location: Cedar Rapids. So we take our Cedar Rapids community outreach efforts very seriously. We donate to local charities, we sponsor local events, we marshal teams for fundraising efforts, and we even knit hats for babies in local NICUs. We highlight these efforts in our company meetings to reinforce that – like our clients – supporting our local community is a goal at the highest level – as worthy as EBITDA or client satisfaction.
At Geonetric, we have had all-hands company meetings every month for about 10 years. These meetings are a linchpin in reinforcing our award-winning Geonetric culture. The constant, rapid change of our company and the open, transparent culture we have makes it almost impossible to not hold them.
Meetings that pull together 70+ employees for an hour (or more) to hear the CEO drone on for awhile cost a lot and takes people away from directly productive work. But they’re worth it to us, because celebration is a key aspect of our culture.
At every meeting we have the opportunity to celebrate in five ways:
We celebrate our clients’ incredible successes. Our company meetings showcase the latest site go-lives, show off major projects that we recently completed, and talk about what exciting things clients are doing with Geonetric. We truly are blessed to have smart, innovative clients with great ideas. This is our chance to showcase how, together, we turn those ideas into reality.
We celebrate our clients’ results. We’re here to do revolutionary work for our clients – and that work only matters when our clients are successful. We happen to have the ability to see across all of our clients’ efforts and the results of our collaborations in aggregate. We’ve started tracking the total impact we’ve had for our clients – an astounding $275 million in total downstream revenuefor them as of June 2012 – and we’re excited to watch our impact grow.
We celebrate our teams’ successes. Not everything we do is as high profile as a new site launch or a million-dollar client savings. The “behind the scenes” projects are just as critical to Geonetric’s (and our clients’!) success. Sometimes it’s celebrating a new process improvement. Sometimes it’s celebrating a new idea that was implemented.
We celebrate each other. Geonetric’s culture puts a lot of emphasis on peers providing feedback to each other. When was the last time a coworker told you that they appreciate something you did, publicly? Our company meetings give team members the chance to “kudo” a peer (yes, with a Kudos bar) by telling everyone how they live the Geonetric values, and do revolutionary work for our clients. We go through about 40-50 Kudos bars at every meeting!
We celebrate particularly notable efforts. One team member is publicly acknowledged as being “Spot On” in exemplifying Geonetric values, and gets recognized by proudly displaying Spot, our stuffed dog mascot, on his/her desk for the month.
It’s so easy to get bogged down in the day-to-day trenches and forget that smart, dedicated people can do incredible work over long time spans. I just finished the two hour marathon all-hands company meeting which wraps up 2011 and communicates plans for 2012. In doing so, I had the same reaction I have every year: Holy cow we got a lot done!
Here are some of the highlights:
Revenue: For the sixth year in a row, we had record revenue growth, which should easily qualify us for the Inc. 5000 list for the sixth time. To me, as a business owner, this validates that we are building products and delivering services that our clients love and want to buy more of.
New clients: We added 11 new clients, renewed contracts with 15 clients and added major new initiatives with several more. We started the year with about 30 clients representing about 200 hospitals and ended it with about 40 clients representing 500 hospitals.
Client retention: Probably most important, we’ve done an exceptional job in building strong relationships with our clients across the country: We lost zero clients to competitors and we took two from significant competitors. Over more than 10 years of working in healthcare, we’ve retained more than 93% of clients over that entire time. We have competitors who try not to lose too many in a single quarter!
Net income: 2011 was the second most profitable year we’ve ever had. As a privately-owned business, ensuring that we’re making money while we grow at a breakneck speed is obviously critical. But it also gives our clients and prospects the confidence in our ability to thrive over the long haul.
Rob Curley, all-around geek and President and Executive Editor of Greenspun Interactive, the new-media division of the Las Vegas Sun had his now obligatory keynote speech at the Healthcare Internet Conference (this is his third or fourth time, I believe). As always, it was a treat: great ideas, tremendous passion for his work, and fabulous insights. And not everyone can use pornography as a punch line repeatedly in a presentation and get away with it, though maybe you can if you’re from Vegas!
But I felt like it might be worthwhile to translate some of the ideas into actionable thoughts for healthcare experts, because, well, hospitals are not newspapers. And it might be easy to draw the wrong lessons from his great presentation.
For example, you almost certainly do not need his “real time balls” visualization of site traffic (though it would impress your IT people!).
Here’s what I came away with from Rob’s presentation:
1. You need to have balls. Fight good fights and take on tough targets.
Can you imagine the pressure on the Las Vegas Sun from some of their key advertisers – the major hospitals in that area – to keep from pointing out that those same hospitals are covering up the fact that they’re killing people? Or the sensitivity of taking on the local school system when you’re writing critical stories about where your kids go to school? You can’t accuse Rob and the LVS of shying away from a fight!
Back in February, Geonetric was honored to receive the Patriot Award for supporting National Guard and Reserve members. So when I was invited to attend the annual Employers Support of the Guard and Reserves Awards Luncheon in West Des Moines earlier in April, I was beyond honored. Above and beyond honored, in fact.
At the luncheon I was presented with the Above and Beyond Award, an elevated version of the Patriotic Employer Award. The Above and Beyond Award recognizes employers who do just that – go above and beyond to support the National Guard and Reserve members we employ.
I was honored to be acknowledged. It’s humbling to see all these great people defending our country. Providing friendly policies for Guard and Reserve members is the least we can do as employers.
I just finished reading Dr. Peter Pronovost’s book Safe Patients, Smart Hospitals about patient safety, largely around Central Line Infections and the easy changes hospitals can make that significantly reduce the risk of complications during central line insertion and care afterward. It’s a fabulous – and heartbreaking – read.
The first insight is the importance of distilling key information down to a simple checklist, similar to Atul Gawande’s book, The Checklist Manifesto. It’s a valid and important point: if you seek broad adoption of best practices, you need to make the steps as simple and clear as possible. But I found the second half of his book more interesting, because it explores the tougher question: Once you have the checklist, how do you get it adopted broadly? What if the culture makes the change hard? How do you build awareness of the changes you seek on a large scale, across potentially thousands of doctors, nurses and staff at multiple facilities?
One of Geonetric’s clients, Genesis Health System, happens to be working on exactly this problem. Don Abbott, Nursing Informatics Liaison at Genesis took on this challenge. Perhaps you’ve seen Oregon Health and Sciences University’s “Pink Glove Dance” designed to raise awareness of breast cancer. Abbott and his team took the “cute dance video for awareness” concept a step further, and used it to educate staff on the steps to prevent central line infections.
Though the audience and topic is narrower than breast cancer awareness, the approach is perfect and illustrates how you can build adoption in a large organization like Genesis:
The team that’s (largely) responsible for implementing the procedure made the video
The video was filmed at four different locations throughout the health system and included staff at all levels
The video is playful – staff is much more likely to remember this tune than what was written in a jargon-laden procedure manual
The video is made to be viral – easy to distribute and easy to watch again
We’re excited to announce that our next release, VitalSite 5.2.7 is finishing final testing, and includes 48 new features and improvements. Each quarterly release is packed with items big and small, and is part of our way to keep clients at the forefront of eHealth. Most of the new capabilities were requested by our clients, and range from minor enhancements to big new ideas.
One of my favorite new features builds on one of our core technologies: SmartPanels.
SmartPanels gives you the ability to automatically show links to related content as you browse the site. It’s important that it be automatic, because managing all of those links manually across thousands of content pages would be extremely time consuming.
Asante Health System has a good example of a SmartPanel on their cancer service line page at Rogue Valley Medical Center.
Usually I’m trumpeting the great work done by my team at Geonetric, but today I’d like to talk about our clients’ great work. One of the best things about working with smart clients is they do such amazing things!
A couple of examples I thought to highlight for you:
Mercy Medical Center yesterday featured a live colonoscopy on their website. It’s of a Mercy employee undergoing the procedure, while simultaneously live tweeting the event on Twitter, and broadcasting each step on Facebook! What a great way to engage the community on an important issue and make the most of an opportunity! Kudos to Melissa Erbes at Mercy who put it all together.
Southern Regional Health System is in the process of acquiring a Certificate of Need to bring open heart surgery to their area. Marcus Gordon put together a section of their website announcing the program, as well as a coordinated series of tweets on the subject and matching print advertising. So far, they’ve seen impressive results! Great job Marcus on getting the word out!
Adventist HealthCare built a microsite to support their efforts to build a new Clarksburg Community Hospital, focusing communication efforts toward a single site that includes key video messages from community leaders and supportive residents. They also created a Facebook site specifically for this project. Rick Rinaudot put this plan together and has done a fantastic job of building the online resource for this critical project.
Ensure we innovate quickly, try out new ideas and test them rapidly
Release a constant stream of upgrades of our Web and Patient Portal products to all clients every 90 days
Respond quickly to marketplace input as technology and trends change
At the time I characterized the approach as “using software engineering as a competitive weapon,” and we’ve succeeded in doing exactly that, as evidenced by our win Tuesday night at the Technology Association of Iowa’s Prometheus Awards. We took home the 2009 “IT Innovation in Health” award for our patient portal product.
Scrum allows us to differentiate ourselves in a couple of intriguing ways.
I just read an annoyingly provocative article by Mark Cuban, one of those billionaire types who needs a bit more attention in the social media realm. He claims “you should NEVER listen to your customers” and, falling for the bait, thought I’d post on the matter.