Erin Meyer’s Assessment Tool

Erin Meyer, the author of The Culture Map and “Navigating the Cultural Minefield” , had identified eight dimensions to capture the difference between various cultures.  Using her experience with these techniques, she has created an assessment tool for HBR.  As I am born and brought up in India and have significant work experience in Canada, I decided to take the test twice, by putting the same answers and different nationalities.  And the comparison is definitely something to talk about.  I will be evaluating all the eight dimensions in sequence.

Communicating:  This measures the degree to which a culture prefers low- or high- context communication.  In low-context communication cultures, such as in Germany and the Netherlands, the communication is precise, simple, and explicit.  Here, repetition and written communication are appreciated for the sake or clarity.  In high-context communication cultures – such as in China, India, and France – communication is sophisticated, nuanced, and layered.  Here, reading in between the lines is expected.  Less is put in writing and more is left to interpretation. 

Canadian culture is the extreme end of low-context scale, whereas Indian culture towards the high-context scale.  And I am placed right in the middle of the scale. And yes, I have seen this transition in me, as I feel I am no longer as ‘wordy’ as I once used to be.  Now, I prefer to convey the message in a little words as possible.

Evaluating:  This measures the relative preference for direct versus indirect criticism.  For example, French are high-content communicators as compared to American, but are more direct in their negative feedback.

Canadian cultures stand right in the middle on this scale, whereas Indian culture is slightly more towards indirect negative feedback.  As far as I am am concerned, I am strongly leaning towards direct negative feedback.  I am not sure where this influence came from.  It could very well be from my clinical background, where a direct word of caution is a norm.  Also, it could because of the fact that Indian culture varies a lot; and I am influence from a sub-culture that prefers direct negative feedback.

Persuading:  This dimension measures principles-first versus applications-first, also known as deductive versus inductive reasoning.  Typically, people of Germanic and Southern European cultures find it more persuasive to lay out generally accepted principles before presenting an opinion or making a statement.  In contrast, American and British managers begin with opinions or factual observations, and adding concepts later if deemed necessary.

Canadian culture, like that of America or Britain, lays strong emphasis on applications first.  In contrast, there is no mention of Indian approach, which means they follow a holistic approach.  I am myself place in the middle of the scale, from which I infer that mine would be typically Indian approach.  Though I must add that I haven’t paid much attention to  my own approach during routine conversation. 

Leading:  This scale measures the degree of respect and deference shown to authority figures, where the spectrum is between egalitarian and the hierarchical.  Those from Scandinavian countries and Israel fall into the egalitarian category, where those from China, Russia, Nigeria, and Japan are into hierarchical category.

Canadian culture leans towards egalitarian, where as Indian cultural is strongly hierarchical.  I am place right in the middle of the scale.  I believe this is how I have been, as far back as I can remember about myself.  And Canadian environment gave me comfort, and an opportunity to be myself.  I believe that in hierarchical atmosphere, the purpose or mission is lost in honouring the hierarchy. 

Deciding:  Contrary to popular perceptions, egalitarian cultures need not necessarily be consensual and most hierarchical one need not believe in top-down decision making.  For example, Japanese culture is hierarchical, but a firm believer in consensual culture.  Similarly, Germans are more hierarchical than Americans, but are more likely to take group discussions. 

Canadian culture straddles somewhere in the middle, and as expected, Indian culture strongly prefers top-down decision making.  And my approach mimics that of Canadian culture.  I believe my approached changed towards consensual after working in Canadian environment.

Trusting:  This scale balances task-based trust with relationship-based trust.  In a task-based culture, such as the United States, the UK, or Germany, trust is built through work.  However, in relationship-based societies, such as in Brazil, China, or India, trust is built by personal and affective connections. 

Canadian culture is at the extreme end of task-based trust, whereas Indian culture is strongly relationship based.  I myself have a strong tendency towards being task-based, but not as strong as Canadians in general.  I believe, being a person of technical background, I was always had leaning towards task-based trust.  They may have been reinforced further upon exposure to Canadian work environment.

Disagreeing:  Everybody agrees that a degree of disagreement or confrontation is healthy.  Typically, in countries like Indonesia, Japan, and Thailand, public airing of disagreement is considered something undesirable.  In contrast, in Germany, France, and the Netherlands, people are quite comfortable with it.  This dimension measure how an individual views confrontation.  This does not mean that the person himself is confrontationist.  It just shows how one feels it is likely to improve group dynamics or to harm relationship within a team.

In Canadian culture, the opinion is somewhere in between, whereas in Indian culture there is a tendency to lean towards non-confrontation.  I am a bit surprised here as I was expecting Canadians to be extremely non-confrontationist, as they are typically politically correct.  Similarly, I was expecting Indians to be extremely confrontationist, as they are quite argumentative.  But, being hierarchical and believers in top-down approach, it makes them non-confrontationist in work environment.  As for myself, there are no surprises as I am leaning towards confrontationist attitude.  I prefer to have thorough brainstorming before any decision is made, and generally an open discussion helps build trust and understanding.

Scheduling:  All business follow as schedule, but in countries like India, Brazil, and Italy, people treat a schedule like a suggestion.  In contrast, in Switzerland, Germany, and the U.S., people stick to the plan.  This scale measures you view of time as linear or flexible, depending on how much value you place on structure or adaptability. 

In Canadian culture, the norm is strongly suggestive of linear, where as in Indian culture it is extremely flexible.  As far as I am concerned, I am more linear than an average Canadian.  I think this is primarily because of how I am.  I was like that even when I was in Indian environment.                           


Employer Tie Financial Rewards, Penalties To Health Tests, Lifestyle Choices

This article is by Kaiser Health News (Appleby, 2014) goes into details whether incentives can help promote healthy lifestyles.  It gives example of various organizations.  Every year employees of Swiss Village Retirement Community have their check up done.  That helps to determine how much they pay for their health coverage.  For example, those who manage to keep level of smoking, obesity, BP and cholesterol below a certain level, get discounts on their premium.  Similarly, employees of Jones Lang LaSale, get cash discount upon meeting a certain targets.  Even though proponents of such approach agree that financial benefits help make healthier choices, the studies so far have been inconclusive.  On top of that supporters of those already suffering from chronic diseases fear of discrimination. 

The management of Swiss Village feels that this approach has helped slow down the increase in their health care cost.  And at the same time, helped keep employee health in focus.  Further, the health screening is being gradually extended to family members who are covered by insurance.

The article strongly supports the idea that such programs should be voluntary.  They should not be a condition for offering coverage.  And there should be a reasonable alternative for those who cannot achieve the medical goal.  Although there is not general agreement about what that alternate would look like.  The perception is that they are not voluntary as portrayed, as you are charge premium not participating. 

Taking the example of Broward County, which recommends employee participation in screening programs, and charges them if they decline.  Those who participate are offered disease management program for asthma, high blood pressure, diabetes, congestive heart failure or kidney disease.  This was disputed by the state of Colorado, which necessitated that the program be accredited, not penalize workers for not participating or not meeting the benchmarks.  This and other legislations recommended provision for alternatives and raised their concern that linking test results to insurance premium can result in discrimination.

They do raise the point rather strongly that by making deductibles higher, the employers are making life tougher for those already sick.  Though the employer contest this claim as they feel as they are the ones paying for insurance cost, they have every right to impose such measures. 

From the available data so far, it is hard to gauge the impact on the health care bill of employers.  Although have been reasonably successful in taking employee off smoking, the results for obesity have been less remarkable.  That could be due to the fact that the latter is multi-factorial.

Overall, I would agree with such financial incentives as they not only save money but also help keep one healthy.  I would call it an example of positive discrimination.  It may be called as loss of privacy by some, but they should see it as a greater good for themselves. 

It is indeed a good idea to involved the spouses or other family members in the screening process, especially if they are also covered by insurance.  It becomes necessary because employees are known to take leave because of illness in the family.  So, that would be loss of productive days even though the one employed is not sick. 

There is a lot of mention that the screening programs be voluntary.  I would party agree that agreeing to participate should not be a condition for employment.  But, there should  be disincentives for not participating.  As for alternatives for those who are unable to achieve the medical goals, there could be a few alternatives.  One of the possible one could be to pay them a fixed amount, which will allow them to purchase coverage from health care exchanges.  Also those who are suffering from  non-lifestyle diseases should be exempted as it of no fault of their own.  Included in this list should be those whose condition cannot be reversed by changing lifestyle behavior, such as those in advanced stages of Diabetes, Cardiovascular diseases, Cancer, etc.  With insurance cost of those undergoing assessment getting reduced, resources can be freed up for those critically or with disability.  Another option for those already having health problems is standard premium with penalty or best plan from exchange, whichever is lower.  Either way, health problem should not be a condition for employment. 

Appleby, J. (2014). Employers tie financial rewards, penalties to health tests, lifestyle choices – kaiser health news. [online] Retrieved from: [Accessed: 2 Jan 2014].

Flexible Leadership

Was reading Leader Be Nimble by Dr. Jessica D. Squazzo in November/December 2012 edition of Healthcare Executive.  It talks about a very important question about leader’s knowledge and capability.  In increasingly complex world of healthcare, leaders have to judge and support people with varied skills.  So, how should one be a good leader?  It is not possible to learn all the fields of health administration.  The article begins by saying that a leader need to be a jack-of-all-trades, but an open-minded person.  The key attributes should be flexibility and open-mindedness.

Further to reach that senior place, they are more likely to be successful if they follow a zig-zag career path than a ladder-like one.  They may have to make a few compromises along the way, but this way they are more likely to gain varied skills and experiences.  Also, people may still believe that compensation is the biggest driver, but in actual they can be flexibility, open-mindedness and pursuit of lifelong learning.  It gives an example of a retired US defense personnel taking up the job of senior executive in a acute care facility.  One would think only negatives about such a transition, but his experience was otherwise. Among the things that came in handy were team building, the necessity to complete a task and building a consensus based on reason.  Other things I believe a person with such background will bring are ability to create urgency/criticality around the task at hand.  The another example of flexibility is to be ready for anything because you can never craft a perfect plan. 

One should also be willing to adapt, as the lateral moves allow you to gain varied experience.  It would be a very conservative idea to rise through the ranks of an organization.  Quite often, such organization need fresh idea that an outside person can bring.  Also, leaders can make virtue out of necessity when they are put into a difficult situation.  The experience they then gain elsewhere can propel them back into better position.  It is this exact virtue of adaptability that is going to bring them back in.  The article also underscores the point that the days of remaining in a particular organizations are over.  So, it becomes critical for leaders to decide when to make a move.  On short term, I’d say that they shouldn’t make a move unless the reasons are really compelling.  Especially if the people at work like you and you like them as well.  On long term, I’d say one should plan a move when there isn’t any challenge left at the current organization.  Also, leaders must do a favour to their current employers by starting to promote next generation of leadership well before they decide to move. Remember, one of the essential qualities of leaders is that they create more leaders.  Probably the best way to be remembered once you leave the organization. 

Leaders in true sense should come out of their comfort zone.  In every challenge, they should see an opportunity to learn and deliver even more.  In today’s trying times, they should be happy to be entrusted with greater responsibilities.  A great metaphor would be cycling uphill and downhill.  When in testing times, as in cycling uphill we have no choice but to work hard, else slip backwards.  Further, while going downhill we can either sit back and let the gradient work for us, or take its advantage and work as hard as we were while going uphill.  In the latter approach we will gain enough momentum to cross any further hurdle with relative ease. 


Trust & Confidence: Does Your Board Have These In You?

Was reading John M. Buell’s article in Healthcare Executive Sept/Oct 2010 edition about to develop health relationship between CEO and the boards. 

As we all know, board’s focus has changed over the years from philanthropic and financial oversight to bringing in expertise, accountability and community focus.  As the background of board members becomes more complex, gaining their support has become critical.  In light of this CEOs should embrace this change with positive attitude and should see this as an opportunity to seek support from more experienced people.

It is imperative that CEO keeps open and transparent communication with the board members, especially when it related to negative outcomes in future.  It generates some discussion, and helps prepare board for underperformance in future, and also serves the purpose of board education.  If the performance isn’t as bad as projected, then all the more better for the CEO.  So, always better to set right expectations.

Also, regular ongoing interaction with board members will help alleviate the fears that they will not treat underperformance fairly.  A well qualified board is generally aware of the complexities of managing an organization, and an atmosphere of open communication will further alleviate CEO’s apprehensions.

While communicating consequences of any initiatives, one would naturally communicate the benefits, but one has to convey the potential risks and downsides as well.  Any pointed question from board should be seen as an opportunity.  A full discussion on every aspect will help, as there would be no false expectations.  And there will be a level of comfort on both the sides.  While communicating the risks, it will be helpful if risk management strategies are discussed as well, even in brief.  This will convey the message to the board that the management is in control.  CEO shouldn’t be afraid that board will micromanage.  If there is great working relationship and the latter is well informed, they’ll not.

CEO don’t and are not expected to know all, and they shouldn’t convey to the board that they do.  Instead, they should be upfront with the board that they don’t know and why they don’t know.  Taking further they should both work together to be ready for unknown.  As quoted,

“By doing this, you make the board a strategic partner and have board members own some of this uncertainty, Trustees will be more forgiving, understanding and empathetic is something doesn’t go according to plan because they will be in the same position as you.  CEOs can use this sharing-the-uncertainty approach to their benefit and change the relationship for the better.”

Once the trust is established, it is needed that board members understand their roles.  This can be done via formal or informal board education.  Formal board education can be done via some short educational programs or having a consultant come in.  Informal education can be an ongoing process, at every interaction or meeting.   Board Chair can be taken into confidence whenever some course correction is needed during meetings or otherwise.  

The expanded role of board has given rise to specialized role of its members.  It may look like micromanagement, but it in fact is “microgovernance”.  When we talk of microgovernance, we mean committee structure that takes care of specialized duties like audit, patient safety & quality, community engagement etc. 

Taking example of St. Vincent Health, Indianapolis, the article talks about the ideal size of the board.  Such that members are fare mix of expertise and the number is large enough such that they can form various committees.  Also, board shouldn’t be too large such that meaningful discussions and engagement is not possible.

At Hartford Healthcare System, they give a lot of emphasis on board being constructive.  The key lies in through selection process such that only those focused on organization mission and vision are selected.  Once selected they prefer to spend good deal of time with members as it helps CEO understand their perspective and their level of expertise.  This would give the member an opportunity to develop understanding of challenges, something that cannot always be done at the meeting.  The personal relationship developed during one-o-one meetings will help the CEO speak in language most members understand.  Similarly, opportunity should be given to members to mingle and know each others perspective. 

Even after all due diligence, it is not necessary that all the steps taken would be correct.  But, as this statement puts it so aptly,

“And when a decision turns out to be unsuccessful, as the CEO I would rather say to my board that we figure out a solution together and make corrections.  Having the board help in figuring out the answers places me in a much better position that if I had claimed to have the answer and discovered the answer was wrong.  Having a board that challenges your thinking but also stands by your decision is the ultimate scenario for an effective board-management relationship.”


10 Secrets to Creating a Culture of Individual Accountability and Execution

ref: 10 Secrets to Creating a Culture of Individual Accountability and Execution

The article talks about four stages of cultural transformation through which an organization goes in order to execute a plan.

  • Culture of collaboration: At this stage shared vision and culture of collaboration is developed among senior management.  It is important that don’t get satisfied with this activity, as very little is being accomplished at this stage.  We’ve just begun to do the right things, and the outcomes are yet to be achieved.
  • Culture of individual accountability:  This stage is very important as it makes the plan actionable and ties vision to goal.  It itself is made up of three components
    • Measurable outcomes: A lot depends what matrices are chosen.  Decision making can be only so good.  It is necessary that middle managers involved with creating matrices are well informed both about strategic vision and ground realities.  It becomes incumbent on the leadership to promote the former.  For the latter, the managers will have to take the lead.
    • Aligning deliverables with strict due dates with the annual performance objectives: Here it is important that senior leadership sits down and work with the middle managers.  It is important that both are on same page.
    • Transparency: Everybody in management should have access to all plans and updates.
  • Culture of execution: The transition from culture of accountability to that of execution requires two steps. First, the developed strategy should cover all the critical steps. Secondly, it should be convey to each and every employee. That way they’ll be able to understand how their performance is aligned with the greater strategic vision of the organization.
  • Culture of innovation: This is the final stage where employees begin to identify problems themselves, observe change brought about by improvement steps and their input becomes critical to ongoing efforts. At this stage it is important for senior managers to keep their employee engaged and motivated.

Here are the secrets to moving towards culture of accountability and execution

  1. Decide what really matters: Generally healthcare organization follow a structured planning process. It has its own downside, especially when too much has been loaded on the process. The impression then goes around that the process is more important that the outcome. We should be careful not to overload the system, as its then it will allow minor adjustments during the way.
  2. A plan that is 70% correct is acceptable: It should be like a half-planned trip that allows for minor impromptu stops or deviations. It’s impossible to make a perfect plan at the outset.
  3. Keep goals clear and directions simple: Goals should be easy to comprehend by all, such that they can understand how they responsibilities are linked to them. And along with it you require open two way communication. You won’t want an environment of hearsay.
  4. Assign objectives, strategies and tactics to individuals owners with firm due dates: Well accountability can be at the team level, and it is just fine. But, to further the culture of execution, individual responsibility is a must. I believe that’s how most organization already works.
  5. Measure outcomes, not processes: We should first decide upon the outcomes before we go about setting matrices.
  6. Align incentives to performance: It is important that incentives be linked to accomplishment of tangible goals and not routine work. They are linked to overachievement, e.g. greater patient safety outcomes than planned, greater budgetary savings.
  7. Review execution at least monthly, preferably weekly: The speed of execution and collective accountability reflects on how often you review. At the same time it is important that the review process should become a burden. Automated dashboard is one way of having information accessible without much executive time spent on it.
  8. Give your team a dedicated time to execute: It needs to be understood that meeting only take stock of the situation, and execution is done outside the meetings. So, there needs to be a balance, and the team members should be given adequate time to execute. In fact, there is no harm if meeting is cancelled if there is nothing much to share.
  9. Push execution to the front lines: It is very important to engage the frontline staff about how their routine work is so important and is linked to greater strategic vision. A good example would be a senior executive addressing the infection control staff about how patient safety is so closely related to what they consider as mundane work.
  10. Align mission, vision and strategy: Finally, mission, vision and strategy should be linked like a tight chain. All loose ends need to be identified and fixed.

What Losing My Job Taught Me About Leading

ref : What Losing My Job Taught Me About Leading

Quite a few points being discussed here.

First, we should connect with our coworkers and those we network by being “fully present – in every moment”.  We should try to understand those people, and that way they’ll understand us.  That way relationship would be more meaningful and productive. 

Also, honour the people who have supported you, and that would include people across the whole spectrum.  We generally don’t realize this thing when we are employed or are in secure environment.  In fact, we should begin right at this stage, so what when we are in crisis stage, we won’t have to worry.

“Even after you secure your next job, keep in touch with these people. Maintain thoughtful relationships with people who can help you think through big issues throughout your career. Vigilantly try to be helpful to many of the people who had been so helpful to you. Over the years, I’ve had the opportunity to more than repay their kindness.”

Even otherwise, this is the time to think innovatively and do things others don’t get time to do.