A631.5.4.RB - Leading System Wide Change

In your reflection blog, consider how difficult it must be for a leader to grow into a person who can lead a system-wide change effectively. Perhaps you remember leaders who attempted system wide interventions but failed because they were not capable of pulling it all together. On the other hand, you may know leaders who were able to do what you thought would be impossible. From your point of view now, what is required for a leader to be successful?

So it has been far too long since I've been here. I'd like to say that I have some great reason but after three years and a host of life events I'm running out of steam. So for the three of you that read this I will endeavor to be more reliable. For my professor, I offer apologies and no excuses. Though if you have any words of wisdom for a student hitting the wall please feel free to email them to me.

Anyhoo...I should get to answering the above questions!

What is required for a leader to be successful?

I have often held that emotional intelligence is one the keys to successful leadership. That being said, another key is the ability to get along with people. It seems simple on the surface but highly unique people can carry some undesirable traits. Einstein was a womanizer and Alfred Hitchcock was highly vindictive; both of these men rose to the tops of their fields despite these faults. It is speculative but in some ways I argue that having a certain part of you personality that is like biting on tinfoil is required to rise to the top. At some point one has to take a stand and not be afraid to make hard choices. That being said, the same personality traits that lead to being able to make hard choices are the same traits that allow someone to become selfish or vindictive.

This is why I argue knowing one's self and knowing one's own emotional reaction to stimuli is paramount to successful leadership across a multi-variable spectrum. Einstein really just did math, Hitchcock just made movies, they weren't truly leading across different spectrums. I order to accomplish such a feat a leader has to build a support network, create a common vision, bring together disparate goals, and remove or convert subversion. This takes people skills! People skills is such a colloquial term but I think it is germane to the discussion. Charm, vision, sense of humor, principles, assertion without aggression, these are all people skills and without them it is likely that a leader will self-destruct at a certain level.

I have seen this in action. I worked for a supervisor that seemed to be in a position just beyond his abilities. In many ways he was a good leader but he lacked the ability to see beyond himself. This led to conflicts with other departments, increased tensions with staff, and a decrease in production. In time things began to entropy as the system turned on itself and what started out as an attempt to create change across all systems ended up with squabbling factions. It was rather fascinating to watch.

I think growth into a leader is incredibly difficult. I believe that a good mentor is needed, as well as ability to accept feedback. Without proper guidance the path to success is very hard. I know for myself I see where I am struggling and part of that is I don't have a good support structure in place. My own failures have led to a self-assessment where I need to scale back outside activities to focus on core goals. This took some hard knocks and it has helped me understand that no one succeeds in a vacuum.

A631.2.5.RB - Cooperation and Competition

New class, new subjects for the blog. For this week I am looking at the process that went into forming a geographically separated team. This team will form a work-group throughout the weeks to come


What behaviors seemed to help your team successfully complete its task?

Communication was key. In this week I was the weak link in communication as I had overlooked the project being assigned so early. As a result my communication wasn't timely and therefore not helpful. While I added my inputs towards the end of the week they were not useful as a whole. The other team members were not able to make use of my data. Thankfully, the data inputs are individual and not requiring processing or I would have set them back.

What factors inhibited decision-making or problem-solving?

Geographic separation encompassing several time zones is the biggest issue. Had everyone been on my time zone the deadlines would have been easier to manage. Additionally, until my inputs were in place it was impossible for me to be reached. This makes it even more difficult for the team to be able to understand what is happening.

How much time was spent on decision-making and problem-solving?

This would be hard to answer without knowing how long it took each person to formulate their parts of the charter. I know my contributions were fairly straight forward. Also, we would need a defined problem to solve to truly answer this question.

How was information shared among team members?

Information appeared to be shared openly and evenly. Contact numbers and emails were exchanged which should facilitate future information sharing. Information was not always given in a timely fashion but that was more my failing than the team's failing.

How did issues of authority or power affect the team?

They did not seem to affect the team at all. This was a straightforward assignment with very little need for interventions or process examination. True issues of power tend to develop when there is more than one way to solve the issues. This assignment did not lend itself to that paradigm. Additionally, all members have done these before and are practiced in the information needed. Having this experience removed any need for direction or true authority.

How did collaboration and competition influence the outcome?

The team seemed to be very collaborative. The outcome was influenced by one team member posting close to the end of the deadline. The aforementioned issues played a part in this outcome.

Did team members make process interventions?

They didn't seem to be needed. The members of the team have all done this type of work in the past. Having done that type of work the team was able to smoothly add information and produce a product. Once again, as the projects grow in complexity this will change.

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Hiring and Recruiting

Watch this awesome video. I really enjoy learning about Google's culture and I hope you do to!

1. Does Schmidt's description of the Google Culture make sense to you?

Yes it does. I love flat cultures and I like recruiting to fit an atmosphere rather than a job. Not having huge hierarchies allows people to feel very empowered. When they know they are free to pursue their own projects and are supported in this idea it goes even further towards creating an empowered and trusting employees. These types of cultures also fosters innovation. Centralized command stifles innovation and having worked for an organization where centralized command is the norm I can tell you that I feel very nervous floating new ideas. I often joke with a few trusted co-workers that I have angered the Collective and while most of them don't get the Start Trek reference they at least get the idea that I feel we are expected to be drones (if you click that link a guy shows up at your door and gives you back your virginity).

2. Is this a reasonable way to view the work that most people are doing in your workplace?

I wish. Working in a hospital means that I have to have somewhat stricter guidelines than programming. However, that being said, I think it would be nice if teams dedicated to program improvement were given more latitude to make decisions. Suffice it to say we are not particularly innovative and that bothers me a great deal. It seems we repeat the same things over and over and hope that somehow results will just magically appear. I have always enjoyed process improvement and I actually plan on loaning out this class's textbook to a few people to see if I can gain some small amount of traction.


3 As a leader, does it take courage to have and to implement this point of view? Could this backfire?

I think it just takes faith in your employees. It isn't comfortable relinquishing control. And I see how managers have been burned by placing trust in weak employees. I am a union supporter but they can make it difficult to remove obstinate employees or implement organizational change. So when a manager wants to empower an employee he or she needs to be careful to pick trusted employees. Trust is a two-way street but I do see how managers often have more to lose. It can take a great deal of courage to be willing to make mistakes to find those correct employees.


4. What can you take away from this exercise to immediately use in your career?

That I need to apply to Google, or a firm that specializes in helping create the type of culture that Google has established. I am not in a place where I am truly empowered to make decisions and that can be very frustrating. I also don't think any great changes will be coming around any time soon. I work for an organization that still thinks flash-drives will activate Skynet if plugged into the computer. Overall I think it takes external pressure to create new cultures in well-established organizations. When there is no incentive for change it becomes very hard for new ideas to take hold.

Corporate Re-invention

These past two weeks have had me pulling my hair out getting ready for a national inspection. As this affects our accreditation as a hospital I will leave it to your imagination to visualize how busy it's been. So this is a no-frills post. Enjoy!


1. Michael Bonsignore, CEO of Honeywell, states that Honeywell will not be an extension of the old Honeywell or Allied Signal. He is creating a new culture that blends the best of the merged companies of Honeywell and Allied Signal. He says that Honeywell will compensate and reward people that look for best practices from both companies in creating a new corporate culture and punish those who do not. Do you predict Honeywell will be successful?

The nice thing about being Honeywell is that you are Honeywell. They have their presence in so many aspects of electronics and defense that they can still fail upwards. 

If the question asks if I think the merger of cultures will be successful than I can say that I believe it will. It won't be an easy transition but ultimately people will go along if they feel supported and valued. It's amazing the return on investment one can get from simply letting people know they are supported even in times of trial. By adding in an incentive measure the CEO is letting people know that contributions to this change will be valued and that also can secure some buy-in. 

2. What barriers do you see based on what you observed in the video?

The biggest barrier I can see will be psychosocial in nature. The employees of the bigger Honeywell, and this is pure supposition, may feel that they are the "bigger brother" and that since theirs is the acquiring company the smaller company's employees should be doing the listening. This is not in line with the CEO's vision for the company's future. It would behoove Mr. Bonsignore to let Honeywell know that the smaller company is an investment in the future of Honeywell and is not to be seen as a lame duck that needed rescuing.

A second barrier would be the sheer size of the merger. In smaller companies it would be easier to merge two cultures, if the company is small enough the cultures can be merged over pizza and beer. With Honeywell there are geographic challenges, layers of managers with varying degrees of loyalty and competency, and thousands of employees for whom change is very scary. To assume that this will go smoothly would be fantasy. A steady and patient guidance will be needed. 

3. What critical success factors should Honeywell consider as it crafts its organizational strategies around a new culture?


Though it can be hard to measure I would list morale as a big success factor. Honeywell needs skilled and motivated workers in order to survive. Skilled and unmotivated workers will lead to stagnation. The merger will strain morale (more in some areas than others) and watching for upticks here will be important.

 Increased shareholder value is an obvious metric for success. This is largely dependant on getting the new system working as quickly as possible.

 These first two will build a third factor of public perception. Once again this is hard to quantify but increased sales, positive press, actual growth, and favorable returns are generally good indicators of how the public is perceiving a company to be functioning. I think these are too often viewed as separate entities rather than the all-encompassing concept. Wal-Mart's recent market woes are largely due to the public perceiving their labor practices to be poor. They may very well be poor or they may very well be industry standard. If the latter is the case Wal-Mart forgot they ARE the standard due to their size and as such the public will focus its attention there. Honeywell is not in the same market and caters to a different demographic but the paradigm can be the same.

4. What can you take away from this exercise to immediately use in your career?

 I am trying to focus on learning how to use small changes in a resistant system to formulate bigger changes downstream. I am not ready for a Honeywell merger or a culture shift as the system in which I operate still thinks that I plug in a flash drive I will activate Skynet and bring doom to mankind. In essence, I hope to bank this insight for a time when I can formulate bigger change. Right not I work with the tools at hand.

50 Reasons Not to Change

Change is frightening for many. It removes us from our comfort zones and  challenges us to think of new ways of doing things. Hopefully change is something that happens to all of us, but as we know it is often avoided and we do so with a variety of excuses.

1. How do you react when you hear colleagues using some of the excuses listed in the 50 Reasons Not to Change graphic?

My personal pet peeve is hearing "we've always done it this way." It really does drive me nuts. My initial resonse is to ask "does that mean it cannot be done more efficiently?" It is rare that things cannot be improved upon, but even if the examination determines that a particular system component is working correctly that does mean that it should be exempt from future examination. The world is constantly changing and what works today might not work tommorrow. There needs to be constant feedback and examination of processes.

"It needs committee study." I hear this and I know that nothing will be done...ever. Languishing in committee is the death knell of any proposed change. Yes I get that topics need to be discussed and data gathered but to consistently refer to committee tells me that you are unable to make a decision.

2. Do you ever use any of these excuses yourself?

I am often hampered by lack of equipment so I have avoided some change by using that excuse. In my defense the proposed changes did not include the equipment and support needed to carry them out. I can only devise so many workarounds before the change is worse than the problem it was meant to fix.

3. How can you overcome the thinking that creates those responses to change efforts?

It can be very difficult to overcome these entrenched mentalities. Often cognitive dissonace sets in and the target becomes even MORE resistant to change. In many ways this has to be overcome before the change process really starts. In other words, the target has to see a need for change. In the private sector falling sales or monetary losses will often drive change. Even then, there will be resistance and you will probably lose some people depending on the scope of the change.

Once change is in progress it may be that you have to employ coercion techniques, persuasion, compromise, or even outright directive approaches to overcome entrenchement. I prefer reasoned discussions but often people become emotionally invested in their positions, then I find it useful to explore the whats-in-it-for-them portion of the equation. That way they are able to transfer emotions to the new concept.

4. Do you agree with Seth Godin’s concept that change is driven by tribes?

A bigger discussion can be found here where a comparison of Godlin's Tribe Theory and Watt's approach to Influence can be found. Tribe theory is based on a interlocking relationships and those relationships are not always clearly defined. As with any tribe there are a mulitude of variables in play among those relationships such as politics, friendships, romances, and any other human to human interaction possible. This isn't particulary new but it does help frame the discussion in a way that stops setting such clear views boundaries of leadership and influence. And THAT is something with which I can agree. Leading people takes more than strategy (thought that has to be there) it takes an understanding of the relationships and connections among the followers.

5. What can you take away from this exercise to immediately use in your career?

I work for an organization that can be very slow to change. There aren't a great deal of external motivators in play to force change. This has led to a great many entrenched managers. Understanding how these paradigms of resistance have been put in place has been instrumental in trying to change my small corner of the world.

NASA Culture Change

For those of you that want an hour of CSPAN here you go! Grab your popcorn, grab the kids, make a night of it. All kidding aside it is important to understand cultural change in NASA as it pertains to culture change in organizations. Also, it isn't a bad speech from a business perspective and I think it is a great example of a how an organization has hit the reset button and accepted responsibility for how their culture has failed

1. Why did NASA Administrator Sean O'Keefe address NASA employees to describe the plan to
bring about proposed changes to NASA's culture?

NASA's employees needed to hear how leadership was accepting responsibility for the failure in culture. He will need the support of the organization's people in order to execute change. It also sends a message that this is a priority for leadership.

2. Was he believable? Is it important whether he appeared to be believable?

I think he was but I also have not had much experience listening to O'Keefe's prior speeches. In some ways managers lose credibility when they repeat themselves over and over yet take little action. I think for a culture that has gone awry actions will speak far louder than words. That being said I think he said things that many people needed to hear. His words on climate and being able to "speak up" were very important and they do send a message. Couple those with action and I think that the cultural will go a long way towards being improved.

3. Why did he talk about NASA values?

It is helpful to remind people of shared values. Not only for the people listening but for himself. Value systems need to be consistent throughout an organization and throughout their partners and when leadership is not only sending the message but acting the message those values percolate throughout the various levels of the organization. However NASA is a large organization with many layers and the message, while consistent in a speech, won't be applied evenly throughout those layers without much effort on the part of Mr. O'Keefe.

How Companies Can Make Better Decisions

You have to love the Harvard Business Review great information without all the glitz and glamour of PBS. This week's video is an interview with Marcia Blenko of Bain & Company. She is discussing decision making as the building block of leadership effectiveness. This means that ultimately that change management will also need to be build on effective decision making.

Marcia Blenko argues that decision effectiveness correlates positively with employee engagement and organizational performance. How do you think that employee engagement relates to decision effectiveness?

To put it bluntly and in non-academic terms...people know when their leaders haven't a clue. There can be a tendency for managers to exist in a fog where they think their ineptitude is some how transparent to the people at the bottom of the organization chart. In my personal experience the people at the bottom of the chart are often more in tune with how the company is living and breathing than the people at the top. It is my firm belief that productivity follows morale. Poor morale makes people work just hard enough not to be fired. That link will be the best part of this blog. However, when people feel that effective decisions are being made, even if they are not always in line with what a given person wants, they are more motivated and engaged. This may mean that leaders need to actively listen to what their people are telling them. People are generally wanting to be heard so badly that they are willing to pay for the privilege.

What are some impediments to good decision making?

Marcia lists a few in her interview and I could just refer back to that but instead I will give an example from my own organization.

Leadership in an organization is a learned art. There are very few natural, charismatic leaders that also make effective decisions. Within my organization there are very few trained managers. Sure they are highly educated doctors, psychologists, and the like but having a PhD in psychology doesn't always equate to effective leadership. Add in a healthy does of bureaucratic tomfoolery (family friendly blog here) and you have a recipe for completely ineffective decision making. I feel that being properly trained to handle managerial tasks is crucial and lack of that training is an incredible roadblock to good decision making. I often use the argument that in order to manage three doctors I would need to have a great grasp of doctoring. In order to manage a healthcare system I need to know how to lead.

Blenko suggests that there are four elements of good decisions: quality, speed, yield, and effort. In your opinion, is there anything missing from this list?

Good decisions are no bigger than they need to be in order to get the job done. I would argue that precision would be a fifth element of decision making, and no I am not going to link to two movies in one blog post.

To elaborate I feel that some decisions can be too sweeping in scope. In order to overhaul an entire system one must fully understand all the variables in play. It may be that smaller, more targeted decisions towards one variable can have bigger ramifications down the road. The Law of Unintended Consequences should always be considered when making decisions. There are times bold strokes may be needed but careful leadership will always encompass the downstream effect of decisions. In other words, make a change, measure results, make a change, measure results. Rinse, Repeat. If one does not measure the results of an action before taking another you can wind up chasing the gauges to what can be called an unintended air-frame/ground interface.

A Day in the Life

Another video! I rather enjoy these as I tend to learn something from each one. This video isn't a reflective as others but it was interesting to see how Southwest keeps morale up among their crews as well as promote a culture. As a bonus this video starts with some sweet 90's corporate music. Enjoy. 

Is the Culture Committee at Southwest effective in establishing cultural norms?

Southwest is known for having a unique corporate culture. I think the Committee is doing an excellent job as exemplified by this hilarious attendant. If you watch nothing else you should watch video to see how Southwest's culture is personified. With that I can move on.

From what you can tell, what is the purpose of the culture committee at Southwest?

From just the initial video I would say the purpose of the Culture Committee is to promote the welfare and moral of the crews on the aircraft. However, it is probably safe to say that the committee has more than one function such as designing new programs to keep morale high and ensuring that needs of the crews are being met.

What would you see as a viable mission for a culture committee in your place of work (or your last place of work if you are not currently working)?
Patient care can be a demanding field and there are many ways that culture committees can be useful. However, the hospital does endeavor to provide regular gatherings as well as food and drink for the staff. In addition, the union often does cookouts and bar-b-ques outside in the common areas where staff can gather for a a free lunch. It isn't always possible to promote a uniform culture in an organization as large as the Department of Veteran's Affairs but locally the union does a fantastic job of providing those little thank-yous that go a long way.

What can you take away from this exercise to immediately use in your career?

I have always thought that a positive and fun culture can go a long way towards keeping employees happy. A happy worker is a productive worker. Within my unit we try to keep things as light as possible but that carries with it the danger of seeming flippant to outside observers. It is a careful balance!


With that in mind I am going to go watch the Super Bowl.

21st Century Enlightenment

Another video! This is one of my favorites and I highly recommend it. Below are the questions that came with the assignment and I will attempt to answer them but I hope that you, the reader, take away something of your own from the above video

1. Why do you think the talk is titled 21st Century Enlightenment?

Global societies are undergoing quite a bit of change and not all change is always good. 21st Century Enlightenment means that as people we need to change the way in which we think and interact within the societies that sustain us. One-tier concepts such as freedom, progress, or technology are great for breaking down complex concepts but they carry with the the trap of simple answers. Quite frankly, getting your philosophy from a bumper sticker means that you lack the relationships needed to be aware of your overall place in society. Additionally, this trap of simple thinking disconnects the individual from the society that provides the individual with the tools for success. Nothing ever happens in a vacuum and enlightenment is no different. 21st Century Enlightenment means that we govern ourselves with empathy and self-awareness and not just concerning ourselves with the individual. It will be a profound shift in thinking for many.

2. What does Matthew Taylor mean when he says "to live differently, you have to think differently"?

We cannot solve new problems with old thinking. Any fundamental shift in society comes from new modalities of thought. In order for us to create a more empathetic society we need to start to think in more empathetic ways. It isn't enough to ask "is this right for me" but to look past ourselves to how others view the world and attempt to reach across those boundaries.

3. At one point in the video (4:10), Taylor argues that we need "to resist our tendencies to make right or true that which is merely familiar and wrong or false that which is only strange". What is he talking about? Can you think of an example within your company or your life that supports this point?

To make something right that is merely familiar means to ascribe logical fallacies to things that make us feel better. Some call this confirmation bias. You see this quite a bit in arguments such as gun control. Person A defended his home from an invader therefore we are safer with weapons in our homes. However the math does not support this argument. It just makes a person feel better to have a weapon in the home; thus it is true because it is merely familiar. On the other side of the coin we can look at the current gay-marriage debate in the US for an example of people attempting to make wrong what is merely strange. Current attempts to modify the Constitution to ban these marriages are people taking this argument to its absurd ends.

In my areas of patient care there are those that subscribe to the idea that things are wrong for being different and it can be rather infuriating to overcome. When it comes to addiction rehabilitation certain amounts of empathy are called for however this does not mean that there cannot be natural consequences for actions. For example, being intoxicated at work could lead to termination and this is a natural consequence. Empathy does not mean shielding those effects but to understand why one would see their actions as justifiable.

4. Taylor argues that our society should eschew elements of pop culture that degrade people and that we should spend more time looking into what develops empathetic citizens. Would this be possible?
I think we should but I am not so sure that it is possible. I've largely dropped most of pop culture from my life; I don't even have cable or antennae service. This allows me to pick and choose my entertainment through streaming or getting out and enjoying the arts. However, I have reached a point in my life where I can afford to make those choices. Not everyone is that fortunate or has that freedom. For many, entertainment is taken where it can be found and it would be understandable for peoples that are disenfranchised to experience a certain amount of schadenfreude over other's suffering. I wager most of you reading this has taken a fleeting pleasure at watching a Lindsay Lohan-type meltdown. Sure, we might feel guilty afterwards and the thoughts themselves are most likely fleeting but they are there.

I do believe that is a goal towards which we should all strive. There can be no harm come from less degradation and more empathy. If everyone already thought this way we wouldn't need an enlightenment in the first place.

5. At the end of the video, Taylor talks about atomizing people from collaborative environments and the destructive effect on their growth. What is the implication of these comments for organizational change efforts?

Overall organizations must seek collaborative environments. Even simple change mechanisms such as Lewin's Model state that collaboration and buy-in are key to successful change. The simple fact remains that we all need something from each other. Simplistic thinking and rugged individualism often leave out that a person's success is dependent on using the protection and resources the group provides. People cut off from adequate protection and resources do not grow as well as those that are provided those tools. Go to any impoverished school district and see how growth is stunted in areas cut off from the fruits of society. This paradigm can be scaled to sub-units in an organization and even down to the individual. Without support people are doomed to fail.

6. What can you take away from this exercise to immediately use in your career?
This has re-enforced my need for a global perspective. The myth of rugged individualism is just that...a myth. We live in an increasingly global environment, we cannot isolate from it. It affects everything we do and buy. Typhoons in China raise prices on goods in the US. Shady investment practices in the US cause bankruptcies in the United Kingdom.Faster communication means we are more aware of the world around us than ever before. Hiding from this change does not make it go away, it just means you get left behind.

A630.1.4.RB - Board of Directors

Ahhhh...good to be back. I keep these informal rather than academic though I do link references and after such a lengthy absence I can only imagine my tone will be more conversational than ever! Well let's get to this shall we?

For those of you that aren't my instructor it may be beneficial to view this video before continuing. 

This week we are going to be discussing a situation in my organization similar to what is portrayed in the cartoon linked. As I work for the Department of Veteran's Affairs you would think that I would have no trouble finding areas where pessimism and resistance to change left obstacles unconquered; and you would be correct...but only to a point. The VA patients seem to enjoy their service almost as much, if not more, than their private sector counterparts. That survey may not have accounted for patients that have no other choice but to use VA hospitals, healthcare being what it is in the US, but it  still can lead to the conclusion that administrative bungling and in-fighting is largely transparent to the patient. Even the recent black-eye the VA received in the Phoenix patient deaths was only at the result of a "contributing" though not causal factor. While that statement reeks of bullet-dodging it also has a small kernel of truth. The point isn't to rehash that debate to clarify that even in its darkest moments the VA ranks above private healthcare outright killing people by the thousands simply from not being able to afford care. Comparing the two gets really close to a straw-man argument but it is still fair to say the VA isn't killing en mass due to lack of access. 

However, for those that work in the VA, the in-fighting is severe and resistance to change is quite severe. "We've always done it that way" seems to be the motto I most hear in meetings and it drives me up a wall. In my corner of patient care we teach life skills and vocational development to addicts, alcoholics, and to people suffering from mental illness. Usually they have all three. As just one of our tools we utilize internal contracts with departments such as housekeeping or medical supply to place patients in paid roles where they can gain stability and practice using life skills in a structured and sober environment. This allows us to transition the patient back into the community. Sounds great right? However the recidivism rate is very high. In many cases patients see these jobs as quick way to gain cash rather than be genuinely ill. So in essence there are a few bad apples that cause a great deal of work for the staff and therefore divert our attention from those that need care. A small group of us have proposed adding a step to our assessment process that would allow us to ask a few simple questions to those requesting admission that would screen patients, or at least give us information to help hold them accountable. However, the powers that be are resisting this change as it is a departure from standard procedures. There are some legitimate concerns that this information could be used to deny care and while in certain situations it is ethical to deny care in the current climate it is a public relations nightmare.  In any patient care scenario one must accept some "bad apples" in order to serve the greater body of patients. In truth, the worst cases are often the people that need the most care (even if these patients refuse to see it). In short, there is a great deal of grey area in which a compromise could be found however it seems that resistance to explore these options leads to no change at all.  

As it stands, some small progress is being made within the program by tightening our controls where we are able. We've implemented processes that don't need larger approval in order to apply a uniform admission process as well as allow us to better develop personalized treatment plans. These plans hold both the providers and patient accountable for success and allows for more outcome control. Through this we hope to see our patient outcomes improve and early indications are that it is working. However much more time will be needed to fully appraise our progress.