On this episode of the Cassling Academy Podcast, Marc Costanzo chats with Dr. Mike Freel, an Associate Professor and Program Director for Bellevue University's Master of Health Administration; also our co-host of the Cassling Leadership Institute. So what does it take to be a successful leader in healthcare? Keep reading to learn more about various aspects of leadership, from emotional intelligence to employee performance management, and get insight into transitioning from a tech to a leadership role.
The following is an interview transcript edited for clarity and length. If you prefer, you can listen to the full podcast in the player below.
Marc Costanzo: Dr. Freel, welcome to the podcast.
Dr. Mike Freel: Thank you. Appreciate it.
Marc Costanzo: Let's just start off with telling me a little bit about yourself and how you got interested in leadership development.
Dr. Mike Freel: I came up on the clinical side. I was a transplant coordinator for about eight or nine years in Nebraska. And during that time, I started to get my Master's in health education. Some of the topics around leadership were interesting to me. And then after I received my Master's, I went on and got my PhD in human resource development, which was a focus on leadership and organizational change, which is where I became interested in emotional intelligence.
I found that clinical nurses had higher levels of emotional intelligence than other industries like research or sales or even clergy. That lead me to the question, did nurses get into the field because they have high emotional intelligence or did they develop their emotional intelligence because they got into nursing? A follow-up research project down the road.
Marc Costanzo: I'm interested in that leap from clinical work to this leadership research component. Was it something you always intended to pursue or is it something you decided to pursue once you got into the clinical world?
Dr. Mike Freel: Like a lot of people, we fall into positions that we find most interesting. I never set out to be as focused on leadership as I am. Back then, I was focused on the clinical side and I was looking at clinical opportunities. But it was through my education that I became interested in leadership and then doing more education for hospitals on the transplant side is really what got me introduced to working with hospitals and talking about leadership topics. And so, as I started to gain more knowledge and experience about leadership, it seemed to coincide with the education that I was doing for those hospitals. When I left the transplant business, I went to Nebraska Methodist College, where I was a chair of certificate programs. That's where I started to do public speaking on leadership topics and really enjoy it.
I had a colleague who told me a long time ago, "You make time for the things that you really enjoy doing." While I was doing everything else, it really kept me motivated and engaged in those positions that I had. And now I just love it ... I'll talk your ear off about leadership.
Marc Costanzo: Please do.
Dr. Mike Freel: That's what we're going to do today.
Marc Costanzo: Definitely. How did emotional intelligence sort of enter your sights as you were going through?
Dr. Mike Freel: It didn't. It's a funny story. I remember I was looking for a dissertation topic, getting my PhD. And I didn't know what I wanted to do from a research standpoint. I think it's important to give yourself a chance to evolve, to explore topics and find what interests you and pursue that. Don't go into it thinking that you know exactly what you want to do because I think you're selling yourself short that way. I remember the room I was in, where I was sitting, the table, chairs, walls, they were white. And it was like a lightning bolt hit me. I was in one of my classes and we were talking about emotional intelligence and I said, "This really sounds interesting to me. I want to pursue it.".
I had an advisor at the time who said, "You know, I seem to recall that there's another approach to emotional intelligence. I think you should investigate it a little bit more." And I'm glad he said that because there's really two models of emotional intelligence. I was going down what's called a mixed methods model or a mixed model of emotional intelligence, which is great. And organizations that do development on those topics are really doing a service for their employees. But I pursued what's called an ability model of emotional intelligence. It's much more sound as far as the research goes and it's really based in people's ability to identify and use emotions and gather emotional information to make decisions. And so that's what I based my research on. And that's really where I base my consulting and coaching on is on that ability model.
Marc Costanzo: Can you be a good healthcare leader without being necessarily emotionally intelligent or is that a critical component if you really want to excel in leadership?
Dr. Mike Freel: Everybody's got different levels of emotional intelligence. In the ability model, there's four different skills. Everybody has different degrees of effectiveness when it comes to those skills. The more successful leaders are able to recognize and use the emotional information that's available to them. They're able to problem solve and make decisions based on that. These are the folks that, you know, when you come into work, usually you're told you have to leave your emotions at work, at home, you don't bring that stuff to work. But you know what? We bring that stuff to work and it makes us who we are. It makes us the employees we are. And effective leaders are able to identify that emotional information and lead using a lot of different emotional information to make decisions, to problem solve, to be creative, to be compassionate, to be empathetic. It's out there, it's free information too. You just have to know what you're looking at.
Marc Costanzo: Definitely. I would imagine, even if as much as we try to compartmentalize what's going on in our personal lives and what we had happen before we walked through the doors of a workplace, we're still carrying that in. And then you talk about healthcare, which is this emotionally dynamic place anyway with extreme highs and lows, you have to be able to understand what your people are going through.
Dr. Mike Freel: Yes, so flip it around. If you're a rad tech and you've had an incredibly stressful day and the beds are lined up down the hallway and you're just trying to get everything done, not only are you bringing emotions with you to work, you're taking them home too. And I think people who are a little more emotionally intelligent recognize that how they think and feel is all affected by these things. Our moods are one way of looking at that. Moods are really sustained emotions. If you're happy and you're happy over a long period of time, you might experience joy. And the opposite is true too. So we have to recognize that employees take it home with them as well.
Marc Costanzo: Is that a pretty big blind spot for some healthcare leaders or are there other big blind spots? And then sort of following off of that, if a healthcare leader has identified a blind spot that they have, how do they go about fixing it in themselves and on their team?
Dr. Mike Freel: By blind spots, I think you mean that there are some unidentified skills or unidentified deficiencies in what they do or they do not have as far as knowledge and skills. Emotional intelligence is not a common topic that people go out and learn about. One thing that Cassling has done really well is brought emotional intelligence to the forefront over the last year. And we've had a few webinars on it. I think it can be a blind spot in that people don't always recognize the emotional information that's out there. It's also a very advanced kind of leadership topic.
We have to remember to be grounded in certain skills and behaviors in order to be effective leaders. When I think of blind spots, the first thing that comes to mind to me is performance management. How do you keep people doing the great things that they're doing? How do you stop them from doing all that silly stuff that they'd been doing? You tell them, "Don't do that, don't do that," and they keep doing it. Why does that happen?
A basic understanding of performance management is critical in order to be an effective leader. You can combine that with a lot of different other skills and behaviors, but I really think that holding people accountable and getting the best work from people while also making sure that they're satisfied and engaged in what they're doing, that's a critical competency.
Marc Costanzo: How do you improve that? If you're a new healthcare leader coming onto a team where that hasn't maybe been the best in that particular organization. How do you even go about that?
Dr. Mike Freel: A lot of times I hear symptoms rather than problems. I hear, "Freel, you've got to come in, you've got to do a session on motivation because our people just aren't motivated." And I'll look them in the eye and say, "You know what? Motivation is not your problem. Motivation is a symptom of a bigger problem. Let's find out what that is. Let's look at that together and figure out why are you seeing some of these motivation issues." The thing about performance management, and a lot of leaders don't like to hear this, but it's not really the employee's behavior, the employee's performance that we're talking about. We're talking about the leader. Leaders have to understand, how do you engage employees to get the best performance?
So there's lots of examples of this, but I'll use something very simple. So Marc, you're supposed to be here at 8:00 in the morning and you've been coming in at 8:15. No one said anything.
Marc Costanzo: It's pretty accurate.
Dr. Mike Freel: Yeah, 8:30. I saw you roll in today at 9:00. But no one's said anything to you. I mean, in your head, it must be okay because no one's said anything about it. In my head as the leader, I'm like, "Why is he coming in so late? Doesn't he know that he's supposed to be here at 8:00?" So really when it comes down to accountability, it's my job as a leader to make sure that you understand that you need to be here at 8:00 in the morning. And if you're not, there needs to be a conversation or eventually some consequences for not doing that.
In performance management, we often talk about gaps. Where I want you to perform and where your actual performance is. In this case, I want you to perform at a certain level, but you're not. And so we have a gap. I want to try to alleviate or remove that gap so that we are on the same page. And you can fill in the blank with any task, topic, outcome, performance metric, standard, whatever you want. But if there's a gap, most of the time it's up to the leader to ensure that the gap is at a minimum. And at best, you flip flop it, so the employee is performing above your expectations.
Marc Costanzo: I want to mention quickly too that a lot of these things we've touched upon, you have done entire Cassling Leadership Institute webinars on these topics. There's one on performance management, there's one on emotional intelligence, and there's a couple of others out there as well.
Dr. Mike Freel: We've talked conflict, we've talked change, we've talked a lot about critical competencies for effective leaders throughout the Cassling Leadership Institute. And it's been a hoot. Participants learn a little bit from me, but they learn just as much from everybody else. And that's what's interesting.
Cassling is one of the organizations that gets it. They understand the value of development. And what I like is that when I walk into Cassling here, you can see it, you can see the positive culture. It's on the walls, how you're greeted at the door, and how people interact. Not every organization is like that. We have to understand culture drives this. One of the reasons I like working with Cassling is because you wear your culture out on your sleeve, it's there for everybody to see and it's positive.
Marc Costanzo: Thank you. That's something we pride ourselves on.
What it Takes to Be a Successful Healthcare Leader
Marc Costanzo: What are some of the most important traits of a healthcare leader?
Dr. Mike Freel: That's a great question.
Marc Costanzo: Not weaknesses, but strengths.
Dr. Mike Freel: This is such an important question and I hope people will pay attention to this because actually, using that language with regard to traits, traits have absolutely nothing to do with leadership. The research supports that. Traits do not equate to effective leadership. It doesn't matter what you look like, that's a trait. What matters is what you do. What matters are behaviors.
Leadership is all about human behavior. If you know a little something about human behavior, you can be a better leader. Traits don't equate to effective leadership, but yet they are involved. One of the examples I use is being an introvert. It's a trait. A lot of people might be familiar with the Myers Briggs trait-based assessments or Keirsey trait-based assessments. There's lots of them out there. They try to label you based on how you score on an assessment. But those are traits. Whoops... One thing you have to do as a presenter is remember to turn your phone off.
Marc Costanzo: It's all good.
Dr. Mike Freel: Being an introvert and how you look as an introvert has nothing to do with leadership. But it has something to do with how you prefer to behave. If you're an introvert, maybe you lead in a more quiet kind of manner versus an extrovert who might be a little more out there and gregarious and energetic. It doesn't mean that you can't be that, it just means that you prefer to lead a little differently. Traits are involved with leadership, but you really can't equate traits to effective leadership.
But if you take it a step further. What are the behaviors? What are some of the key behaviors of effective leadership? The first is how to deal with conflict. Without a doubt, that's the number one issue I hear when I do workshops. The ability to deal with conflict or working with conflict is always going to be number one.
Marc Costanzo: Are people afraid of conflict?
Dr. Mike Freel: People have different preferences for how they like to deal with conflict. And even emotional intelligence can come into play with this. But if you only have basic conflict skills and you're in a healthcare organization as a leader, you're going to need to improve those skills. Conflict is everywhere. You can't get away with it or away from it. Communication skills is another. Being an effective communicator is critical. Problem solving is critical, and creativity. I'll throw that in there as well. Especially in healthcare anymore, we cannot keep doing things the same way we've always done them. The worst thing that you can say to me is, and my skin is already crawling here, but, "We're going to do it this way because that's how we've always done it."
Marc Costanzo: Oh no.
Dr. Mike Freel: Drives me up the wall. As a leader, you can't be happy with the status quo. You should always be striving to improve your own performance or performance of your department or your organization. Doing things the same way that we've always done them is not going to get you where you need to go. Effective leaders are able to challenge those assumptions and they continuously look at how they can do things better.
In healthcare, we're tasked with doing more with less. So if you're not getting creative, if you're not problem solving, if you're not engaging your employees, you're going to fall behind. A lot of leaders think that since I'm the leader, I'm in charge of everything and then everything has to come from me. One of the fallacies, or mistakes, is that leaders neglect to share their leadership. Because they think, "If I share leadership, I'm going to lose it." The opposite is true. If you shared leadership, you are going to become a better leader and you're developing other leaders at the same time. You know, when it comes to problem solving and creativity, chances are your employees will probably have a pretty good idea or suggestions about how to do things differently. It's up to the leader to kind of vet those and discuss those and come up with solutions that are going to improve outcomes.
Marc Costanzo: I think you're absolutely right on the willingness to embrace change is so important, especially in a field like healthcare that evolves so rapidly, where the landscape a year from now might look completely different because of a rule that CMS issues or new patient standards. So being willing to adjust on the fly is so critical.
Dr. Mike Freel: It is. If anybody's been in a workshop with me, they've heard this statistic before, but 70% of us don't like change. I'm one of those. But I've recognized and I know that about myself, so I'm able to deal with it a little bit differently. But if 70% of us don't like change and healthcare is changing on the fly almost daily, as a leader, you've got some issues you're going to have to deal with, you're going to have to create some buy in.
Everybody's heard about the cliche about getting on the bus. You have to have the right people on the bus. Well, you have to have the right people in the right seat and you have to have a driver who knows how to drive and knows where you're going and has a map. When we get to where we're going, boy, we sure hope that you're on the bus with us. But if you're not, it means that you left for some other reasons. As leaders, we want to ensure that we get to where we're going with everybody that's going to be able to help us and assist us when we get there.
Marc Costanzo: How do you get those people that are kicking and screaming against change onto that bus? And especially if it's an organization that might be averse to change. How do you steer that conversation?
Dr. Mike Freel: Communication is key. You've got to let people know what their role is and what the expectations are. People might not want to go down that road on that bus with you. But you want them, you need them, they have expertise and skills. They have knowledge that is in their heads that you're not going to be able to get out if they take it with them. So you need to create buy-in or importance of why they need to be involved and how you need them and what their role is. And you can't do that through an email. You've got to get out and talk to your people. This is "management by get your rear end out from behind your desk and go talk to people." It's a critical skill when it comes to leadership.
Transitioning from a Tech Role to a Leadership Role
Marc Costanzo: I want to switch gears a little bit on. If somebody is in a tech or a specialist position right now and they want to make that switch and they want to evolve their career, how can someone make that leap? What would you suggest to that person who's wanting to go in a management or executive type role?
Dr. Mike Freel: We call them career ladders for a reason. If we're stepping up and up and up on those career ladders, we want to advance. Now, a lot of people want to advance, not everybody. But I really enjoy seeing people and talking to people who are interested in advancing and they take the initiative first. They go to their supervisor, they go to their boss and say, "You know what, I'm interested in advancing my career in this field or for this organization. How might I do that?" So they start off by taking the initiative to have that conversation. A lot of times it involves special education or training in order to do that, and I am completely on board with that. First off, it needs to be the right program for them. It needs to be aligned with what their career goals and their personal interests are. And they need to take those steps in order to get that education or training.
I get calls all the time from potential students, they say, "I'm thinking about taking your program and can you give me any advice?" The number one piece of advice I can give them is there is never a good time to go back to school. There is always something that's going to get in the way, whether it's job or kids or family or whatever it might be. What it takes is pulling the trigger and doing it. You know, take that initiative, take those first steps, and start. Once you start, you keep your head down, stay focused and get through it. Getting an advanced degree opens doors. I've seen this over and over with students, especially graduate students. They're like, "Well I'm not sure what I'm going to do after I get my degree." And lo and behold, before they've even graduated, they contact me and say, "You won't believe what just happened. I got promoted to such and such position and now I'm doing this for this hospital or this clinic." They love it because even approaching the end of their program, the doors are opening.
Marc Costanzo: Are hospitals and healthcare systems looking for people who have those additional degrees now, maybe more so than in the past?
Dr. Mike Freel: Absolutely. They are looking for the people with the credentials. They'll look at someone say, "Okay, you've got MHA behind your name. You've got your Master's degree." That's the first step. The other step is that, "Okay, now that I've recognized that you have a graduate degree, I'm going to put that to the side. That was your ticket in. Now let's talk about what do you do?" So now we're getting back to that leadership piece and that behavior piece about what do you do that makes you effective? And that's what they're interested in. They want to know, what was your past experience? What have you accomplished? What are you most proud of? What did you maybe get hung up on? What were some of the snags? That's what they're going to look for. The graduate degree will get in the door. It's up to you to take it the rest of the way. But it's really focused on where are your interests? Take the initiative to do those things.
MHA Degree vs. MBA Degree
Marc Costanzo: You mentioned MHA, so I know the two big degrees in healthcare that you see a lot are MHA and MBA. What is the difference between the two? And also is there one you recommend more than the other? Or can they both get you in the door depending on what that door is and what the role is that you're looking for?
Dr. Mike Freel: Great question. There's a difference between an MHA and an MBA. The MBA is probably going to be more focused on the finance side. You're going to be taking more finance courses, you're going to become more knowledgeable with regard to some of the intricacies of finance. The MHA on the other hand will include finance, but it's a much broader healthcare kind of degree. It's really looking at the business side of healthcare.
In our program, we talk about leadership. We also have courses on human resources, strategy and strategy development, the finance courses, health information technology. In all of these courses, and I can speak for Bellevue, but our content is really leading edge. We don't rely so much on textbooks to convey content to students because let's look at health information technology. It changed yesterday. What happened to that textbook that was published yesterday and is it current? Well, no. So we focus more on the current research and looking at professional organizations to present the information to students because it's leading edge, it's always changing. So that's the focus of our program.
Is the MBA better than the MHA? Again, I would leave that up to the student. I'm a little biased because I'm the director of the MHA program, but I think both degrees are very valuable. Anytime you can advance your knowledge and skills in areas such as healthcare finance or for an MBA student who might want to learn more about health information technology and security, which is a hot topic right now. There is some overlap, but you can be effective and you can get hired with either.
Providing the Best Care Delivery
Marc Costanzo: As we wind down, what topics are you seeing have the most impact in healthcare right now? And specifically, what do today's leaders and even tomorrow's leaders need to be paying attention to?
Dr. Mike Freel: Right now, we're looking at care delivery models and how do you get care to patients? We're starting to see trends in, well in the Omaha area you've seen some pharmacies attaching the small clinics to the pharmacies. In areas such as the Southern U.S., not only are they attaching clinics, but they're attaching big, full-service clinics to those organizations, trying to creatively come up with some different ways for delivering care.
We see home health models and telehealth. Most hospitals, if they haven't already implemented a telehealth program in some department or area, are looking at it heavily. Care delivery is at the top of the list, which means we need healthcare administrators and healthcare leaders who are able to think outside the box. You've got to be creative and think critically about how are the changes or how are the decisions you're making going to impact that care delivery down the road?
Marc Costanzo: It goes right back to what you said about your willingness to change and you have to be willing to adapt to changing times.
Dr. Mike Freel: And explore, and that's something that we didn't mention today, but leaders need that certain level of a willingness to take risks in an entrepreneurial spirit. It circles back to culture. Do we work in a culture where mistakes are seen as an opportunity to cut heads? Or are mistakes seen as opportunities to learn and develop and grow and do something different? Most organizations want to take that second perspective, and I hope they do. If we're going to change healthcare, that's what we need.
Marc Costanzo: Is there anything you want to add that we haven't covered?
Dr. Mike Freel: No, I appreciate the opportunity. Bellevue University has worked with Cassling for a number of years and we've been privileged to help provide the development for the Leadership Institute. Like I said before, Cassling gets it, they know the value of development. And I appreciate all your efforts and all your time in helping to do that.
Marc Costanzo: Thank you for being here. And if anyone has enjoyed this as much as I have, feel free to see more of Dr. Freel's great vast wealth of knowledge at the Cassling Leadership Institute.
Dr. Mike Freel: Thank you.