Are You Willing to Do the Dirty Work?

Happy Monday, Healthcare Leaders!

Welcome to this week's edition of The Healthcare Leader where we’ll explore how to gain influence as a leader, three forms of healthcare compensation, and how to use the “sparkle factor” to succeed in business.

And for those of you attending the 2026 ACHE Congress, make sure to say hi to the 34 speakers we interviewed earlier.

Let’s dive in!

Several years back I walked into an art gallery with a hospital CEO. It was a hot summer day in Central Oregon, and we were ready to spend a few minutes in air conditioning. 

As we casually looked around the shop, we came across a large, gross-looking beetle in the middle of the gallery floor. 

The gallery manager said, “Let me get my assistant to remove that insect”.

The CEO, who was certainly not someone who enjoyed bugs, responded, “It’s okay, I’ll take care of it.”

He then spent 15 seconds awkwardly chasing the beetle through the shop, scooping it into his hands, and rushing it outside. 

It was not his most graceful moment, and the shop manager looked at me with eyes that said, “Well that’s embarrassing for him!” 

At that moment, I realized what an amazing leader this CEO was. Here, a gallery manager with one employee was too good to pick up this bug in his own shop. Meanwhile, a hospital CEO with over 1,000 employees was willing to take on the embarrassing task so someone else didn’t have to look awkward. 

In his book, Give and Take, Adam Grant states there are three types of people. Takers, matchers, and givers.

Takers are always looking to get ahead at someone else’s expense. They model their careers after Game of Thrones and Survivor. Their motto is: “I don’t need to do my best, I just need to do better than the person next to me”. 

Meanwhile, Matchers are people who believe in fairness above all else. I will treat you how you treat me. Most people are matchers – and they are often the ones that put takers in their place.

Finally, there are Givers. Givers have an abundance mindset and assume the best in people around them. They’re willing to give more than they receive – with an understanding that it makes the world a better place. 

Guess which type of person most frequently makes it to the top of an organization? 

You might think it’s the Takers – who are willing to do just about anything to get ahead. And while they can appear to do well for a period, their selfish attitudes eventually catch up with them.

It turns out Givers achieve the highest positions in society because they focus on the greater good. By lifting up those around them – even when it comes to small things like picking up a bug – they gain the respect and support of others. 

Now smart Givers, who are most likely to rise to the top, do occasionally say no to Takers. If it becomes apparent someone is trying to take advantage of them, they may reduce their giving from 100% of the time, to 60% of the time. So they’re still willing to give more than they receive, but they do draw a line. 

When you focus on others above yourself, you become the kind of leader people are willing to invest in. The kind of leader able to make lasting change both within your organization, and across society.

If you’re attending Congress this week, you’ll get to hear directly from Adam Grant.

Discussion & Reflection

The U.S. healthcare system is a complex web of payor models — with three that dominate the field. Working in healthcare, you will likely hear about, and potential work in, all three of these models.

Understand these three models and you’ll be able to have far more sophisticated conversations around healthcare reimbursement.

With fee-for-service, providers get paid for each service they perform. You charge for every test, procedure, and consultation.

While it’s the most common model, it has its drawbacks. On one hand, it incentivizes thorough care; on the other, it can lead to unnecessary tests and treatments. It also leads to a lack of care in rural areas where the demand (and thus the reimbursement) is lower.

Most hospitals and clinics in the US are fee-for-service.

Cost-based reimbursement has been a lifesaver for rural healthcare. Here, providers are reimbursed based on the actual costs of the services they offer, plus a little extra for overhead.

While an Emergency Department physician in a city may manage 2.5 patients per hour, in a rural hospital that may be 1 patient per hour — with both hospitals on the hook for the same support salaries to cover the care. By offering additional subsidy to the rural hospital, they can afford to pay staff and keep care close to home.

Two common cost-based reimbursement venues are Critical Access Hospitals (CAH) who receive financial benefit from Medicare patients, and Rural Health Clinics (RHC) who receive financial benefit from Medicaid patients.

Finally, we have population-based payment, also known as capitation. With PBP providers receive a fixed amount per patient, regardless of how many services they provide.

Keep your patients healthy and you get to pocket the money. End up with a high-risk population and your profit margins disappear. It’s all about efficiency and preventive care; population health.

The lead player in the US is Kaiser Permanente — and this was really the intention behind the Affordable Care Act (Obamacare). If implemented effectively, this really is the best form of reimbursement as it aligns incentives. Healthcare organizations are encouraged to keep patients healthy rather than just treating them when they’re sick.

Discussion & Reflection

One of the most profound lessons I learned on how to be excellent and impress others came from Mr. G, my high school Algebra teacher.

Mr. G was a very challenging grader. Unlike many other classes where everyone ends up with an A, getting a C really was the average in his classes. 

However, Mr. G also offered an opportunity to improve your grade. On every homework assignment you could earn 5% extra credit by adding what he called the sparkle factor. The sparkle factor was simply taking a little extra time to do something that visually improved your assignment.

This “little extra” could be anything from typing out your homework, to drawing a cartoon in the corner, to attempting a few extra questions, to turning in the assignment a day early. It was simply doing something that showed you were willing to go beyond the original ask for the assignment.

I’ve taken this concept with me into the corporate world. Whether delivering a project for my boss or having a conversation with someone on my team, I try to constantly think, “what’s something I can do in 5-10 minutes to noticeably improve this person’s experience?”. 

Although “the sparkle factor” isn’t an official business concept, it’s one of the most valuable lessons I’ve learned on how to impress and surprise the people around me.

Discussion & Reflection

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Until next time, stay inspired!
Rob Erich, MBA, FACHE