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JOHN SHUFELDT, MD, JD, MBA, FACEP
So you missed the “cancer.” Maybe you still don’t even know you missed it. At this point the patient (your business) is dying and you plod along unaware of the impending doom, like a smoker with a chronic cough. Your business is losing weight, its cheeks are sunken, skin sallow, as it grows weaker each passing month. One day soon it will start coughing up blood, and then it will be too late.

Now What?
There is a cure. In fact, the cure is not all that hard. Unlike treatment for real cancer, it probably won’t cause you to lose much hair, vomit often, or be susceptible to infections. You will, however, have to critically appraise your team. If you are going in for treatment, don’t just cure the obvious tumor, do the positron emission tomography (PET) scan and go after all of the cancer.

What is the PET scan for eradicating the cancers in your company? It is called the People Performance Culture Model (Figure 1). It is a simple tool, variations of which have been around for a long time. Some credit Jack “From the Gut” Welch (Former CEO and Chairman of GE) with its wide application. Basically, it helps leaders categorize employees into four groups.

The model is simply an X-Y graph where the four quadrants represent the four possible combinations of performance and culture. The vertical axis represents performance graded from high to low. The horizontal axis represents conformity to the values of the organization.

Quadrant 1
No brainer. These are the “rock stars.” They look for the challenges, lead by example, and are willing to stretch and want to be rewarded for success. Invest in this group. Give them progressively harder assignments, coach, mentor and groom them for future leadership positions by paying for graduate education.
This is the group you want to hire before someone else and reward and praise them. These are the rising stars on which your company’s future depends.

Quadrant 2
This group is more challenging. They will test your mettle as a leader. This group “lives the culture.” They are enthusiastic, hard working, and truly want to please. For whatever reason, they are just not quite up to snuff. The quality of their work is average, yet they keep coming back for more challenging assignments because they honestly want to grow. Their enthusiasm allows them to breeze through the interview process but the complexity of the role may have simply caught up with them.

This is the group you want to work with to determine if they are on the right seat on the bus. It may be that easy; simply change the seating assignments. If these employees were average in a revenue cycle management role, try them in sales or marketing. Their infectious enthusiasm may win clients.

These employees require the most work. If you can work with them to figure out where they belong, you will have employees who will go to the wall with you. You may even grow them from a 2 to a 1.

Quadrant 3
No brainer. This is the big lesion in the colon that needs to come out. You should not have hired these employees in the first place. They were someone you once trusted’s brother, son, daughter, husband, etc., and they screwed you. They have neither the skill set, nor the desire, to conform to the culture or quality espoused by your organization.

They will last for a bit, but pretty soon, you will be forced to resect them. They will threaten you on the way out, call you names, and swear they will bring down the company. Get rid of them nonetheless. Despite what these employees may promise, they will never move to Quadrant 2 because they are incompetent and unaware; a lethal combination.

Quadrant 4
These “Q4’ers” are the most challenging individuals. They are smart and may even work hard. Their work is solid and they turn it in on time. These employees may be department leaders and even hold positions on your executive team. Despite their work output, they are cultural misfits. They are ego-driven, manage up, and belittling to others. They may be sexists or racists. They could be much more insidious by quietly undermining (possibly inadvertently) the goals of the organization. You would never have them for close friends, yet you can’t argue about the quality of their work.

You speak with them, befriend them, encourage them, yet they make no lasting changes. They get better for a short time and then revert back to their recalcitrant ways. They either don’t get the importance of values and culture or truly do get it but believe by performing well they are above it. I have seen this challenge a number of times. Sometimes these people have been in the organization for years. Everyone knows they are a pain to interact with yet they seem to be ensconced.

These people are akin to the ling nodule on the chest x-ray and the polyp in the colon. Their cancer slowly spreads throughout the organization. They look for and attract others to join their cause and then continue to spread their discontent among even the most motivated people. It becomes hard day after day to not listen to them. Their slow, constant de-motivational ideas and mantra slowly start to erode the very fabric of the once-solid culture.

This is the rub. Despite their above-average work output, they will bring down your organization by running off the rock stars in quadrant 1 who will learn through observation that “culture” is nothing more than a catch phrase at the organization.

Quadrant 4 individuals have to go, and go immediately. Jack Welch said that GE did not make its rapid transformation until his leadership team went through the entire organization and sought out and eradicated this group. After they accomplished this very difficult task, they stood up in front of their team and said, “We had to make a very difficult decision today. We let someone go who has been here for years and whose work product was solid. However, they did not live the culture that we here at GE espouse and thus, they have no place in our organization.” The ability to accomplish these challenging tasks sets the good leaders apart from the great ones and is one of the primary reasons that some companies seem to consistently outperform others within the same sector or space. After ridding your organization of the Q4s, you may not see the results overnight; however, I guarantee that others will thank you both in their words and in their work and your company will achieve results well beyond your expectations.

Curing ‘Cancer’

John Shufeldt, MD, JD, MBA, FACEP

Chief Executive Officer at MeMD, LLC, Mentor and Author at Outliers Publishing, Principal at Shufeldt Consulting, Founding Partner of Shufeldt Law Firm