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About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit or contact Ankota.

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The Ankota Healthcare Delivery Management Blog

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How To Improve HME Delivery Management NOW


 Improving HME Delivery Operations

In "How to Improve Delivery Operations Management," Dave Kopf, Editor of HME Business writes, "One of the major elements of HME business overhead is running delivery and repair fleets and their supporting operations. It is a staff-intensive, and involves continuing regular capital expenditure for fuel and repairs, as well as depreciating assets — the vehicles — that need to be regularly replaced."

It's on every HME's mind: How Can I Cut Costs Now?



Kopf points out that the practice of managing deliveries and planning routes consumes a good amount of staff time, which also means more overhead. The HME industry has been grossly underserved with technology until recently, and most HMEs are still in the dark ages when it comes to leveraging technology.

Managing deliveries is both complex and expensive. Kopf and other experts note primary costs to consider, below. Ankota offers additional guidance on how technology can address and reduce these costs directly. I cannot speak for other software companies, but in our experience with Ankota's HME Optimization technology, these results can be achieved in less than one quarter, even making the system self-funding.

HME Technology Reduces Costs resized 600

It's a matter of survival. With reimbursement cuts, many HMEs are certain to fail. Technology MUST be leveraged immediately to improve profitability and allow providers to survive and grow with fewer staff. It's all about productivity improvement and that is best achieved through automation.

A few more things to consider when choosing a system:

  1. Get rid of paper now. Does the system provide a "closed loop" electronic process? You can initiate orders, plan and track staff, vehicles and deliveries (including signature capture), generate invoices and payroll -- all electronically. Your billing and payroll should be done instantly as a result, further reducing staff needed to support operations. It is not unusual for an HME to consume .5-.75 FTE filing delivery sheets, or scanning and attaching them in another system. That process can be fully automated, saving a single office several tens of thousands of dollars in direct labor costs per year. 
  2. Scheduling & Route Planning: does the system simply create routes and maps based on the schedule? Or does it utilize optimization technology to schedule deliveries in such a way that the appointments and sequence in which deliveries are made are optimized, resulting in fewer miles traveled and lower fuel expense? You want the latter, for sure. It can reduce your cost per service order by 25-50%.
  3. Integration with existing systems: Does the system connect with your order entry system so that your staff can avoid time wasting efforts like entering data multiple times? Same should go for integration with your billing and payroll systems (or services you use for these).
  4. Finally, only use web-based technology that you can pay for on a monthly or quarterly basis. The technology will serve you far longer, will provide greater innovation, and you can always hold the vendor's feet to the fire when issues come up. Good web based products will also support offline use and syrchronize when you have a connection.



Delivery of Home Medical Equipment (HME/DME) is critical to the overall success of the healthcare system. HME Providers must utilize technology to maintain viabillity and survive resimbursement cuts. Technology can be used to improve profitability quickly and put HME providers in position to participate in Coordinated Care and Accountable Care models. Without Care Coordination technology that ties delivery operations to those who plan and authorize care, HMEs will be left out. 

5 Percent of the Population Accounts for 50% of Health care costs


Only 5 percent of Americans accounted for roughly half of all U.S. health care spending in 2009, according to a report from the National Institute for Health Care Management Foundation.  Conversely, the 50 percent of Americans with the lowest health care costs accounted for just 3 percent of the total cost of health care in 2009.

What does this mean for the world of home health?

More and more evidence (both anecdotal and clinical) is proving that managing care for the sickest and/or costliest patients results in less hospitalizations and other complications for them and reduces their health care costs significantly.  There's a great (althrough somewhat long) article in the New Yorker on this topic by Atul Gawande who authored Ankota's 2010 Book of the Year, the Checklist Manifesto.  Click the article below.

Hot Spotters Atul Gawande New Yorker

Home health and private care companies can play a key role in the ongoing care of these individuals, monitoring their health and making sure that they're capable or have the necessary assistance with their activities of daily living (ADLs).  This can improve outcomes, lower overall care costs and be reimbursed under the Accountable Care Organization (ACO) model.

Other Findings:

The report also found:

  • U.S. health care spending reached $8,100 per person in 2009. Approximately $2,500 went to hospital services and $1,600 went to physicians and laboratories. The balance of the spending went to a variety of other sources, including retail prescription drugs, home health and HME
  • A total of 15.6 percent of the U.S. population recorded no health care spending at all
  • People with chronic conditions (one or more) were two to four times more likely to end up in the top 5 percent of health care spending.
  • Total 2009 U.S. health care spending reached nearly $2.5 trillion, accounting for 17.6 percent of total GDP.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit or contact Ankota 

Update on Mediware's Announced Acquisition of CareCentric


We do not ordinarily post announcements on the Healthcare Delivery Management blog, but this is relevant to many HME companies, Home Healthcare agencies, Infusion and Private Duty providers who are among our readers.

Mediware Acquisition of CareCentric logo

On March 31, Mediware Information Systems, Inc. (Nasdaq: MEDW) announced that it had signed a definitive purchase agreement to acquire assets of CareCentric, Inc.’s, home medical equipment, home health and home infusion businesses. According to a press release issued by Mediware, the company plans to close the acquisition within 30 days.

We wanted to inform customers of CareCentric's Caretinuum and Mediware's HomecareNet that they will continue to be able to use Ankota HDM to optimize business operations, coordinate with other providers and lines of business, and reduce home healthcare delivery costs. Ankota will continue support for both product integrations, helping Home Health Care, Home Medical Equipment (HME/DME), Infusion and other companies to operate more efficiently. 

For any questions regarding Ankota's relationship with CareCentric or Mediware, please contact Will Hicklen at


Ankota Shares HME News Most Read Stories


HME News most read logo


Ankota would like to share this from HME News:

Each month, the editors of HME News compile the top 5 most read stories from and send them to you in an email alert, keeping you up-to-date on what's most important in the industry. The links to the top 5 stories for March are below.

Competitive bidding hearing draws crowd

WASHINGTON — It was standing room only at a congressional staff briefing held March 2 on competitive bidding, a sign, HME industry stakeholders say, that there might be support for another bill to repeal the program.

Competitive bidding: A bill for the Hill
WASHINGTON — When industry stakeholders convene here for AAHomecare's Washington Legislative Conference this week, they will be carrying an important piece of paper with them.

Legislative conference: 'Senator, we're here to talk to you about competitive bidding'

WASHINGTON — Looks like providers had the luck of the Irish March 17 during AAHomecare's Washington Legislative Conference. H.R. 1041, the new bill to repeal competitive bidding, picked up 18 new co-sponsors in that one day.

Competitive bidding update: Bill, auction and PAOC
WASHINGTON — With members of Congress on recess last week, there are no new official co-sponsors for H.R. 1041, the bill to repeal competitive bidding, but commitments are trickling in, according to AAHomecare.

CMS admits RAC got it wrong
FARGO, N.D. — CMS plans to halt automated CPAP audits in Jurisdiction D after learning that its contractor has misinterpreted Medicare policy, AAHomecare reported last week.

HME News Business Summit

Don't Let Being a Home Care Exec Melt You Down


entrepreneur logo

entrepreneur Dont melt down title

I recently conducted an informal and wholly unscientific survey of homecare CEOs, including CEOs of home medical equipment and a physical therapy businesses, and found some major overriding stresses that keep them awake in a cold sweat at night, including:

Stress at night

We all know it intuitively, but most of us don't do anything about the stress.  The Japanese have a word for it when it reaches extremes: Karoshi. It's the corporate equivalent of Hari-Kari and literally means "death by overwork." The Japanese government recognizes it as a cause of death and has campaigns to reduce Karoshi. Families of the deceased can and do successfuly sue employers when a family member dies from overwork. Officially, the Japanese work 20 hours less per year than Americans, although some argue that they work more off the books than their American counterparts.


So what's the point of this blog post? I don't presume that we have a prevalence of home healthcare workers about to fall victim to Karoshi. We do, however, widely recognize caregiver fatigue, whether it be family or professional caregivers. We have a responsibility to better undertstand it and help mitigate the risk of caregivers, who are already stressed, becoming even more so. Entrepreneurs rarely acknowledge the exhaustion that often develops among their ranks. I speak with hundreds of home healthcare executives and their counterparts at Home Medical Equipment (HME/DME), Therapy and Private Duty home care businesses who seem to be determined to make Karoshi a common word in US households. They have the best of intentions and, like the caregivers they employ, are fully committed to their professions and their clients.

Today's post is an effort to encourage our current and future customers--Home Health Care agencies, Therapy, HME and Private Duty companies--to AVOID KAROSHI!

"This is not good for my mental and physical well-being," says Douglas Heddings of New York City in a recent article in Entrepreneur entitled "Don't Melt Down."

The article continues, "Researchers agree. Frequent long hours can increase stress and touch off a host of health hazards, including insomnia and high blood pressure. Poor decision-making starts to creep in. And unlike your laptop, your system doesn't have an internal fan to cool it down.

"Entrepreneurs are, of course, an action-oriented bunch by definition. That's usually a good thing. But a bias toward action can get in the way of the thinking needed to set limits and work smart. Too many entrepreneurs default to reactive behavior, reflexively jumping to the chime of a new e-mail, the pressure of a ticking clock and other external pressures and interruptions. They let technology and time manage them. This leads to the burnout model of work--they just keep going until the paramedics arrive."

What can you do? Well, we don't have all the answers, but there are several that fit within our area of expertise and that have been proven to reduce some of these stresses and dramatically improve business performance at the same time. 

A few helpful hints from Ankota on avoiding Karoshi by better preparing your business to run well and run consistently:


For more on improving business performance and making life in charge a bit easier, click here or on the Ankota logo and ask Ankota to help.

ankota logo color[5]

For more on avoiding Karoshi, click on the Geekpreneur logo here:

Geekpreneur logo

Home Care Leadership: Lessons from Egypt


Leadership for Home Health Care Washington Post

I love analogies and often look to draw lessons from other industries to apply to the post-acute care services world, which includes Ankota’s customers in Home Health Care, Private Duty or Private Pay Home Care, HME, Infusion, Respiratory Therapy, and so on. As the need to coordinate services among multiple providers intensifies, and new entrants like Accountable Care Organizations (ACOs) assume more prominent positions, leadership models will be challenged and new leaders will emerge. Whether inside your organization or in our industry at large, never before has the issue of leadership been more critical. Never before has there been greater opportunity.

Current events in Egypt provide a few key, very compelling examples of failed leadership that apply directly to our world of healthcare.

HME Home Health Leadership Control

What Mubarak ignored at his peril

Originally published in the Washington Post Feb 2, 2011, by John R Ryan.

Question: Egypt's unfolding political crisis raises a broader question: Can an entrenched, powerful leader, one who has resisted change, successfully lead a country or an organization in a different direction if circumstances suddenly demand it? Or is it necessary to bring in new leadership?

John Ryan leadership home care


Watching events unfold in Egypt reminds me that the country's ruling class would have benefited greatly from reading American futurist Bob Johansen's groundbreaking book Leaders Make the Future when it published two years ago. In it, Johansen and his colleagues at the Institute for the Future pinpointed ten trends that leaders of any organization or nation ignore at their peril. The crisis in Egypt highlights two of them in particular.

First, Johansen foresaw the rising influence of "smart mob organizing," through which social networks are used creatively and purposely to fuel change. We've recently seen the value of Facebook, You Tube, Twitter and other social media vehicles in growing America's Tea Party and fomenting revolution in Tunisia. Now, the same tools are proving to be powerful change agents in Egypt. Efforts by the Egyptian government to crack down on them highlighted its hostility toward another emerging trend named by Johansen: quiet transparency.

To quote Johansen on leading in a volatile, uncertain, complex, ambiguous world: "Quiet transparency in leadership begins with humility. ...leaders will definitely have to give up some control. They need to decide what they can and want to manage, since they cannot directly supervise everything. Leadership control is something of an illusion."

Home Health HME Infusion New Leaders emerge

The protesting Egyptian citizens want to be recognized, respected and valued by their leaders. Egypt's leaders, however, have fought tooth and nail to maintain total control, even up to this very moment--and that has indicated a lack of foresight and judgment, and a misplaced sense of urgency. The complexity in our world demands more capable leadership that creates direction, alignment and commitment, which means we need interdependent leaders at all levels of governments and organizations.

Increasingly, leaders today can accomplish little or nothing without trust from their followers. Being open and authentic, maintaining an attitude of servant leadership, builds that trust. Efforts to dissemble or manipulate tear it down. Our approach to leadership, like eating or exercise, is a habit developed over years. Turning around self-defeating practices can be done over time with a lot of effort. But the cumulative effect of those habits makes it extremely difficult for an entrenched leader to move a country or company in a different direction on a dime. Turning around GM required a fresh approach and new leaders. It's hard to see how the case of Egypt, where a giant, explosive divide exists between the wealthy elite and the newly energized masses, will be different.

Click here for the complete, original story on


Everyone Counts in Home Health Care, Too.


A fellow Miami University alumnus, Tim Walsh, publishes a blog titled "Leadership and Sports." I am a fan of sports analogies (pun intended) and his posts tend to be both brief and entertaining, so I occasionally take a peak to see what he's saying. I happen to like blogs because the better ones tend to share some useful stuff with a bite-sized approach...and I can read them on my iPhone. That's ideal for someone like me who has no real time for recreational reading. 

Tim Walsh Leadership and Sports Blog

I was especially interested to read Tim's take on our beloved Miami's upset, come from behind win in the Mid American Conference Championship last weekend against #25 ranked Northern Illinois. I noticed just below that entry a short post titled "Everyone Counts," and took the few moments it required to read it. It struck me immediately how this relates to Ankota's customers.

The ecosystem of providers that make up the post acute care services world--Ankota's customers--employs an incredibly wide ranging and diverse set of skills. Physicians, nurses, case managers, therapists, delivery drivers, companion aids and even housekeepers and handy men, are all integral to an efficiently run home healthcare model: a Private Duty home care company, and HME delivery company, and infusion therapy company, an Accountable Care Organization (ACO), a hospital discharge planning organization, and so on. Obviously, some are very highly skilled and educated, while others may be less educated, immigrant workers for whom English may not even be their first language. That presents specific challenges in developing technology for this wide range of users, of course. The dynamics among employees and with their patients and clients can be tremendously complex. Not a single one should be overlooked, as they all have a tremendous impact on your company's performance and reputation.

I won't spoil Tim's message beyond that, but read on and think about who the kicker is in your organization.

Walsh 042

Sunday, November 28, 2010

Everyone Counts

It probably doesn't surprise you to know that the average lineman in college football is 300 pounds-most of it muscle. You may not be surprised to know that college running backs are over 6 feet in height and weigh north of 200 pounds. None of this size matters in the last seconds of a tied game.

This weekend, two important games were decided by kickers. On Friday night, Boise State lost for the first time and dashed any hopes they had to play for the national championship. They blew a 24-0 halftime lead against Nevada, but had a chance to win with 2 seconds to go. Their kicker, Kyle Brotzman, missed from 26 yards out-that's a little more than an extra point (more on that later). They were tied in overtime when Brotzman had a chance to win it with a 29 yard field goal. He missed that one too. Nevada drove down the field and their kicker, Anthony Martinez made a 34 yarder to win.

Last night, I'm watching Georgia and Georgia Tech play in their annual rivalry. Tech was down by 14 in the fourth quarter but came back. Their kicker, Scott Blair lined up for the extra point to tie the game with less than 5 minutes remaining. Oops-wide left. Tech couldn't recover and lost a game they should have won.

The point of these stories is not to throw stones at field goal kickers. The point is that they are the smallest guys on the field with little to do during a game. If they kick off, kick it deep and keep it in play. Make all extra points and make all field goals within your demonstrated range. Keep loose and don't panic. In some respect, they have to have the same mental make up as a closer in baseball. Keep things straight in your head!

In business, everyone counts. There may be those in your organization that don't have a big role. Do know however, they can make a huge difference. Think of the receptionist that is the first impression for your organization. Think of the clerk who makes sure everyone gets paid every two weeks. They may not seem important at first-but they too can be game changers. Make sure they understand their role and how important it is that they perform at a high level.

I'm sure Mr. Brotzman and Mr. Blair will survive these games and find a way to redeem themselves. They are important members of their respective teams. Keep this in mind as you review your team and their individual contributions.
Miami logo

Home Care, HME and Private Duty Leadership: Sources for Creative Thinking


idea man weird

One of my (almost) daily rituals is to read through articles or blog posts on topics like innovation, creativity, leadership, execution, or the like. I do not spend a lot of time on it, often as little as 5 minutes and no more than 10-15 minutes. The idea is is to provoke my own creative thinking and provide better insight into our customers.

I will tell you how I do it -- feel free to post your resources & links in the comments section for all to see. 

Here is how I approach it to keep it simple and save time: I use a bookmark folder in my browser window, easy-to-create filters in my email inbox, Twitter and LinkedIn, and I subscribe to a few listserves and email newsletters. That’s it. And I don’t read most of it. I'll explain and share some of the links I use below.

This approach also eliminates most of the time that people spend searching online for something worthwhile to read. I always have more readily available than I need and it has already been searched and sorted for me. All I have to do is scan through it until I see something interesting.

Bookmarks I have a folder bookmarked in my browser window where I save links to good blogs or magazine sites that I stumble across. You might name this something as simple as “TO BE READ” or “GO TO.” I don’t bother to organize them beyond this. I also subscribe to several blogs and receive email updates when new articles are posted. I include links to these blogs in the “TO BE READ” folder, and I have a “TO BE READ” folder on my desktop and in my email inbox.

It is easy to be overwhelmed by all the pieces you get. Here is the trick to dealing with the traffic:  Ignore them. Most email systems like Outlook and Google’s gmail will allow you to create filters and rules that will automatically sort through your email and file these messages away in a folder that you designate, like my folder named “TO BE READ.” Scan through the headings and titles periodically and only look at the ones that interest you.

The ones that interest you will do so at a time when it matters. Maybe something has been on your mind because of a recent problem client. Suddenly, you notice a piece that discusses ways to deal with problem customers. That piece may not have interested you a month ago and would have been a complete waste of time to read when there were more pressing or relevant topics. Today it matters to you.

Listserves I subscribe to a few listserves that are used by Ankota’s customers and prospects. Listserves are unique in that they allow me to sit in on the conversations our customers and prospects are having. For me, the primary value is that I can hear first-hand what’s on our customers’ minds. They share problems, solutions, and more. It is like a virtual support group for your employees and it makes them much more productive.

The people who make the decision to purchase Ankota’s technology are usually CEOs, CFOs, VPs and other executive leadership. They rely on Ankota to help run their businesses more efficiently, but they are not the people who operate our products on a day to day basis. Executive management is interested in things like efficiency data, on time performance (a key indicator of customer satisfaction) and whether they are reducing expense items like number of miles traveled per order, not how difficult it is to schedule staff and plan travel routes. Those on listserves are the people who interact with our product and our competitors products every day. We can learn more about what works and does not work and what troubles them in their jobs.

How To:

Use your browser to bookmark links to sites, create a folder just for these types of links and add to it as you come across ones you like. Here are a few to get you started

Decision Health

21 Ways to Generate Business Boosting Ideas

Home Health Interactive - a service of Decision Health

SmartBrief on Leadership (click to subscribe)



Ankota Blog


Aging In Place Technology Watch Laurie Orlov


Tim Rowan’s Home Health News (5 newsletters here)

 Home Health News, Tim Rowan's Home care Technology Report


Decision Health has several for various home health care segments

Private Duty

Medicare Certified


Social Media

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Click here to learn more, and click on these lists to

Follow Twitter Home Care List

Follow Twitter Private Duty List

Follow Ankota

describe the image   Good for connecting with colleagues, technology companies, and industry insiders. There are user groups for home health care, telehealth, HME /DME , and so on. Go to my profile (Will Hicklen) and you can see the healthcare related groups that I am connected with.

Home Health Care & HME Under Duress: Ankota White Paper Abstract


Understanding “Economic Pressure” and Major Opportuities for HME Providers, Home Health Care Companies, Private Duty, and others.

measuring operating efficiency for HME businesses

The following is an abstract from an upcoming Ankota white paper:

This paper is intended to examine some of the forces placing at risk the profitability of Ankota’s customers and suggest immediate steps to improve operations. This is especially critical for those businesses whose revenues (payments or reimbursements) are regulated, such as certified Home Health Care and Home Medical Equipment (HME or DME) providers.HME providers face additional extremes now with competitive bidding.  I would include therapy businesses such as infusion therapy, physical therapy, occupational therapy and others in this discussion, as well. Anklota refers to this industry collectively as “the Home Care Ecosystem.”

It should be noted that companies in markets that are under duress are often presented simultaneously with great, new opportunities. As your competition is focused on their problems, most of them will suffer and miss these opportunities. Those that do not adapt and improve are more likely to fail. 

This discussion should help you to understand some of the forces at play and help you focus on your immediate response. The key is understanding these forces and focusing on ways to improve company performance immediately.

The paper analyzes what economic forces are acting upon businesses in the home health ecosystem. Businesses under duress tend to experience one or two key pressures:

1)    Downward pressure on revenues.

2)    Upward pressure on costs.

Collectively, these pressures have a profound effect on profitability, disrupting entire industries and often driving many companies out of business.  “Survival of the fittest” is a term that often refers to the companies that make it.  But what makes companies fit to survive?

Most companies tend to retreat in a crisis. They lay off staff and cut back on marketing or other expenses, and so on. This tends to only accelerate their demise. They tend to continue to do business the same way, with the same poor levels of productivity. They market themselves the same way and offer the same services. These companies effectively concede market share, unwittingly reduce their capacity, and are the ones that are most likely to fail.


So what do successful companies do?

Yes, scrutinize costs and cut any that are unnecessary. I spoke with an agency last week that said they called their insurance broker and told them they wanted to shop their policies. The broker contacted the insurance company, and their premiums were dropped immediately. Now is a great time to shop all of your insurance coverage. That's just one simple idea.

Improve productivity. Many companies learn to measure capacity and productivity only as a result of facing a crisis. Learn to do it now. This includes the development of key performance indicators by which to continually measure your business going forward. Don’t try to solve every problem, just pick off some big ones now and then continue to improve.

Invest for growth or to reduce operating expenses. If your agency is looking to grow and you have access to capital, there are businesses under duress that might make great acquisition targets. Likewise, you can improve the value of your business by utilizing technology that helps you to reduce marginal costs and scale capacity.


Major findings:

Home health and HME have immediate opportunities to reduce operating costs & expand capacity using existing resources.

Private Duty Providers are uniquely positioned to grow, avoiding pressures from regulated reimbursement models.


Keep an eye on the Ankota blog for the complete paper to be released.

Developing Leadership in Home Health Care, DME & Related Companies


As a reminder, you can register to receive automatic email notices when new entries are posted to Ankota’s Healthcare Delivery Management blog. Simply look to the right side of this page and you will see the place to enter your email address. No other information is needed. I am excited to report that our registrations and readership have more than DOUBLED over the last month. So, if you are one of the people who have passed along the link or posted it on your own blog—we thank you very much!

Now, on to today’s post about Leadership…

A couple of great pieces on the topic of Leadership hit my inbox today and I thought I would pass them along. Rather than analyzing or summarizing each, I will tell you what I like about the article or the site and provide the link so you can read it directly. Enjoy!


10 Good Things for Home Care, DME Leadership


1)      10 Things Good Managers Believe  on bNet, by Steve Tobak, a well known business strategist and executive coach. bNet is part of the CBS interactive business network, focused on business issues that Home Health Care, DME, Infusion, RT and other home care related companies might find very useful.

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2)      Tobak’s article draws from another piece that I really like, 12 Things Good Bosses Believe, by Robert Sutton. Sutton writes on leadership for Harvard Business Review and is the author of books such as his newly released Good Boss, Bad Boss (click on the book cover below to see on


Leadership development for Home Health CareGood Boss for DME, HME, Home Health, Private Duty



3)      Leadership & Perfectionism, by Mike Myatt, Chief Strategy Officer for N2growth. Myatt poignantly acknowledges, “This may be difficult for some to get their heads around, but perfectionism is not a leadership trait.” My natural tendency is to be a bit of a perfectionist in business, but I am much more effective and accomplish more when I’m not. Maybe you are the same way. Either way, this piece might provoke some thought.


Leadership perfectionism

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