Tag Archives: Leadership

The Campaign for Accountability in Healthcare

Johns Hopkins’ physician Marty Makary is campaigning to make healthcare safer – and cheaper – by publishing healthcare outcomes for all to see. His new book, Unaccountable, is sure to be a clarion call for true healthcare reform – as opposed to the partisan bickering we hear on a daily basis. We should all be grateful for him and his tremendous work in this area.

The Accountability Dance

The call for reform is simple and clear. Transparency and accountability are critical for true and positive change, yet people rarely embrace accountability – especially people in positions of power. Accountability “occurs” under two conditions: either it is imposed forcibly by another, or one willingly offers (submits) to it.

It takes a lot for people, and organizations, to reach the point where they are willing to impose accountability on someone they know. The concern for harmony, draw of money, focus on short term goals, and an inner fear of hypocrisy are all overwhelming forces that drive people away from it. It takes courage.

Under what conditions will a person voluntarily submit to accountability? People submit to accountability when:

the authority has the person’s personal interests at heart
the authority is just and fair in administering consequences
they share a common and compelling goal or value
there is an opportunity to learn from or redeem the situation

Absent these conditions, people squirm out of personal ownership for their gaffes, and they deflect responsibility for their behavior. Absent these conditions in healthcare we will find doctors and hospitals fudging their numbers – thus thwarting the goal of better care.

Solutions?

I wonder just how we can create a system that conforms to these conditions. And if we do, there is still much more work to be done. In healthcare, we need the kind of management innovation Gary Hamel discusses in The Future of Management. It’s a tall order, and it will take the combined efforts of many, many people. But I am ready and eager for the challenge. How about you?

A Formula for Courage

I recently read Breaking the Fear Barrier by Tom Rieiger of Gallup Consulting. In it, he makes the case that parochialism, territorialism, and bureaucracy grow from fear. Managers fear losing the ability to control their outcomes so they build organizational barriers, e.g., unnecessary or self-serving rules and policies, to protect their interests. Ultimately, those barriers do more than protect parochial interests: they protect the organization from succeeding. Rieger also offers sound medicine for organizations that are wrapped up in fear and bureaucracy.

Rieger Sets a Low Bar

His advice is good, but he sets an awfully low bar for people. He seems to accept that people will not be courageous and recommends methods for breaking barriers erected out of fear. Rather than treating the nasty symptoms – the barriers of bureaucracy – we should aspire to overcome the fear that gives rise to it. Cowardice succumbs to fear whereas courage overcomes it. I don’t know about you, but I would rather overcome than succumb. Courage is a virtue; cowardice is a vice.

We fear failure, we fear looking silly, we fear seeming inferior to others, and we fear losing what we have. Fear stops us from voicing a dissenting opinion, changing jobs, confronting poor behavior, facing problems, and so on.

It’s plain to me that people need a formula for courage more than they need a medicine for dealing with the symptoms of cowardice.

Life Calls for a High Bar

I would like to offer my addendum to Breaking the Fear Barrier. I’ll call it “A Formula for Courage.” Everyone should learn this formula by heart because courage is an essential element of a virtuous character.

Ingredients:

Moral Compass
Worthy Goal
Humility
Self Sacrifice

* Note: Some formulas call for a measure of love.

I confess that I don’t know the proper portions, but I am confident that each is needed.

Moral Compass

A moral compass is the first ingredient because you must want to be virtuous and know what virtue looks like in order to pursue it. Your moral compass also gives you a clear vision to see where the trials of today are headed and to know what to do about them. Today’s small transgressions often lead to grave consequences tomorrow. A strong moral compass provides you with that foresight and the wisdom to face trials now.

Worthy Goal

Why would anyone stare down a giant, risk failure, or endure personal harm? Because the cause is worth it! Of course, if you haven’t set out to accomplish anything or set your mind on being a certain kind of person, then you have no reason to take a risk. When I am coaching people, I’ve learned that they need to be reminded of their values and goals when they are facing tough situations. Often, all it takes for people to move to action is a simple reminder of who they are striving to be.

Humility

Have you seen the t-shirts proclaiming “It’s all about me,” “Queen Bee,” or “I’m with stupid”? Don’t wear them. Courage requires a clear understanding that “it” is not all about you. Instead, it’s about putting a transcendent goal above your personal interests, and courageous leadership means placing that goal and other people before you. The Apostle Paul counsels Christians in Philippi as follows:

Do nothing out of selfish ambition or vain conceit, but in humility consider others more important than yourselves. Each of you should look not only to your own interests, but also to the interests of others. (Philippians 2:3-4)

I’ve noticed that humble people are generally trusted and admired. I’ve also noticed that the same people who esteem others for their humility often bristle at the notion that they should submit to others or truly serve people. It feels demeaning, and perhaps it is, but true humility and submission are hard to separate.

Self-Sacrifice

The ultimate act of valor is to give one’s life for another person or cause. Boys, even grown men, fantasize about being the hero who rescues another person from imminent bodily harm. In real life self-sacrifice comes in smaller increments – kind of like Chinese water torture. The little opportunities for self-sacrifice can seem like occasions to erode dignity one annoying drop at a time. Instead of the drama of life or death, the stakes we face are things like approval from others, a chance at a promotion, bonuses, inconvenience, and our fragile egos. This type of self-sacrifice is a bit less glamorous and a lot harder to choose.

That’s it – that is my formula for courage. I don’t expect Mr. Rieger to include it in his second edition, but one never knows!

What do you think of my formula? Will you try it? Would you change it a little and make it your own?

Feedback, The Breakfast of Champions

The other night I watched two teenage sisters shine. They shined so brightly that their audience beamed with pride at their character and accomplishment. The girls volunteered to make a presentation and be coached in front of roughly fifty adults at a meeting of the Institute for Cultural Communicators (ICC). After diligent preparation and no small amount of creative labor, the girls stood in front of their audience ready to deliver their performance. What happened next reminded me of a paper my wife wrote entitled “Feedback: The Breakfast of Champions.” The girls confidently delivered their presentation. Then they consumed enough “breakfast” for a team of champions. Again and again, they performed and consumed, performed, and consumed. It was beautiful– and so were they.

With each cycle, their presentation improved. The girls listened carefully and graciously, though it was no doubt trying to be jostled around by such direct feedback– don’t do that, try this, now this… In the end, the performance was greatly improved and so was, I believe, the audience. We, the audience, witnessed two young ladies gracefully accept and respond to a public critique of something they personally created and performed. The contrast with the adult workplace was glaring, at least to me.

As I reflect on the contrast and draw on my years of experience, here is what I see.

ICC	Workplace
Interdependence	Autonomy
Feedback is expected and wanted by both parties	Feedback is threatening to both parties
Feedback is essential to the process	Feedback is an exception to the process
Critics are viewed as partners	Critics are viewed as rivals
Accepting feedback is a sign of character	Accepting feedback is a sign of weakness

I doubt that these girls have always taken feedback so well. Most people don’t. But I am pretty sure I know how they got to this point: Their goal is to improve, and their learning process is collaborative. Twice a month they gather with other students and adults to work on their communication skills. In those sessions, they routinely give and get feedback just like breathing– in and out, give and get—and the results are exceptional.

…I wonder what would happen if adults in the workplace did the same thing

Failure Management, Sick Care, and Ray Lewis

Recently, I have been interviewing physicians about their practices, their professions, and their so-called lives. With all the changes in healthcare, many docs are finding it hard to navigate the emerging business models while caring for their patients and prospering financially. There is a lot to it. But when I ask, “What are the three most important problems they would like to solve?”, this is what comes up:

Dealing with Poor Performance and Difficult Behavior in the Workplace

It just isn’t covered in medical school.

Well, if you are a doctor, you can relax a bit. You have a lot of good company. Although performance management is covered in business management programs, most managers are poorly prepared for these same challenges. So I thought I would share the single most common mistake people make in managing performance in healthcare and other business settings. No kidding, this is THE SINGLE MOST COMMON MISTAKE as of 11:01 a.m. on October 3, 2011. It’s all proven 100%.

Failing to focus on performance

Sunday, aka football day in the fall, has just passed. All week, 32 teams with 1,760 players, 590 coaches, and numerous ancillary staff thought, trained, and practiced in order to perform at their peak on Sunday afternoon. All week, performance was their single focus; it is all they talked about. Regardless of the outcomes of yesterday’s games, (the Ravens won, but the Eagles didn’t!) there is no denying that these people consistently perform at high levels.

Wherever we see excellence, performance is the focus of the people in the organization. Managers and staff think about it, they plan it, they talk about it, and they rehearse it. When things go well, they notice it and talk about why it went that way. When things don’t go well, they notice it and talk about why they didn’t go that way. And it’s not just “managers” who are talking about it. It is everyone, because it is everyone’s goal. They work together on it all week. When someone screws up, colleagues on peak performing teams talk directly with the person about it without hesitation or worrying that it is “not my place.”

In recent years my doctor has begun talking about healthcare in a new way. He has been talking about “health care” versus “sick care.” Our nation is burdened by sicknesses created by the failure to create health. For years medicine has focused on curing sickness versus creating and sustaining health. So what do we have? We have a country plagued with diseases created by destructive life habits. Somehow we have expected health without doing the work to create and sustain it. Managers make the same mistake in their organizations. They expect performance without doing the work to nurture, create, and sustain it. If I only had a nickel for every time a manager said to me, “You’d think they would know how to do this!”

Did Ray Lewis become a 16-year-star automatically? No, he studies, trains, and coaches other players all week on how to perform with excellence. He works hard at creating high performance rather than expecting that it will happen on its own.

So what does it take to create high performance in your workplace?

Define what high performance looks like for every role, for every task, and for the business as whole. (Leaders have the responsibility to do this but are wise to do it collaboratively with staff.)
Spend time and effort figuring out what it actually takes to perform in your environment.
Measure performance and talk about how you are hitting, exceeding, and falling short of the mark on a regular basis.
Talk about performance and how to get there continuously, like you would talk about the weather, your weekend, and where to eat for lunch. This is relatively easy to do when you have defined what is needed, set clear standards for success, and talked about what it takes to get there. But it is hard to do if you just expect it without defining it or communicating about it.
Refine, adjust, and learn along the way.

Even if you are not the “person in charge,” you can do these things to create high performance in your workplace. Ray Lewis started with himself, then started talking with his peers and coaches about what he was doing to excel. My doctor is talking with his patients about caring for their health rather than managing sickness. What is keeping you from doing the same?