A colleague of mine asked me a while back a simple question: "What's the best advice you ever got?" Navigating through choices in life is hard. Uncertainty seems everywhere. The pace of change is dramatic. How to stay on top? How can I correct after an error? How do I maximize the chance of success?
While I can’t claim any core wisdom on these issues, I have received some good advice along the way. I also pay attention to what others who are successful do and say. I can summarize the best advice I ever got in three phrases:
- Be prepared
- Pass going uphill
- Ask for feedback
“Be prepared” is a bit out of favor in our instant messaging, ultra short attention span era. I’d guess I first experienced "be prepared" in the Boy Scouts — yes, I really did do that. The staff that works for me now once confided in me that they call me ‘the boy scout’ behind my back. I can think of lots more worrisome images for the ‘boss.’ Being prepared is doing your homework. And not just the Cliff's Notes the night before. Read the articles, digest the material, and think. These days it often means “Google it!” — see what else I can learn. Being prepared means making better decisions with some data, examples, or history to guide me. And I still have my backpacking list, honed over 40 years of hiking, with reminders of all the stuff I need to take along to be prepared for wilderness contingencies. And that list does not include a GPS unit or a cell phone. It does include wool layers and waterproof matches.
“Pass going uphill” came from my high school cross country ski coach. We practiced it every fall when we were running. We’d do “wind sprints” on our long runs. The guy in the back of the line had to sprint around the rest of us to the front. Coach made us do it going uphill to practice for the real races in the upcoming winter. His idea was twofold. First, you can dig deep and find an extra reserve to push even when you think it's tough going up this hill. Second, the guy you just passed is likely to drop back faster if you pass him when he thinks he’s working as hard as he can. It’s about winning.
“Ask for feedback” is about managing myself. I wish I had learned this one earlier in my career. I’m sure there were mentors and coaches who tried, but I didn’t really get this one till I had assumed some management and leadership roles. Comically, I remember talking with my close friend and partner Michael Polifka about perceptions of myself over the years. I would sometimes lament to him that others didn’t understand me or my intent. His advice was very pragmatic: “get over it; just do the right thing.” It was good advice, and I used it.
Then later I hired a career coach as I entered several leadership roles. Howard’s advice has been clear and consistent. The only way you can understand how others perceive you is to ask. And you have to do so frequently, in real time, and of different constituents. Perception is, in fact, reality. I have to get over my internal compass. I know my intent. It doesn’t matter that I meant well. If others perceive my actions or behaviors as insensitive, wrongheaded, or worse, then I need to know that. And the only way to learn, and get better, is to ask. So I ask 2 questions about whatever the topic is: 1) what am I doing well? And 2) what can I do better?
I still don’t do this often enough. I still get caught up in my agendas, projects, timelines and bull forward. Then I bump up against some negative perception and think “wow, I did it again…didn’t ask for feedback often enough, and hit a wall”. So, like the rest of you, I am still learning.
So readers, tell me, what is the best advice you ever got?
I’ve been engaged in some healthy conversation with members of our Quality/Safety Department recently about how organizational change occurs at the level of the individual worker. Health care organizations have recently been looking outside ourselves to other industries for performance improvement ideas. The “Toyota model” of performance improvement is based on the teachings of Deming since the 1940s and has transformed auto manufacturing. The same principles have been used in a number of healthcare organizations in the United States to dramatically improve processes, standardizing, becoming more reliable, and reducing waste. Examples include Virginia Mason Medical Center in Seattle, and Bellin Healthcare in Green Bay Wisconsin. Our own efforts in Lean Six Sigma training and process improvement here at SVHC have improved the outcomes for care at end-of-life, with cost savings; reduced “bedsores” at Centers for Living and Rehab, and a number of other hospital processes.
When this team shows up to work on me, I want them to have a flawless execution of their process, and enjoy their work. |
So the debate is: must we change the culture (attitudes, willingness to change, engagement in process improvement, trust, team behavior) before people can participate in performance improvement and change in their work? Or whether the experience of improved work leads to the changing culture. Our health system is currently engaged in accountability training, one component of which teaches that in order to change culture, peoples beliefs need to change. And beliefs are based on experiences. so if you really wants someone to change their beliefs, they must experience something new that tells them that their previous beliefs about the organization are no longer true.
Brent James, MD, teaches that an organizational culture of safety includes an organizational commitment to detecting and analyzing patient injuries and near misses, and is a "just" culture. A "just" culture has also been described as a learning culture. He distinguishes this from cultures that are "pathologic" (shoot the messenger), and those that are" bureaucratic"(write a new rule). A learning culture understands the broader implications of patient injuries or near misses and generalizes. To generalize requires standardizing a process and improving it.
So the dialogue I have been having (and I will upload a couple comments from my colleagues) surrounds where to focus the energy. Can one "teach" a new culture? Or does one experience a new culture because processes and behaviors have changed? I think one has to "teach" that there are behaviors that are more effective (like asking for feedback and really listening), but that in the end it is the experience of the improved process in the workplace and improved behaviors in the workplace that changes the culture. Our health system is on that journey, and has experienced dramatic improvements in infection rates, complicaiton rates, and mortality. Now we need to unleash the energy of every person who works here to be able to help the organization standardize and improve their own work process, just as Toyota has done with cars.
Read No Satisfaction, the complete article on the Toyota method that appeared in Fast Company Magazine.