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?
A complaint I often hear is that I’m away too much. “I should tend the home fires.” “It must be nice to spend so much time at nice places.”
The time I spend away is deliberate and strategic. To lead change, I must know where we are going. While maintaining operations is crucial, leadership is fundamentally about looking ahead 3-5 years so our organization will be positioned to be successful.
 |
|
Conference Rooms: If you've seen one, you've seen them all.
|
To do that, I travel to conferences where I can learn new concepts about change and leadership from leaders at the cutting edge. SVHC's leadership team travels to national events for the same reasons. We often take large teams to events that are provocative and influential. This brings the culture and learning to a broader audience earlier, and allows teams to really get moving when we come home.
My travels largely are around three themes:
1) Regional groups that create influence for our organization in acquiring resources and having policy influence. For example:
* My role on the executive committee of the Vermont Blueprint for Health. Since its inception, I have helped to shape its priorities so that the state advances primary care and electronic medical records.
* The Voluntary Hospitals of America Physician Executive Council. I meet with CMOs from around New England regularly. We make formal presentations to one another about important local topics- starting hospitalist programs; reducing mortality; standardizing orders; improving ED flow. We teach and learn.
2) National organizations that teach and share learning rapidly across the nation. The Institute for Healthcare Improvement (IHI) is the best. Attending this conference has led to:
* Completely changing our strategic and operational planning structure and language, which has alowed us to be more effective managers.
* Creating the Board Quality and Safety Committee, Patient Quality/Safety Department and its training methods, and our decision to hire the Juran Institute to guide our improvement efforts. Our VP for Quality Safety, Alex Heintz, received her certification as a Patient Safety Officer from IHI.
* Better methods for engaging physicians, completing improvement projects, reducing harm, disclosing adverse events to patients
3) Specific skill building for my role:
* Legal and compliance training
* Certification in performance improvement for health care
* Science of leadership for improvement
* Communication, finance, and other dimensions of management
So travel for these reasons is a core of my job. And those ‘nice places”? Yes – some are nice. Conference rooms all look alike however, and traveling (by plane especially) has me yearning for that lovely and quiet Vermont commute every time I’m away.
SVHC Leadership tends the home fires by delegating much of the work. We plan, deploy, and support the resources in the institution to get the work done. Medical staff task forces have addressed and improved multiple operations this year: orthopedic service success, integration of med staff with health system, helping primary care doctors acquire electronic medical records, improving pediatric call and ER call, and obstetric service challenges. Our local Blueprint pilot and its management is considered the “north star” best example in the state. We have lots of very talented people in our institution. My job is to help to hire them, give them resources, plan their work to be sure it’s aligned with the goals of the organization, and get out of their way.
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.