Pronovost advises all boards and CEOs

Johns Hopkins' Peter Pronovost offers sage advice to the board of the troubled Parkland Memorial Hospital in Dallas as it searches for a new CEO.  Actually, though, his elegant advice could apply equally well to "untroubled" hospitals because most of them still are not fully carrying out their public trust--a task that requires a deeper view of how to deliver quality and safety to patients and families, to respectfully engage all staff in front-line driven process improvement, and to be transparent with the community about their successes and failures. Excerpts:

History may provide some guidance. Historian Rufus Fears [right] notes that great leaders — leaders who changed the world — have four attributes: a bedrock of values, a clear moral compass, a compelling vision and the ability to inspire others to make the vision happen. Parkland needs one of these great leaders.

The key values of the next CEO should be humility, courage and love — and these values must guide the leader’s behavior. Parkland will not be able to improve unless it acknowledges its shortcomings; this will take humility. Yet Parkland is a great organization with a rich past and bright future. The leader must honor the past and look forward. The leader must be able to live with the paradox of being humble yet confident.

To avoid a revolt and get staff passionate about the vision, the leader will need to transparently communicate where Parkland is going and why, how Parkland makes decisions and what those decisions are. Yet the next CEO will need to deftly dance between democracy and autocracy, between conversations and results. To make all the needed fixes, to bring Parkland back to where it needs to be, much needs to be done, and only with a passionate and engaged staff can real change happen.

Yet perhaps the greatest value will be love. Avedis Donabedian, one of the fathers of quality improvement, was interviewed on his death bed by a student. The student asked, “Now that you have been a patient and devoted your life to improving care, what is the secret of improving quality?” Donabedian told him, “The secret of quality is love. If you love your God, if you love yourself, if you love your patients, you can work backwards to change the system.”

This is what Parkland needs. The hospital’s doctors, nurses and administrators care deeply about patients; they do not want to harm them. They work with broken, underresourced systems. The next CEO must recognize this and seek to understand rather than judge, to learn and improve rather than blame and shame.