Tuesday, August 18, 2015

The Wrong Map

Over two years ago, the folks over at the athenahealth kindly invited me to submit columns to their Health Leadership Forum, and I have done so on an occasional basis since them. As I recently reviewed the columns, I realized that my own thoughts on the topics of leadership and coaching have evolved a bit, and I thought my readers over here at Not Running A Hospital might enjoy witnessing the transition. So for several days, I will be reprinting the posts from the Forum over here. Comments are welcome at the original site and here. Today's reprint is from a post dated February 7, 2014, "The Wrong Map."

My good friend and negotiation guru Michael Wheeler includes an anecdote in his new book, The Art of Negotiation: “Many years ago, a military patrol was caught in a fierce blizzard in the Swiss Alps. The soldiers were lost and frightened, but one of them found a map tucked in his pocket. After consulting it, the men built a shelter, planned their route, and then waited out the storm. When the weather cleared three days later, they made their way back to the base camp.”

Wheeler continues, “Their commanding officer, relieved that his men had survived the ordeal, asked how they made their way out. A young soldier produced the life-saving map, and the officer studied it carefully. He was shocked to see that it was a map of the Pyrenees Mountains that border Spain and France, not the Alps.”

He suggests three reasons how the wrong map could help save climbers lost in the Alps: it rekindled the soldiers’ confidence, provided an impetus to get moving, and sharpened the soldiers’ awareness.

While Mike uses the anecdote to draw lessons for negotiators, perhaps it also offers suggestions to leaders in health care. Their institutions face formidable challenges, and the way forward is not always clear. They know that standing still — failing to act — is more dangerous than going in slightly the wrong direction. But how do you motivate your staff to take action and deal with the ambiguity of the situation?

The traditional wisdom is that you have to “create a burning platform.” Such an approach uses the threat of imminent financial disaster or major loss of market share as an incentive to those in the organization. Well, maybe. But the problem with a burning platform is that your people fear that the only way to go as they step off the platform is down.

Few people want to take accountability for initiative in that situation. Frankly, most people are risk-averse, and telling them that the world depends on them for decisive action is not highly motivational.

So, how do we get people past their natural risk-averse tendency? How do we suggest to them that any (thoughtful) action is better than sitting back and waiting? How do we get them moving in a direction that has some probability of being correct? How do we help them sharpen their awareness so they are alert to the need for mid-course corrections if the original path proves to be off target?

What map of the Alps can we offer our staff?
The traditional one is a strategic plan: We engage in a long process to survey our strengths, weakness, opportunities, and threats. We fan out through the organization and create working groups to enhance buy-in of our analysis and the alternatives we choose. We overlay the process with nifty charts and graphs, careful to include the “levers” that will make a difference in our financial situation or competitive posture. Then we assign the strategic initiatives to various inter-disciplinary groups and create key performance indicators for each division of the company to measure our progress in carrying out the plan.

It is hard to imagine a less inspirational start to a journey of change than this kind of centralized, highly numerical, and bureaucratic approach. Here’s a secret. Every strategic plan I have seen in the health care world says the same thing: “Let’s focus on what we are good at that pays us well, where we can gain market share, and do more of that. For the things we don’t do as well, or where payment is not good, it’s okay not to grow or even to shrink.”

I’m not suggesting that an organization should avoid a strategic vision. Indeed, having such a vision is a key role of senior management. I am suggesting that the way to give your “soldiers” the confidence to leave the campsite, engage in experiments, take risks, and be creative does not come from an externally generated strategic process. Instead, we need to allow confidence-building measures to grow organically from within the organization.

In previous columns, I’ve talked about the value of the Lean process improvement philosophy in reducing waste, i.e., improving the operating efficiency in an organization. With the Lean approach, the front-line staff is empowered, expected and encouraged to call out problems in the work place. Management is expected to swarm around those identified problems—in real time—and invent experiments to test out countermeasures to improve the delivery of goods or services to the customer.

Well, it turns out that Lean also provides that “map of the Alps” in an uncertain environment. The “map” here is a general philosophy, approach, and set of tools that is independent of the actual physical and competitive work environment. It maintains and enhances our confidence as a team. The “every person every day” theme of Lean provides ongoing impetus to keep moving. Finally, knowing that the organization expects and encourages the staff to call out workplace waste sharpens their awareness.

The “map” for dealing with the challenges of a health care institution is being held by every staff person in our organizations. Our job is to create an environment in which they can feel the map in their pockets and set off each day in the right direction — to reduce waste, improve efficiency, and deliver better service to patients and families.

1 comment:

Barry Carol said...

I wonder if a placebo effect from just about any action that sounds or seems reasonable and plausible can be helpful as compared to doing nothing. I know from personal experience that sometimes when I’m not feeling well and want to see my doctor to get the problem evaluated, just making the appointment improves how I feel.

Drugs can have a similar effect even when they won’t address the underlying problem as long as the patient doesn’t know that and thinks they will help. For certain drugs that some patients take on an as needed basis like tranquilizers or nitro tablets, just knowing that they are there and available reduces the likelihood that they’ll be needed.