Recently, one of the Healthcare Value Network member CEOs asked a series of world renowned Lean experts what they felt the most important leadership behaviors are in a lean organization.
Here is what Paul O’Neill had to say.
Dear Dr. ,
Here is my prescription for Leadership for any organization interested in achieving habitual excellence:
1. A leader who establishes cultural norms for the organization so that everyone in the organization can say “yes” to three questions, every day, that will define the organization:
a. I am treated with dignity and respect by everyone I encounter, every day. (Without regard to my ethnicity, my title, my pay grade or rank, the duties I perform, my educational attainment, or any other distinguishing characteristic.) Everyone is accorded exactly the same high level of dignity and respect.
b. I am given the things I need; education, training, tools, encouragement, and protection from risk so that I can make a contribution to the work of the institution, that gives meaning to my life.
c. I an recognized for what I do.
2. A leader who causes the creation of an institution-wide system of continuous learning and continuous improvement that engages every employee as part of the problem solving team. Necessary conditions for such a system to work are: real-time identification of everything gone wrong; an associated root cause problem solving process and institution-wide sharing of problems identified and solutions implemented. Total transparency is an essential element of this process.
3. A leader who articulates and establishes aspirational goals for the institution By aspiration, we mean goals that are set at the theoretical limit of what is possible. For example, zero nosocomial infections, zero medication errors, zero patient falls, zero work place injuries for all employees, zero wasted time spent hunting and fetching, zero duplicative or repair work for things not done correctly the first time, i.e., lab work or imaging studies. (Setting goals at theoretical limits sharpens the understanding of the size of the opportunity relative to current performance. Benchmarking against national averages or even better performers can create the illusion of success or satisfaction with “good enough”.)
4. A leader who systematically takes away all of the barriers and excuses as to why points one, two and three are not possible. For example, we can’t afford to be perfect, we don’t have enough people to do these things, accidents are inevitable, etc.
5. A leader who takes personal responsibility for everything gone wrong.
As a starting point for change and as a proof of concept, a “would be” leader should establish a goal for the institution that makes zero work place injuries a “pre-condition” for the institution, (not a priority, a pre-condition) and then implements the steps above beginning with the creation of a real-time safety data system, with data available to all employees 24 hours each day, detailing incidents, causes, changes in practices to be adopted across the system the same day. Ensure that everyone within the organization can say “yes” to the following question, every day:
a. Is my personal safety and that of my colleagues a precondition?
Starting institutional change with work place safety gives substance to the sentiment that says, “our people are our most important resource”. Virtually every institution professes this sentiment; very few can demonstrate it is true by operating in a way so that no employee is ever hurt at work.
Learning and using the tools and behavioral practices necessary to move along the path to an injury free work place are exactly the same as those required to achieve major progress on making health care safe for patients.