A Monthly Publication from Citrin Consulting
May | 2011


Courageous Leadership

TED Talks

The Health Care Corner

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Courageous Leadership

Go Ahead and Screw Up

The CEO did not like the results of the report. And he told me so.

I was not completely surprised since the cultural survey I completed along with the focused interviews revealed a number of critical issues in management operations. Yet the results were better than I expected given the tone of comments I received from staff or heard (unsolicited) from members of the team. He admitted that something did not feel right about the data and summary results presented and his tone left it very clear that there would be more discussion before we could move forward onto any future action steps.

When we met the next week, he thought he had put his finger on the problem and it was more or less directed at me. He told me that one of the things he liked about how I approached my work was that I had a “strengths-based” orientation. In a strengths-based model, we begin by looking at what the organization does well and then build on those resources for future growth and even to address weak areas that need improving. Although my report highlighted the strengths of the organization right at the beginning of my presentation, my conclusions and recommendations did not take the organization’s key resources (strengths and assets) into consideration leaving the results and recommendations sounding like a response to the negative complaints we already knew.

I knew immediately that he was right and I had made an error. One of my strengths is that I’m able to acknowledge mistakes. I quickly acknowledged it and thanked him for his insight in recognizing that our report did not adequately focus on how we could use the organization’s best assets to grow their business and improve their culture.

Making mistakes is a natural part of personal and organizational life and one that I believe we should embrace. Of course, most leaders are afraid to admit their mistakes for fear of being seen as incompetent.

Amy Edmonson, a professor at Harvard, who has studied errors in organizations, believes that the learning opportunities from failure are boundless but that almost all organizations, ironically, mismanage their mistakes.

Mistakes can happen in three contexts:

  • Sometimes bad such as when straightforward policies are not followed and errors occur. If you are interviewing a new candidate for a position in your company, make sure you don’t ask questions about their health or marital status. Training in the proper way to interview avoids these kinds of problems, but they do happen regardless. A good way to avoid these kinds of mistakes is through the use of checklists, similar to what pilots use as part of their pre-flight procedures.
  • Sometimes inevitable such as when complex systems lead to errors and mistakes. Following a community disaster, hospital emergency rooms are rife with the potential for medical errors given the crisis nature of the setting. These failures, Edmonson believes, are often attributable to small process errors and by examining and predicting how they occur, their impact can be minimized.
  • Sometimes good because they provide new information that had not been considered before. These “intelligent failures” may occur when a company develops a new product line, attempts to innovate a new business process or shift an organization to a matrix based management system.

While we certainly want to do everything we can to avoid mistakes 1 and 2, they will occur. Counteracting the “blame culture” that typically accompanies these errors can be mitigated by creating a culture that strives to identify, analyze and then embrace the mistake as a way of more deeply understanding why and how it occurred. Most leaders default to the simplest explanation that the staff member made the mistake, but the error is potentially an opportunity to evaluate your organization’s “worst practices”.

As for mistake 3, creating strategic errors is the sign of innovation. Encouraging experimentation is a hallmark of great management and providing a safe environment in which staff can talk about their actions without fear of repercussions will help create an environment in which mistakes are viewed not as an excuse for poor performance but as recognition of the complexity of today’s workplace.


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TED Talks

I love techy stuff and in this Ted Video, Mark Matas, formerly of Apple shows us the next generation digital book that is fully interactive and is used on the iPad and iPhone. As I watched it, I thought it looked like more of a documentary than a book but when he started making the windmill turn by blowing on his iPad, I knew it was something all together different. Check it out at: http://tinyurl.com/6hykrh2


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The Health Care Corner

Are you a Healthcare Patient or Consumer?

I wrote this as an Op-ED for the Pittsburgh Post Gazette and have resubmitted it to them after some comments back from them, so it may or may not be published. What are your thoughts about your role in the healthcare system? Send your comments to me at [email protected] and I’ll include them in next month’s newsletter.

Despite Paul Krugman’s opinion (Patients are not consumers), it is inevitable that people will begin to see themselves as consumers of healthcare rather than just as patients in healthcare. And that will be a good thing.

Right now our health care system is supported by two legs of a three-legged stool. The first two legs are comprised of providers (physicians, hospitals and allied health professionals) and payers (employers, insurance companies and the government) who are deeply involved in the day-to-day management of healthcare. The third leg of the stool represents the recipients of healthcare (call them consumers, patients, or customers) who are generally marginalized within the healthcare system. According to a report issued by the Center for Studying Health System Change only 41% of Americans are engaged in the management of their own health which may mean they get preventive exams, monitor medical conditions and follow their physician recommendations. None of these measures include an awareness or recognition of the costs of healthcare but we are already seeing progress in that arena as well.

Mr. Krugman states that comparison-shopping doesn’t work with medical care but the data is already showing that just the opposite is true. The economic reality that everyone will be paying more for their healthcare will, as it does in every economic system, lead people to look for lower cost options that provide the best value. We’ve already seen that happen when stores like Giant Eagle and Walmart began providing low cost generic discount drug programs. Health customers have flocked to this program with recent reports suggesting that consumers have saved over $2 billion from the Walmart program alone. Another example of consumer power can be seen in the growth of neighborhood retail medical clinics that provide urgent and routine care in almost all cases less expensively than what they receive from their primary care doctor and certainly from emergency rooms. While the growth of these has not been as rapid as predicted both their cost and convenience are based on a strong consumer driven proposition. And when you visit a retail clinic, you will see pricing posted prominently by the front desk, just like you see in other consumer environments.

Perhaps even more important from a consumer’s perspective is the availability of quality information. Most consumers wouldn’t think about buying a new car without ordering a Car Fax Report that details the auto’s life history. Today there is an array of healthcare quality data from a number of sources including their own health plan and organizations such as the Pennsylvania Health Care Quality Alliance. This website provides a tool enabling the viewer to see how hospitals perform in a variety of areas including heart attacks, pneumonia and healthcare related infections As this information becomes more readily available (probably coming to a smart phone app near you) consumers may actually call up this information “on the fly” to compare hospital quality reports prior to going to hospitals for non-critical care.

Getting people to think and act more like healthcare consumers (where we are in charge of our healthcare) rather than healthcare patients (where our doctors or payers are in charge) will be a significant step towards bringing balance among the key stakeholders in healthcare. And like any consumer revolution, it will all be for the good.


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