Studer Q. Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top. 1st ed. Wiley; 2007

I decided to read this book because I have been a fan of Quint Studer’s philosophy ever since reading some of his blog writings (here’s a great example, and note the power of blogs to bring in a new audience).
Results That Last is written from the perspective of a seasoned health care executive. I love stories, and Quint puts some very good ones in here. I appreciate that (a) he’s an optimist (”I believe that life rewards action more than inaction”) and that he shares his successes and his mistakes.
I think this book is especially good reading for a person starting a new position (that would be me) in that discussion on good leadership behaviors and creating a transparent plan are a great foundation for integration into an organization with a lot going on (aka every organization).
I agree with the commentary on striving for breakthrough performance - I especially like this quote that we should all remember:

Great companies must have at least 70 percent in the 5s

There are few things I didn’t like/agree with, and these could be chalked up to “controversial ideas” because I have heard them in mainstream health care. A lot. And we should rethink them:

Controversial idea #1: “I had to keep two groups of customers happy: patients and physicians.” On this one I worry that duality of customership creates confusion and doesn’t distinguish the best health care organizations, in my opinion. i understand that physicians refer patients to hospitals and need to tools to deliver great care for them. This is different than saying that they are a customer group like patients are. I prefer the approach that organizations like Park Nicollet use: “The patient is our only customer.”

Controversial idea #2: Making employees happy results in making customers happy. I’ve done a little research on this which I need to dig up (but, please help me here if you know of some) and I think the two are more comingled than people think. It’s possible that when an organization works hard to keep it’s customers happy, this results in employees being happy because ultimately they come to work to deliver for customers. The converse is also true, that an organization can keep employees very happy and have unhappy customers.

Controversial Idea #3: Focus on low vs high performers as opposed to functional vs dysfunctional processes. I think the book excels in demonstrating some baseline leadership behaviors like honesty and standard work like rounding, but I worry that there’s excessive attention paid (right up front, in the first chapter no less) on dealing with “low performers.” This is a bit antithetical to what people like me do in applying Toyota Management strategies - I suggest asking “why?” five times to see if a person is performing poorly or whether their environment is performing poorly for them.

There are two really great things mentioned in this book as well:

Impact of pre-visit and post-visit calls: Great data about the value of these, and in a system that has a personal health record, we just do “pre-visit and post-visit e-mail”. Wonderful.

Key Words at Key Times: Loved this as well. I used to do it in clinical practice - start every visit with “Welcome to our medical office” and end every visit with “Thank you for coming in to see us.” (It is interesting to me that some doctors/nurses don’t think to say “welcome” to a patient when the patient comes to see them!)

Overall, I think the book is actually a very good baseline/starter for more discovery about leadership approaches. Since I tend to be ahead-of-my-time-guy/person/citizen I’d probably recommend following this with something on LEAN or Toyota Management.

• The Seven Things That Surprise New CEOs - I’m not a new CEO and don’t plan to be a CEO, but I thought these ideas are useful to anyone starting a new position (and technically we should all act as if we are CEO’s of our practices/our projects/our goals for ourselves and society)

• Novice to Expert: Use Collaborative Leadership to Go Further - Very nice piece on collaborative leadership - told from the perspective of the Navy. LEAN-like.

• A medical center is not a hospital — Cleveland Clinic Journal of Medicine - Article in Cleveland Clinic Journal of Medicine describing one physician's sadness about changes in health care - "I'm not a hospital guy anymore." Thanks to Health Care Renewal blog for the link. ("read the whole thing and weep")

Herring, Cedric. “Does Diversity Pay?: Racial Composition of Firms and the Business Case for Diversity” Paper presented at the annual meeting of the American Sociological Association, Montreal Convention Center, Montreal, Quebec, Canada, Aug 11, 2006. 2008-09-13

Defining the Attributes and Processes that Enhance the Effectiveness of Workforce Diversity Initiatives in Knowledge Intensive Firms Authors: Modupe N. Akinola, David A. Thomas

The answer to the question in the post title is Yes.

In the last year or so, I have been challenged and challenged myself personally to understand the impact of workforce diversity, and these scholarly works helped a lot to understand it better. The impact is significant.

The first paper was written by Cedric Herring at the University of Illinois at Chicago and widely reported, both on NPR and in the Washington Post. It is a well-done regression and factor analysis of 251 for-profit business organizations’ performance dependency on racial diversity.

As defined in the paper:

Diversity is an all-inclusive term that extends beyond race and gender and incorporates people in many different classifications. It includes age, geographic considerations, personality, culture, sexual preferences, tenure issues, and a myriad of other personal, demographic, and organizational characteristics. Generally speaking, the term Aworkforce diversity refers to policies and practices that seek to include people within a workforce who are considered to be, in some way, different from those in the predominant group. In the 21st century, workforce diversity has become an essential business concern.

The paper represents a first-of-its kind analysis in that it controls for organization size, region, and age (with the idea that larger organizations typically have more racial diversity in them). And all of the tested hypotheses are statistically significant in the affirmative:

1. The more racial workforce diversity a business organization has, the greater that business organization’s sales revenue will be.
2. The more racial workforce diversity a business organization has, the more customers it will have.
3. The more racial workforce diversity a business organization has, the larger market share it will have.
4. The more racial workforce diversity a business organization has, the greater that business organization’s profits will be relative to its competitors

The second scholarly work is about the attributes of effective diversity initiatives. Not surprisingly, one of the cornerstones of effectiveness in this area is leadership, and leadership at the executive level. The intermediate outcome, that leads to the important outcomes above are the creation of an organization whose “population of underrepresented minorities experience the firm climate as being open to diversity and feel as if their race will not hinder them from career progression.”

Why is this important?

People like me are interested in the topic of diversity and disparities because we want to grow, learn, and do better every day. We also want to be in environments where we can succeed by performing well for the people we serve. Data shows that most people prefer to live in diverse environments. This information promotes the idea that people probably prefer to do business with organizations that create diverse environments. The data support the idea that leaders who are truly interested in organizational performance are interested in supporting diverse environments.

As mentioned in the second paper, the world’s best companies understand this:

Several Fortune 500 firms (e.g. IBM, Verizon, Pepsico, GE) have experienced sustained success in their efforts to recruit and retain a diverse workforce, making these firms exemplars in diversity management and ripe for future empirical research.

Why is this important for me?

Around the time that this blog post appeared, I was sitting in a Seattle Metro bus on the way home, in one of the front seats, looking at a poster of Rosa Parks placed overhead, celebrating her accomplishments. It was right after Martin Luther King, Jr’s birthday. I knew that in a different time or place, even in 2007, that I’d be sitting in one of the seats in the back. More importantly, those who would come after me would also be asked to sit in the back, if I did not make a sustained commitment. I realized at the moment that there’s a lot of good news out there - so many organizations have made clear commitments to diversity, and are able and willing to hire the best talent regardless of background. Those are the organizations I will always be a part of.

And yes, Kaiser Permanente is one of them.

(see: Kaiser Permanente’s score in the Corporate Equality Index (score: 100%)).

• Strategy Execution and the Balanced Scorecard (HBS Working Knowledge) - Excellent article with another reminder that strategy deserves its own bandwidth, and should be tied to operations, back and forth, in other words, always checking that what we're doing every day matters. Nice nod to leadership: "There are two key issues. First is leadership. Without strong visionary leadership, no strategy will be executed effectively." This can be challenging in healthcare. Luckily, our patients and their families want to help.

Hello Health Launch Party 7.31.08 - a set on Flickr

Thanks to Jen McCabe Gorman for sharing. The party looks like a lot of fun, and let us hope it helps patients and their families and communities become more involved and engaged in their health. Congrats to Jay & Myca.

Content of Weblogs Written by Health Professionals. [J Gen Intern Med. 2008] - PubMed Result

This is a timely analysis of the content of blogs written by health professionals, by a fellow in the Robert Wood Johnson Clinical Scholars program. It is great to see that the RWJ Foundation (indirectly) would be studying the ways that tomorrow’s physicians will communicate. The article indicates that violations of patient privacy are rare, and suggests training of health professionals in this realm.

I agree with both, because health professionals should learn how to blog well, which really means they would learn to communicate well.

This would also mean, by the way, that I disagree with the creation of this headline about the study: Health Care Provider Blogs Do Not Maintain Anonymity, Study Says. My takeaway from this is that there is still a tendency to paint blogs in the negative within the health care press. That will change.

It is also not lost on me that the author has chosen a gmail address to be contacted, maybe blog and Twitter URL’s will follow in the world of PubMed….

I was speaking with Jane Sarasohn-Kahn today about some work she is doing for the California Healthcare Foundation and she asked me the question, “Do you think physicians would pay for their own continuing medical education (rather than being funded through industry support)?”

I immediately thought of this manifesto that I just read, whose conclusions I couldn’t agree more with, when I said, “yes we would.”

ChangeThis :: People Don’t Hate Change, They Hate How You’re Trying to Change Them

If you believe that people hate change and that it is your job to change them, they will hate it. If you believe that people thrive on change and that your job is to unleash it, you will tap into a limited source of ingenuity, energy and drive that will allow you to consistently take your ideas into big results.

This is exactly the theme we uncovered the Patient Centered Health Information Technology initiative, and what I have described many times on this blog and on the DailyKaizen blog (see: Let it Burn; a Wildfire of Respect), when I said, “in every part of every company there’s a monstrous capacity for creativity waiting to be unleashed.”

I sometimes hear about people in healthcare being “change averse.” I don’t think they are at all.

As we move toward Health 2.0, we have plenty of capacity to do things differently; nothing is static if it means doing things better for our patients. It’s what I see, again and again.

JAY PARKINSON + MD + MPH

How long before HelloHealth comes to Washington, DC, with the most regional-serving walkable urban places per capita in the country?

Note: There’s been some buzz about walkability for other cities as well, also fine choices for those who love living in places that support walking.