• What’s Needed Next: A Culture of Candor – HBR.org – We’ll tackle upward communication first. Consider the results of an intriguing, relatively obscure study from the 1980s, in which organizational theorists Robert Blake and Jane Mouton examined NASA’s findings on the human factors involved in airline accidents. NASA researchers had placed existing cockpit crews—pilot, copilot, navigator—in flight simulators and tested them to see how they would respond during the crucial 30 to 45 seconds between the first sign of a potential accident and the moment it would occur. The stereotypical take-charge “flyboy” pilots, who acted immediately on their gut instincts, made the wrong decisions far more often than the more open, inclusive pilots who said to their crews, in effect, “We’ve got a problem. How do you read it?” before choosing a course of action.

I’ve always respected the Disruptive Women in Health Care blog, and disruptive women in health care in general, so I was pleased to become March Man of the Month (or March’s Honorary Woman), with an interview of one of my favorite leaders…..

Disruptive Women in Health Care » Blog Archive » March Man-of-the Month: Dr. Ted Eytan Interviews Holly Potter, Kaiser Permanente’s VP for Public Relations, on the Use of Social Media in Health Care

I have just returned from Boston, where I was honored to be a visitor to the Kaiser Permanente Executive Leadership Program, at Harvard Business School. The trip came about because my boss, Marty Gilbert, MD, is the Permanente Executive in Residence at the program.

I have never been to business school, and defintely not Harvard Business School, although I have read HBS cases many times in the past. So for me, this was a treat to see the methodology used to take HBS cases and use them to teach. On this particular day, cases about Benihana restaurants, the Internal Revenue Service, and (one of my favorites) Toyota were leveraged to talk about operations flow and leading change. The professors were very dynamic and I thought their use of the chalk boards was very intriguing – this is the first thing I think a student notices. They even hand wash all the boards in between sessions.

The teaching itself seems to lend to the learning of accomplished professionals, in my opinion. The professors stop short of guiding the students on how they should apply the material in their leadership roles. They actually avoided asking for examples in people’s professional work during the interactive session, which is probably a very tempting thing to do in this situation.

Beyond the professors and the material, though, I couldn’t help but be impressed by the people in the program and Kaiser Permanente’s commitment to it/them. In my travels I have met many physicians in other health systems who are told, directly or indirectly, “Management/Leadership training is for managers/leaders, not physicians.”

The Executive Leadership Program is not just for physicians, though. Staff from across the program are involved, as are leaders from the Labor Management Partnership. Needless to say, this is a very accomplished group who I was very humbled to be present with.

With thanks to Marty, the students, and team at Harvard Business School for allowing me to watch them in action!

More images below, click on any to see full size:

This week’s photograph was taken at Washington, DC’s Loeb’s New York Deli , and has Anita Samarth and Trenor Williams, MD, assisting fellow customers with their breakfast meals. This kind of thing just happens in a city/state that’s the #3 most extroverted in the United States.

The occasion of our breakfast was a monthly dialogue of a group of mid-Atlantic health information technology professionals that get together regularly to learn from each other and and to believe that everything is possible, because it is. Here’s a photograph of the full smiling group (except for me, the photographer…).

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.