Category Archives: Baldrige

The Baldridge Journey – Lessons from…

12 Friday Jan 2018

Posted by in Balanced Scorecard, Baldrige, Developing Leadership Systems, Praxis Solutions

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Thrilled CustomersFifty-five pages, single spaced 10 point font, 2 column format and 165 graphics. This is a Baldridge application for a small rural hospital west of Olympia Washington. In adopting the Baldridge excellence framework they have gone on record saying, “we want to become the best”. Facilitating the discovery, identifying their systems and processes and then writing the document was a privilege. Exhausting for sure. Five and a half months of workshops, 4-5 complete rewrites, hours of edits, checks and double checks. Still bound to be a few errors. Frustrating but the lessons are massive.

Baldridge is brilliant. I have been in the Baldrige world for six or seven years. With each touch of the Baldrige system I am more aware of its brilliance. Nothing is more comprehensive, demanding, or relentless in pursuing excellence than the Baldridge framework.
Excellence is not a mystery. Baldridge takes the mystery out of the pursuit. With the final edit their next step in the journey is crystal clear. Every health care organization is swimming in data. They are paddling as fast as they can a river of numbers. A myriad of regulatory, oversight, government and private organizations require, gather, and assemble mountains of data for public consumption. Much of it is buried in data warehouses where the statistical relevance is debated by some who want to resist change and others that want to prove preconceived notions about health care. But the numbers are there. This organization’s next hurdle is lining up their data with their vision. When they do this, look out.
Baldridge promotes systems thinking. Having worked with this hospital for a year in developing a formal leadership system, it is clearer than ever that health care is a web of interconnecting systems that must be integrated if the cost of health care is ever going to be contained. This hospital is the primary health care provider in a county of high unemployment, high rates of drug & alcohol abuse, and high poverty. Three years ago the county was ranked #33 out of 39 counties for population health. Today they are at #28. Sounds like a minor advance but they have moved the dial on a clock that is hard to move. By recognizing that medical health cannot be separated from behavioral and social health and by partnering with social service organizations and even competitors this little hospital is making an impact. They have begun to integrate social, behavioral and medical health care delivery. They have recognized that treating the cause of illness is immeasurably cheaper than treating the symptoms of illness. The result is that their patients are healthier, at a lower cost and enjoy greater access.
Baldrige provided the framework for excellence. They provided the vision.

Leadership: Its the System Stupid

02 Monday Oct 2017

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Oops! Road SignMay I please have your attention? Leadership is a system it is not a person!

Living in the shadow of Microsoft world HQ I have many friends who work with Microsoft. Without exception, everyone repeats the same thing: the culture is toxic. It is impossible to work collaboratively because the rules of engagement are such that one can only advance on the back of co-workers or by heroic effort which means 80-100 hour work weeks. Those who genuinely want to work for organizational mission, who want to produce outstanding products and services that are truly innovative (and have a life outside Microsoft) – cannot. I am even hearing reports, that experience with Microsoft, once a ticket to the C-Suite, is now considered a negative work experience. Employers are concerned they may inherent the toxic culture.
I recently read Kurt Eichenwald article titled Microsoft’s Lost Decade (Vanity Fair, July 24, 2012). In it he blames the toxic culture on the practice of stack ranking employees. For example, a manager with 10 employees has to rank each one in a performance order of 1-10. This means that two will get a great review, two will get ranked with deficient performance and six will get average reviews. Therefore, to consistently get a great review, one must make sure his team mates score poorly. His conclusion is that Microsoft could hire Steve Jobs, Mark Zuckerberg, Larry Page, Larry Ellison and Jeff Bezos and one of them would rank as a disaster.
Therefore, Microsoft could hire the best leaders and creative thinkers on the planet but the system of leadership would prohibit them from leading effectively. Each may bring tremendous value to the company but only the one who can sabotage his colleagues would be considered successful. Conclusion: the leadership system will always trump the individual leader.
In 2013 Microsoft announced the practice of stack ranking was being abandoned. Let’s see how long it takes to change the underlying culture.

Three Leaders, One Leadership System

27 Wednesday Sep 2017

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Close up of men's rowing team

Leadership Systems: All Leaders Pulling Together

Three leaders. All well recognized for their expertise. All brilliant and hold post graduate degrees. All operate non-profits. Two are CEO’s of similar organizations with a similar mission and comparable size. One is growing rapidly. The other is growing but slowly. One has that unique ability to gather followers. Volunteers and funding flow easily but he struggles with long term strategy. He is concerned that growth and well-meaning activity is masking real and long-term transformation. The other is a brilliant strategist but struggles communicating new concepts and making them simple. Hence, funding and the necessary volunteers don’t come so easily. My observation is that both struggle putting the necessary systems in place to be as successful as they would like. Especially a leadership system. To them, leadership is an individual person.

The third leader is the CEO of a different type of non-profit. He operates in a world of dynamic change, high competition, high regulation and everything he says and does is open to public review. He understands that leadership is not about one person exerting power and control. He is building a formal leadership system. It is a work of art. His senior leadership team is operating – like a team. They are mission driven and their leadership system is designed to execute on that mission. Yes, he hires leaders for their technical expertise and experience but he also hires them to the requirements of the leadership system.
For long term organizational excellence, transformation and innovation my bet is on leader number three. His personal leadership is not about attracting followers but about executing organizational mission. He understands that this will take all leaders pulling on their individual oars in concert with the others. My prediction is that soon, they will be recognized nationally for their excellence.

Leadership Systems – Delivering Maximum Value

09 Sunday Apr 2017

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PartnersSummary

Given the total lack of evidence that developing leaders actually results in better organizational performance, maybe it is time to convert what we know about leadership. The model says that by accumulating individual power and influence we earn a trip to the C-Suite. Instead, we should be developing strong leadership systems that focus on maximizing customer value.

Problem

John Maxwell is as good as anyone about insights into leadership. But the tagline to his bestselling book: 21-Irrefutable Laws of Leadership, may give us a clue as to why our thinking about leadership is wrong. It states: Follow Them and People Will Follow You. With this model of leadership, the primary function of leaders is the accumulation of organizational power and influence by getting personal followers. The problem, is that the focus is on the individual leader and not the needs of the organization, to say nothing of the customer.

Solution

Focus on Developing Great Leadership Systems.

Under this model, leadership is understood as a system that is interconnected with other systems and the leader submits everything she controls (elements), and builds critical relationships (interconnections) to deliver maximum value (purpose or function). It is not about leaders and followers. It is about leveraging the highest value of each interconnecting system to provide the maximum total value to the customer, patient, or student.

All organizations – governments, nonprofits, hospitals, commercial, manufacturing, high tech, and educational – all operate in systems. For example, hospital operating rooms operate in a world of interconnected systems. There is the admitting system, the diagnostic system, the technical systems, the surgical systems, the facility system, the surgical support system, the purchasing system, and many others. When individual leaders, understand they lead within a system that has been intentionally designed to deliver maximum value, then and only then can mission be attained.

Practical Impact

In his book, The Power of Habits, author Charles Duhigg tells the story of the Rhode Island Hospital. Even though it was a leading educational hospital and Level 1 Trauma Center it was also a place of feudal fights where nurses were pitted against surgeons. Nurses even had their own color coded method of identifying surgeons they worked with. Quoting Duhigg: “Blue meant ‘nice,’ red meant ‘jerk,’ and black meant, ‘whatever you do, don’t contradict them or they’ll take your head off.’ ”

Duhigg recounts the true story of an elderly man who was brought in with a Subdural Hematoma. Immediate surgery was required. Ignoring repeated caution from the nurses, the surgeon stated: (Quoting Duhigg): “If that’s what you want, then call the fucking ER and find the family! In the meantime, I’m going to save his life.” Within two weeks the man was dead. The surgeon operated on the wrong side of the man’s head. It would be easy to say that the fault was the surgeon’s and he should be dismissed, (he was). However, over the next four years similar accidents occurred for which the hospital paid $500,000 in fines.

The good news is that changes were made. It might be obvious to say, they implemented check lists and other procedural changes to improve patient safety. However, the stronger reality is that they challenged, broke and then transformed the entire leadership system. Leaders become subservient to the requirements of a system rather than every leader establishing their own operating procedures. The result was a dramatic drop in errors and a prestigious award for Critical Nursing. Where the old leadership system put the surgeon at the top of the pyramid with virtual unquestionable authority, the new system empowered everyone around the care of the patient – delivering maximum value. Duhigg concludes with an example of a routine surgery performed by an experienced and well trained surgeon. Before he started he went through a check list but missed a minor point. In response, the youngest and least experienced nurse pointed out the error which was welcomed by the surgeon.

A leadership system, therefore, is the system that connects leaders, and organizes the elements they control with the critical relationships to produce the desired outcome – maximum value. With the example of Rhode Island Hospital and the old system, surgeons had enormous and virtual dictatorial power, which often came at the expense of their patients. Under the new system, the surgeons recognized the nurses as part of a total system of patient care. The result was more medical value provided to the patient. It was not a matter power and control. It was about delivering to the patient maximum medical value for their health.

Challenges

The largest challenge to thinking about leadership as a system is the hundreds of books and training courses that provide rich formula driven approaches to personal power and influence. A simple search on Amazon books about “leadership” and 200,000 titles will come up. Same search on “Leadership Systems” and 16,500 titles come up. Virtually all titles on leadership places the individual leader at the center of the story. A review of one title found 50 different traits of effective leaders. Any combination of Jesus, St Francis of Assisi, Aristotle, Nelson Mandela, Martin Luther King, Jr, or Winston Churchill would never be able to adequately demonstrate all 50 traits.

A good example for the weakness of modern day thinking on leadership is an outstanding book by Stephen Covey, Speed of Trust, the one thing that changes everything. the problem with it is this: if an organization has a system that destroys trust, how can any one individual, especially one just emerging as a leader, ever change an entire organizational system? For most, the system itself will kill any attempt to create a culture of trust.

 

First Steps

Determine the requirements of the system. We just did this with a local hospital. When asked about the requirements of a leadership system – the lights went on – both form them and us. As a community based hospital they determined that the focus or the requirment of a leadership system was the empowerment of their staff, their patients, and their community. The implications were massive. From this basic requirment, we then identified critical behaviors and activities of leaders, then a plan to train and deploy the system and then the final – how to measure it. Basically they determined three measures for their leadership system:

1) Staff safety;

2) Patient safety;

3) Engagement with the community.

Each of which is easily measurable.

Comments Welcomed: Dan@PraxisSolutionsNP.com

Credits

Mr. Theo Yu, MPA, a doctorinal candate in Transformational Leadership from the Bakke Graduate University.

This article was originally published by: Management Exchange, an online community dedicated to reinenting management in the 21st Century. It can be viewed in its orginal format at:

http://www.managementexchange.com/hack/leadership-vs-leadership-systems

What is a Leadership System?

28 Tuesday Feb 2017

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operating-room-nurseDefinition of a leadership system: The system that connects leaders, and organizes the elements they control with critical relationships, which will produce a desired outcome.

Every organization has a leadership system. It might be a good one or a bad one, but there is a leadership system built into every organization.

In her book, Thinking in Systems, author Donella Meadows writes: “A system is an interconnected set of elements that is coherently organized in a way that achieves something. If you look at that definition closely for a minute, you can see that a system must consist of three kinds of things: elements, interconnections, and a function or purpose.”

A leadership system, therefore, is the theory of systems applied to leadership. Using Meadows definition any leadership system is going to exhibit three component parts – elements, interconnections, and function or purpose.

Elements of a Leadership System can be:
• The leader;
• Organizational Mission;
• The current system;
• The unique product or service being provided; and
• Governance including the regulatory environment.

Interconnections (critical relationships) of a Leadership System can include:
• Reporting structure;
• Core business processes; and
• Customer requirements.

Function or Purpose of a Leadership System may include:
• The customer;
• The way in which the customer will be served; and
• Plan on execution of organizational mission.

Though not immediately recognized, every organization of any size has a leadership system. The question is, does it work? As others, have noted, systems have a way of driving behavior that is not intended. This is probably at least one answer as to why a leader can go from one organization and produce transformational improvement and go to another organization and fail miserably.

In his book, The Power of Habits, author Charles Duhigg tells the story of the Rhode Island Hospital. At the time, it was a leading educational hospital and Level 1 Trauma Center. Its intensive care unit was considered one of the best in the country. It was also a place of feudal fights where nurses were pitted against surgeons and usually lost the battle. Dhuigg tells the true story of an elderly man who was brought in with a Subdural Hematoma. Immediate surgery was necessary. Only the surgeon, ignoring input from nurses in the OR operated on the wrong side of the man’s head. He eventually died. The man was not the last. Within a few months, others died to simple system procedural failure.

The good news is that changes were made. While it might be easy to say, they implemented check lists and other procedural changes, the reality is that they challenged, broke and then changed the entire leadership system. The result was a dramatic drop in errors and a prestigious award for Critical Nursing. Where the old leadership system put the surgeon at the top of the pyramid with virtual unquestionable authority, the new system empowered everyone around the care of the patient. Dhuigg concludes with an example of a routine surgery performed by an experienced and well trained surgeon. Before he started he went through a check list but missed a minor point. In response, the youngest and least experienced nurse pointed out the error which was welcomed by the surgeon.

A leadership system, therefore, is the system that connects leaders, and organizes the elements they control with the critical relationships to produce the desired outcome. With the example of Rhode Island Hospital and the old system, surgeons had enormous and even dictatorial power, which often came at the expense of the nurses. Under the new system, the surgeons (leaders) recognized and organized the nurses as both a critical element and relationship in the care of a patient (desired outcome). The perspective and input of nurses become  valuable relationship that would make the whole greater than skill of the individual parts. The result was more intellectual and practical care given to the patient and not less. It was not a matter of surgeons winning or losing power and control. It was the patient receiving the best possible care.