Off Track – Now What?

By Rob Thames

It happens. The organization is off plan…by a lot; and it is not the first time. More than a modest correction or a “wait until next month.” Many factors were likely involved, but the relentless dynamics of the market have overwhelmed a longstanding management team. It is akin to a cyclist who has slipped back from the peloton due to chronic cadence deficit – and now the gap is widening.

When a leadership change is made while the organization is on plan, it is often political. When an organization is off plan, and a leadership change is NOT made, it is often political (or paralysis). But when performance is off plan and the board and/or corporate office makes a CEO change, what are the key considerations?

Mitigating Decision-making Errors Along a Transformation Journey

In Part A of this two-part article on decision-making errors, the main categories and types of decision and judgement errors were reviewed along with some associated logic fallacies.

So What?

Two practical questions emerge. First, what can we do to improve our judgement? A combination of antidotes is often recommended to mitigate the untoward effects of these decision traps: being humble and aware, knowing yourself and knowing others, and following a process are the top three. The first, being aware, is like telling a pitcher to “throw strikes” (well-intended, but not of great practical help – this is what the pitcher is trying to do but it does not help him/her do it!). The second, to know oneself, is harder than diamonds and steel, according to Benjamin Franklin. The third, following a process, offers the most tangible promise for something we can actually do that can consistently make a difference.

Decision Making Traps: Decider Beware

Leadership Transformation Series

Decision Making Traps: Decider Beware

This is Part 4A in this Four-part Leadership Transformation Series (LTS); 4B will follow.

Transformation in healthcare is personal: it requires the transformation of health system leaders. The LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how we make decisions: 4A Reviews decision-making errors.

4B Addresses how to mitigate decision-making errors

4A Healthcare Transformation and Decision-making Errors

Leaders – and their organizations - succeed or fail based on their decisions. Yet the evidence is clear that our decision making is perilously fraught with biases and irrational behaviors of which we are not even aware. These biases are so ingrained in our psyche that, like water to fish, we cannot imagine that they are even there, much less clouding our view – regardless of how “well-intended and objective” we believe we are. In short, bad decision-making is largely hard-wired.’ Just as many medical errors are associated with unexplained variation in medical decision-making (How Doctors Think), so too are many leadership errors are associated with unexplained variation in management decision making.

Traditional change is oriented in the past; it involves more, faster, better, but not different (Daniel Prosser). Transformation is future-oriented; it requires the creation of something from nothing, i.e., letting go and giving up something in the past to create something new. This means that, to do transformation well, it is even more important that our hidden decision biases be flushed out and made explicit. Leaders on a transformation journey are at higher risk for decision making traps and consequences than in traditional change. Said differently, leadership decision making in transformation is less forgiving.

A brief review of categories and types of decision and judgement errors include the following:

Systemizing Healthcare: The Integrator Role

The leadership need for ‘the Integrator’ is re-shaping traditional CEO and COO roles.

A few decades ago, the role of ‘the Integrator’ in healthcare leadership did not exist – at least not in the form needed today. Unlike roles with new names – CTO, CMIO, CPHMO, etc. - the same titles of CEO or COO may be used for a healthcare system, yet the shapes of these roles bear little resemblance to those with the same titles used in a hospital or other ‘vertical.’

While a hospital administrator/CEO is expected to stay close to the pulse of acute care operations, the system CEO is expected to transcend operations to assure an aerial view/perspective, i.e., to become more visionary and system-focused. The transition from hospital to system requires a view that is less entrenched with how we have run hospitals and more focused on the population served. Despite use of the same title for both roles, it is the difference between being ‘tied down’ and ‘freed up.’

‘Pushing up’ the system CEO role creates space between the maximization of operations in an individual vertical, e.g., hospital, physician practices, and pre- and post-acute services (possibly insurance) and optimizing a system of care for a population. The integration leadership challenge for health systems involves numerous business verticals or silos. But this is only a start: to ‘systemize’ healthcare systems, integration of IT/digital, consumer engagement and culture to a new level are needed. In this space, created between the elevated CEO visionary role and numerous operating entities, is the work to ‘systemize.’

Healthcare Integration: Ship-to-Shore Work and the Ultimate Weapon

Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.