John Maxwell once wrote that, "The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails." Leading through turbulent times calls for a healthy balance of what I like to call "realistic optimism." Leaders who practice "realistic optimism" balance the need to confront the reality of the situation with a plan for how to navigate through the rough waters (to use another metaphor). I believe that the most successful leaders in these turbulent times are the ones who learn and adapt from so-called high reliability organization, organizations that operate in complex, high-hazard domains for extended periods without experiencing significant disruptions in their operations or catastrophic failures. To build upon Maxwell's quote above, leaders in high reliability organizations are the ones who adjust the sails.
Dr. Leslie Jurecko is a pediatric hospitalist who currently serves as the Chief Safety, Quality, and Patient Experience Officer at Cleveland Clinic Health System. In her role there, she is responsible for the development and implementation of one of the nation's premier health systems' enterprise-wide quality and safety strategy. If there is any health care organization that currently meet the definition of a high reliability organization, it is Cleveland Clinic. Dr. Jurecko has studied high reliability organizations extensively, and she recently listed 10 leadership mindsets for high reliability organizations. I would like to list these mindsets here.
1. "Healthcare is a dangerous place to work." Unfortunately, hospitals and other health care organizations have some of the highest rates of patient harm and employee injuries in the United States. The late Paul O'Neill, who served as the Chairman and CEO of Alcoa, Chairman of the RAND Corporation, and the U.S. Secretary of Treasury was a strong proponent for workforce safety in health care organizations and believed that physical and psychological safety was a prerequisite for patient safety. As leaders, we need to recognize that we work in a dangerous industry and commit to keeping our workforce safe, so that they can keep our patients safe.
2. "Complex systems have complex problems and require robust solutions." One of the five fundamental characteristics of high reliability organizations is "Reluctance to Simplify". The problems we are experiencing in health care today are complex (see my post on "wicked problems"), and trying to oversimplify their solutions is only going to make things worse. We should refrain from trying to improve safety, reliability, and efficiency through limited action plans that involve either policy changes or mandatory education and training.
3. "Patients are part of the solution to your difficult or complex issues." Some of the best health care organizations have figured out that patients and families are important members of the health care team. We need to do a better job in bringing patients and families to the table whenever we are trying to solve some of health care's most challenging problems.
4. "Reactivity breeds fear and fear stalls progress." High reliability leaders establish a culture of psychological safety where our colleagues will feel both empowered and supported to raise concerns about safety and reliability. Rather than reacting to bad news, these leaders adopt a "growth mindset" to help solve problems and prevent mistakes and errors from becoming safety events in the future.
5. "Stop blaming caregivers for system issues." Lucian Leape wrote, "The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes." High reliability leaders understand that in order to find and fix problems within the system, they have to commit to establishing a culture of psychological safety (see above) and create a "just culture" where people are not punished for making an honest mistake.
6. "Attention is the currency of leadership." Ronald Heifetz wrote that, "Attention is the currency of leadership. Leadership could be defined as getting people to pay attention to tough problems that they would often rather avoid facing. When you're an authority figure, people are already paying attention to what you do and say. So you can direct attention more easily to a set of key challenges." By paying attention to what is happening ("Sensitivity to Operations"), high reliability leaders will focus the rest of the organization's attention on finding and fixing problems within the system.
7. "Vulnerability is your superpower as a leader in a high reliability organization." When a leader acknowledges that he or she is not perfect - when that leader admits to making a mistake - they are helping to build a culture of safety and reliability in the organization.
8. "Ask 'why' five times...then ask again." Leaders in high reliability organizations "always take the next step" and dig deeper to find the root cause to a problem.
9. "Stories are great, but stories with data are better." I like to use anecdotes, stories, and metaphors as a leader to help build a compelling case for change. Leveraging the power of data can make these anecdotes, stories, and metaphors even more powerful!
10. "Commit to proper change management." I've talked about change management in a number of recent posts. As I recently wrote, "Managing change is one of the most important jobs for a leader in any organization. Managing change is all about managing people. And managing people is hard." High reliability leaders are committed to proper change management.
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