I just finished reading "The Boys In The Boat", an amazing story that is beautifully recounted by author Daniel James Brown.
In 1936, a team of nine working-class students from the University of Washington won the gold medal for rowing during the Olympics in Berlin, then the capital of Nazi Germany, right under the eyes of Adolf Hitler. They won against unbelievable odds, first by defeating the rowing teams from the wealthy top universities on the East Coast, and then by defeating the elite rowing teams from Great Britain and Germany. They also won despite cheating by the Nazi organizers of the Berlin Olympics.
What makes this story so compelling for any one in a leadership position in healthcare is the unique cast of individuals, who, with humility and determination, were doing their very best as a team over a four-year period. First, there was boat builder George Pocock, a Brit of humble upbringing, who ultimately became a legend in building the best, sleek rowing shells. As a young man, he learned effective rowing techniques from ordinary laborers and fishermen on the Thames in London and subsequently created a different style of oars that required a different style of rowing, as compared to the traditional rowing techniques used by the leading British universities. He had a keen insight into materials, rowing techniques and people. Then there was coach Al Ulbrickson, a stoic and unassuming figure, who quietly built strong rowing teams over a number of years. And finally, there were the eight oarsmen and one coxswain, who ultimately soared as they overcame challenge after challenge. Personal and collective hardships did not stop them from pursuing excellence together. The result was poetry in motion on the water, in which the boat and boys became one.
Interesting is what George Pocock and Al Ulbrickson did and did not do to create a consistent and high performing team that beat all odds.
First, they did not:
Use the same shell designs and rowing techniques as all the other leading teams in the US and Great Britain, with their long rowing traditions.
Many in healthcare are quick to proclaim that healthcare is different from any other industry. While that is true to a certain extent, there are also many similarities. People working in healthcare do, in essence, not differ much from those working in other industries and the underlying "physics" of care delivery processes is not all that different from production or service delivery processes in other industries. Consequently, healthcare leaders should not continue to think "inside the box" but instead look elsewhere for inspiration to create great organizations. Fortunately, a number of healthcare organizations are leading the way and are providing great examples themselves.
Benchmark their own performance against their competitors and analyze at great length and in great detail the many things that could be measured about the competing teams.
Healthcare organizations continue to be somewhat fascinated with benchmarking their own operational and financial performance against that of others. There are a host of serious problems with benchmarking, ranging from lacking context because of geographic, case mix and organizational differences to lacking correlation of these performance indicators with the ones that matter to patients and their caregivers, such as safety, outcomes and the patient experience.
In addition, benchmarking is often associated with the desire to boost productivity and to reduce costs. Efforts to cut costs based on productivity benchmarks usually ignore how operational issues and the physics of patient and workflows are affecting current performance. The results are often limited and short-lived. The reason is that benchmarking prevents healthcare leaders from developing, in the words of Edwards Deming, a profound knowledge of their own organization and the many factors that drive its performance.
Use limited funds as an excuse for poor performance, even though all nine young men were from poor, working-class backgrounds and the Great Depression was still raging. In addition, Washington University's rowing team was not as well funded and wealthy as compared to the elite schools from the east.
Healthcare is going through a very turbulent time and undergoing many rapid changes. It is, therefore, very easy to find plenty of excuses for why a hospital, surgery center or clinic is struggling. Leaders must now rigorously focus on improving internal operations, while, at the same time, experiment with new ways to deliver high quality, safe, affordable and easily accessible care to ensure that their organization remains relevant and viable.
Leave the training of the rowing teams to lower level individuals, while just observing things in comfort and from a distance. Nor did they blame the oarsmen and coxswain when practices did not go well.
All too often, senior management is far removed from the front lines, where patients and caregivers are being cared for. It is tempting for them to be absorbed in meetings that are solely focused on strategy and budgets. The result is frequently a serious disconnect between the perceptions and priorities of the board and senior management on the one hand and the daily challenges faced by front line staff, the patients and their caregivers on the other hand. In addition, many organizations still suffer from a "shame and blame culture" when mistakes are made, instead of addressing the underlying system and process failures.
What George Pocock and Al Ulbrickson instead did do appears to be, in a number of ways, textbook Lean leadership.
- Set clear goals and focus on two things only: times to beat, mostly their own, and searching for that unique combination of strengths, personalities and techniques that would consistently create high performance. This required both Ulbrickson and Pocock to constantly experiment and spend time with the boys to get to know them thoroughly.
The lesson here is that it is far more productive to focus on improving your organization's performance rather than just looking at and copying the numbers from other healthcare organizations. It also requires a willingness to experiment, to deal with failed experiments and to learn about what does work.
- Go and see. Both coach Ulbrickson and George Pocock were with the boys on the water every day and under the same, often brutal conditions, regardless of heat, rain, storms or bitter cold. They were thus able to observe and coach the boys from close up.
In a previous post, I talked about the need for healthcare leaders to develop a profound knowledge of their own organization and the people who work on the front lines. This requires regular visits to where front line staff is taking care of patients and enabling them to improve the safety, quality and efficiency of healthcare services, as well as the patient experience.
- Observe problems, come up with possible counter measures and then try them out to see if they yielded the right results. In some instances, the boys themselves developed successful strategies for overcoming challenges and using their energy and strengths wisely.
- Unfortunately, there are no manuals or scripts that healthcare leaders can follow to determine how to best run their organization in these turbulent times. Instead, they can only improve and ensure the success of their organizations through trial and error by using the scientific method for improvement. The tried and proven method of Plan, Do, Study, Adjust (PDSA or PDCA) is a sound approach for improving performance and providing better value to patients and their caregivers.
- Treat the boys with respect and foster teamwork between them so that they created a near ego-less team spirit, in which the boys each learned to blindly trust the others.
Likewise, everyone in your healthcare organization must be encouraged, trained, coached, empowered and engaged to identify and solve problems, to work well with others across the organization and to learn together to constantly improve.
- Find inspiration in unlikely places. George Pocock grew up with rowing at elite British universities, but developed a unique rowing technique from watching laborers and fishermen on the Thames and experimented with these techniques himself. Al Ulbrickson, as coach, embraced this different approach to rowing and never questioned it because he saw the benefits.
Healthcare leaders should look for inspiration to become the best by adopting approaches for improving safety and performance from other industries and companies, such as manufacturing (especially Alcoa and Toyota), the airline industry, the hospitality industry and the U.S. Navy Nuclear Program.
- They focused on being the best in competitive rowing, no matter what obstacles they all encountered as a team or as individuals. They all cared deeply about what they were doing and, in the end, felt that they were being part of something greater than themselves.
In these turbulent times, it is often tempting to see patients as a means to secure the viability of a healthcare organization, as opposed to seeing the patient's health and reduced suffering as the end goal with the organization as the means to accomplish that. All too often, patients are an afterthought rather than the reason for existence for healthcare organizations. It is about creating organizational culture in which everybody, from the board and C-suite down to the front lines, cares deeply about and owns the mission of the organization to reduce suffering and promote health and healing.
In effect, the boys in the boat were an omen for the Nazi government of things to come, even though it did not realize it. The boys in the boat symbolized the courage, strength, tenacity, ingenuity and teamwork of the American people that would ultimately defeat and destroy the Nazi regime. In this, we can learn from what is often referred to as the Greatest Generation.
These are some of the many inspirational and valuable lessons in this page-turner about integrity, leadership, developing individuals, fostering teamwork and defining clear goals that are worth emulating in healthcare.
Paul Schilstra is President and founder of primeASCENT, LLC, a healthcare consulting firm that focuses on helping healthcare providers pursue operational excellence. He has over 25 years of domestic and international experience in healthcare, having previously served in a number of executive positions at global companies. He feels forever indebted to the doctors and nurses who provided excellent, compassionate care during his daughter's three life-threatening episodes. They gave his daughter a chance at a successful life after surviving premature birth first and then leukemia twice. He can be reached at paul.schilstra@primeascent.com.
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