What hospital leaders can learn from Tom Brady

At a time when many leaders are focused on Simon Sinek's Start with Why, we were intrigued and somewhat delighted to learn of the old-school directives used by quarterback Tom Brady to lead the New England Patriots to the most spectacular comeback in Super Bowl history.

The Patriots' historic win provides unique insight to steady leadership under adverse circumstances. How does a leader inspire followership and precise execution when all around is crumbling? In Brady's case, during low points of the game, it was through basic messages such as "do your job," "trust the process" and "focus on the next play," as reported here by sports columnist Dan Wetzel.

• How could these seemingly benign comments influence performance?
• Why did Brady choose them?
• And what conditions were necessary for them to be effective?

First of all, we need to highlight that inspiration is not in short supply among Patriots' players. As the Wetzel points out, "These are the kids Brady inspired to play football. These are the kids who grew up watching him do the impossible. These are the kids who now surround the 39-year-old, and still can't quite believe that they share a locker room with him."

So there can be very little doubt that nearly all, if not everyone, on the Patriots team feels deeply connected to the organization and to their quarterback. Thus, the team culture provides fertile conditions for dreaming the impossible and then making it come to life.

So why then did the greatest quarterback of all time choose such seemingly pedestrian language to rally his teammates? There is nothing out of order about the words, but neither is there anything extraordinary that would seem likely to engage recipients a deep level. The answer lies in the context in which the words were spoken.

In our view, there are several factors that must be present in order for old-school directives such as these to be effective.

Let's first assume that the team member (running back or hospital technician) is personally motivated to perform, fully aware of the job standard and has had ample opportunity to hone key skills, which are the building blocks of individual transformation. "Do your job," though simple and presumptive, serves as the reinforcement necessary to build momentum and drive change. Conversely, if standards, readiness, or motivation are lacking, the same blunt pep talk could cause confusion and disillusionment. Even worse, 'do your job' can be viewed in a derogatory manner, as if a manager is looking to deflect accountability and place blame on the subordinate.

One way leaders help teams to "trust the process" is by ensuring the standard of work that clearly defines expectations is evidence-based and championed by the team. For instance, in the hospital setting, nurse hourly rounding and bed-side shift reporting have convincing bodies of research1.2 indicating that the safety, quality and experience of patient care improve when the processes are in place. Trust is built when the process is collaborative, practiced and proven.
Back to the sports analogy- the routes, hits and catches are standard processes within a playbook strategic plan. Brady's mantra 'trust the process' calls players to resist the temptation to completely abandon the season's strategic plan, but instead recommit to the standards of excellence and embrace some sideline PDSA (Plan, Do, Study, Act), which is a vital part of any improvement process.

Brady's approach is accountability in action. You are either out of the office talking to team members about accountability or you're not. In our observations, leaders who are visible and active in communicating expectations and reinforcing standards are more successful in driving change. Borrowing from Sinek's language, these same high-performing leaders continually connect the 'what' to the 'why,' so team members are rallied around the same purpose. It's unlikely that Mr. Brady only showed up on Super Bowl Sunday to be an active leader. In fact, as Wetzel reports, Brady's on-the-field effort "equaled it on the sideline and in the halftime locker room and in the huddle and in the years and years it took to build to such an aura that everyone trusted his words."

Leaders who struggle with holding individuals accountable are more likely to ask an employee, 'Would you/could you...' than they are to state, 'My expectation of you is...' We sometimes hear hospital leaders lament that although they have trained their teams and everyone knows what to do, their results don't seem to reflect it their performance expectations. It's likely that these leaders are not thinking about accountability and coaching until they spot a problem, such as HCAHPS scores dipping into the red, and that they would benefit from Brady's more extreme version of accountability.

Lastly, "focus on the next play" helps team members focus their thoughts to cut through noise, distraction and excuses. A steady reminder of what matters and what doesn't matter has never been more important in today's world of competing business priorities and employee burn-out. This requires that the team leader be highly present, deeply engaged and truly aware of what is happening at all levels of the organization.

Leaders who are setting their sights on achieving top performance goals should consider Tom Brady's model for developing a championship team as their call to action:

1. Connect to the why
2. Develop evidence-based standards of performance
3. Embrace straightforward accountability
4. Be an active and visible leader every day, every play.

1. Daniels, J. F. (2016).Purposeful and timely nursing rounds: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 14(1), 248-267.
2. Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient safety and quality of care. Nursing, 45(8), 1-4.

About the Authors

Kate Sims
Kate Sims is an Advisor with Press Ganey Associates, the leading provider of health care performance improvement solutions. Kate partners with senior healthcare executives to plan, deploy, and continuously improve their patient experience and employee/physician engagement strategies. Kate is experienced in change-management and process improvement; offering strategic and practical perspective to reduce waste and respect people. Prior to Press Ganey, Kate served as Patient Experience Leader for Inova Health System in Fairfax, VA. In this capacity, Kate was a trusted advisor and leadership coach to a variety of hospital stakeholders. As part of a larger team, Kate supported the health system's 5-year strategic plan for patient experience. Kate earned her Masters of Healthcare Administration from Saint Joseph's University in Philadelphia, PA. She is a member of the American College of Healthcare Executives and a volunteer with Space Coast Volunteers in Medicine.

Matt Pickens
Matt Pickens is currently Regional Director of Florida for Press Ganey's Client Management group. In this role Matt works with hospital and medical practice executives to help achieve the mission of reducing caregiver and patient suffering. Previously Matt served as Vice President of Marketing and Reimbursement for Baxano Surgical, a publicly-held, minimally invasive spinal implant company. While in this role Matt guided his company's efforts to attain a Category I CPT Code and was appointed to an AMA committee dedicated to CPT Code reform.
Matt holds an MBA from the Wharton School of Business with a concentration in Health Care Management and a Bachelor of Arts in History from Princeton University. While at Wharton, Matt was Chairman of the Wharton Health Care Business Conference and the Grand Prize Winner of the 2002 Wharton Business Plan Competition. Matt currently resides in Winter Park, Fl with his wife Rebecca and their three children.

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