Why Won’t Healthcare Leaders Take Prudent Risks?
The short answer is they don’t believe in them, but Beliefs, Actions, and Results (BAR) offers a new way to think about the environment of the organization—an ecosystem where people embrace risk, and excellence prevails amid fortitude and good judgment. Beliefs reflect those perceptions leaders consider “correct.” Over time, the group learns that certain beliefs work to reduce indecision and doubt in critical areas of the organization’s functioning. As leaders continue to support these beliefs, and the beliefs continue to work, they gradually transform into an articulated set of more engrained beliefs, norms, and operational rules of behavior.
Organizations beliefs describe the principles and standards that guide a leader’s ethical and business decisions. When asked to compose a list of their organization’s values, leaders typically mention integrity, quality, patient satisfaction, and enhanced shareholder value. While laudable, which of these would a successful company not value since success demands each of them? A list of ideals any organization would embrace doesn’t really distinguish a success-driven hospital from any other, and it doesn’t get at the core of what might compromise a particular entity’s success.
Excellence demands that beliefs address the tempests that trigger failure and provide a compass for navigating uncharted seas, even at high cost. Instead of writing admirable values on a plaque in the foyer, successful leaders live their beliefs and expect others to do the same since these beliefs serve as criteria for making business decisions.
Actions—the tough calls involved in running any organization—don’t speak louder than words. Frequently, “actions” don’t even whisper because they take place between the two ears of senior leaders. However, most people don’t consider decision-making the most important action leaders take. Decisions—good, bad, seen, or unseen—serve as the link between the leader’s beliefs and the results the organization will enjoy or rue. When we trace tragedy and regret back to their roots, we find ourselves lamenting a bad decision, or noticing, in retrospect, a decision a leader didn’t even realize he or she made or failed to make. When leaders create an environment where words and actions operate in harmony, however, an almost magical alchemy takes place.
In healthcare organizations, alchemy involves transforming the status quo (the base metals) into the golden ideas of improvement—not just different ideas but better ones. From this change comes innovation, which stands squarely at the heart of organizational learning—with rigidity, caution, and fear as its arch enemies. Fear causes us to build silos that serve as our fortresses. When we fear, we go into protection mode and become risk averse.
The term “learning culture” presents yet another paradox. Culture acts as a stabilizer—a traditional force, a way of making things predictable. How then, by its very nature, can culture become action-oriented, adoptive, and innovative? How can a leader stimulate and stabilize at the same time prompting, both perpetual learning and change? Maybe the answer lies in perpetual forgetting.
An action-oriented environment must contain core shared assumptions that the appropriate way for an organization to improve involves proactive problem-solving, learning from mistakes, and effective decision-making about what needs to change. If leaders reflect fatalistic assumptions of passive acceptance, learning becomes more and more difficult as the rate of change in the environment increases. If leaders accept the “we’ve always done it that way” argument, their beliefs doom the organization to mediocrity. If they could forget for a moment how they’ve “always done things around here,” they could position themselves to take a risk and create an opportunity.
Leaders of the best organizations expect failure. They realize that if failure doesn’t happen, people haven’t pushed hard enough. They refuse to settle for mediocrity in themselves, their direct reports, their quality, patient loyalty, or financial sustainability. They set a course for excellence and see the irrefutable links among planning, learning, decision-making, action, and success.
In a constant effort to improve, these leaders make knowledge digestible; they understand that if people can use information quickly and easily, they’ll internalize it. They identify sources of innovation and replicate them—continually deconstructing success to understand better how to repeat it or amplify it.
They understand why they’ve had great success, not just that they’ve had it. Additionally, they find out what they and others can do to identify what must happen to drive the organization to a higher level—not just more volume but more profit. They also eagerly examine failure and cause/effect relationships—not to assign blame but to learn and grow.
