Back in the mid-1990s, I did a lot of web work for traditional media. That often meant figuring out what the client was already doing on the web, and how it was going, so I’d find the techies in the company, and ask them what they were doing, and how it was going. Then I’d tell management what I’d learned. This always struck me as a waste of my time and their money; I was like an overpaid bike messenger, moving information from one part of the firm to another. I didn’t understand the job I was doing until one meeting at a magazine company.
The thing that made this meeting unusual was that one of their programmers had been invited to attend, so management could outline their web strategy to him. After the executives thanked me for explaining what I’d learned from log files given me by their own employees just days before, the programmer leaned forward and said “You know, we have all that information downstairs, but nobody’s ever asked us for it.”
I remember thinking “Oh, finally!” I figured the executives would be relieved this information was in-house, delighted that their own people were on it, maybe even mad at me for charging an exorbitant markup on local knowledge. Then I saw the look on their faces as they considered the programmer’s offer. The look wasn’t delight, or even relief, but contempt. The situation suddenly came clear: I was getting paid to save management from the distasteful act of listening to their own employees.
Continue reading “Healthcare.Gov and the Gulf Between Planning and Reality”
Filed Under: Tech, THCB
Tagged: Healthcare.gov, HIT, IT, Management, Web Development
Nov 26, 2013
In recent years, Parkland Memorial Hospital in Dallas, Texas has faced intense media scrutiny and government investigations into patient safety lapses. As the hospital searches for a new CEO, the Dallas Morning News asked me and other experts to answer the question: “What kind of leader does Parkland need to emerge as a stronger public hospital?” Below is the column, re-used with the newspaper’s permission. While it is focused on one hospital, the themes apply broadly. The type of leader that I describe is needed throughout health care.
Public hospitals such as Parkland are a public trust, serving the community’s health needs by providing safe and effective care to a population that lacks alternatives.
Major shortcomings in the quality of care provided at Parkland have eroded that trust. Now trust must be restored. The community is counting on it. It’s literally a matter of life and death.
Parkland’s board is searching for a new CEO to lead this journey. The CEO’s task will not be easy: Resources are tight, resident supervision is insufficient, staff morale is low, systems need updating, and preventable harm is far too common.
History may provide some guidance. Historian Rufus Fears notes that great leaders – leaders who changed the world – have four attributes: a bedrock of values, a clear moral compass, a compelling vision and the ability to inspire others to make the vision happen. Parkland needs one of these great leaders.
Continue reading “Building a Better Parkland”
Filed Under: OP-ED, THCB
Tagged: Leadership, Management, Parkland Memorial Hospital, Peter Pronovost, Quality
Nov 15, 2012
Disruptive leadership. That’s a thing now? I’m told that this is a kind of leadership—I thought it was a market dynamic.
What does it take to be a “disruptive” leader?
Does it mean talk like a pirate when explaining how the company will be cutting benefits?
Does it mean dress like Ali G and try to imitate him but only muster a WASP accent?
I suppose it does…but that’s the easy part.
Job #1 in leading a true market disruptive: FIND AND FERTILIZE THE HIDDEN RAGE AT THE STATUS QUO THAT LIES WITHIN ALL OF US. Find it in yourself and feed it and then find it in others and attract them to work with you.
I’m constantly looking for change in my personal life. For example, I just bought a Tesla. My other car is a 1983 Land Rover. Why? Because in 1983 you didn’t need to sell cars with a seatbelt dinger and airbags in the front seat andD because Tesla is the first ATTACKER disruptive car maker to make it past the fetal stage in my entire life. I must feed them. I HATE the established car industry! I have been trapped inside a small number of culturally (and occasionally financially) bankrupt brands that have lost any interest in fighting the over-regulated morass that constraints.
Continue reading “State of Disruption”
Filed Under: Health 2.0, THCB
Tagged: Change Management, Disruption, Innovation, Jonathan Bush, Management, Tesla
Oct 5, 2012
Recently, I had an enlightening encounter with Horst Schulze, who led Ritz-Carlton Hotels to national awards and has since opened his own hotel chain, Capella. Hortz gave an informal presentation to members of a program that I’m taking part in, the Baldrige Executive Fellowship, and we continued to talk afterwards. Capella has five ultraluxury hotels from New York to Singapore, and all have been recognized as tops in their region. Horst spoke to us of a culture of excellence. He knows—he has built such a culture time and time again. Excellence does not occur by chance. It requires clear goals and a system.
Horst explained that to be great, everyone in the organization needs to know the goals, in order of importance. For Capella, the goals are 1) keep existing customers, 2) add new customers, and 3) optimize the spend of each customer. Every employee not only needs to know the goals, but they need to know the behaviors to achieve them. The Capella employees ensure a warm welcome, compliance with and anticipation of guests’ needs, and a fond farewell.
All employees are required to know service standards. Twenty-five of them. One of them states that you are responsible to identify and immediately correct defects before they affect a guest—for example, getting customers food when the restaurant is closed. Defect prevention is key to service excellence, just as it is to delivering safe health care. Another service standard states that when a guest encounters any difficulty, you are responsible to own it and resolve the problem to the guest’s complete satisfaction.
Capella has standard processes for everything—how to submit defects, how to resolve them. And they trained staff in the goals, the behaviors and the processes. Each hotel, every morning is required to have a huddle at which all staff attend. They review the goals for the company and read one of the behaviors, called service standards. Every day they read a different one. They cycle repeats every 25 days.
If a manager did not do this, Horst said, they would be fired.
Continue reading “The 25 Questions”
Filed Under: Hospitals
Tagged: Care Delivery, Hiring, Management, Peter Pronovost, Quality, Ritz Carlton
Aug 4, 2012
One of our account managers sent me a link to this open letter written by a high-level employee to the leadership of Research in Motion or RIM, makers of the BlackBerry, laying out their concerns about the company. The company faces stiff competition in the smart phone market and recently announcedplans for 2,000 layoffs.
The account manager thanked me for what I have done to lead us in a way that has avoided this fate for athenahealth. So, thanks to him.
HOWEVER, I don’t think we are totally free of all eight concerns rattled off by one anonymous OG RIMMER. Here are some of her/his pleas to management and some of my thoughts on them as they apply here at athenahealth. (If you could see our internal blog version of this post, you’d see more than a dozen thoughtful comments from athenahealth employees on how they think we can learn from this story.)
Continue reading “Learning Hard Lessons from the RIM Story”
Filed Under: Uncategorized
Tagged: Jonathan Bush, Management, RIM
Aug 5, 2011