Say What You Mean And Do What You Say

An early mentor once told me that as CEO he considered that his job description could be summarised in one sentence: How can we do better?

This simple imperative has served as a useful reminder to me that what really matters  for any leader is to leave things in a better place than you found them. In my work as a leader and CEO in healthcare, I’ve learnt two important lessons. 

Two Lessons From Experience

1. You've got to be authentic – this means you’ve got to be true to yourself. People can detect insincerity from a thousand yards and nothing will destroy trust faster than the difference between what you say and what you do.

2. You’ve got to find a language which reaches people. I’ve noted in a previous post that managers and clinicians frequently misunderstand each other. This despite both frequently wanting broadly the same things.

Healthcare is not “production” or “manufacturing” or “a.n. other service”, no matter how similar some elements of these different industries might be. 

In many organisations I’ve worked in, the language of service improvement has become messy. Very similar or identical activities are badged differently. For example: PDSA (Plan Do Study Act) and Improvement Cycle are really the same thing. All this kind of thing does is sow confusion and mistrust.

Four Areas Of Work

As a healthcare leader, you’ve got four areas of work.

  1. To understand what the service has to deliver to achieve a strong patient or service user experience. 
  2. To work out how the available people, skills and technology will be aligned to deliver to the patient or service user. 
  3. To clarify the key processes which must be designed to deliver services safely and reliably (such as managing patient flow through a hospital for example).
  4. To find ways of positively influencing the relationship between the outcomes that are being delivered and the costs which are incurred in doing so.

To make a difference, you must design an organisational system that holds these four elements together and which allows accountability to be maintained at each point of delivery. 

This kind of architecture is important, but on its own is insufficient. 

People must believe that what they are doing fits with their values and that the organisation holds these values in common.

Continuous Improvement And Patient Safety

One way of connecting this together is to cloak the work of continuous improvement in the garbs of patient safety. This is not meant to be cynical. It’s more an acknowledgment that healthcare workers aren’t likely to feel in their bones that tackling continuous improvement is why they come to work each day. 

Arguably your responsibility is first and foremost to ensure that what is being done is safe, or as safe as possible. Certainly once you accepts this position as your primary responsibility then it becomes far easier to engage your people in conversations about improvement. Who doesn’t want healthcare to be safer?

Instead of inflicting the language of continuous improvement on a sceptical workforce, you should find a language with fits more naturally with healthcare workers’ concerns. Shakespeare wrote:

A rose by any other name would smell as sweet.

Making things safer” travels further than “let’s do continuous improvement”. A deep commitment to patient safety also threads it’s way through each of the four domains mentioned above.

Say What You Mean: Do What You Say

The work of improving patient safety is never completed – there is usually something more which can be done to perfect any care giving situation, given the tremendous development of treatment options and the intrinsic variability of individual patients. 

It’s easy to see how relevant improvement science is to the work of healthcare. In fact it is crucially important that healthcare mainstreams these techniques, given the size of the challenge most healthcare systems are facing. 

Don’t confuse the people you lead by using language they either won’t understand or which is unlikely to chime with the things they think are important.

Find a way to say what you mean and then follow through consistently.

If I were giving advice to a younger me, I would say that the one sentence summary of a CEO’s job today is:

How can we make things safer and how will we do it?

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