I was able to have a chat with Eric Ries yesterday as we were recording some video of him answering some follow up questions from the LEI webinar he did for us last week on Lean Startups (that will be on the LEI website relatively soon).
As Eric talks about some of the management and leadership challenges found in startups, it’s hard to not recognize these problems as just basic human nature that we’re fighting against, or the common dynamics in organizations, even big healthcare systems.
After he answered one question, I asked him “Are you sure you’ve never worked in healthcare??” It seems like it’s all the same… from manufacturing to healthcare to startups.
There are a few common dynamics at play, it seems.
For manager and leaders, are you able and willing to admit that you’ve ever made a mistake, based on data and evidence? Do you even look for data? Data means you might be proven wrong, so that’s scary to some. Being able to admit a mistake, reacting to feedback from customers is what Eric calls a “pivot” in lean startups terminology. It’s a necessary part of any PDCA cycle, looking at data and gauging if you should continue forward or adjust your course – in that case, changing your product or your business model.
Some leaders, operating in a mindset or culture where they have to be somehow infallible – they won’t admit to making mistakes. For example, if we’ve taken some action, in a hospital, to improve patient satisfaction, yet the data shows otherwise, are we willing to accept that data? Are we really being scientists and following the Plan-Do-Check-Act cycle?
One hospital I worked with had the CEO make a pretty imperial top-down decision to carpet the inpatient unit hallways, the theory being that would cut down on nighttime noise and patient complaints would fall. The carpet was first installed in one unit and the data actually showed that the carpet didn’t help – in fact, it created more problems for the staff with zero impact on patient satisfaction. But senior leadership declared victory and decided to install carpet in other units. Staff members and the quality department saw data that suggested they actually shouldn’t do that, but the word didn’t (couldn’t?) get to senior leadership.
I guess you could call that a Plan-Do-Don’tCheck Cycle (PDdC).
When we feel that we can’t be wrong, leaders will often to go any extreme to rationalize or justify their past decisions, to prove themselves correct. This is dysfunctional and harmful to the organization. Why do leaders fear being wrong? What creates that climate? Is it external factors (fear of losing their job) or pride that gets in the way of admitting that the “Check” in the PDCA cycle says we need to change course? Why are staff members sometimes fearful to present data that might contradict their leaders?
There’s what you might call a Plan-Do-Check-Justify Cycle (PDCJ).
All of the discussion about Lean – “lean startups” or “lean healthcare” often isn’t about technical tools at all. It’s about changing mindsets and deeply ingrained human and organizational behaviors. That’s why Lean is so difficult even though the concepts are relatively simple to understand.
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