One Purple Audacious Goal… Northwestern Football or Healthcare Improvement


This might seem like a post about football… but stick with me even if you're not a sports fan.

Many of you regular readers know I'm a Northwestern Wildcats football fanatic, from my days as an undergraduate. I was there in the early 1990's when the team's reputation was still horrible. We won maybe 2 games a year, often losing by scores like 63-14, and had suffered through a 34-game losing streak that led to ESPN naming that era the third-worst team of all time.

After my freshman year, the school fired head coach Francis Peay after he ran up a record of 13 wins, 51 losses, and 2 ties. They hired a first-time head coach, Gary Barnett, an assistant out of the Colorado program. Nobody really expected much.

But, I learned the power of setting what some call a “Big Hairy Audacious Goal.” I was at a men's basketball game in January 1992 when Barnett had just been hired. He was introduced to the crowd at half time and he gave a now-famous (and very much off the cuff) pep talk where he proclaimed he was going to “take the Purple to Pasadena” (our school color and our sports uniforms were traditionally purple).

I think most of us thought he was crazy. I don't know what else you would expect the man to say. Why would you take the job with a plan to lose? Northwestern hadn't been to the Rose Bowl since 1949. Hell, we hadn't even been to a bowl game (ANY bowl game) since.

But by the fall of 1995, his fourth season as head coach, the Wildcats beat Notre Dame in South Bend, they beat Michigan in Ann Arbor (I was lucky enough to be at both games in person), and they ran up a 10-1 record, winning the Big Ten title. He indeed took the Purple to Pasadena.

I was reminded of all of this because I saw an interview clip with Barnett that was recently done for the Big Ten Network. He was asked if he, during the first losing seasons, regretted such a goal. Of course, he said no:

I don't know if I'm that bold or that brave. You have to admire the BHAG, especially when you can back it up. “Taking the Purple to Pasadena” is so much more inspiring as a goal than an incremental improvement goal.

“We're going to increase wins by 10% each year” isn't quite as captivating.

Wins in the Barnett era went: 3, 2, 4, 10. It was by no means an overnight success, but you could see the team was getting better each year, even if the results in the win column wasn't showing it through 1994. 1995 wasn't a huge surprise (it was a bit of a surprise) if you had been tracking the team's progress.

I couldn't help tying this to some healthcare improvement efforts I was reading about today in the book The Best Practice: How the New Quality Movement is Transforming Medicine. I was reading about the efforts of Dr. Richard Shannon at Allegheny Medical Center, now famous in the lean healthcare world. After learning from Paul O'Neill and the Pittsburgh Regional Health Initiative, Dr. Shannon set some audacious goals for reducing infection rates.

He didn't want just 10% reductions. His goal was zero, as had been O'Neill's goal for injuries at Alcoa. What other goal can you have? It's the equivalent of taking Northwestern to the Rose Bowl. It might seem unlikely, but a real visionary can find a way to make it happen.

From the book:

The section chiefs and hospital administration were clearly uncomfortable with O'Neill's approach and wanted to set a more modest target. How about this, they said, we'll set a goal of reducing infections by, say, 10 percent, or 15 percent. That way, they would be participating in the effort but with a much more reasonable goal. They took this position not because they were opposed to improvement or weren't excellent doctors and administrators; rather, like so many people in health care, they believed that these infections were inevitable and that there was only so much that could be done. Shannon understood this, but knew the incremental approach was exactly what O'Neill was trying to avoid.

“How about this,” he suggested to the CEO. “You declare some modest goal on behalf of the organization-‘we're going to reduce infections by ten percent over the next two years,' or whatever you want to decide … and I'm going to take the two units that I control, and I'm going to eliminate central line infections in ninety days, and then I'm going to show you how I did it.”

The reaction around the table was predictable: Are you crazy? Why would you do that? But to her credit, CEO Connie Cibrone gave Shannon the go-ahead to try.

And we know now that Shannon was successful as they went more than two years without a single infection. That was the equivalent of taking the Purple to Pasadena. Shannon is now doing this same work at the University of Pennsylvania Health System. His method is transferable; I'm sure he can recreate his success. Coach Barnett was not able to recreate his Northwestern success at Colorado… so the parallels aren't perfect.

But I love the lesson. What audacious goals is your organization setting? What's your plan for getting there? Do people find the goal inspiring? Or does it make the leader seem crazy?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Great story, Mark. Dr. Shannon's success is similar to that of Dr. Peter Pronovost with his protocol for prevention of central line-associated sepsis. The central line rate in 103 Michigan ICUs went to zero within six months after implementing Dr. Pronovost’s protocol. Zero-defect healthcare is now undeniably a live possibility, especially in devices and procedures associated with critical care — the things we do TO our patients while were doing things FOR them. Compare this to the tolerance for defects implied in calculations of "Sigma"-level performance. Zero defects an audacious goal? You bet – but now proven to work in multiple settings.

    It's more than simply implementing protocols, however. The power to produce these kinds of results is all in appreciating each institution/setting as unique and making sure the opportunity is properly designed and connected to the practitioners of patient care.

    By the way, another great book that shines a light in this area is "Better — a surgeon's notes on performance" written by Dr. Atul Gawande.
    /Dr. Pete


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