Former Lehman CEO Blames His Former Employees, but so do Some Hospital CEOs
From Lehman's Wreckage, New Lives – WSJ.com:
Disgraced Lehman CEO Dick Fuld says in this WSJ piece:
“‘I spent too much time out of the office with clients and trusted other people to manage the risk,' he told employees of a new firm staffed by former Lehman workers, says an attendee. ‘I'm sorry.'”
That kind of CEO excuse making and blaming is far too common in Western management. Many CEOs blame outside factors when their company is struggling or failing. I think it's particular odious to blame “the staff” when you are the boss.
What responsibility did Fuld have other than to make sure the right people and the right processes were in place? Granted, a leader might be excused when there's one “rogue employee” but what about when the whole system has rotted and collapsed?
Quality starts at the top, I'm reminded of Dr. Deming saying. But nobody listened.
The same thing happens far too often in healthcare. When a medical mistake garners public attention, we often see the CEO or CMO or COO laying blame at an individual. Again, what responsibility does the top leader have for the system? In the Quaid case, the Cedars-Sinai CMO bemoaned the fact that people didn't follow procedures. Well whose responsibility is that?
I forget who I heard ask this question at a meeting or conference lately:
Does a hospital CEO take personal responsibility for EVERYTHING that happens in their hospital? If systems are broken and a preventable error occurs and harms somebody, should the CEO take responsibility? In what circumstances? What do you think? What is your experience?
By comparison, in that recent discussion, an American plant manager had said “I was personally responsible for every damn thing that happened in that plant.” That sets a high bar. Yet, it's the right message, I think.
If you look at the Japanese business culture and CEO leadership behaviors, they DO take responsibility. There's far less blaming and deflection of responsibility. You get the big paycheck, you are responsible. It's a tough, high-pressure job, I'm sure — but that's what you sign up for, that sort of responsibility, right?
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I think the Hospital CEO being analgous to Plant Manager is false. Most manufacturing plants have a handful of products and key products compared with a hospital which has dozens if not hundreds of key products or processes. I think the better analogy of plant manager in a hospital is the service line leader (VP of Surgical Services, Director of Emergency and Trauma Services, whatever). I think at this level the leader should have command of everything that goes on underneath them. I think the big miss in all of this is that we don't have the expectation for these service line leaders to be accountable at the process level for everything in their charge. Rather we give them expectations about doing physician relations or business development (yeah someone needs to be doing this) and sluff off the accountability to do the managers and supervisors underneath them or to a matrixed support organization like quality management.
To the first commenter, I think there's this misconception that manufacturing plants are "simple." Hardly anyone cranks out just a few products over and over again.
Maybe a better analogy to hospital CEO is a small family-run manufacturing company. Each organization might have 3 to 4 thousand employees and pretty broad responsibility. The small company CEO has the same responsibilities as a hospital CEO, short of the complexities of doctor relations (which seems very complex, I'll give you that).
Having working in the metals processing industry for a dozen years I have no misconception that manufacturing plants are simple and did not want to make that impression.
Compare making microprocessors to knee replacement surgery and there is no question about which process is complex and which is simple. The challenge for hospitals is the breadth of services and the variability in demand. I think this type of complexity has prevented healthcare leaders from focusing at the process level which is the lesson we should learn from our colleagues in manufacturing.