Why Does this Hospital CEO Have to Go Undercover? Or Does He?
Update: I edited the post title to add “Or Does He?” See the CEO's comment below, suggesting that the TV report gave the wrong impression and that he wasn't really “undercover” in a sneaky way like the CBS TV show. See also the text from a memo where he announced this program to staff. My apologies to Mr. Musyj for wrongly concluding that he had been shadowing staff as anybody other than the CEO.
The Canadian CBC News had a story (with video) about David Musyj, the CEO of Windsor Regional Hospital called “Hospital CEO goes undercover.”
My initial reaction, as I tweeted it was this:
“Dear hospital CEOs, if you are going to the gemba (and you should), don't do the corny undercover thing. Be real, be present. Help. Lead.”
The whole idea of the CBS-style “Undercover Boss” approach is deceitful and nowhere near as effective as real “gemba leadership,” as practiced by CEOs like Dr. Gary Kaplan at Virginia Mason Medical Center and Dr. Dean Gruner at ThedaCare. Kaplan and Gruner don't need to go undercover, nor do I think they would want to!
When being interviewed, Musyj said he “learned about the pride that workers have in healthcare.” I hope that wasn't really a new learning for him.
The anchor asked Musyj “what surprised you?” and he replied, “It's interesting to see how the dots get connected together” and how “everyone relies on everyone else to get it done.” He added, “By taking a few hours to spend time in those areas, you see how the dots connect.” Musyj spent time in the kitchen, pharmacy, delivering supplies, nursing, etc.
Going to the gemba (a Japanese word the place where work actually gets done, such as the point of patient care) is a core part of the Lean management approach. Kaplan, it is said, goes to the gemba daily, and I know Gruner is out there quite often. See this video that shows Kaplan at the gemba. It's a way of managing at ThedaCare, for leaders at all levels. Many of them, if not all, spend at least two hours in the gemba each morning, observing, coaching, and working with teams on improvement.
When I work with hospitals that are just starting with Lean, one of the things I have leaders and staff do is to spent days in the gemba observing in a structure way. They see what Musyj saw – that things usually get done through workarounds as people work through the waste and bad systems. People in healthcare are so dedicated, they'll make things happen… but the waste often causes frustration, exhaustion, or errors to occur. You have to see the waste before you can fix it.
So why couldn't Musyj go out there as the CEO? (EDIT: He says that he wasn't hiding his identity). Why sneak around and hide from your staff? Why go undercover instead of being an adult and a professional and talking to people? They are scared of the CEO? They won't talk to the boss? If so, that's a problem in the culture that needs fixing and sneaking around only reinforces that the CEO is above everyone else.
I don't know if you can really sneak around anyway. If people don't even recognize the CEO, that's a problem. Outsiders stand out. If the same team is always working in the pharmacy, some random guy who is there really sticks out. That's often me, as an outside consultant. You're not just randomly there for a day.
One person sort of called Musyj out (EDIT: Musyj says they were all joking):
“I went into a room one time, and somebody said to me, ‘You're a dead ringer for the CEO of this place. Maybe you should ask him for some of his money,' ” said Musyj, who played along. “I said, ‘Yeah, the CEO makes a lot of money, doesn't he?'
I'm sure that person would feel like a fool if they now realize they were actually talking to the CEO. That's where the dishonesty of Undercover CEO hurts, I think. And Musyj was pretending to be one of the guys by bitching about the CEO's pay? Good grief.
Musyj seemed good natured about having been to the gemba, but I'm afraid he missed the real opportunity. Is that gemba time a one time exercise to get some publicity about, or is it a new way of managing?
The anchor asked what else surprised him and Musyj said, “Little things for staff. They just ask for little changes. If we can make the little changes for them, it makes such a big difference in their daily lives, so being able to hear that and to be able to make a change that, in the grand scheme isn't that big, makes a big difference.”
Musyj says one small change he approved was taking wheels off a desk in the emergency department, because when patients would lean on the desk, it slid away. Musyj's staff didn't always recognize him as he walked among them.
Instead of just making that one change, I wish Musyj would stop and question why little things like that weren't getting fixed on a regular basis. What can he do to change the culture, as CEO, to have Kaizen and improvement be a part of everybody's daily work? Why does it take the CEO being there to get things fixed? Oh wait, the staff didn't know it was the CEO. Or did they?
How can Musyj help create a Kaizen culture where staff are identifying and fixing things locally, with their own supervisors? Maybe he'll read our book that's coming out early next year — Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. We do NOT recommend in the book that CEOs play cutesy undercover games.
That example of fixing or removing the wheels on the cart is EXACTLY the type of small improvement that is managed through the daily Kaizen (or continuous improvement) process at healthcare organizations that are featured in our book like Franciscan St. Francis Health System (where my co-author works), Children's Medical Center Dallas, Seattle Children's Hospital, and others. That's also the type of improvement that the users of our KaiNexus software are making, using our software to manage the Kaizen communication process at the front lines.
The TV reporter seemed to think it was sort of cute and admirable that Musyj went to the gemba (they weren't calling it that, by the way). It's good that he went, but I think the circumstances are questionable and the real lesson was lost to him, it seems.