My Thoughts on “10 Ideas That Hospital and Health System CEOs Need to Ditch,” Including Blame


I saw this piece by Bob Herman at Becker's Hospital Review and ended up writing a blog post here instead of writing a long comment there. The piece is:

10 Ideas That Hospital and Health System CEOs Need to Ditch

I was happy to see ThedaCare's CEO Dr. Dean Gruner quoted – listen to my podcasts with him, episodes 119 and 144).

1. Old: Micromanage your employees. New: Empower your employees.

This is where a Kaizen approach is very powerful. If we're going to fix the problems we have in healthcare, we need to get the ideas and efforts of everybody in healthcare. A Lean leader doesn't micromanage and a Lean leader doesn't think they have all of the answers or that they can do it all themselves.

I'd caution the UCLA CEO David Feinberg, MD that you have to do more than say employees are empowered. You can't just say that every staff member should feel empowered to provide the best possible care. You also need systems that make that possible. I don't know if this is the case at UCLA (it's a common healthcare situation), but telling employees they are empowered and then not providing the time to fix things… that's probably more discouraging than if you had never told people they were “empowered.”

2. Old: Management by walking around. New: Management by watching and listening.

A Lean “gemba walk” is very different than the old “MBWA” approach. Leaders aren't just roaming around to be visible and to slap people on the back. Leaders need to be observing, listening, asking questions, and offering help as a servant leader (again, this doesn't mean doing everything yourself).

Dr. Feinberg is probably a rare CEO in spending hours a day with patients:

Dr. Feinberg takes this idea to heart at UCLA, especially when it comes to the health system's patients. Every day for a couple of hours, he meets with patients to ask how they are doing and what he can do to assist in their care. 

3. Old: Knowing everything and dictating the work. New: Knowing your leadership and trusting them. 

Yes… down with micromanagement and command-and-control leadership styles.

4. Old: No mistakes are allowed. New: We learn from our mistakes. 


While this is not groundbreaking news, it never hurts to remember that humans are not error-free. Mistakes happen, and ignoring that fact would only be an impediment to becoming a more “reasonable” leader. 

Reasonable or “just” from a “Just Culture” standpoint… understanding when problems are caused by bad systems and bad processes (at least 95% of the time) and when it's caused by a person's bad choices and bad actions. We shouldn't blame or punish individuals for systemic problems.

I might blog more about this story in a separate post:

Nurses in medical error get “re-education”

That sounds ominous, like a trip to a “re-education camp,” but it sounds like an application of Just Culture ideas… learning from mistakes and realizing that “lack of training” is a systemic issue. Giving nurses the correct education (it's not re-education if they weren't educated properly to start) is a good start, but the organization also has to reflect on WHY the original training was lacking.

The five nurses linked to misuse of insulin pens at Derby's Griffin Hospital will not be terminated or suspended, a hospital spokesman said.

Meanwhile, the hospital has tested almost 1,000 patients for HIV and hepatitis as a result of the error, and hopes to test another 2,000.

In May, hospital officials announced that pieces of a small number of insulin pens, used primarily to treat diabetes, had been used on more than one patient, leading to possible contamination.

When news of the flap broke, Griffin officials said they had identified five nurses who either misused the pens or witnessed the misuse. At that time, hospital President and CEO Patrick Charmel said the nurses would be “disciplined,” but indicated that the punishment wouldn't be severe.

On Friday, hospital spokesman Ken Roberts confirmed that major action, including firing, won't be taken against the nurses. He said that decision was made after an investigation by the hospital showed the nurses hadn't misused the equipment intentionally.

“I assure you, if someone did something willfully, wrong, it would be a different action,” Roberts said.

He said the hospital has counseled all the involved nurses, but couldn't say what, if any other action had been taken. One of the reasons severe punishment was avoided was that the problem came to light because nurses came forward about it.

“If someone does self-report (a problem) and they get kind of whacked for it, then people won't want to report” these incidents, Roberts said.

He added that the real cause of the problem was a lack of training about the insulin pens, and nurses and other hospital staff are being “re-educated” about the safe use of hospital equipment.

This is a horrible situation and I'd hate to be a patient worrying about Hep or HIV… but I think this was the right call in not firing the nurses.

5. Old: Physicians are the customers. New: Physicians are our partners. 

Yes, physicians should be partners in focusing on the real customer… the patients.

6. Old: Having clinical competency is enough. New: Clinical competency is expected, and collaboration is required.

I'd state this as “Clinical competency is expected, but operational competency is now required.”

Better collaboration is one way we get better operations and processes. Staff members, through Lean practices, can get a better understanding of the work their colleagues do and how each person's work fits into a system.

7. Old: Buy a lot of new technology. New: Invest in people and culture.

Your employees and your investments in them are the only real competitive advantage. Dean Gruner is quoted in talking about ThedaCare's “no layoff philosophy,” which I've written about here and here.

8. Old: Demand change. New: Nurture change.

Yes… again, the old command-and-control style with the boss making all of the decisions should be behind us. Our friend Paul Levy, a former CEO, says, in part:

Paul Levy, former CEO of Boston-based Beth Israel Deaconess Medical Center, recommends hospital leaders lose the old idea of martial law leadership and instead nurture new outcomes through Lean principles.

Leaders play an important role in setting direction, but the “how” (how we improve) comes mainly from the people doing the work (with coaching and guidance).

10. Old: Formal leadership. New: Informal leadership.

I still don't understand why most everybody in healthcare wears a suit tie. Who are we trying to impress or exert authority over through what we wear?

What would you add to that Becker's list? Annual performance reviews? A better understanding of statistics?

How many of these are being practiced by your CEO? How many are just being talked about?

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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 post. I would add getting rid of annual reviews. A very lagging indicator of performance. I visited a company that had continuous coaching when needed. They didn’t wait till the end if the year to tell you if you did a good job or not. Everyone got their merit raises if they were there at the end if the year.


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