Leading From the Top (Part II) – Transforming Our Thinking

Guest post by Dennis Sergent, President, Sergent Results Group.

In Leading from the Top Part I, I described how one leader transformed in his first weeks at the Detroit Medical Center (DMC). Mike Duggan, now the mayor of Detroit, told a great story of how he discovered that he was the culprit responsible for wide ranging problems in the hospital system.

When Mike talked with the Nursing staff about how to overcome roadblocks, their primary complaint was that it took too long to discharge ambulatory patients. It turned out that Mike’s management guidance to the Accounting department was the first cause of system breakdowns in several other places at DMC.

Ask “Why” – until you can’t anymore

After Mike gave better leadership direction to Accounting, he thought differently about the original problem the nurses described, thought further about the causes and effects, and wondered why this process existed at all. When he asked “why,” he began to transform his thinking, and a familiar question came to mind. This question recurs in much of my work as a leader of transformation: “Why improve what should be eliminated?”

So, Mike asked his team “why” they had to wheel out patients who were able to walk out under their own power. The first answer was that it was policy and practice. Mike asked “why” it was a policy, and the next answer was that Federal regulations required it. Mike asked for a copy of the Federal requirement. 

Days later an answer came back: There is no Federal requirement, it is a State of Michigan requirement. Mike asked “why” and requested to see the chapter and verse of the State requirement. Again the answer came back that there was no State requirement either; it was a requirement of the DMC’s insurance carrier.

Undeterred, Mike again asked “why” and requested the specifics of their insurance coverage. By now you can guess the outcome. There was no requirement. So again Mike asked “why,” and this time, the answer was something like, “Why not stop doing this and see what the outcome is?

The DMC leadership team set about putting a new practice into place: ambulatory patients could walk out under their own power, without wheelchairs.

Your staff will applaud you

When Mike got back to his office later, he heard a disturbance from the hall, and joyfully discovered the Nurses were cheering. They were celebrating the decision to stop doing something that had been embedded in the culture at DMC, built into policies that served no real purpose or requirement. In other words, they stopped trying to improve that which should be eliminated, and in doing so removed a source of delay and unhappiness for customers and staff. 

Sometimes it IS all in your head

Mike’s latest chapter in his story of transformation brings home yet another lesson for us all. Fundamental problem solving begins with defining the problem and chasing down the multiple causes that are in the system – but it doesn’t stop there. In DMC’s case, the real roadblock was not the policy or practice, but in people’s thinking. They thought that there was a “requirement” of the system that did not exist at all, except in their minds. Stephen R. Covey said,“The way we see the problem is the problem,” and this is a perfect example. They had not asked “why” enough! Their thinking held them back from asking why this practice existed at all. 

Free your mind

The moment of discovery for Mike as CEO and leader was that ultimately, our thinking can help us solve problems, yet it can also imprison us. W. Edwards Deming once said:

“We’re living in prison, under the tyranny of the prevailing style of management, a style of interaction between people, between teams, between divisions, between competitors. We need to throw overboard our theories and practices of the present, and build afresh.” 

DMC did exactly as Deming suggested. They built afresh and began to transform themselves and their system. When they discarded what was not a requirement of the system, but a distraction in the system, they could attend to what was really needed. They could focus attention on what their patients needed to improve their health outcomes and go home healthier than they came in. The end results were happier patients and customers, happier team members, reduced cycle times, and lower costs – all because the team found out the answer to “why.

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This post was first published on Dennis Sergent’s LinkedIn page in January 2017.

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