Archives for category: Leadership

I haven’t posted in quite awhile. Why? Because for the last 6 months I have devoted over 125 hours to creating a course that will provide you with the tools to fix our healthcare delivery system. Every system is designed to produce the results it achieves, and unfortunately at this time our healthcare systems are inadvertently designed to harm patients.  You will learn how to apply the principles that high performing manufacturing systems to continually improve quality, you will learn how to apply the lessons you learned in team sports to becoming an integral member of your healthcare team. When patients become part of the healthcare team they are far more likely to receive higher quality, safer and more efficient care. You will learn how to recognize impending errors and dangerous conditions so that you can avoid harm. One of the most important lessons I will be teaching is how you can become an adaptive leader, a leader who can bring about change, and goodness knows our health systems need to undergo dramatic changes. And finally I will teach you how to organize others to achieve the goal of continually improving healthcare delivery. The course is free and it is offered through the University of Florida and Coursera. The Institute of Healthcare Improvement with the help of Michael Briddon has generously offered a number of teaching modules that have been incorporated into our course. Upon completing the course you can become part of the solutions. If everyone makes one or two small improvements every week or month our systems of healthcare delivery will steadily improve. WE ALL CAN MAKE A DIFFERENCE.

Time line for Samule Adams' campaign for American independence. Horizontal axis = time, vertical axis the degree of campaign activity

Time line for Samuel  Adams’ campaign for American independence. Horizontal axis = time, Vertical axis the degree of campaign activity

The founding father most responsible for encouraging the colonist to seek independence from Great Britain is Samuel Adams. While he was in college at Harvard his father, a brewer and successful businessman, was driven to bankruptcy by a capricious ruling by the British Parliament. From that day on Samuel Adams dedicated his every hour to convincing his fellow colonists that our country needed to seek independence from the intrusive governance of the British.

As he began his efforts the Massachusetts Bay colonists were complacent. They were prospering and did no have to expend money for military protection. Their trade with the British was lucrative. All was well, why change? It took 17 years for Samuel to convince his fellow countrymen to act. How did he convert them from complacency to urgency?  He used 5 approaches:

  1. One-on-one meetings – He met individually with his countrymen to discuss British rule and to share his vision for an independent America. Using personal narrative and sharing the misfortune of his father he recruited those with a shared vision to join his campaign for American independence.
  2. Assembled a leadership group – Through his one-on-one meetings and through his membership in the Caucus club he identified young and influential members of the community to form a leadership team to create strategies and tactics for the campaign for independence. He also helped to create the “Sons of Liberty”.  Among his recruits were his younger cousin John Adams, and a highly successful merchant John Hancock.
  3. Editorials in the Boston Gazette and Public Advertiser.  These anonymous editorials warned of the danger of taxation without representation. When British soldiers shot 5 colonist for throwing snowballs, he labeled the event the “Boston Massacre” and had Paul Revere create an engraving and distributed the posters depicting the massacre throughout the Massachusetts Bay Colony
  4. Organized large gatherings beneath the Liberty Tree, Faneuil Hall and the Boston Harbor.  It was here that his fiery oratory aroused his audience and created an urgency to act.
  5. Created effective strategies and tactics that countered the British Government’s every move to manipulate the colonists. When the Stamp Act taxed colonists’ commercial activities Adams convinced his fellow countrymen to institute the “nonimportation” of British goods (100 years later this tactic received the name “boycott”). The refusal of American merchants to buy British products led British merchants to complain to their Parliament and encouraged the Parliament to rescind the tax.

The ultimate event and culmination of Samuel Adams campaign for independence came I773 when he organized the gathering of over 7,000 people (over half of the population of the Massachusetts Bay Colony) at the Boston Harbor to protest the unloading of tea by the British ship the Dartmouth. He had previously orchestrated a unanimous ruling by the colonial North End Caucus forbidding the unloading of British tea in Boston Harbor. This act was in response to a ruling by the British Parliament allowing the East India Tea Company to import their tea directly to the colonist, bypassing the American Merchants. The captain of the Dartmouth came to this large gathering and requested that he be allowed to unload his tea because the British Parliament had mandated that all cargo must be unloaded in American ports within 20 days and the 20th day had arrived. Samuel Adams instructed the Captain to go to the governor and request an exception to leave the port without unloading his tea. The captain beseeched the governor to make an exception, but he refused.

The captain returned to the huge gathering and informed Samuel Adams of the governor’s order. What should Samuel Adams do? Should he insight a riot, be labeled a traitor, and be immediately jailed? He implored the crowd “This meeting can do nothing more to save our country” and disbanded the crowd. As though on cue, 40 men dressed in Indian outfits yelled out “Boston Harbor a tea-pot tonight”, marched to the British ships unopposed, and with hatchets split open 342 chests of tea and dumped them into the harbor.

This act infuriated the British who blockaded the harbor, and sent 4 infantry regimens to Boston. These events precipitated the Battle of Lexington and Concord, the first Continental Congress, the Declaration of Independence, and the Revolutionary War.

Nothing is more American than organizing fellow countrymen to act. And those of us who have been injured by medical errors should follow the example of Samuel Adams to create a sense of urgency among our caregivers and our health systems. We should follow the example of this great founding father so that others will not suffer our fate, and to assure that those who have been injured by medical errors receive the care and compensation they so justly deserve.

For more about Samuel Adams read Chapter 6, “Culture is Nothing More than Group Habit” in Critically Ill, A 5-point plan to cure healthcare delivery.

A true change causes significant disequilibrium and those resistant to change try to reduce disequilibrium by either attacking the leader of change or delaying the change.

A true change causes significant disequilibrium and those resistant to change try to reduce disequilibrium by either attacking the leader of change or delaying the change.

This week I learned about the story of a family medicine resident who discovered a nearly fatal medical error and questioned the senior physicians about how to prevent future patients from suffering similar harm. As a consequence of his questioning of his superiors he was labeled as a trouble maker who did not respect authority. He has been suspended from his residency for the past 5 months, and as a consequence of reaching out to the press he has escalating a private disagreement into a public firestorm.

What went wrong? This resident is a member of the millennium generation, a generation that was raised differently than past generations. Parents of the millennium generation have treated their children more as colleagues and explained to them the reasoning behind each rule and family decision. These children have been closely supervised and encouraged to participate in formal activities such as sports teams, music lessons, dance lessons, acting lessons, and many other supervised activities. Their close supervision has encouraged an acceptance of authority and of institutions. As a consequence of the recommendations by the famous pediatrician Dr. Benjamin Spock, this generation has been nurtured, and rewarded for their every achievement. Everyone on the children’s soccer and baseball team received a trophy. Most people in this generation have been raised to think that they are special.

What does this mean for health care? These young people are not about simply following orders and deferring to those in authority. Rather, they want their work and the systems they work in to have meaning and purpose. They want to know the reasons behind every decision. The millennium generation asks “Why?”.

In my view this generation has the potential to transform health care. They promise to be the leaders of change. Because they have no stake in the status quo, they are far more likely to challenge it. They have altruistic goals and want to improve our society. Whenever someone tries to bring about a change in the way things are done, he or she is an adaptive leader. Health care badly needs adaptive leaders because the status quo (over 100,000 deaths and over 1 million life-altering injuries per year in the United States caused by preventable medical errors) is not and never should have been acceptable.

The dangers associated with adaptive leadership are well known. This quote by Noccolo Machiavelli, 1515 insightful describes the age old impediments to change:

There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies all who profit by the old order, and only lukewarm defenders in all those who would profit from the new order. This lukewarmness arises partly from fear of their adversaries who have the law in their favor; and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.

Whenever a meaningful change in the way things are done is attempted disequilibrium occurs. Those in favor of the status quo feel a sense of loss. As shown in the figure above, they try to reduce the discomfort of change by attacking the leader who is trying to bring about the change, or by delaying the change. The key to effective adaptive leadership is to maintain the degree of disequilibrium in the productive zone. If there is no discomfort meaningful change is not being achieved. However, too much disequilibrium can lead to outright rebellion. If leadership can moderate the degree of disequilibrium eventually the change will become the new “way it is” and will be regarded as the status quo (far right of the figure).  Those in charge should avoid punishing those who are leading change because punishment will serve to maintain the status quo. Adaptive leaders need to be protected and rewarded. Our patients are counting on them!

To read more about adaptive leadership please go to:
Critically Ill: A 5-point plan to cure healthcare delivery (Chapter 5) by Frederick Southwick also available in Kindle

Leadership on the Line Staying Alive Through the Dangers of Leading by Ronald Heifetz and Marty Linsky