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Barriers to Innovation
I have had the privilege of being in a leadership role in several organizations staffed with very bright, energetic people. But it was often difficult to bring these people together long enough to achieve common goals. Some time ago I read an article with the provocative title “Leading People Too Smart to Be Led,”[1] which offered some observations that seem relevant to the problem. The article was based on an interview with David Krakauer, president of the Santa Fe Institute in Santa Fe, New Mexico. “Born out of frustration with traditional university bureaucracies, SFI has no departments, no formal hierarchies, and no tenure…I wanted to know how Krakauer leads a wildly creative, highly effective organization. There were six things he told me that I think could be transferrable to leaders in any organization.” 1) See yourself as “a colonel with an army of generals.” Most physician organizations have a leadership structure akin to a parliament. There is a prime minister, but he/she holds the position only with support of the majority party and can’t command anyone. This is incomprehensible to managers in large, bureaucratic healthcare organizations, but is one reason why most of them are not getting their physicians to work effectively within their systems. 2) “Don’t valorize failure…Instead of celebrating failure, we need to reframe the challenge. Here we celebrate success. We also celebrate experiments.” I have noted before that physicians are willing to make decisions, but think of each one as an experiment subject to revision if the desired outcome is not observed. While an experimental mindset is essential in this time of rapid change in the healthcare arena, tempering it with some forethought and consensus building is desirable. The trick is to avoid “paralysis by analysis.” 3) “Encourage smart recklessness.” This is the flip side I noted in the previous paragraph. “People sometimes overprepare to avoid embarrassment.” I have tried to lead discussions with my leadership team many times over the years. Often, they find it difficult to speak up, even though they know there are no wrong answers and no penalty for not knowing “the answer.” With time, though, most will participate freely and seem to enjoy the process. Maybe another way to think about this is to not avoid risk, but to manage it. 4) “The organization should be a crucible, not a crib. Encouraging rigorous, constructive debate is indispensable to navigating challenges of high uncertainty, from extending the bounds of knowledge to scaling a business…Many companies, however, develop cultural and procedural barriers to productive debate, valuing organizational harmony over innovation.” I have noted that “group think” is the norm in large bureaucracies. Individuals who challenge the conventional wisdom rarely succeed and often end up leaving, further hurting the experimental mindset. 5) “Search for stupid practices as much as you seek best practices…After all, stupidity is at the heart of why and how things go wrong.” Having spent much of my time doing quality improvement projects, which focus on defining best practices, this suggests that we need a similar process to define stupid practices. However, it turns out we usually know which routines are stupid, but we get used to them. Unfortunately, much stupid practice now is mandated by governmental overseers who are trying to get organizations to prove they are providing “value.” It does not help to know a practice is stupid if you are stuck with it—in fact it can be demoralizing. One of the biggest challenges in medical organizations today is to keep the focus on the big picture—why we are doing what we do and what we want to achieve—despite the distractions of adhering to incredibly large numbers of detailed requirements that end up constituting stupid practice. 6) “Persist…On days when nothing is going right, and even Management 101 seems to be failing, focus on persistence. If the vision and purpose are sound, you may just get further than you thought you could.” In medical organizations that means keeping our focus on the patient. Of course, every medical organization says it is doing so, but there are many things distracting both the organization and the individuals within it. It is easier said than done but being successful requires we remember why we have the organization in the first place. Robert Gates, in the introduction to his book A Passion For Leadership, (Vantage Press, 2017,) makes the following points. “Everybody hates bureaucracies, even those who work in them. Yet in twenty-first-century America, apart from a handful of hermits and survivalists living off the grid, dealing with impenetrable, impersonal, infinitely complex, obdurate, arrogant, and often stupefyingly incompetent bureaucracies is an every day travail for everyone…Despite political paralysis in Washington and elsewhere, bureaucracies inexorably—day by day, year by year—intrude ever more pervasively into our daily lives…But for most businesses, success and self-preservation require that leaders and employees work hard every day to innovate and change with (or before) the times, to overcome sluggishness, poor customer service, and the stifling effect of layer upon layer of management that inevitably delays and complicates decision making. As a rule, companies that do not promote innovation, strive to reduce overhead costs and managerial layering, and become more customer-friendly don’t do well in the long term… Another unpredictable factor in the oversight of institutions—mainly public ones but a lot of businesses as well—is the uneven quality of the individuals elected or appointed to fulfill the role. Members of Congress, state legislators, and (especially for business) regulators, for example, vary dramatically in expertise, diligence, understanding, and just plain smarts. Too often, it is the members who fall short in one or more of those categories who create the most problems, block reforms and appointments, oppose constructive change, and try to impose unworkable or costly policies, rules, or programs… The culture of public bureaucracies and all too many private sector organizations is also a serious obstacle to change and reform. Fundamental to bureaucratic culture is risk avoidance: It is almost always safer for the public bureaucrat—and too often the business bureaucrat as well—to say no than yes. In a public environment of exposés, recrimination, faultfinding, and investigations both by officials and by the media, not acting is usually safer than acting—especially if the action involves something new or different. Common sense, and sometimes even doing the humane thing for someone, are set to one side out of fear of incurring a cautious supervisor’s displeasure or being disciplined—or even fired—for not going “by the book.” The challenges to innovation, then, are large. But just maybe Dr. Krakauer’s last point is the one to remember. Persist. 6 August 2018 [1] Wolcott, Robert C. Leading People Too Smart to Be Led. 2 February 2017. https:hbr.org/2017/02/leading-people-too-smart-to-be-led.html. Accessed 3 February 2017. |
Further Reading
Confronting The Quality Paradox - Part 1 On Failure Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A consideration of how to tolerate failure. On Resilience On Strategy Politics and Medical Organizations Organizational politics are inevitable, so recognizing the types and the advantages and disadvantages of each is important. Putting Patients At The Center Of Healthcare Putting patients at the center is crucial for healthcare organizations, but how can it be done? |