Staying Productive in a Crisis: Lessons from Health Care

The Question:

My industry, health care, is under pressure and in the spotlight, with the stimulus bill, H1N1 (swine flu), and discussions about the sky-rocketing cost of health care. In this intense environment, I worry our decision-making will be disjointed.

At leadership@washingtonpost.com or enter them in the comments section below]

Dear Hopeful,

Crisis leadership has two phases: the emergency phase when your task is stabilizing the situation, limiting the damage, and buying time. When the triage is over, you can enter the adaptive phase, when you work to solve the underlying issues.

The temptation here is to treat the emergency phase only and, once things are looking better, to ignore the much tougher adaptive phase. This won't work, just as throwing away your anti-biotics when you start to feel better, rather than taking the whole course of medicine, may lead to getting sick again. As a leader, your job is more than just handling an emergency calmly and restoring equilibrium: that would make it too easy for people to return to the status quo with a sense of complacency.

Rather, you need to handle the emergency with an eye to keeping people's attention on the ongoing adaptive work to be done. This means making the most of these pressure-cooker moments. After all, if you've got the heat turned up, you might as well cook something. And, in fact, without such heat and pressure - what we call "disequilibrium" - you might find it hard to get your organization to make changes in the first place.

The question, as you write, is how to turn this disequilibrium into something productive. Since the level of urgency in your sector, health care, is already high, the main concern isn't how to turn up the heat, but how to direct the urgency in useful directions.

Your challenge is to draw attention in your organization or community to the thorniest problems, like cost containment, access, quality of care, and patient safety. You want everyone focused on these issues because finding solutions will depend not some big fix from an authoritative expert, but rather widespread experimentation among many different individuals and organizations involved in health care. For examples of how radical improvements can come from unexpected sectors, see Steven Spear's "Fixing Health Care from the Inside, Today," where he describes health care managers borrowing ideas from the Toyota Production System to improve patient care.

Here, then, are your two tasks:

First, challenge the media to direct the public's attention beyond the immediate emergencies and illuminate not only the widespread problems, but the possible solutions. This means working all your press contacts and having a clear communication strategy. You have the advantage that health care issues affect everyone, either directly and indirectly as a patient, friend, or family member. In your own organization, focus on the two or three long-term issues you think need the most attention, and continually make the connection between these bigger issues and today's crises.

Second, encourage people, both inside your own organization and across multi-constituencies, to run numerous small experiments - for example, a different one on each floor of a hospital or each county in a state. Evolutionary biology sets the stage for the process of experimentation, enabling thriving species to flourish in new and challenging environments. Our experience has supported this, showing us time and again that organizations that thrive during complex times are the product of widespread experimentation. Leadership requires diminishing the shame associated with experiments when they fail. Communicate clearly to your organization and those in your industry that by running these experiments, and monitoring their progress, new learning and growth will come to health care.

As you unbundle the big adaptive issues into smaller pieces, and distribute them widely in the health care system, you orient people's attention and also, importantly, provide them with a sense of agency. We hope, for all of our sakes, that you and other health care leaders are successful in managing these changes.

[Send your leadership questions to leadership@washingtonpost.com or enter them in the comments section below]

By Cambridge Leadership Associates

 |  May 21, 2009; 7:29 AM ET |  Category:  Change management Save & Share:                 
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