Monday, December 10, 2012

Tip 11: Closing in on the knowing doing gap

Closing in on the knowing doing gap

homework eating catIn the past few issues we've been closing in on the "Knowing Doing Gap". I was first exposed to this idea early in my career as a physician when I began to ask the question "What really matters most to patients?" It became much more clear after being exposed to Jeffery Pfeffer and Robert Sutton's, Harvard Business Review book called, "The Knowing Doing Gap: How Smart Companies Turn Knowledge Into Action." While you can apply these lessons in many contexts, there is no wider "Knowing Doing Gap" than what we see in Healthcare. Readers of the Coach+Leader may have taken the time to stop and ask "What matters most to patients?", but many leaders and physicians have not. Again, it's not for a lack of caring, it's more about simply being too busy/focused on the "operational" factors to listen to the patient. So we naturally fall short in the delivery.

I had an insightful coaching conversation with a Chief Medical Officer last week. He told me that he was moving forward in working with his medical staff to develop role descriptions to improve physician leadership. While discussing some of the specifics in a meeting with some of his docs, he told me he made the mistake of using the word "accountability," because it seemed as if it was, or has become a dirty word with his physicians. He said that it seemed to instantly change the mood of the conversation and it took a while to get the discussion back on track. "I don't understand why I got that reaction," he stated. So, why did a group of highly accomplished physicians frame the word negatively? And as their CMO stated... "These are my good guys".

Well these so called "good guys" have a point. As soon as the "A" word was uttered, they were asking, "Accountable to whom... you, the CEO, the Board?" "Is this one more thing to do?"

They're reacting to the notion that we leaders believe we must hold people accountable for their performance and the results of their actions. This top-down approach to accountability doesn't often work out in anyone's favor, and is indicative of the "command and control" business environment that dominates healthcare. We should be asking ourselves: Do you see accountability as a challenge or opportunity? Is the idea of accountability being promoted as a carrot or a stick?

If you recall, our last Coach+Leader issue concluded that so many of these so called "accountability tools" are often perceived as top-down measures, punitive systems, corrective tools, etc. So naturally when we hear the "A" word being uttered by our bosses, it comes across negatively. How do we work around that? We need to shift from that old mindset to one that acknowledges and celebrates individuals that demonstrate the behaviors that matter most to patients.

Tip 11: How to close the "knowing doing accountability gap": Putting the patient in the center.

A few weeks ago you might recall our Coach+Leader issue titled: Accountable to no one... well maybe the patient? There's a hidden lesson in that title that's counter to the command and control way we've been getting things done. First we need to determine how and why this accountability conversation became so challenging? Then, we need to center the conversation on patient accountability.

If we're going to have a successful conversations on the subject of accountability, no one can argue that it must be about the patient. Think about it, when you put the patient in the center of your accountability discussions you remove the "command and control" barriers that dilute involvement. This puts fear and egos on the back burner and allows you to engage staff in a more personal and relevant dialogue. When we take the middle man (organizational leadership) out of the equation, the conversation is directly about the role we must play to be accountable to the patient.

Framing the conversation around being patient-accountable, shifts the purpose of accountability from a negative to a positive. I'm not suggesting that the word "patient" has magical powers, but I have used it many times to shift a seemingly top-down conversation directed at medical staffs, to a highly collaborative discussion that helps us acknowledge our need for improved accountability through a lens based on putting patients first.

Understand also that the "A" word does not need to result in a conversation about what do do, but more about how to show up with the behaviors that create the right conditions to reduce harm and improve care. Working with your staff/team to develop a role description to improve accountability can't be a conversation of what I (the leader) want from you, but a conversation of accountability based on what our patients require from all of us. You'll discover that this ongoing challenge of improving accountability becomes much less of a lofty conversation about what we leaders wish our staff would do, and more about the role we must all play to gain our patient's trust.

One final thought: For leaders that successfully collaborate with staff and build a role description, there is NO "Knowing Doing Gap"... everyone is clear about what matters most to patients, because it informs their day-to-day work and how they practice as leaders.

The Coach+Leader will return after the first of the year. Enjoy a happy and peaceful holiday.

Brian Wong, M.D.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.
Brian Wong, M.D.The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

  1. Patients expect us to work as teams.
  2. Patient centered teams need a coach.
  3. Every leader has a coaching role.
It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

Brian WongEveryone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.