On Leadership, Toyota, and Successfully Implementing Change

Medical Robot

I am a medical doctor and Professor of Medicine. I treat human beings. I also understand how they behave. Humans are creatures of habit. And when it comes time to improve performance, many of us fear, or even reject, change.

However, maintaining the status quo rarely leads to improvement.

And in the practice of medicine, improvement should be a priority.

Through trial, error, and eventual success, I have found that effective change requires unique skills often not taught in standard leadership courses.

Gatorounds 1.0

My first significant experience with implementing change came when I decided to improve teamwork during hospital work rounds at the University of Florida (UF).

Modern medical care has become too complex for one person to manage.

When faced with complexity, the business world assembles multidisciplinary teams in which members effectively share their expertise and work together to achieve their goal.

I had found that caregivers were not enamored with business models, and my attempt to use the Toyota Production System as the guiding set of principles met with resistance.

Learning From Athletics

I realized that virtually everyone can relate to a successful athletic team, even if only as a spectator. Modeling our rounding system on athletic principles proved to be a more practical and accessible model. The use of athletic principles allowed me to draw on every caregiver’s past experiences to improve their teamwork.

I embraced this approach with great enthusiasm, so you can imagine my dismay when my colleagues exhibited a lukewarm response to my concept of Gatorounds (named for the university’s mascot, the alligator).

I didn’t understand that proposing this seemingly straightforward approach would force a dramatic change in the way work rounds were conducted.

The physician would no longer be the captain of the ship, but rather become the team coach.

This meant that physicians would have to give up some of their power and empower others to truly assist in the care of their patients.

This challenged the concept of the lone heroic practitioner managing every detail of his or her patient’s care.

Creating Social Disequilibrium

I did have the backing of the Chairman of Medicine, so I began to implement Gatorounds, and I experienced firsthand the effects of creating social disequilibrium. I’d created playbooks that defined the role of each caregiver and established a schedule for arriving at patient rooms.

The idea of scheduling was met with great resistance by one of the chief residents.

When bedside nurses were encouraged to be active participants on the multidisciplinary teams, one resident folded her arms and refused to enter the patient’s room.

I pointed out that, as the quarterback, she needed to be on the field.

Unfortunately, this metaphor was lost on her, and she remained in the hallway, scowling.

In the midst of implementing these changes, I failed to recognize the degree of resistance I was generating and blindly forged ahead. Physicians began talking behind my back. I was viewed as a troublemaker. The Chairman of Medicine became displeased and suggested I was a poor leader, even threatening to discharge me from my role as Division Chief.

Realizing that my good intentions were being misinterpreted, I went on sabbatical.

Studying Leadership

I joined the Harvard Business School’s Advanced Leadership Initiative, and for the next year, I studied leadership, teamwork, organizing people to bring about cultural change, and healthcare delivery systems.

The mistakes I made in implementing Gatorounds quickly became obvious.

As luck would have it, my absence from UF eliminated some of the friction I’d caused. Some of the physicians had appreciated the positive effects of Gatorounds, and once I was no longer pushing this system on them, the concept of using athletic principles to promote teamwork became part of the status quo.

Gatorounds 2.0 

When I returned to UF, a new Chairman of Medicine and Vice Chairman for Clinical Care had been appointed, both of whom saw the potential benefits of Gatorounds.

They encouraged me to reinitiate my pilot program.

Actively keeping in mind what I’d learned at Harvard, I began to quietly implement Gatorounds 2.0.

This time, while coaching new physicians on the fundamentals, I repeatedly asked questions and listened to their concerns. I was profuse in my praise when the proper procedures were followed.

When the appropriate protocol wasn’t being followed, I gently suggested a better way.

Occasionally, I invited physicians for a cup of coffee, creating a comfortable environment where I could describe the successful approaches of other physicians that they might consider emulating.

I carefully managed these relationships, encouraged everyone to help with the implementation, and recruited a group of physician champions.

I’m proud to say that Gatorounds has now been fully implemented, and staff satisfaction has steadily increased.

Rounding now takes 2/3 of the time it once did, and without any decrease in patient satisfaction.

The Adaptive Leader’s Playbook

For an adaptive leader to successfully implement change, he must be fully cognizant of the challenges he faces. People try to prevent change in one of two ways: procrastinating and personally attacking the leader. Change creates smoke, and people think where there’s smoke, there must be fire.

The key skill for an adaptive leader is to generate smoke without a destructive fire.

Disequilibrium should be monitored, and change slowed, when emotions run high.

The Ideal Leader

The ideal leader coaches others and trains them to be effective leaders. The creation of a leadership team responsible for making decisions and implementing change can diffuse the responsibility and protect the individual leader from becoming the sole target for those in favor of the status quo.

By identifying like-minded employees to create a leadership team that develops strategies, the adaptive leader will be able to establish more effective approaches.

3 Steps to Change

There are three elements to keep in mind when approaching change:

  1. Trust others to design strategies for change, and encourage everyone to act.
  2. Continually compliment and reward those who create, and support effective strategies for change.
  3. Keep your eye on the goals; accept that change will make people uncomfortable, and understand there will be discord.

A leader who is knowledgeable, encouraging, and patient can orchestrate fruitful change. Indeed, they’re the only ones who ever have.


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Learn, Grow & Develop Other Leaders

Dr. Frederick Southwick is a Professor of Medicine at the University of Florida
He is the author of “Critically Ill: A 5 Point Plan To Cure Healthcare Delivery”
Email | LinkedIn | Twitter | Blog

Images Source: blogcdn.com

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True Leadership: Hearing the Littlest Voice

Hearing Small Voices

Leadership comes in all shapes and sizes. It shows up in every aspect of life. It really hits home when it becomes a life and death situation. 

Especially when the life and death situation is a family member.

My Story

In 1988, my family faced a medical situation that even I, as a doctor, couldn’t fix.  My wife, Mary, awoke with a lightning-sharp pain in her leg; she couldn’t bare the weight of the sheet upon her foot.  A physician we visited indicated that Mary was suffering from a nerve injury, and gave her pain medication.

As her health worsened, we were unable to reach him or contact him in any way.

After several days of pain that ended with bruises across her body, we got an internist to see Mary.  She found clots in Mary’s legs, and sent us to the hospital.  Mary’s blood work there showed that she could be suffering from an allergic reaction; I’d given her penicillin for strep throat a week earlier.

Was this the cause?

  • Five days into Mary’s hospitalization, she began coughing up blood.
  • The clots from her legs had dislodged.
  • Her blood thinner had failed; the dosage she’d been prescribed was too low.
  • The attending nurse acknowledged this, but said she couldn’t report the error for fear of losing her position.

Mary developed chest pain two days later, and tests confirmed she’d suffered a heart attack.  Her new cardiologist diagnosed her with inflamed blood vessels and prescribed new medication.

What else could possibly go wrong?

  • Mary’s lungs filled with liquid.
  • She was drowning in her own body.
  • She was placed on a ventilator and went into shock as her organs began to shut down.
  • Her heart stopped beating.

We’d sought help for a nerve injury, and we were now facing death.

Why Top-Down Leadership is to Blame

Hierarchy over Health

To cut to a long story down to size, miraculously, Mary recovered.  But she never needed to suffer as she did.

Unfortunately, most healthcare systems – and many other types of businesses – follow a command-and-control model.  This philosophy forces everyone to wait for the boss to make a decision, inevitably resulting in delays and frustration for everyone involved.

Most of those on the front line give up trying to make permanent changes.  They stop speaking up.

Imperfect Example

Our bedside nurse was a perfect example of the insanity.  She knew the intern wasn’t using the correct dosage, but she didn’t want to appear to be questioning the authority of the physicians.

And, although I was a physician myself, I was treated with disapproval when I spoke up about the issues I noticed.

There was, ironically, no room in this dynamic for a second opinion.

Top-down leadership structures emphasize compliance, and exclude the customer’s or patient’s viewpoint.  Autonomy is stripped from workers as they endeavor to fulfill specific performance measures.  Altruism and a real sense of purpose are extinguished.  The people who best understand the customer’s perspective – the front-line workers – are effectively silenced.

When people lose sight of the importance of their work, morale goes down and turnover goes up.

How Leadership Can Empower

A Great Example

Better environments can be created where all levels of our workforce can be heard.

Effective organizations, like Toyota, encourage everyone to make suggestions.

At Toyota, employees receive extra pay when they contribute a suggestion for improvement that gets implemented.  This allows front-line employees to feel like they’re making a difference, and it forces those at the top to acknowledge the contributions of those below them.

Power structures need to be flattened

While we need people to administer, these people should be working alongside lower-level employees – not over themRespectful communication and teamwork need to be the guiding rules in each business.

Effective teams value the contributions of each and every member.

If each person feels charged with the task of improving his environment, each staffer will also gain a new sense of identity.  His job will increase in significance as he takes a new level of ownership over it.

The bottom-line is this:

When people feel empowered and their morale is high, they’ll help us build better systems and provide better care for our clients.

They’ll report incorrect dosages.

Everyone is a Potential Leader 

Simply Seeking Improvement

It’s easy to assume that the leaders in each company are those who hold the loftiest positions.  This is simply not true.  A leader is anyone who influences others to improve.  Therefore, anyone can, and should, become a leader.

This includes everyone from janitors to IT professionals to doctors.

Treating everyone as a potential leader – and encouraging them to do the same – cultivates a problem-solving culture.  Rather than simply complaining, personnel are emboldened to point out how problems impede them from providing the best customer service they can – and they’ll actively work to solve the problems.

They view problems as their issues, and they view themselves as people capable of fixing them.  By always focusing on what’s best for our customers and patients, we remove the worry of being perceived as troublemakers for addressing problems.

We also eliminate concern of job loss for being good at our jobs and recognizing issues.

A Culture of Encouragement

In a culture where leadership at every level is encouraged, every point of view is taken into account.  The test of a true leader is one who can share authority with others because his eye is on doing the right thing – not on being right.  As this view of leadership is embraced, trust and cooperation develop.

When an error occurs, everyone will come to the rescue.

When everyone feels responsible, everyone is willing and eager to help.  And when everyone is involved, even the littlest voice is heard.

So, does your work environment encourage leadership at all levels? Have you lost sight of the importance of your work? Are you treating or being treated as a potential leader? Does your company make everyone feel responsible for your success or failure? 


Never miss an issue of Linked 2 Leadership, subscribe today.
Learn, Grow & Develop Other Leaders

Dr. Frederick Southwick is a Professor of Medicine at the University of Florida
He is the author of “Critically Ill: A 5 Point Plan To Cure Healthcare Delivery”
Email | LinkedIn | Twitter | Blog

Images Source: heinvest.files.wordpress.com