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Healthcare needs operating systems not 'whack-a-mole' management

July 3rd, 2014

by Jeffrey Flaks

We've had many remarkable leaders in American healthcare, but, on average, we still get unremarkable results. The answer is simple (but not easy): Leadership needs to be less about charisma and style, and more about creating managerial systems--what I call operating systems--that standardize excellence. The stakes couldn't be higher. We must produce higher-quality, better-integrated care at a lower cost.

Successful sports teams get systems. Phil Jackson, now the president of the New York Knicks, won multiple championships with the triangle offense borrowed from Tex Winter (his assistant coach). For Jackson, the system and the supporting culture were the keys. When asked about the possible departure of one of his best players, Jackson told the New York Times: "Just deal with what is and move forward." How can he be so calm? It's because his system isn't about any single individual.


In medicine, our systems are typically too narrow and focused on today's urgent problem. Something flares up. We respond with checklists, standards, action plans and guidelines to improve performance on, say, a significant safety issue--only to see compliance fall off elsewhere. Even when we use lean or Kaizen practices, it's done in a limited way. Staff members treating patients end up dealing with a pile of disconnected initiatives on top of their core duties.

This isn't system thinking; this is whack-a-mole management. Something else pops up that needs attention, but nothing is done to improve the whole environment. Without a more global organizational perspective, we risk cutting costs reactively rather than thoughtfully. And, as we consolidate and build new partnerships, we introduce more cultural variation into the mix, making our organizations more confused and chaotic, and generate more crises.

There is a better way to run healthcare delivery systems. We should apply
lean principles broadly to what and how we do everything. It's time to create organizational operating systems that standardize every facet of our work. Among other things, it means developing common meeting agendas, uniform daily workflows, cascading communication and consistent use of relevant data across the enterprise.

In such a system, problem solving and innovation aren't add-ons; they're part of the mission. By focusing clearly on well-defined and clearly articulated goals, we can create organizations that are efficient, effective and reflective of their highest aspirations. General Electric speaks of the GE Way. Each of our organizations should have similar ways that leadership, staff and patients recognize.

Leading health systems already use lean principles to create more economical and purposeful workplaces and work cultures. The ThedaCare system in Wisconsin is a trailblazer in creating lean management systems. In the foreword to "Beyond Heroes," the book about ThedaCare's journey, John Toussaint, M.D., CEO of the ThedaCare Center for Healthcare Value, writes, "When lean thinking goes only skin deep and management does not change, improvements cannot be sustained, and savings never quite hit the bottom line."

"Every system is perfectly designed to get the results it gets," Paul Batalden, M.D., a senior fellow at the Institute for Healthcare Improvement and professor emeritus of pediatrics at the Dartmouth Institute for Healthy Policy and Clinical Practice at Dartmouth Medical School, has said.

We must create new systems to deeply reshape our organizations so that we can get the healthcare results that our communities deserve. We need winning systems like Phil Jackson's that don't depend on any single player--or leader.

Jeffrey A. Flaks is the executive vice president and chief operating officer of Hartford HealthCare in Hartford, Connecticut.


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