This from the New Yorker. It's a long form piece, but even if you've got a short attention span like me I recommend checking it out.
We are used to thinking that a doctor's ability depends mainly on science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously.
There you have it. Team cohesion, focus, drive, rebelliousness when necessary...those are the things that can make the difference between the top of the bell curve and the bottom, even when your people are just as talented as other teams, doing essentially the exact same procedures.
Interesting that you say "doing essentially the exact same procedures." My take on it is that the various folks are doing *very* different things, although all within the normal operating parameters of being a physician. Anyway, I think the following quotation applies well to our line of work: “[National clinical guidelines for care are] a record of the past, and little more—they should have an expiration date.” Could you imagine if EJB 2.0 or the pet store expired? :)
Side note: what is it with everyone I work with all of a sudden religiously reading the New Yorker? Is there some new social/political/intellectual relevance? Or is it just a temporal anomaly? We've subscribed to it for years, but when I find the exact same (3 week old) issue that I'm reading on Lorin's desk, and Mad Man starts talking up Gladwell, well that just seems odd.
When Thong starts quoting Bruce McCall, I'll know that some wider conscientious awareness tide has tipped.
-n
"cohesion, focus, drive, rebelliousness when necessary". Agreed, all important behavior for people who want to continually change, evolve, improve, innovate…
There is a school of management that believes that, in a fast changing organization, the flexible and adaptive will excel over the rigid and predictive. The umbrella concept is called "The learning organization". I found a page that covered the basics as written by Peter Senge (http://www.infed.org/thinkers/senge.htm, hmm no html so you'll have to copy/paste). His book "The Fifth Discipline" is in my top 3 recommendations for leaders and managers who are serious and have some experience.
IMHO, people who have drive, focus etc. and improve, innovate etc. usually do it through learning or end up learning as part of the process. I am hard pressed to think of an example (although i only spent 5 seconds on it) where someone continuously innovates but learns nothing. People who do not themselves learn will either run out of people who give them new ideas or run of new people for the same ideas. This is a big reason I am not sure that the medical centers mentioned in the article that don't have the learning leaders can actually have the exceptional results. The median group cannot standardize on a moving target. They will standardize on a certain snapshot. By the time they standardize to what the exceptional group is doing the exceptional group will have moved on. The whole idea of standardization is wrong. The whole idea of processes and tools providing exceptional returns is wrong. The only reason to do it is because it is much easier to write up a "plan of attack" and force everyone to do it than to actually invest in people.
But, there is another problem with continuous learning. Unlike continuous integration you cannot just put cruisecontrol on it... at least not yet. It actually takes a huge effort to learn and do anything well. The only gauranteed reward is the satisfaction that comes from making a huge effort.
As you can probably tell this subject is of some interest to me, even if I haven't got it all clear yet. The greatest challenge is to give people time and direction and _hope_ that they will become learning leaders. That is the only way to create organizations that live on beyond the person and it is only when one of these people move and lead other organizations can those organizations achieve exceptional results. For some reason the analogy that comes to mind is, "grow me a mango tree in SF by describing a mango to the high yielding field of lemon seeds. Put one mango seed in there and well there's a chance some mango trees will show up in a few years".
I will disagree with one point you have made above -
"... even when your people are just as talented as other teams, doing essentially the exact same procedures."
I would argue that the teams are not equally talented, only equally trained. In fact it is important to differenciate between talents, skills and knowledge [First Break all the Rules, http://www.amazon.com/exec/obidos/tg/detail/-/0684852861/103-7184366-4209468?v=glance]. I would argue that at best the teams are equally skilled and have a similar amount of knowledge. Talent is a whole different ball game.
hmm... in the last one hour that i have been typing this neil came, read, commented and left. I need to go and subscribe to the newyorker before these pretentious nitwits excommunicate me. :)
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