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HTA in Italia: pessimismo dell’intelligenza, ottimismo della volontà

Il 24 ottobre scorso sono stato invitato da Giovanni Morana, dinamico direttore della radiologia dell’ospedale di Treviso, ad un convegno sul tema della TAC Dual Energy. Il programma prevedeva una parte dedicata a questa interessante tecnologia ancora in fase di sviluppo e ricerca e una dedicata all’HTA.

hta-venezia-2016hta-2-venezia-2016

L’incontro si è tenuto all’Ateneo Veneto, una fondazione istituita da Napoleone dopo il disfacimento della Serenissima Repubblica di Venezia, in uno splendido palazzo a fianco del Gran Teatro La Fenice.

Per un accidente della storia, il 9 ottobre 1996, nella stessa sede avevo organizzato un workshop, alla presenza dei politici e direttori generali della aziende sanitarie del tempo, dal titolo: “Razionamento o razionalizzazione dell’assistenza sanitaria – il ruolo dell’HTA”, starring Renaldo N. Battista al quale il collega direttore generale di Venezia (il compianto Carlo Crepas) aveva tributato gli onori che la Serenissima Repubblica tributava ai Capi di Stato e agli Ambasciatori in visita a Venezia: il corteo in barca lungo il Canal Grande.

hta-venezia-1996

L’invito di Giovanni Morana ha suscitato in me due sentimenti: il piacere di discutere oggi con i clinici (italiani, stranieri e un brillante giovane collega italiano che lavora a Charleston, Carlo De Cecco) e i produttori di tecnologia i metodi e le opportunità offerte dall’HTA; l’amarezza di toccare con mano la lentezza con la quale in questi vent’anni l’HTA si è diffusa in Italia!

Quanta strada ancora da percorrere! Se smettessimo di buttarci a pesce sulle cose urgenti e ci occupassimo un po’ di più delle cose importanti (De Gaulle) …..!!!

Il XXI secolo non ci ha portato ancora superare lo storicismo gramsciano: “Tutti i più ridicoli fantasticatori che nei loro nascondigli di geni incompresi fanno scoperte strabilianti e definitive, si precipitano su ogni movimento nuovo persuasi di poter spacciare le loro fanfaluche. D’altronde ogni collasso porta con sé disordine intellettuale e morale. Pessimismo dell’intelligenza, ottimismo della volontà”. (Q28, III)

Anzi…..

 

Move over teamwork: other forms of co-operative working? @pash22 @leadmedit @muirgray

Taken very broadly, there are two kinds of management or business research thinking when it comes to teams: perspectives that think teams are a decent functional way to organise workers to work effectively, and perspectives that are much more critical of the very concept of teamwork.

Instinctively, anecdotally, and from much research over the last few decades – we all know that teams often don’t work. ‘Dream teams’ of exceptional individuals can turn out to be nightmare units, groupthink and other faulty decision-making biases can make the whole less than the sum of its parts, and sometimes people end up in too many teams or don’t even know whether they’re in or out. I would argue that this is because teams are relatively artificial constructs; they are often no more than idealistic ‘boxes’ that exist unevenly only in the minds of some managers and workers.

Frequently, organisations are not like traditional sporting events or the inside of rowboats – they are much more variable, overlapping, organically changing configurations of people. Being inside a team or outside a team is not a neat shift from one state to another – teams or groupings vary continually in how ‘groupy’ or cohesive they actually are. Most management research, however, has focused on teams as neat boxes or islands that sometimes conflict a bit, but generally agree in their perceptions, have stability of membership, and have a relatively fixed relationship with their external environments. In short, it has been a romance of teams, a science of convenience, and an exercise in wishful thinking.

However, none of this is to say that teams are always doomed or flawed. With the right culture, tasks, and aligned sets of HR practices, teams can innovate and achieve highly effective working patterns. As with all social and workplace issues: it depends on the context and getting the conditions and circumstances right. However, many of these favourable initial ingredients or conditions for optimising teamwork either remain elusive or appear in an implausibly long list. It is no mean feat to ensure the selection of diverse members, extensive team-building and clear unifying goals. Teams themselves are also a moving target; in general they are changing: members come and go more often, technology encourages collaboration over almost any distance, and traditional hierarchies have become much flatter.

What I wish to say is that teams should be considered more dynamically as sitting within a broader spectrum of many cooperative working options simultaneously; as one work arrangement among many. The guiding word here being cooperation. There are multiple ‘building blocks’ of cooperation, from small-scale to large-scale, guiding how people work together, that managers can consider as part of a broader, customisable repertoire. I tend to refer to them as a ‘cooperative value chain’ or a ‘high-cooperation HR menu’. This cooperative toolkit consists of the five following components:

1) The individual. I want to be alone. Many job descriptions, rewards packages and other parts of the psychological contract bestowed via HR practices still revolve around individuals and their needs or talents. Many artists, technical problem-solvers, leaders and so on, may find they work most effectively as a demarcated, unique individual. Western, individualistic cultures may also favour personalised working this way, for at least significant portions of employees’ time, as proactivity, autonomy, and flexibility are emphasised in their roles. Single individuals are still cooperating, but in their own reflective way; they may also occupy special positions in social networks (see below) or fulfil boundary-spanning roles, where they are the individual link bridging units of cooperation that would otherwise have no way to interface.

2) The dyad. Two heads are better than one, but three’s a crowd. Some work roles explicitly involve pairs – software programmers check each other’s work, police officers patrol in pairs, and mentoring and other partnerships can occur in this way. But more exploitation of this unique two-person unit may be possible in workplaces than is currently realised. Some would argue that a dyad/couple is a small team, but I would argue it constitutes a special relationship. Two people cut a fruitful compromise, a middle ground between the egoistic isolation of working alone and the potentially biasing social pressures of a larger group.  Of course such pairs need to be carefully matched to each other and the workflow to get the most out of the pairing.

3) The classic team. The whole is greater than the sum of the parts – go team! As discussed above, in some situations, a neatly bounded, interdependent team with a clear goal may be possible. But a team charter or checklist should be carefully put in place to ensure the key conditions are right before proceeding with what is a larger, more elaborate cooperative endeavour in terms of the numbers of people involved. Social and task criteria to keep it working effectively together will need to be addressed, including a meaningful shared purpose, a differentiated mix of suitable members, clear rules or norms, wider resource-based support, and adequate coaching. Leadership, technology, lifespan, and competing teams or other boundary memberships in the wider environment will need to be addressed, in line with the other cooperative options above and below.

4) The multi-team system. Teams don’t exist in a vacuum, but in a ‘team of teams’.Beyond single teams, research is increasingly considering multi-team systems (MTSs) or ‘teams of teams’. Army, Navy, and Air Force; or Police, Ambulance, Fire would be obvious examples, but of course most organisations contain multiple groups, divisions, functions, layers etc. with potential for forming and/or recognising MTSs. One commanding team might lead several subsidiary teams, or teams with specific goals might come together to achieve a higher goal. As with single teams, structures need to be made crystal clear and cooperative flows and linkages choreographed and monitored carefully. People may need to be cross-trained, or to attend multiple team events, but without taking on too much workload. The relationship between the immediate goals of one team and the higher goals of the set of teams need to be clarified, as well as prioritised in various scenarios.

5) The social network. The wisdom of crowds. In a sense here we come full circle as individual employees occupy distinctive positions within collaborative networks, but in an increasingly interconnected world with more permeable communication boundaries, anyone can be meaningfully connected with up to 150 others at any one time. We enter the realm of crowd-sourcing, flash mobs, consortia, and other self-organising forms of social movement or widespread cooperative organisation. The boundaries of entire businesses and sectors may be transcended, co-operators may never meet or be totally aware of each other, and finished products may be complex mosaic or snowball outputs, difficult to link directly back to the inputs and processes of diverse contributors. Yet impressive tasks and economies of scale can be achieved, sometimes on goodwill and intrinsic motivation alone.

In conclusion, HR practitioners should try to take advantage of mapping this broader array of cooperative building blocks simultaneously. Rather than simply asking ‘to team or not to team?’ they should consider offering employees a greater range of performance opportunities via these other cooperative value chain options, enabling them to work more naturalistically and fully unlock their talents.

http://www.hrzone.com/feature/people/move-over-teamwork-what-about-all-other-forms-co-operative-working/141116

Coaching or telling. Which works? Here’s the evidence… @leadmedit @muirgray @helenbevan

Given the name of my company, Head Heart + Brain you won’t be too surprised to learn I like to have an evidence base for what I do. The ‘brain’ part of the name represents understanding the science behind leadership and change. This links to my curiosity about ideas that ‘seem obvious’ to me but that don’t get traction. I talked about this in my article on Emotional Intelligence. I feel the same about coaching. Whilst many companies use external coaches to work with senior people HR find it harder to gain traction for the manger as coach. Companies we work with still have many managers who adopt a ‘command and control’ style; that is telling people what to do. What is the evidence of which works best; coaching or telling? Is coaching actually more effective than just telling people what to do especially in complex change? I will look at some of the evidence which may help to understand which will maximise performance.

Brain basics

Let’s look at how the brain works in an organisational context.

The brain functions by making connections and associations, linking what is happening now and what has happened in the past, the memories both conscious and unconscious. This combination creates a kind of map of connections in the brain. No two maps will be the same even though the biological process for creating them is. The maps are created by making over a million new connections every second. This gives you some indication of the complexity. The brain likes order so seeks to connect new information to what is already known, to categorise it. Gerald Edelman developed the Theory of Neural Darwinism which provides a physical explanation for how our mental maps compete for resources.

The way the brain seeks to predict and make connections is explained by Jeffrey Hawkins in On Intelligence. He says our prediction abilities differentiate us in the animal world. When we first encounter something we are relatively slow to understand it. Like this article we need first to get the foundations in place. In learning a new skill for example it takes a while, maybe a few minutes or days depending on the complexity, for it to become familiar, that is create the map. The more embedded these maps the more we free up mental resources. We call this process forming a habit. Habits are run by the older more energy-efficient parts of the brain. This process of shifting activity, including thinking, from the high energy, relatively inefficient, prefrontal cortex to the more efficient areas is a basic operating mode for the brain.

Linked to this is neuroplasticity. Expert Norman Doidge, in The brain that changes itself points out, there is substantial evidence we can “rewire our brains with our thoughts.” Hebbs Law states that ‘neurons that fire together wire together’. So the more you focus on something the deeper the neurological connection. When we delve into and analysis a problem we are reinforcing the connections in the brain. This occurs through a process called myelination, the more a pathway is used, the stronger it becomes. When we repeat an action, a fatty covering called myelin coats the neural pathway, making connections stronger and more secure. Because the default is to go with the pathways that are developed it is hard to change habits but easier to create new ways of working. But it is still difficult to change without focused support and intentional effort.

The other relevant question is whether there are distinct functions responsible for emotional, as opposed to general intelligence. Research by Reuven Bar-On isolated these regions by studying people with damage to the brain in areas correlated with diminished ability in understanding self and understanding others. His findings clearly point to brain areas which relate to understanding self and others, that is Emotional Intelligence, which are distinct to areas associate with general intelligence.

So with this understanding as background let’s look at the impact of telling someone to change verses coaching them to change.

Telling versus insight

A premise of coaching is that people work things out for themselves. The difference between being told and having insight is all about creating new mental maps. If you are thinking about something like how a new process will work or the reaction of your team to a new strategy you are creating a mental map. These new thoughts are energy consuming from a brain perspective so you often do this when your brain is freed up from other activity like in the shower or on the walk to work. This type of thinking creates what we call an ‘aha moment’ or an insight. This is literally new connections happening, a new map or part of a map is formed. If you are told how to carry out the new process or what the strategy means for your job you still have to create that mental map. So coaching insight is more brain-savvy than telling an employee the answer. To take any kind of action people have to think it through for themselves. They can do this for themselves and immediately create the map when the coach/manager asks questions that create insight or they do it later after they have been told. The additional issue with telling is that it is more likely to set up a threat response (see more in the CORE video) as the individual’s predictions and connections are different to what was expected. As we have observed before, this difference creates an error message and a sense of pain in the brain. This in turn moves people away from the new information and increases the likelihood of resistance.

Managers who tell rather than coach not only waste their own energy but they are potentially making it more difficult for employees to accept a new idea. Are your managers and coaches creating insight or giving advice?

Transferring skills

You will have experienced that an insight comes with a burst of motivation or energy but this quickly dissipates if not reinforced. Reinforcing the insight creates new connections and potentially new behaviour. Because this type of action and thinking is hard work, because it takes more brain energy, people may avoid it or give up too soon before a deep map is formed. But people are also adaptable and can find shortcuts.

new study provides strong evidence for a “flexible hub” theory of brain which has implications for using skills. “Flexible hubs are brain regions that coordinate activity throughout the brain to implement tasks – like a large Internet traffic router,” suggestsMichael Cole, the author of the study.

By analysing activity as the flexible hubs connected during the processing of specific tasks, researchers found unique patterns that enabled them to see the hub’s role in using existing skills in new tasks. Known as compositional coding, the process allows skills learned in one context to be re-packaged and re-used in others, shortening the learning curve. By tracking and testing the performance of individuals the study showed that the transfer of these skills helped participants speed their mastery of new tasks, and use existing skills in a new setting.

Are your coach/managers focusing people on transferring existing skills to the ‘new world’ to speed up change?

Moving to action

Conventional wisdom, in many businesses, is that if people understand rationally why they need to do something the change will occur.  Kevin Oschner estimates 70% of what we do is habitual and that includes your job. As previously mentioned habits are run by the older parts of the brain, the basal ganglia. Because habits operate out of our conscious awareness our rational understanding is not enough. Coaching on why the new behaviour matters to the individual and designing a strategy might work.

Several things need to be in place to achieve behavioural change. Matt Lieberman says we must go beyond conscious systems and use our unconscious or “reflexive” systems. Goals for the new behaviour tend to be created in the conscious reflective system but we need to also control the unconscious habit system by managing triggers that generate the old behaviour. Elliot Berkman studies goal setting and achieving new behaviour and his research suggests there are several elements that must be aligned.

For example in new habit formation there is a sequence:

  1. cue;
  2. when to act,
  3. routine;
  4. the steps to take,
  5. and reward.

Are coach/manages working with both systems? Are they creating new behaviour by creating new routines and rewards? Are there strategies to manage the triggers that will prompt old behaviour?

We are social

The science shows social needs are primary in the brain, something many forget at work. Social pain activates the same regions as physical pain. When someone is put down, or their ways of working are controlled, or they are told what to do, especially publically, a threat response is activated reducing the ability to think clearly. You know that feeling – “I’m just blank, I have no mental space.” The frontal cortex is drained as the limbic system hijacks the energy. Again, a strike against telling!

This evidence base may go some way to persuading reluctant managers to adopt a different style.

But I am not going to fall into the same trap – and will practice what I preach.  So far be it for me to tell you that telling doesn’t work.  I’ll leave you with a few questions to generate you own insight.  What reaction have you experienced when telling someone to change? When has telling someone to do something differently worked?  What has been the benefit for you of creating insight in others?  What, good, surprises have you got from asking questions rather than telling?

The Precipice: Influence and Manipulation @helenbevan @leadmedit @wricciardi @pash22

BY 

In some ways, to influence and to manipulate can seem to be the same thing. After all, the intent of both influence and manipulation is to get other people to behave, think, or make the decision you want them to. But is that really the case as demonstrated by these definitions from thefreedictionary.com?

Influence:  (n) 1. A power affecting a person, thing, or course of events, especially one that operates without any direct or apparent effort. 2. Power to sway or affect based on prestige, wealth, ability, or position.  (v) 1. To produce an effect on by imperceptible or intangible means; sway. 2) To affect the nature, development, or condition of; modify.

Manipulate: (v) 1. To move, arrange, operate, or control by the hands or by mechanical means, especially in a skillful manner. 2. To influence or manage shrewdly or deviously. 3. To tamper with or falsify for personal gain.

As indicated in the definitions, the main purpose of both influence and manipulation is  to sway; however, there is a definite difference between the two. Influence is an ethical behavior; manipulation is unethical. We admire leaders who have mastered the power of influence; equally, we mistrust leaders we believe to be manipulative. They are both getting us to see things their way. Taken too far, influence can move to the other end of the spectrum and become manipulation.

The differences between influence and manipulation include the:

  • reason behind the intention to persuade another person
  • truthfulness and accuracy of provided information
  • transparency of the process
  • benefit, affect, or impact on the person.

Manipulation implies an intent to fool or trick someone into doing, believing, or buying something that leaves them harmed in some way. We view manipulators as schemers. Out to get what they want using whatever means possible, manipulators selfishly pursue their own agenda, trying to control instead of wanting to influence another person. For example:

Influence Someone offers a proposition that is beneficial to both parties.

Manipulation: Someone offers a proposition that serves their own purposes and is against the other person’s interest. They conceal a desire to move the person to their point of view in a way that will only benefit themselves. In addition, if their intention were uncovered, the discovery would cause the other person to be less receptive to their idea.

Influence: All information provided is accurate and shared openly.

Manipulation:  Information is withheld or distorted to trick or deceive.

Influence Someone is willingly led to something they want or that will benefit them.

Manipulation: Someone is led to something that will harm them or lead them to eventual regret.

Influence Requesting someone to do you a favor you believe they won’t want to do using sincere appreciation.

Manipulation: Getting someone to do you a favor you believe they won’t want to do using guilt or emotional blackmail.

Many years ago I worked with a manager who often ended his directives with, “And if I find out you didn’t follow what I said, you’re fired,” Looking back now, I assume that he was not confident in his role, his ability to do the job, and/or his effectiveness as a manager and leader. We have all known people who, like my former colleague, get others to do what they want through fear and intimidation. Using these tactics may accomplish what they want, but it does not make them leaders. Like love and hate, there is a fine line between influence and manipulation.

 

A New View Of Leadership @leadmedit @WRicciardi @muirgray @pash22

By Nigel Nicholson http://bit.ly/1d2urwz

For every Winston Churchill, there is a Fred Goodwin. What makes some leaders soaraway successes, while others crash and burn?

When a flock of birds simultaneously takes to the air or when a herd of buffalo wheels and turns as one, it is a miracle of coordination. Who is leading? This is a very human question and presumption.

Sit in a packed stadium and watch the crowd rather than the sport and you will see waves of emotion and expression, uncoordinated except by the spontaneous urges of people infecting each other with thought and feeling. Not a leader in sight.

Picture the scene: I am working with a group of executives and the topic is teamwork. I ask them what the critical factors are to getting high performance out of a team.

It is only a matter of time before one person says that the group needs a leader. Lots of heads nod in agreement around the room.

At this point, I assign them randomly to groups to perform a task, and when we analyse what transpired, it is evident that the best performing team turned out to have no designated leader, and the groups that made a point of appointing a leader performed indifferently.

Look closer and you will see that teams lacking a recognisable leader do not lack leadership. It is present, no less than in the flock or herd, but it may be hard to pin down.

Leadership is not a thing but a process. It is something that helps systems to function; coordinating and directing effort. Yet, clearly, we are infatuated with leadership, which is why more space on business bookshelves is occupied by the subject than any other topic.

So why yet another book – mine?

Although there are lots of great leadership recipe books and stories of leadership success and failure, what I couldn’t find was any analysis that connected our biology as a species that loves to be led with what we see going on around us in business.

Cometh the moment, cometh the man or woman. History teaches us that just when we are in our darkest hour, a hero emerges to show us the way – Winston Churchill and Nelson Mandela in politics, GE’s Jack Welch and IBM’s Lou Gerstner in business.

Smart businesses and societies organise themselves in ways that help these leaders to emerge, but history’s parade contains as many disappointments and disasters as successes.

In the new frontier of postDarwinian thought, this turning wheel of adaptation and maladaptation is called co- evolution.

What’s special about leadership is that leaders can be game changers; rewriting the conditions under which success and failure are defined. Leaders are the tools of historical forces, and the makers of history.

What comes out of this view is what I call the Leadership Formula. To be effective, a leader has to be the right person, at the right time and place, doing the right thing. This has some simple implications and some tricky ones. The simple ones are that there are many ways of being a leader, and there are many leadership situations.

But leaders need to watch out, for situations change faster than people do.

This is where it gets tricky. It turns into a strategic challenge of whether or not leaders can bend the situation to their will or be versatile enough to ride the waves of change.

One of the smartest things Nelson Mandela did was to quit while he was ahead, climbing off the turning wheel of history before it crushed him, making way for a technocrat successor, Thabo Mbeki, to move the country to its next stage of development.

With our leadership infatuation we have to beware of the football manager syndrome, replacing leaders as soon as things go wrong. Rather, succession should be strategic, to meet the needs of changing times.

Now let us climb into the mind of the leader to see how the process of leadership actually works. What you find is an interdependent triangle of being, doing and seeing.

Being – who you are – determines what you do. In leadership, character matters because we view the world through a prism of identity. Many leaders succeed and then fail because who they are filters how they see the world and scripts the actions they take. Look at Kenneth Lay, architect of the Enron disaster.

Doing – what you do can shape your character. This is especially true of malleable people not troubled by strong instincts and impulses. They can be conditioned. Tony Blair’s account of his ‘journey’ through his premiership seemed to involve a lot of development and discovery by doing, but it was seeing – his analytic capabilities applied to experience – that informed his choices.

Seeing – this is the most fundamental starting point for leadership, and the least regarded. It is the vision of leaders that drives them and us on. They see the world as it is and how they wish it to be. The challenge they face is to keep pace with the environment and the effects of their actions.

Being openminded does not guarantee you will see what is truly important. Perspective matters, and is the key to leadership effectiveness. Openmindedness is a mark of the new generation of leading-edge business leaders, people such as Larry Page, Sergey Brin and Eric Schmidt at Google or Mark Zuckerberg at Facebook.

How Being, Doing and Seeing work together can be illustrated by thinking about change. Did you ever try to influence someone – like a spouse, a boss, or, worse, a teenager? Often we try to do this by direct attack on the Being part – ‘Get your mind right will you, please? If possible, be like me’.

Does it work? Does it hell! OK, next tack – try changing the Doing part, say by forcing a person down a new route, with the aid of rules, rewards and punishments.

Does this work? Sometimes, but it can take time. The mind has to play catch-up with behaviour, as was the case with banning smoking in public places.

Want instantaneous change? Seeing is the key. Reframe safety as threat, danger as opportunity, desire as dependence and people can switch their goals and their actions in a flash.

That’s the thing – the only person that can change you is you. This is a special human gift: the ability to change our lives and states of being in an instant, like Saul on the road to Damascus.

It is an unfortunate tribute to human persistence and optimism that we are forever trying to change people by the hardest and most impossible routes.

Great leaders know that seeing – vision – is the key to influence. Steve Jobs enveloped people in his ‘reality distortion field’ (a Star Trek concept applied to him by a colleague) and Jack Welch was a master storyteller.

Let us now apply my leadership framework, which I call the Situations, Processes and Qualities model (SPQ) to unlock the secrets of why certain leaders emerge, and why others fail.

There are many different kinds of leadership situation – every time you get promoted, take on a new assignment or employ new people, your leadership situation changes. Look at financial services, where an almost nonexistent leadership culture with everyone contentedly churning inside a bubble of self-inflating growth now finds itself struggling to be reborn and crying out for a new style of leadership.

Fred Goodwin was more a dealmaker than a leader, who expanded RBS to gargantuan proportions, until its collapse revealed the fatal absence of a coherent vision that met the needs of a changing world.

The first lesson of the SPQ model is to read the world and understand how it is changing. This might sound simple, but it is fraught with difficulty, not least the problem that people around leaders inhabit the same reality bubble.

They only see what the leader sees, and those with a different perspective get scant air time or are suppressed. The more powerful and successful leaders are, the less likely they will be to hear dissenting voices.

Leaders like Robert Maxwell, Goodwin, and Al ‘Chainsaw’ Dunlap (of Sunbeam) were surrounded by likeminded supporters in a climate where bad news was often suppressed. Leaders have to go undercover in their own organisations, engage in counterfactual thinking and allow their vision to evolve with a changing reality.

The second lesson of the SPQ model is the importance of doing what is needed for the situation. In principle, anyone can learn how to craft and deliver a powerful message, practise the skills of empathy, build a team, and so on.

It just takes time, discipline and desire. The last of these – desire – is the Achilles heel of doing what’s needed. If your backhand is weak, you may find it easier to run round and play a forehand, rather than work on your weakness.

There is also a capacity problem, and here we are bedevilled by the lonely leader problem – where leaders are isolated, insecure and obsessively meddling in every detail. What is needed is not just a strong team and the ability to delegate but what I call Critical Leader Relationships – a handful of trusted confidants who can be eyes and ears, helpers and advisers, and sources of support and honest feedback.

Michael Eisner, Steve Jobs and Bill Gates enjoyed their greatest successes at Disney, Apple and Microsoft respectively through their partnerships with people with complementary gifts, who advised, challenged and supported them when needed.

The third lesson of the SPQ framework is that leaders have to know themselves and control themselves. Unfortunately there are major disincentives to self-control.

Leaders often find their narcissism and arrogance and unfettered displays of their identity – a surfeit of ‘authenticity’ perhaps – are not just rewarded but revered by followers longing for the magical protective power of heroism and charisma.

Indeed, at the heart of leadership lies a dilemma or rather a balance to be struck between instinct and insight, between shaping and versatility, and between innovation and adaptability.

On the one hand is the need for leaders not just to respond to the forces around them but to shape them, as Steve Jobs famously did. Power is not just an opportunity but a duty to make elements of their world follow their vision. Leadership is about taking charge. This goes beyond accountability.

The performance of your boss and your peers is not your remit, but if you can help them and share your vision with them you should do so.

On the other hand is the need for deep insights into the leadership situation – to anticipate the waves of change and ride them with agility and versatility. Welch’s virtue as a leader resided in his ability to change his strategy to match the new realities he had created.

There are many forces that the leader cannot control but must navigate with skill. To do this, leaders need to develop techniques of inquiry.

Asking questions is the least developed skill in management. Too many leaders see their role as being advocates, declaimers and speech-makers.

All useful at the right time and place, but reading other people is an equal need – using what I call the art of ‘decentring’ – knowing what the world looks like through the eyes of others.

Management-by-wandering-about is another time-honoured insight technique – mostly practised by new leaders when they are finding their feet, but too often neglected as their in-tray piles higher over time.

What leaders need most of all is clarity of vision founded on a secure sense of personal and business identity, and which can be communicated with passion. This does not mean speechifying from a podium but storytelling in ways that are simple, compelling and that make sense. People need a narrative that makes sense of their experience and connects the past, the present and the future. People need to see the logic of the journey and to be reassured that if the future is not going to be like the past, it is connected in ways that are also a part of their story.

There are four stories, actually, that all leaders need – not necessarily to tell but to keep in their hearts and minds in how they act and communicate:1. Who am I and why I am here? This is not a recital of one’s CV but is about how to be real to people around you and show that you have chosen to be where you are for a purpose.

2. Who are we and what do we stand for? This is the ‘I’ of identity, that declares the purpose and raison d’etre for the part of the organisation the leader is responsible for.

3. Where are we going and why? This is the mission story, hard to tell when the future is shrouded in fog, so often a message of commitment, hope and determination.

4. Why we must change – this is the call to people on the journey to let go of the past and embrace the future. The ‘I’ of leadership is also the eye of leadership – identity plus vision, communicated with passion.

Nigel Nicholson’s The ‘I’ of Leadership: Strategies for seeing, being and doing, is published by John Wiley & Sons at £18.99.

 

What Makes an Authentic Leader? @Medici_Manager @WRicciardi @LeadMedIT @pash22

http://bit.ly/1hyuiVk

We listen to someone on stage. The message resonates yet we wonder if this person is really authentic.

We listen to an interview and the conversation seems authentic. Yet we wonder if a similar tenor of exchange happens in the privacy of their home or office.

We call individuals to be an authentic leader yet there may be as many definitions on what authenticity is as there are perspectives.

We hear someone bluster on and we grow tired. Yet being brash is who this person is. They are being authentic.

We hear of a leader really believing that working in an office is better for the organizational culture than working from home. We disagree. Yet this is the individual’s core belief. They are being authentic.

We want authentic leaders yet whose definition of authenticity applies?

What Makes an Authentic Leader?

With authenticity, we think:

  • Trustworthy
  • High integrity
  • Genuine

Each is a characteristic and each is important. Who defines authenticity though? With some research, I found a TED Conversation in which the following question was posed – What does it mean to be authentic? There were 108 responses! There are varying views on authenticity.

In a recent Forbes blog by Jan Bruce, she highlighted three things leaders must do to stay authentic. Each are important elements. Actions define authenticity. For me, there needs to be more to define what makes someone authentic. A group of diverse individuals could outline many other actions authentic leaders should take. There isn’t a set standard of actions for authentic leaders.

Characteristics are important to being authentic, just as actions are. Interpretations vary though. What one finds authentic, another may not. The key may be found in how authenticity is realized. Authenticity needs to be a part of our very being. Interpretations may come and go. Distractions will definitely come and go.

What needs to be steadfast is our authentic being. We need to have an authentic intelligence about who we are as a leader and person. We need to be smart in how we engage and maintain our authenticity.

What Makes an Authentic Leader? 4 Ideas for Authentic Leadership Intelligence

There is a smartness to authentic leaders. Smartness does not mean all-knowing; it does mean approaching your leadership craft with an authentic intelligence, knowing the impact of how you lead. To develop this intelligence, highlighted below are four ideas to consider in building your authentic leadership capabilities.

Embedded empathy. Authenticity needs to be other-centered. If it is all about an individual, then the self-centeredness will eventually harm many more than any potential good done. In other words, authenticity needs to connect to others, understand one another, and raise each other up to do more in better ways. Authenticity and active empathy need to be tied tightly together. Empathy raises a leader to consider what works best for more than just one.

Enabled community. Empathy leads to a leader’s embrace of community. How a leader enables a greater community raises their authenticity because it moves from a one-dimensional view to a multi-dimensional one. More than this, whatever action we take as a leader has a multiplier effect. The multiplier effect needs to be an enabled community working toward a higher-purposed mission or goal. An enabled community holds a leader accountable and keeps their focus on what is best for a broader base of people.

Empowering beliefs. Every leader has a certain set of beliefs, whether defined or not. To be an authentically intelligent leader, the beliefs should be empowering, not limiting. Beliefs pursued by a leader need to pass a test of:

  • Do they make others better?
  • Do they call on others to raise their game in how they work, live, and lead?

Authentic leaders embody a belief system that empowers all to look beyond themselves and foster a respect-filled and trust-filled environment.

Preventing harm. Another key authentic leader idea is to always say and do things to prevent harm. The old principle of “do no harm” is as valid as ever. Authentic leaders do not incite others to act in harmful ways. Authentic leaders keep environments safe for honest, meaningful interactions and build cultures to encourage problem-solving, innovation, and productive working relationships.

Questions to Check Authentic Leadership Intelligence

This post is a work-in-progress. It is one of the reasons they are called ideas rather than principles of authentic leadership intelligence. I do believe we need to be open to how we view a leader’s authenticity. I also believe we need to think through what enables us to claim to be an authentic leader. If we don’t understand what our authenticity consists of, then we will likely get off track and become inconsistent and inauthentic. Our trustworthiness is put at risk.

To begin to sort through the state of our authentic leadership intelligence, we may need to begin with these questions:

  1. What percentage of our inner circle thinks very differently from me? When they do offer differing ideas, do I really hear and understand them? What practices do I have in place to really understand others and make connections outside my comfort zone? (empathy)
  2. How do my actions enable other worthy actions? What am I doing to gain positive momentum in moving initiatives forward? (community)
  3. What are my core belief? Which of my core beliefs raise others up in taking positive action? How am I setting an example of leading with my beliefs? Be specific. (beliefs)
  4. How am I ensuring no harm is being inflicted on teams in undertaking their goals and objectives? How am I building a culture of innovation and problem-solving? (do no harm)

More than actions and characteristics, I believe we need to have an authentic being and intelligence on what makes us real, positive, consistent influencers. So, the question is clear: What makes someone an authentic leader?

– See more at: http://www.thindifference.com/2013/12/14/what-makes-an-authentic-leader/#sthash.X0uat6QF.dpuf

Four Key Issues in Innovation Management @timkastelle @Medici_Manager @WRicciardi @leadmedit

by http://bit.ly/1iWe5JW

Co-authored by Tim & Ralph

What are the key innovation issues facing the business community right now?

When we met up in person recently we had a great talk about this question.  We’ve continued the discussion over email, and these are the four innovation management issues that we believe people need to be thinking about right now.

Differentiated and integrative innovation concepts

Sustainable innovation cannot be achieved by one-size-fits-all and one-sided approaches. It requires a common understanding of what innovation is, classifying concepts in order to assure individual assessments as well as differentiated approaches for firms to strengthen their innovation capabilities and performance. Further, innovation is about balancing complementary, and often opposing, variables. Therefore, integrative frameworks may help to gain a more holistic perspective and direction of impact. Examples:

  • The Innovation Matrix is supposed to help assigning firms to one of nine types of innovative organizations. Depending on the characterization, a tailored approach can be developed in order to define where innovation should sit in the business model and how to drive growth.

 

InnovationMatrix

 

  • The Three Horizons Model integrates a short, middle and long term view of innovation, often being in tension to each other. It enables generating a balanced innovation portfolio, consisting of activities with different time horizons. This model can be of great benefit when it comes to mixing incremental and radical innovation activities with regard to risk and strategic alignment.
  • As outlined previously, firms need to ensure a balance of exploiting existing businesses with exploring new opportunities, i.e. they need to become ambidextrous in order to thrive sustainably. As each direction of impact requires dedicated culture, metrics, leadership, mindset and organizational setup, this is another tension to be managed. An integrative framework (below) can be useful to determine a firm’s inclination and how to move towards a balanced innovation capability. It’s important to note – particularly for leaders: Exploration and exploitation are different, but equally important!ralphmatrixStartups, typically positioned in the upper left quadrant need to move to the right direction for increased exploitation and optimization of new businesses. Bigger, established companies, in turn, aim at strengthening their exploration capabilities by moving from the bottom right box upwards. One of the main challenges for organizations to attain ambidexterity is to simultaneously enable separation and integration of both directions. While novel opportunities flourish best when they don’t interfere with core business, they must be linked to the firm’s core in order to scale successfully after validation.

A more detailed discussion of this issue is planned for an upcoming post. On a personal level, sustainable innovation requires integrative instead of either-or thinking. In order to be able to manage ambidexterity, Roger Martin suggests to balance reliability with validity by developing a design thinking mindset.

 

Walking through Lausanne, talking innovation

Walking through Lucerne, talking innovation

Reinvention and business model innovation

As the life times of business models steadily decrease and more radical innovation activities are about to enter the pipelines of most firms, the business model is the new unit of design. Indeed, research has confirmed that business model innovators outperform traditional innovators over time.

One key issue here is to establish systematic approaches to business model innovation. While most companies have proven processes for product innovation in place, only few follow process models for innovating business models. Steve Blank has recently pointed out that generation of novel and reinvention of existing business models is imperative for corporations to succeed in the time to come. Some of his points are:

  • For companies to survive in the 21st century they need to continually create a new set of businesses, by inventing new business models.
  • Most of these new businesses need to be created outside of the existing business units.
  • The exact form of the new business models is not known at the beginning. It only emerges after an intense business model design and search activity based on the customer development process.

Unlike execution of existing business models, the invention and validation of new business models is based on a scientific and emergent approach: defining and testing hypotheses through rapid iterative experimentation. This is what the Lean Startup approach is about. It also implies designing and testing solutions on a minimum viable basis to gain a high iteration and learning frequency through customer feedback.

To develop the ever more important (re-) invention and search capabilities into new fields, existing companies are challenged to consider to implement the lean startup concept. Or as Eric Ries puts it: Entrepreneurship is the new corporate function.

 

bmg

 

Another key issue for existing, in particular larger companies, will to build a structure, capable of successfully combining search (= generation and validation of new business models) and execution (= scaling and improvement of existing business models).

Co-creation through open and social approaches

Facing growing complexity, organizations are finding it increasingly impossible to be successful when entirely operating on their own. To move innovation forward more effectively and efficiently, they aim at building appropriate networks and partnerships. Findings of a recent IBM study confirm outperformers to be more inclined to innovate with external partners – including customers. It suggests a clear tendency to leverage openness, connectedness and co-creation.

Combining internal and external capabilities is becoming crucial for organizations to survive and thrive. Interorganizational partnerships and distributed value networks can be formed to pursue open business models and complementary capabilities. One interesting example is the intensified partnering between startups and larger firms to achieve sustainable innovation by combining their natural strengths. There is one simple reason behind: customer value and continuous disruption don’t care about silos and boundaries.

There is also a growing awareness of the benefits to make organizations more social. According to Nilofer Merchant, becoming social is about connecting things, people and ideas. Networks of connected people with shared interests and goals create ways that can produce returns for any company that serves their needs. This refers to both the organizational and the individual level. As for organizations, it’s all about moving from isolation to communities.

Here is Nilofer again:

The social era will reward those organizations that understand they can create more value with communities than they can on their own. Communities of proximity, where participants share a geographic location (Craigslist is an example but co-working locations are another) will allow people to organize work differently. Communities of passion who share a common interest (photography, or food, or books) can inform new product lines. Communities of purpose will willingly share a common task to build something (like Wikipedia) that will carry your brand and its offer to another level. Communities of practice, where they share a common career or field of business, will extend your offer because it extends their expertise (like McAfee mavens). Communities of providence that allow people to discover connections with others (as in Facebook) and thus enable the sharing of information, products and ideas.

On the people level, connecting individual stakeholders through social business design – particularly involving customers – is on the rise. In social organizations, people are seen as most valuable asset to make a difference. As discussed here, a higher degree of connectedness in combination with making interaction workers more effective and efficient, seems to be a prerequisite for strategic advantage over industry peers. Moreover, social designs bear significant potential to help organizations in better tackling the complexity of business model innovation, adaptability and strategic reinvention.  

Building a culture of experimentation

One of the best tools to use to improve innovation capability is experimentation.  We often think that great businesses are built on great ideas.  But the fact of the matter is that great businesses are usually built by tinkering until their great idea emerges – this is the story told in Little Bets by Peter Sims.

Experimentation is an organisational skill that underlies all of the other issues that we have raised here.  While there is no one-size-fits all innovation tool, experimenting is pretty close to being a one-size-fits all innovation skill.  It is an approach that works best when it is used to test hypotheses – so that it enables structured learning.  Experiments and hypothesis testing are an essential part of business model innovation.  If we are trying to embed lean start-up principles into larger organisations, this is a capability that must be there.  Experimenting is also central to co-creation and other social approaches.

Start-ups and smaller organisations often experiment naturally.  The issue that we would like to raise is that this skill must also be nurtured in larger organisations as well.  If you’re a manager, this means building experimenting into your organisational structure and routines. If you are reporting to someone, it means figuring out how much you can get away with, and using that scope of action to support experiments.

Other people may well come up with other innovation issues that are important, but these are the ones that seem most interesting to us right now. Now we just need to start making progress on them! Therefore, we’ll try to elaborate on these issues in the time to come, in order to provide further ideas to help make innovation more successful.

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About Ralph-Christian

Experienced innovation, technology and product management professional. Looking at the intersection of organizational and personal innovation capabilities. Integrative thinker. Boundary spanner. Author of the Integrative Innovation blog. You can follow him on Twitter @ralph_ohr.

Talking about the Network Era @LeadMedit @Medici_Manager @WRicciardi @muirgray

By Harold Jarchehttp://bit.ly/1krMYIf

Interesting things happen when hyperlinks subvert hierarchy, as the writers of theCluetrain Manifesto said in 1999. Wikileaks, Edward Snowden, Arab Spring, and the Occupy Movement are just a few recent examples. Spying on entire populations is another network era phenomenon. In education, the current subversion is the MOOC, which has already itself been subverted by corporate interests. In the labour movement we are seeing things like alt-labour as well as a growing shareable economy. Networked, distributed businesses, like AirBNB, are disrupting existing models, with the inevitable push-back as they become successful.

Networks will transform education, business, the economy, and society even further. In the network era, the creative economy will gain dominance over the information and industrial economies. Professional knowledge distribution will move away from institutionalized business schools into networked communities of practice.

The key to a flourishing society in the network era will be distributed sense-making. Self-instruction, the basis of personal knowledge management, will be a requirement in a growing number of peer-to-peer networks. Networked learning will give rise to networked decision making. David Ronfeldt articulates this well, with his TIMN [Tribes-Institutions-Markets-Networks] framework. Anyone raised during the past several decades probably understands tribes and institutions and even market forces. This is a triform society(T+I+M). But what happens as we become a quadriform society (T+I+M+N)?

TIMN has long maintained that, beyond today’s common claims that government or market is the solution, we are entering a new era in which it will be said that the network is the solution (e.g., here and here). Aging contentions that turning to “the government” or “the market” is the way to address particular public-policy issues will eventually give way to innovative ideas that “the network” is the optimal solution.

In the network era we have to understand how to become contributing members of networks, for work and for life. This should be a major focus for all professional training and education.

“Reed’s Law” posits that value in networks increases exponentially as interactions move from a broadcasting model that offers “best content” (in which value is described by n, the number of consumers) to a network of peer-to-peer transactions (where the network’s value is based on “most members” and mathematically described by n2).  But by far the most valuable networks are based on those that facilitate group affiliations, Reed concluded. – David Bollier

Without good sense-making skills, the citizenry cannot understand complex issues that affect us all, such as individual privacy versus national security. These issues require networked, human intelligence, not broadcast sound bites, nor ‘learning objects’.

Sensemaking should drive policy. Policy drives decisions. Decisions, of course, need to be informed. If the People don’t know what makes their world go ‘round, the folks on the Hill sure won’t. Globalized governments can’t. – Gunther Sonnenfeld

As David Bollier concludes, “Legitimate authority is ultimately vested in a community’s ongoing, evolving social life, and not in ritualistic forms of citizenship.” Should not education move beyond ritualistic forms of subjects, classes, and certifications and toward ongoing, evolving social learning? How else will we be able to deal with the complexities of this networked, connected sphere that we inhabit?

Jon Husband says that we are all in this together.

The interconnected Information Age is beginning to show us that we’re all linked together – and that the whole system matters.

This principle applies to organizations, to networks of customers, suppliers, employees and communities, to our societies and to the planet.

New language for this principle is popping up everywhere – knowledge networks, intranets, communities of practice, systems thinking, swarming, social software, social networks, tipping points.

Awareness is the key.  Maintain an “open focus”.

Being aware of yourself, others and the effects of your actions and ways of being in relation to others is a fundamental requirement in these conditions.

To thrive in the network era we need to understand networks – social networks, value networks, information networks, etc. Therefore we will need network era fluency.

network era fluency

Network era fluency could be described as individuals and communities understanding and being part of global networks that influence various aspects of our lives. For individuals, the core skill will be critical thinking, or questioning all assumptions, including one’s own. People will learn though their various communities and in doing so, develop social literacy. Information literacy will be developed by connecting to many networks. Diversity of our knowledge networks can foster innovation and improve our collective ability to adapt.

Mass network era fluency will keep our knowledge networks social, diverse, and reflect many communities. This kind of fluency, by the majority of people, will be necessary to deal with the many complex issues facing humanity. We cannot address complex issues and networked forces unless we can knowledgeably discuss them. To understand the network era, we need first to be able to talk about it.

The network era has already changed politics, created new dominant business models, opened up learning, and is now changing how organizations operate – on the inside. Once we are able to talk about networks, we will see that many of our current work practices are rather obsolete. From how we determine the value of work, to how we calculate pay for work; organizations will need to adapt to the network era.

I think business leaders and HR departments do not understand this shift, or the fact that this shift is accelerating, so that in a year or two 75% of peoples’ value will be based on their network performance, their ability to contribute to and accept from others. – Stowe Boyd

 

* Content from jarche.com is protected under a Creative Commons Attribution-NonCommercial Share Alike License

Managing Complexity: The Battle Between Emergence And Entropy @Medici_Manager @pash22 @wricciardi @leadmedit

By Julian Birkinshaw, London Business School Term Chair Professor of Strategy and Entrepreneurship. http://onforb.es/19bAvh8

The business news continues to be full of stories of large companies getting into trouble in part because of their complexity. JP Morgan has been getting most of the headlines, but many other banks are also investigation, and companies from other sectors, from Siemens to GSK to Sony, are all under fire.

It goes without saying that big companies are complex. And it is also pretty obvious that their complexity is a double-edged sword. Companies are complex by design because it allows them to do difficult things. IBM has a multi-dimensions matrix structure so that it can provide coordinated services to its clients. Airbus has a complex process for managing the thousands of suppliers who contribute to the manufacturing of the A380.

But complexity has a dark side as well, and companies like JP Morgan, IBM and Airbus often find themselves struggling to avoid the negative side-effects of their complex structures. These forms of “unintended” complexity manifest themselves in many ways – from inefficient systems and unclear accountabilities, to alienated and confused employees.
So what is a leader to do when faced with a highly complex organisation and a nagging concern that the creeping costs of complexity are starting to outweigh the benefits?

Much of the advice out there is about simplifying things – delayering, decentralising, streamlining product lines, creating stronger processes for ensuring alignment, and so on. But this advice has a couple of problems. One is that simplification often ends up reducing the costs and benefits of complexity, so it has to be done judiciously. I have written about this elsewhere (provide link).

But perhaps the bigger problem is this advice is all offered with the mentality of an architect or engineer. It assumes that Jamie Dimon was the architect of JP Morgan’s complexity, and that he, by the same token, can undo that complexity through some sort of re-engineering process.

Unfortunately, organisational complexity is, in fact, more complex than that. To some extent, organisations are indeed engineered systems –we have boxes and arrows, and accountabilities and KPIs. But organisations are also social systems where people act and interact in somewhat unpredictable ways. If you try to manage complexity with an engineer’s mindset, you aren’t going to get it quite right.

I have been puzzling over complexity in organisations for a while now, and I reckon there are three processes underway in organisations that collectively determine the level of actual complexity as experienced by people in the organisation.

1. There is a design process –the allocation of roles and responsibilities through some sort of top-down master plan. We all know how this works.

2. There is an emergent process – a bottom-up form of spontaneous interaction between well-intentioned individuals, also known as self-organising. This has become very popular in the field of management, in large part because it draws on insights from the world of nature, such as the seemingly-spontaneous order that is exhibited by migrating geese and ant colonies. Under the right conditions, it seems, individual employees will come together to create effective coordinated action. The role of the leader is therefore to foster “emergent” order among employees without falling into the trap of over-engineering it.

3. Finally, there is an entropic process – the gradual trending of an organisational system towards disorder. This is where it gets a bit tricky. The disciples of self-organising often note that companies are “open systems” that exchange resources with the outside world, and this external source of energy is what helps to renew and refresh them. But the reality is that most companies are only semi-open. In fact, many large companies I know are actually pretty closed to outside influences. And if this is the case, the second law of thermodynamics comes into effect, namely that a closed system will gradually move towards a state of maximum disorder (i.e. entropy).

This may sound like gobbledegook to some readers, so let me restate the point in simple language: as organisations grow larger, they become insular and complacent. People focus more on avoiding mistakes and securing their own positions than worrying about what customers care about. Inefficiencies and duplications creep in. Employees become detached and disengaged. The organisation becomes aimless and inert. This is what I mean by entropy.

The trouble is, all three processes are underway at the same time. While top executives are struggling to impose structure through their top-down designs, and while well-intentioned junior people are trying to create emergent order through their own initiatives, there are also invisible but powerful forces pushing the other way. The result is often that everyone is running very fast just to stand still.

So let’s return to the leader’s challenge. If these three processes are all underway, to varying degrees, in large organisations, what should the leader do? Well, sometimes, a sharply-focused and “designed” change works well, for example, pushing accountability into the hands of certain individuals who are much closer to the customer.

But more and more the leader’s job is to manage the social forces in the organisation. And in the light of this blog, it should be clear that this effort can take two very different forms:

1. Keeping entropy at bay. This is the equivalent of tidying your teenager’s room. It involves periodically taking out layers of management, getting rid of old bureaucratic processes that are no longer fit for purpose, or replacing the old IT system. It is thankless work, and doesn’t appear to add any value, but it is necessary.

2. Inspiring emergent action. This is the equivalent of giving a bunch of bored teenagers a bat and ball to play with. It is about providing employees with a clear and compelling reason to work together to achieve some sort of worthwhile objective. It isn’t easy to do, but when it works out the rewards are enormous.

And here is the underlying conceptual point. The more open the organisation is to external sources of energy, the easier it is to harness the forces of emergence rather than entropy. What does this mean in practice? Things like refreshing your management team with outside hires, circulating employees, making people explicitly accountable to external stakeholders, collaborating with suppliers and partners, and conducting experiments in “open innovation”.

A lot of these are initiatives companies are trying to put in place anyway, but hopefully by framing them in terms of the battle between emergence and entropy, their salience becomes even clearer.

Why you should reframe your strategy as transformational @leadmedit @helenbevan @Medici_Manager @muirgray

Posted by:

In my last post, I talked about strategy as logic; that is, a system of reasoning we utilise, based on our views and beliefs, about how to achieve change.

My own strategic logic for change (and therefore my practice as a leader of healthcare improvement) has been particularly influenced by Marshall Ganz. Ganz spent decades as a community organiser, leader and enabler of campaigns and social movements before joining the Kennedy School of Government to teach, research and write about leadership of change from a social movement perspective.

It’s very helpful for healthcare leaders to reflect on Ganz’s logic and definition of strategy: how we as leaders turn what we have (resources) into what we need (power) to achieve what we want (outcomes) by focusing on clear strategic objectives. I’m concentrating on this perspective specifically in this blog and will discuss resources next time.

The Montgomery bus boycott

We can see these strategic principles in action in so many of the inspiring stories of social change. Let’s take the example of the Montgomery bus boycott which was a pivotal point in the genesis of the American civil rights movement in 1955-56. Following the arrest of Rosa Parkes for refusing to give up her seat on a bus to a white passenger, the black population of Montgomery, Alabama, boycotted the town’s buses in protest at racial segregation of buses.

By organising for civil rights, a group of largely dispossessed marginalised African Americans was able to pool resources to create collective power for change (enough people withdrawing their use of buses and payment of bus fares so that it had a profound impact). They built power both by pressing the authorities for reform through united action and growing their movement by winning other people across the nation to support and take action for their cause.

And they achieved the outcomes they sought: pressure for change increased across the country and eventually the segregation rules were deemed unconstitutional by the courts.

Ganz, along with other commentators, concludes that the leaders of social movements (“voluntary organisations”) typically have fewer levers and resources for enacting change than leaders of formal organisations have. This makes the strategic focus of leaders, to turn potential resources into power for change, even more important.

Ganz quotes James Q. Wilson:

“In most voluntary associations, authority is uncertain and leadership is precarious. Because the association is voluntary, its chief officer has neither the effective power nor the acknowledged right to coerce the members – they are, after all, members and not employees. In a business firm, the chief officer may, within limits, hire and fire, promote or demote, his subordinates…

“In most associations, power, or the ability to get a subordinate to do what the superior wants, is limited, and authority, or the right toexercises such power as exists, is circumscribed and contingent.”

Use your levers

I concur with Wilson that the kinds of levers and resources available to organisational leaders can create an easier set of circumstances for enacting change (when compared with social movement leaders who have none of these resources). However, on their own, coercion, compliance and other organisational mechanisms won’t create sustainable transformational change within and across organisations.

So I don’t necessarily agree that organisational leaders have a more straightforward task in leading change. In fact, I think that leaders of health and healthcare who are seeking radical changes across their organisations and systems in an ever more complex and unpredictable world have got more in common with social movement leaders than they have differences.

Many NHS change strategies are driven by logic based on extrinsic levers for change: incentivising payment systems, regulatory and quality assurance systems and holding leaders to account to deliver change outcomes. The strategic logic of social movement leaders is essentially based on igniting intrinsic motivation: building shared purpose, connecting with values, mobilising actions and taking meaningful action.

Transformational change across the NHS system requires both intrinsic and extrinsic factors and we as leaders need to find ways to align them and balance the tension between them. Otherwise there is a tendency to overemphasise the extrinsic factors and inadvertently kill off the energy, creativity and sense of psychological safety that people need to innovate and deliver goals for change.

Peter Drucker got it right when he advised organisational leaders to “accept the fact that we have to treat almost anybody as a volunteer”. We can learn greatly from the strategic approaches of social movement leaders who led change that succeeded because people wanted to be part of the change, not because they had to be. They have a lot to teach us about motivating, mobilising and building power for change through the assets and resources of a communitybased on common interests and a common goal, creating capacity for change from within.

Some questions to consider:

    • What is the shared purpose underpinning our change efforts? Is it framed in a way that connects with values and builds intrinsic motivation?
    • What leadership actions can we take to shift power in the system and get the outcomes we seek?
    • Think about loss and gain: what control/power might we have to surrender in a hierarchical sense to enable a more distributed leadership system and quicker, wider progress of change across the system?

 

From The NHS Change Agent

Helen Bevan is chief of service transformation at the NHS Institute for Innovation and Improvement. From 1 April 2013, she will be joining the delivery team of NHS Improving Quality. All views are personal.

How do you create a curious culture? @muirgray @wricciardi @leadmedit

How do you create a curious culture? I struggled with this question until the January 2013 issue of National Geographic landed in my mailbox with this cover theme: “Why We Explore.” Inside was a fascinating article called “Restless Genes”, written by David Dobbs. The article provided panoply of scientific evidence as to why humans explore.

“The compulsion to see what lies beyond the far ridge or that ocean – or this planet—is a defining part of human identity and success.” – David Dobbs

The article helped me conceptualize a framework for enabling a curiosity-based culture inside an organization. I learned three aspects of human behavior that encourage us to explore – why we are curious – and what we as leaders can do to unleash this in our organizations.

I discussed the first two lessons learned in yesterday’s blog post. Here is the conclusion to my thoughts on this subject.

I already knew that human hands with our five fingers, including a thumb, were a competitive advantage for Homo sapiens in the battle for resources. In the final lesson from the article, what I didn’t’ know is that societies tended to develop mythology around those people who excelled at “clever hands,” as author Dobbs refers to innovations created by those hands.

Societies tended to develop mythology around those people who excelled at “clever hands”

Mythology made it “cool” to be “clever;” a little like the adulation the Steve Jobs’ of the world receive today. The marine vocabulary of the Polynesians conferred great status on ship builders, as Dobbs says, “like today’s astronauts.” This social standing was a motivating force to continue exploring.

I recently visited Cisco’s customer briefing center in Tokyo, and as I walked down the hallway past a bank of Cisco equipment, I stopped because I saw a box that was a different color from all the others – white with red lettering. I knew right away when my eyes focused specifically on this box that I was looking at a Cisco “AGS” router; the product that was used in the first-ever commercial Internet connection. A group of us just stood there for a few minutes and talked about what this AGS box meant to Cisco – and the world. It is not an understatement to say the AGS changed the world.

I’ve always believed that culture is built on the backs of important symbols. The mythology around the Cisco AGS router is every bit in our vocabulary as the sail is in the Polynesian marine vocabulary.

Culture is built on the backs of important symbols

The lesson:  Nostalgia is what keeps an organization from moving forward, but the myths of what symbolizes the great accomplishments of your organization should be celebrated and must be front and center in your team’s culture.

“When you set sail to find new lands, you became mythologized – even if you didn’t come back.” – National Geographic Explorer-in-Residence Wade Davis quoted in “Restless Genes.”

Great accomplishments of your organization should be celebrated and must be front and center in your team’s culture

Cisco CEO John Chambers frequently says culture is the responsibility of leaders. Curiosity may kill the cat, but it may be the most important attribute of a resilient organization in a constant state of evolution to win in today’s markets. As leaders, it’s our responsibility to set curiosity free inside our organizations, in the same way the great human explorers dared to go places that others feared and few ventured.

It’s our responsibility to set curiosity free inside our organizations

“…for the larger powers we gain through culture…it gives our malleable genomes, imaginative minds, and clever hands the power to transform even the strongest forces in our environment — wind, water, current — from threat to opportunity.” – David Dobbs

http://switchandshift.com/how-do-you-create-a-curious-culture?utm_content=bufferd0e04&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer

Mindfulness can improve leadership in times of instability @leadmedit @muirgray

A mindful leader can respond to change with focus and clarity, and avoid repeating the same mistakes

by Cheryl Rezek http://bit.ly/15M4lLs

What does the ancient eastern practice of mindfulness, often associated with orange-clothed chanting monks, have to do with the fast-paced, performance-driven style of western leadership? In tough times, it could act as an influential asset in the public service’s fight for survival.

Mindfulness is about paying attention to what is happening in the present moment, a moment in time. It is about focusing attention on the present in a way that allows that moment to be experienced and observed closely. It involves developing the skills to allow yourself to engage actively with whatever is happening at the time, as well as concurrently viewing that moment from a more strategic standpoint.

Developing a more aware and considered approach helps leaders to respond to situations (whether internal thoughts or external events), rather than react to them. It encourages a less critical view which, in turn, creates a more flexible and attuned response. When there is less clutter and fewer distractions within one’s own head it is easier to gain clarity and perspective; mindfulness allows one to both notice more detail and see the bigger picture.

A mindful leader can reduce disorder by bringing focus and intent to the situation. By acknowledging and accepting change, the leader can step back, observe and respond with composure and purpose.

Sometimes our past experiences or immediate reactions will interfere with our ability to view the present in an unbiased way. Once we acknowledge this, we can quieten internal commentaries and assumptions. This process of stepping aside from ourselves allows us to decide what approach will best support the situation at hand, and the agendas and strategies of the organisation.

Dealing with change

If leaders realise that change is inevitable, they can encourage sufficient resilience in individuals, teams and organisations. To lead knowing that change is inevitable – though unpredictable in its timing – allows for flexibility, and a realisation that what worked in the past may not necessarily be appropriate today. This helps to safeguard an organisation from disillusionment and destruction by enforcing outdated rules and processes.

Research on mindfulness suggests that it can also help to:

• reduce the cost of staff absenteeism caused by illness, injury and stress

• improve cognitive functioning, memory, learning ability and creativity

• improve productivity and improve overall staff and business wellbeing

• reduce staff turnover and associated costs.

Mindful leadership is not a patronising fad implying that, if we are calm, everything will be fine. The reality of our working world is that all may not be fine. What mindfulness can do is develop a thinking, emotional and instinctual mind so that the leader can do the best for self, team and organisation.

 

The full version of Cheryl Rezek’s article can be accessed free-of-charge by Public Leaders readers for a limited time on the International Journal of Public Leadership.

Dr Cheryl Rezek is a consultant clinical psychologist, workshop leader and author of Life Happens: Waking up to yourself and your life in a mindful way and Brilliant Mindfulness: How the mindful approach can help you towards a better life.

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Clinicians do not have the luxury to not care about costs @kevinmd @Medici_Manager @WRicciardi

by  http://bit.ly/1g8rOt3

In a large lecture hall of fellow clinicians-to-be, I was told that my job as a physician is not to be concerned with costs but rather to treat patients. My wrist, moving frantically left to right on my page taking notes, stopped. I looked up and my mind wandered: What an odd message to tell those who will be listening to ill people’s symptoms, prescribing medicine, ordering tests and orchestrating people’s care to not worry about.

We have set up this dichotomy of treating the patient or being concerned with costs. We have soaked medicine with the belief that cost-conscious care is rationing at the bedside and the public fear messages that clinicians who care about costs are limiting their care.

How can we teach future clinicians to be so out of touch with one of people’s greatest concerns when seeing a clinician? We know that people forgo medications because of high prices, medical bankruptcy plagues many and some cannot seek care due to cost. What other industries allow someone so crucially involved in controlling costs immunity from worrying about them? Does medicine’s unique role of saving lives exempt it from keeping an eye on the register? Is good care not cost-conscious care?

Clinicians do not have the luxury to not care about costs. The American Medical Association and the American College of Physicians realize this and are blurring the line between the “treat patient” or ”be concerned with cost” dichotomy. They are framing the argument of physicians caring about costs as an ethical issue of the stewardship of limited resources and of providing parsimonious care by using health care resources wisely.

This is a good first step, because bringing costs of care out of the dark eliminates this taboo, hush-hush culture of who’s paying the health care bill when it arrives at the table. Programs across the U.S. recognize this, too, and are weaving into their curriculum how physicians can be aware of costs in medicine. Research is advancing in this area as we explore in greater detail why prices vary so much: implementing comparative effectiveness research, continuing consumer-driven health care efforts and piloting interventions to control health care costs, like holding health communities accountable for the care that they provide.

National campaigns like the American Board of Internal Medicine Foundation’s Choosing Wisely call attention to unnecessary care. We have seen health care costs become more exposed with Steven Brill’s Time article revealing the rates that hospitals bill to patients or use as a starting point for negotiations with insurance companies. And the Centers for Medicare and Medicaid Services made public charges for 100 of the most common inpatient services and 30 common outpatient services, displaying variations in charges across the country for services.

This is not enough though. We need to continue to build this cost-conscious culture in the exam room where medical decisions are made, including both the patient and clinician, because 1) people care about costs; 2) the medical industry is not exempt from concerns about costs; and 3) good care is cost-conscious care.

People care about costs. People have premiums to pay, co-pays to fork over, deductibles to reach, prescription drugs to purchase and co-insurances to manage. This is a lot of financial information for people to keep straight and to be in charge of on top of the responsibilities they have to manage an illness or care for a loved one. We worry about how much health care services will cost us. In May 2012, the Henry J. Kaiser Family Foundation reported that a quarter of polled people had difficulty paying medical bills in the past year. Six in ten have “cut corners” to avoid health care costs, such as skipping a recommended medical test or filling a prescription medicine. As one might imagine, it’s even worse for those who are uninsured, have lower incomes and are in poorer health. Clinicians need to be on the same page as their patients: Costs for their health care matter to them, and people may be afraid to talk about them with a clinician and do not have the tools to know what constitutes a reasonable price for care.

Medicine’s unique ability to save lives is not exemption status from a cost-conscious culture. Just because medicine saves lives, it is not stamped “exempt” from having to think about costs. A good amount of health care is not emergency care, but rather preventive care and treatment of illness. Though health care may be a unique good in our society, the system should not be excused from having to consider sustainable models of spending. When the costs of health care are not transparent to both patients and clinicians, the temptation/decision to limit care may be hidden behind closed doors of obscure insurance policies. Other sectors of society save lives – police departments, prison systems, national security measures – and we still have to consider the costs of financing these services.

Good care is cost-conscious care. Was it worth it or should I buy it? We constantly, prospectively and retrospectively, evaluate how we spend our money: taking that vacation, buying a car, eating out. Was that a valuable use of our money compared to what we gained (pleasure/utility) and would we do it again? Though fewer choices may be available in some emergency situations or medically necessary circumstances where the decision process is accelerated or removed, we still can assess whether the care that we received is worth the cost. Have I been feeling better taking this medication? Has the pain subsided and is the out-of-pocket cost manageable? Has my health improved since seeing my doctor for “X”? These questions tumble around in our minds during our treatments and after in recovery.

Tools for clinicians and tools for health care costs. We are chipping away at this culture of unaccountable spending, of “running dad’s credit card,” when it comes to health care costs. But we aren’t giving clinicians and people the tools they need to partner together to take on this dragon of costs. Partly because people and clinicians don’t know how much health care services cost. Resources like Healthcare Blue Book are slowly becoming places where people can get estimates of how much their care will cost and insurance companies can give rough estimates prior to care. But these are outside of the exam room and can vary considerably.

If we continue to make the standard of treatment a more expensive option when cheaper, equally effective alternatives exist, tools need to be developed for the clinical encounter, in the exam room, where the clinician and patient can participate in shared decision making by incorporating costs: “No, I don’t want that medicine if it costs that much out of pocket,” or “I’d rather try treatment ‘X’ if it will save me that much money.”

Though having these conversations in the exam room may be a tall order for some, neglecting to include such an important issue is bad care. Sending someone home with a fancy procedure and large out-of-pocket costs may not have improved his health, but rather increased anxiety and stress over having to pay for his care. He may have chosen a different course of action had he known in advance the price he’d be paying for years to come. Likewise, prescribing a medication that a person will not pick up because it costs too much does nothing to help improve that individual’s health.

We have a long way to go in delivering cost-conscious care that incorporates the patient’s and the clinician’s views. Evidence-based tools need to be developed for both the clinician and patient to be able to weigh the risks and benefits of a test, procedure or course of treatment, and conversations need to be started between clinician and patient about costs.

I want a cost-conscious clinician who is aware of what I’m being charged and in touch with the challenges I face in paying for my health care. I want to be part of system that acknowledges people’s concerns with costs. People should demand from their clinicians this aspect of their care, and clinicians should demand from their health care organizations the tools to be able to deliver this information. Let’s stop clinicians from passing the buck on the costs of care, and let’s teach future and current clinicians to care about costs.

Patients already do.

Sarah Jorgenson is a medical student who blogs at the Prepared Patient blog and the self-titled site, Sarah R. Jorgenson.

A right to a personal health budget @tkelsey1 @Medici_Manager @pash22

Luke O’Shea, NHS England’s Head of Patient Participation, explains why a “quiet ministerial announcement” is so significant.

http://bit.ly/1h4VSr0

Last week in Parliament, ministers quietly made an announcement : From October next year, thousands people in receipt of Continuing Health Care funding will gain a new legal ‘right to have’ a Personal Health Budget.

The announcement went largely unnoticed by the media, patients and professionals.  Usually Personal Health Budget announcements generate Marmite-like reactions – either heralding the end of the NHS as we know it, or being seen a panacea for a person-centred NHS. But last week there was little reaction.

However, this is a significant announcement for a group of people who have less ability than most to determine the path their lives take.  The hope is that Personal Health Budgets will change that. But will they?

It made me reflect on an important experience I had working as a commissioner in the NHS. It was a trip to meet a man about my age receiving Continuing Health Care.  I think about him quite a lot.

He’d been given a diagnosis of ‘treatment-resistant schizophrenia’ and had been moved around the country for over 10 years because of his complex needs.   After a three hour drive, I arrived at the care home where he had lived for the last five years.  We got on well and talked quite a bit.  We sat in the kitchen and I asked him about his hopes for the future.  He wanted a flat of his own.  However, he’d been told for a long time that they were hoping to sort out a flat, with little sign of progress.  He was stuck.

For the NHS, the care home placement was a success.  He was high risk but had had no hospital re-admissions in recent years.  But it did not offer him what he wanted most, to build a normal life.

When the Personal Health Budget announcement was made it occurred to me that his placement budget would have paid for a flat, a full-time support worker and employment support or training, with some left over.  I wondered whether a right to have a Personal Health Budget would have started a different conversation that day I met him.

For me, the announcement on Personal Health Budgets is part of a wider historic movement where people whose lives have been constrained by the state have been offered greater self-determination.

Why would the NHS not want people to actively determine the path of their own lives?  Should people be allowed to choose and buy their own care?

Well, there is a tension.  They might choose services that fit round their lives and not what suits the NHS.  They might decide a job is more important to them than managing the likelihood of hospital re-admissions.  But what does the evidence say?

The University of Kent controlled trial of Personal Health Budgets, involving 2,000 people, showed patients with PHBs out-performing the control group, and even had fewer hospital admissions.  It seems that patients can be experts too.

The Lancaster University Poet Survey also showed significantly improved well-being for most carers, who tend to bear a huge personal responsibility for this group.  It’s rare that we measure the impact of an intervention on families of patients, but here we have.

So we need a bigger debate about Personal Health Budgets and personalisation in the NHS.  The evidence is good, but there are tensions and the implementation challenges are significant.

Personal Health Budgets are not a panacea, but they do start a different kind of conversation.  And they are not going away.  This announcement is part of a wider historic shift towards personalisation and greater self-determination across public services, which once introduced is very hard to go back on.

So let’s hope this announcement is one small step towards a time when everyone, regardless of health need, is given the chance to determine the course of their own lives.


luke-osheaLuke O’Shea is Head of Patient Participation at NHS England.

He has previously worked in national policy and strategy roles at the Department of Health and as a commissioner in a local authority and the NHS.

Prior to that he worked in a range of government departments including leading work on early year services at the Prime Minister’s strategy unit, as a private secretary to a children’s minister and leading cross government working on ageing.

He describes as his proudest achievements his “modest role at the inception of Family Nurse Partnership in the UK and of my work on ageing”.

Value-Based Health Care Is Inevitable and That’s Good @Medici_Manager @pash22 @leadmedit

by Toby Cosgrove  http://bit.ly/17GkMG7

Vaccines. Anesthesia. Penicillin. Bypass surgery. Decoding the human genome. Unquestionably, all are life-saving medical breakthroughs. But one breakthrough that will change the face of medicine is being slowed by criticism, misunderstanding, and a reluctance to do things differently.

That breakthrough is value-based care, the goal of which is to lower health care costs and improve quality and outcomes. It will eventually affect every patient across the United States. Not everyone, however, is onboard yet, because part of the value-based equation is that hospitals will be paid less to deliver better care. That’s quite a challenge, but one that Cleveland Clinic is embracing as an opportunity to do better. Others must, too.

How the Health Care World Will Change

We all know that U.S. health care is too expensive, too inefficient, and the quality is too varied. The goal of value-based care is to fix that.

A major component of the Affordable Care Act is to change the way hospitals are paid, moving away from a reimbursement model that rewards procedures to one that rewards quality and outcomes. No longer will health care be about how many patients you can see, how many tests and procedures you can order, or how much you can charge for these things. Instead, it will be about costs and patient outcomes: quicker recoveries, fewer readmissions, lower infection rates, and fewer medical errors, to name a few. In other words, it will be about value. And that is good.

Whether providers like it or not, health care is evolving from a proficiency-based art to a data-driven science, from freelance physicians to hospital-employed physicians, from one-size-fits-all community hospitals to vast hospital networks organized around centers of excellence. Each step in this process leads to another.

When hospitals employ physicians on an annual salary as we do at Cleveland Clinic, a doctor is paid the same no matter how many patients he sees, how many procedures he performs, or how many tests he orders. One-year contracts hold our doctors accountable, with yearly performance reviews that include each doctor’s quality metrics, clinical outcomes, and research. And having all your doctors on the same team makes it easier to coordinate patient care among different groups of specialists.

As more independent physicians begin to be hired by hospitals, the opportunity for large group practices and hospital consolidation grows. As consolidation expands, data and transparency become increasingly important, as a way to ensure that caregivers across the system are providing comparable care.

All of this, of course, leads back to quality, which requires an effort to achieve standardization, reduce variation, and eliminate unpleasant surprises. It’s analyzing processes, measuring outcomes, and changing practices until you get it right.

To remain viable in today’s rapidly evolving environment, health care systems must reduce costs while continuing to improve quality and outcomes.

The Cleveland Clinic’s Journey

In the October issue of Harvard Business ReviewMichael Porter and Tom Lee cite six components of high-value care-delivery systems: integrated practice units; cost and outcomes measurement; bundled payments; integrated care delivery across facilities; expanded services across geography; and an information technology platform to enable those processes.

As they note, Cleveland Clinic is one of two medical centers worldwide that has implemented all six, beginning with integrated practice units, which we call “institutes.” A patient-focused institute combines medical and surgical departments for specific diseases or body systems. All of our institutes are required to publish outcomes and measure costs. With bundled payments, we combine all the services provided before, during, and after a complex procedure like joint replacement, into a single charge. We have integrated care through shared protocols and the electronic medical record at all of our 75 care-delivery sites. And our expansion across Northeast Ohio into Florida, Nevada, and overseas allows broad geographic access to our services.

What makes Cleveland Clinic different stretches back to our founding 92 years ago as a physician-led group practice that runs a hospital – not a hospital that employs doctors. This distinction is important. Decisions from the CEO on down are made by physicians based on what is best for the patient.

Mining Data

As a leader in the electronic medical records, we have a wealth of data that can tell us what’s working and what’s not. For instance, we were able to comb through data of heart-surgery patients to find that those who received blood transfusions during surgery had higher complication rates and lower long-term survival rates. This finding – mined from our own data – changed the way we do things; we now have strict guidelines in place to limit transfusions.

We’ve made similar strides in many other clinical areas, using data to drive quality. By collecting data on provider performance and making that data transparent, central-line infections have decreased by more than 40%, while urinary-tract infections have dropped 50%.

Data can help identify variations in clinical practice, utilization rates, and performance against internal and external benchmarks, leading to improved quality and a sustained change in culture. Last year, we established a values-based care team, which seeks to eliminate unnecessary practice variation by developing evidence-based care paths across diseases and to improve comprehensive care coordination so that patients move seamlessly through the system, reducing unnecessary hospitalizations and ER visits.

Lowering Costs Without Compromising Quality

American health care is on an unsustainable path. Health care spending topped $2 trillion in 2011. The Centers for Medicare and Medicaid Services predicts that without major change, it will account for more than 20% of GDP by 2021, up from 5.2% percent in 1960. What that means is that if we continue on our current path, $1 in every $5 spent in the U.S. economy will go toward health care.

We can choose a different path, though. At Cleveland Clinic, we’ve been engaged in an ongoing effort to trim costs across the entire system. Through a concerted focus on our supply chain, we use rigorous value-based purchasing protocols, market intelligence, and business analytics to examine every purchase from the standpoint of value, utility, and outcomes. Over the past two years, this has resulted in cost savings of more than $150 million.

Our electronic medical records are also programmed with a “hard stop” function to reduce unnecessary duplicate tests. This led to a 13% reduction in blood-gas determinations, generated $10,000 in monthly savings for laboratory tests, and resulted in savings of $117,000 in just the first month for genetic testing.

A key part of the cost solution is to educate all caregivers, including doctors, about what items cost. Earlier this year, we created a Cost Repositioning Task Force to work with all caregivers across the entire Cleveland Clinic system to assess everything we do and everything we spend. Now, as part of the purchasing process, dozens of doctors gather to discuss the merits of certain products: Which ones provide the best outcomes for patients? How many are needed? How much does it cost?

Traditionally, knowing the cost of a stitch or a catheter or a bone screw — or any of the thousands of other supplies used during surgeries — hasn’t been part of doctors’ medical consciousness. To remedy that, we’ve taped price lists to supply cabinets in some ORs. In others, posters remind everyone to choose supplies carefully, stressing this message: “Without compromising quality, consider cost-effective alternatives.”

As health care reform kicks into high gear, providers are facing a difficult challenge: being paid less to produce better outcomes. We must view this as an opportunity, not a burden. After all, the providers who make the transition early will be rewarded with more satisfied patients, lower expenses, and pride in a job well done.

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