systems thinking

Practice and preparation

/ Jonathan Sachs

Last week I wrote about the Washington Nationals historic run to win the World Series. Continuing on the sports theme this week, football can teach us a lot about the value of practice and preparation.

Unlike baseball’s grueling 162 game schedule, the NFL plays just 16 regular season games over 17 weeks in their season. Therefore most of the work of a football team is practice and preparation for each game. Coaches and players study film from previous games, practices, meet together, and strategize for their opponents, often around the clock.

Football coaches teach us about the value of organized practice and preparation, which we can apply to the practice of leadership. Over the summer, I read Belichick: The Making of the Greatest Football Coach of All Time by Ian O’Connor. Of the many excellent examples and anecdotes in the book, O’Connor wrote about a now famous play in the final minutes that helped the Patriots win Super Bowl XLIX (49) against the Seattle Seahawks.

In the play, Malcolm Butler intercepted Seattle quarterback Russell Wilson’s pass at the Patriots goal line. The Patriots coaches had the team run this play several times in practice, where Butler played it incorrectly. In the big game though, Butler got it right and helped seal the win for the Patriots. Here’s the story from the coaches:

(If you are having problems viewing the video, you can click here for it)

Practice and preparation can make a world of difference. At work, I have developed a couple of systems to aid in making sure I am prepared. For example, I always print out my calendar for the upcoming week. I highlight in the color blue all the scheduled events that require preparation. I put copies of the documents I need for those meetings in a folder whose front cover is my highlighted weekly agenda.

I know I feel the most confident in presentations that I have practiced and tested with different audiences. I will take bits and pieces of new ideas and test them out in smaller settings before adding them to larger presentations to make sure that they work with an audience. I will also practice the final presentation repeatedly (usually practicing in front of my patient wife, Sheryl) to feel confident that I know the order and timing of everything when the time for the big presentation arrives.

What are your systems for practice and preparation? I would like to hear more about them and include them in a future blog post. Please share them with me here.

KEY TAKEAWAY: The practice and preparation involved in football teaches lessons for leaders in business as well. Often times leaders develop systems to prepare and practice for opportunities ahead to stay at the top of their games. 

Can empathy be taught?

/ Jonathan Sachs / 2 Comments

On May 29th, I spoke to the leaders at Adventist HealthCare at our semiannual Mission in Motion conference where patient experience was the theme of the day. As part of the plenary session I explained to our leaders why I am so passionate about the work of improving patient experience.

One of the reasons, I explained, was that last year, we touched nearly 80% of our community within 1-degree of separation. By one degree of separation, I am assuming that each employee and each patient has at least, on average, one other member of their household. For example, if we treated a mother, her experience in our care would have influence on her whole family. Imagine if we demonstrated kindness and compassion in a way that exceeded the patient’s expectations. If our team and our patients take those behaviors home, imagine the multiplier effect it could have of people leading by an example of deep kindness.the war for kindness

If you attended the Mission in Motion conference, you would promptly leave the plenary for a mandatory breakout session on selecting the right employees for the job. The session educated attendees on certain behaviors, like empathy, which lead to kindness and compassion that can’t be taught. If leaders do not follow a good process for hiring, it may hurt the whole group. This conventional wisdom is present in the literature around excellent service organizations, like the Ritz-Carlton, that deploy a rigorous hiring process to prevent “bad apples” from entering the bunch.

Enter Stanford University psychologist Jamil Zaki, who presents a compelling challenge to the notion that empathy is not a learned trait. In his recently published book, The War for Kindness: Building Empathy in a Fractured World, Zaki describes how his work and research can help people become more empathetic.

Zaki describes his childhood living in parallel worlds after his parents divorced. He described this experience as an “empathy gym,” noticing how two people could have completely different and yet totally valid views of life. He has created a similar type of course at Stanford, sending students to various exercises and experiential learning environments to build their empathy muscles. While the work is rigorous and difficult, he has shown results.

Further, Zaki shows his work in a way that builds trust in the research. At the end of the book, he takes the reader through each study mentioned, chapter by chapter, and rates the quality of the research on a 5-point scale. While some of the research is yet to be validated, it is certainly interesting, controversial at times, and quite progressive.

The initial set up of the book is quite dense, describing several research studies, as well as a general orientation to historical notions on empathy. It was worth the dense crash course to get to the stories and real world examples of building empathy. Zaki takes us through experiments in using literature to stop recidivism, truly understanding “compassion fatigue” in hospitals, and positive and negative impacts of technology on empathy.

The War for Kindness has many implications. It is a helpful roadmap for how we can be more kind, compassionate, and empathetic as a society. It has challenged my thinking on hiring in health care. While I still strongly believe that systems and processes help protect the team and enhance service, I now believe that a motivated candidate can be taught how to empathize. I also believe that we must coach motivated caregivers to have empathy in a way that does not cause burnout or eventually result in emotional numbness towards patients.

I have already bought copies of this book to give away to friends and colleagues, because it is powerful, hopeful, and challenges assumptions about how we can repair our seemingly broken world. It is surely worth the read not only if you lead people, but if you are interested in making society a better place (this should be everyone!).

KEY TAKEWAY: Can empathy be taught? Jamil Zaki in The War for Kindness argues that it can be. The implications in healthcare mean that our team members would benefit from a culture that has built in systems to train people on demonstrating empathetic concern for patients. This is a must-read book.

The War for Kindness is available for purchase on Amazon for $27.00 (does not include Prime discount).

If you work with people, work on culture

/ Jonathan Sachs

In my current role as a patient experience leader for a health care system, a large part of my focus is on culture. If you are already familiar with this blog, you have already seen me discuss culture a lot in the context of leadership and in book reviews. I talk so much about culture because it is what makes systems and processes work reliably and without constant auditing.

For years, I have been working to put the pieces together in terms of how to build culture. Using ideas from authors like Simon Sinek, Malcolm Gladwell, Joseph Michelli, and Adam Grant (to name a few), I have created my own definition of leadership and have advocated for articulating a vision and creating systems and processes to bring that vision to life. However putting the pieces together both from research and experience, has at times has felt like a struggle.

Culture CodeThen along comes Daniel Coyle, author of the best-selling book The Culture Code. In this book, Coyle has compiled a clear and well explained definition around the common characteristics of organizations with exceptional cultures that lead to consistently excellent outcomes. Using examples from organizations like Pixar, the San Antonio Spurs, the famous Upright Citizens Brigade improv group, and Navy SEALs, Coyle shows us what these organizations do differently that allows them to deliver results for the enterprise and its people.

The three over-arching characteristics that every group has in common are:

  1. Build Safety
  2. Share Vulnerability
  3. Establish Purpose

Under each of these simple two-word ideas are many different anecdotes, research studies, and case studies that show not only what these concepts mean, but what building them entails for leaders.

He also delves into the nuances of these concepts that may vary depending on the business. For example, in the book he compares organizations that build a culture for high service reliability (Union Square Hospitality Group – think Shake Shack) vs. creativity and innovation (Pixar).

Health care service delivery is an example of a setting where the culture must be built for high service reliability. Much of this work involves creating genuine connections with patients and their families, which helps determine how to meet their needs both including bridging the gaps in their understanding of their condition, the treatment, the workings of a hospital, and the health care system at-large.

Coyle covers the impact of empathizing with the patients in order to the increase their health outcomes and covers how to create an environment for the staff that promotes empathic behavior.

In the book, Coyle discusses a Harvard neurologist named Marci who researched the impact of listening in the medical setting. She studied non-western healers who used methods that were scientifically questionable, yet found that some practitioners had remarkable results.

To explain these outcomes, she says, “What these healers all had in common was that they were brilliant listeners. They would sit down, take a long patient history, and really get to know their patients…They were all incredibly empathic people who were really good at connecting with people and forming trusting bonds. So that’s when I realized that the interesting part wasn’t the healing but the listening and the relationship being formed. That’s what we needed to study” (Coyle p.154).

In health care, we tend to think of communication as “provider to patient”, with the patient simply answering the provider’s questions. As I take a few steps back think about it, wouldn’t someone want to feel known as a person, and not just by a diagnosis? Just listening to the patient gives the provider an opportunity to create that relationship.

Culture in the health care setting, because of the nature of the work at times being life-or-death, is especially important. Guides like The Culture Code help us build those cultures in a safe and sustainable way.

KEY TAKEAWAY: The best companies are deliberate about building their cultures. In health care, specifically, culture can deliver superior patient outcomes if there’s a focus on the caregivers and seeing the patient as a person, rather than a diagnosis.

The Culture Code is available for purchase on Amazon for $28.00 (does not include Prime discount)

Book Review: Be our Guest

/ Jonathan Sachs

Disney is known for excellence in customer experience at their parks, hotels, and on their cruise ships. The company formed The Disney Institute so that other companies could learn from Disney’s approach. While a Disney Institute summit may set you back over $4,000, a lot can still be learned from its considerably more affordable book, Be Our Guest: Perfecting the Art of Customer Service.

beourguestLike Starbucks and The Ritz Carlton, Disney has a well-defined, self-reinforcing, and rigorous system for customer experience. Disney’s “magic” is delivered through its organizational knowledge of guest psychographics combined with demographics (Disney calls it “Guestology”), its simplicity, and the complete integration and alignment of its system. Disney’s core purpose (like a vision statement) is defined as “We create happiness by providing the finest in entertainment for people of all ages everywhere”.

Guestology

Disney invests time, talent, and treasure in its efforts to not only know who are their guests (demographics), but also what their guests expect and want to feel (psychographics). While demographics are important and relatively easy to access through existing systems, psychographics are even more vital to delivering a superior customer experience.

Disney looks at the mental states of its customers by evaluating all of the parts of their experience through 4 dimensions: Needs, wants, stereotypes, and emotions.

Applying this principle to another business, like in an urgent care, for example, this matrix would resemble something like this:

Screen Shot 2019-02-05 at 11.07.44 AM

This analysis is a helpful tool to get a chance to match your service offerings to the perceptions and emotional states of your customers. Disney implements processes to respond to its guests’ emotions throughout their parks and resorts. For example, Disney was the first to entertain guests who are waiting in long lines to help them be less bored and pass the time quicker. Since guest needs, wants, stereotypes, and emotions can change over time, Disney revisits this framework often to match their systems to guest expectations.

The lesson here is that knowing your customer, not just who they are but what they expect and why they expect it, is an essential component of building a superior and lasting customer experience. Another essential component is making sure your system for responding to these factors is actionable by the employees (Disney calls them “cast members”) who are expected to bring it to life. This is accomplished, in part, through simplicity.

Simplicity

Disney’s customer service system has only two components:

  • The Four Quality Standards
    • Safety
    • Courtesy
    • Show
    • Efficiency
  • Three Delivery Systems
    • Cast
    • Setting
    • Process

The four quality standards are listed in order of importance, giving cast members an idea around prioritization. These standards are deployed up and down the organization and are reinforced through constant training and coaching. To build a culture around the two components, Disney uses its own language to refer to customers, employees, and attractions. Further, cast members are given guidelines, not scripts, for them to use to deliver consistent service to guests.

Part of the art of the four quality standards and the three delivery systems are what Disney calls, “Think globally, perform locally”. Doing so allows individual hotels or resorts to integrate their own flavor and uniqueness into Disney’s approach to service delivery. Disney empowers its cast members by soliciting their feedback as well as recognizing and rewarding performance.

Disney’s cast can also then focus on the three delivery systems, including seeing themselves as a part of a larger whole and responsible for themselves as well as the setting and process. That is also where integration and alignment become important.

Integration and Alignment

The Disney Institute defines integration as, “the work of aligning and distributing your service stands over the three delivery systems of cast, setting, and process” (p. 185). Integration is a way to, “build a service organization greater than the sum of its parts” (p. 185).

Disney has built-in accountability to its components of service through its emphasis on integration. It ensures that Disney is staying true to its core purpose by making sure that its cast, setting, and processes are always accounted for in everything they do. It also makes sure that the three delivery systems are developed with the customer needs, wants, stereotypes, and emotions of the guest in mind.

To make Disney’s guest experience consistent and reliable, the leadership is committed to this model and includes new initiatives through the lens of integration to provide context for staff at all times. At other companies, initiatives often appear disparate and unrelated due to the lack of context. By using an integrated model like Disney’s, companies can usually avoid this type of cognitive dissonance.

Conclusion

Healthcare organizations can learn a lot from Disney and many have worked with the Disney Institute or read books like If Disney Ran Your Hospital. In order to successfully follow the ways of Disney, the leadership of the organization needs to agree to an aligned model that they will always use as context.

KEY TAKEAWAY: Learning about your customers, developing a simple system for delivering to their expectations, and creating integration and alignment around those elements is how Disney creates its “Magic”. Doing it in your organization requires the same level of intentionality and discipline.

Be our Guest is available for purchase on Amazon for $24.99 (does not include Prime discount)

The Difference Between Ideology and Core Values

/ Jonathan Sachs / 1 Comment

ideologycorevalue

I sit in a lot of meetings, read a lot of books, and spend time on social media platforms like twitter to get my daily news. Through these mediums, I have found that there is a difference between ideology and core values that are seldom understood and often confused with one another. The goal of this post is to clarify the difference and provide examples.

Let’s start with core values. Core values are essential for leaders who are looking to make change in our world. They are general principles that guide a leaders conduct and decision-making. Core values inherently have humility and an understanding that issues are rarely “black or white”. In other words, core values are an approach to issues and are designed to be applied to any situation as a guide.

For example, let us say that one of your core values is to put the employees interest first. You can use this core value as a lens to guide your thinking and decide between a variety of options. If the company is facing a down quarter, do you consider layoffs, dip into a rainy day fund, or borrow money? If your core value is people first, you may consider the second and third option more seriously. However, your values may say that the company is over staffed and the long-term interest of its employees rests on laying off unneeded positions that are weighing the company down.

Regardless of the ultimate decision in this example, core values allow leaders to make decisions within a context that they have previously, pre-crisis, identified as important.

Core values allows a leader to navigate issues in a prioritized way, considering nuances and thinking deeply.

Leaders with an ideology are often confused with having core values but that is not correct – one does not necessarily correlate with the other. An ideology is a set of rigid beliefs that can limit options and constrict decision making into the small box of dogma.

Unfortunately, some of the best examples of ideology are seen in politics and often tied to identity. For example, partisans (Democrats and Republicans) often accept the party line and promulgate it, sharing distributed talking points on social media. At times, if a political opponent proposes a good idea, it is immediately spun and rejected, if a political ally proposes a bad idea, it is welcomed and elevated. If an idea from any source, even a good one, falls outside the acceptable ideology it is ridiculed and rejected.

Dr. Frances Lee from the University of Maryland discusses the issues with ideology and partisanship in its impact on the US Presidency. In her research, she finds that often the members of Congress not in the President’s party oppose any proposal by the President simply because giving the President a “win” would hurt them politically.

However, if they were guided by core values, and not ideology, perhaps Congress would be better able to put together workable plans to address some of our country’s greatest needs. Being guided by core values would allow legislators to guided by principles that indicate where compromise is acceptable and allow for creativity and consideration of many options, rather than dismissing trade-offs completely. Ideology does not allow compromise because it is understood as morally superior.

The concept reaches far beyond the world of politics. In business, leaders can also get stuck on an ideology. Sticking to a business model as the environment and technology change is its own form of run-away ideology. Blockbuster and Kodak come to minds as example companies that couldn’t adapt because of how much they believed in their business model.

The world is increasingly complicated. Limiting a decision to an ideology oversimplifies complexity and can create tribal politics in organizations or groups. Core values embrace complexity, allow for explanation, and maintains proactivity.

What are your core values? How do they play out in your work? In how you treat others? In how you approach difficult decisions?

Please let me know so that we can continue the discussion!

KEY TAKEAWAY: Core values are essential for leaders to aid in navigating tough decisions proactively. Ideology can be dangerous in limiting decisions to pre-conceived notions and dogmas. How do you define your core values and how do they help you set priorities and make decisions?