Saturday, November 22, 2008

The Power of Ideas

Our day-to-day lives are very little different before and after my father’s death. Because his hearing was poor enough that it wasn’t any longer possible to talk on the telephone, we never talked. He had stopped sending even his intermittent email communications a while back, so most of our communication was one-way: we sent him books or notes or email now and then. Looking back, we see that we’d tapered down in that area, too, probably because it yielded little response over so much time. We even had the feeling, leaving the last time that we visited him in early summer, that we might not ever see him again. All the same, the world feels different now than it did before we learned of his death.

Shea and I are watching all the seasons of House on DVDs. (My policy is that pretty much anything your 17-year old daughter will do with you, you should do.) Last night, one of the episodes showed House doing the childhood game of “I’ve got your nose” on a patient. My immediate reaction was “my father used to do that with me!” I hadn’t thought about that in years. Even a memory of that sort has a different texture after his death. I’m still trying to sort out the power of the idea that he was alive, just not in contact, compared to the reality of his death. They feel quite different, though I don't really have a handle on how or why.

Recent discussions about evidence-based medicine and error-reduction in health care have me thinking about the other error-reduction and evidence-based literatures. David and I had an interesting discussion about error reduction in aviation (hugely successful, with some elements, like checklists, slowly being adopted in healthcare) stemming from an idle musing on my part about why airlines don’t seem to value teams of people experienced with working together. All airline employees bid individually on schedules and routes, so most (I think) rarely work with the same people. David pointed out that the premise behind airline training, at least for pilots, is that it has to be error-free, no matter who is in the cockpit. That makes sense, I guess. On the other hand, there is still something about working with people you know and trust and have gone through experiences together that seems valuable to me.

The evidence-based management literature focuses on the critical need to get and base decisions on real facts, not beliefs or what-we’ve-always-done practices. Reading that literature, one of the main lessons I draw from it is the importance of people to organizations. Here’s a quote from Jeffrey Pfeffer’s congressional testimony on this topic—an easy read and worth the time:

Although the list of high commitment or high performance work practices differs slightly among authors and studies, most such lists include: a) sustained investment in training and development, including job rotation, both formal and on-the-job training, and a tendency to promote from within as a consequence of the successful internal development of skill and people; b) an egalitarian culture in which formal status distinctions are downplayed, salary differences across levels are less than in the general economy, and in which people feel as if their contributions are important and valued; c) delegation of decision making responsibility so that skilled and developed people can actually use their gifts and skills to make real decisions; d) high pay to reduce turnover and attract the best people, coupled with rewards that share organizational success with its members; and e) employment security and a policy of mutual commitment, so that the workforce does not fear for the outcomes of events over which it has no control and instead, feels reciprocally committed to the employer.

It is important to note, however, that these management practices are not "techniques" to be imported. As David Russo, the former head of human resources at SAS Institute once commented, what matters is not what the company does -- its various programs and policies -- but the philosophy that provides foundation for all of its choices. That philosophy is one of valuing the workforce, treating it with respect and dignity, and making people as if their jobs are meaningful and their contributions important. [emphasis added]

As Kearney commented about the emphasis on training all health care staff always to deal with identity first, how sad that current concepts of quality health care seem mutually exclusive with common courtesy and humanity. Why is it so hard to find a sensible middle ground?

Bob Sutton has some fascinating comments today on a bailout for the automakers, including his experiences with the management culture at GM:

What ideas occupy your thoughts?

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