Great Governance, Great Decisions

Effective GovernancePeople know great governance, even when they don’t have words to describe it.  Great decisions pass our sniff test.  But, organizations get into big trouble when governance stinks.  Glen Tecker, governance consultant, has helped over 2000 companies put words to corporate frustration and find better ways of working.  I wrote about a presentation he gave before.  Here are some highlights from a recent one.

Good Governance: Difference between Oversight, Supervision, and ‘Snoopervision’

Oversight concerns itself with what and whether we accomplish what we wanted.

Supervision concerns itself with what and how work is accomplished.

Snoopervision concerns itself with what, how, and who does what, which leads to ‘administrivia’.

Corporations need to ask:

What do we want to accomplish?

What sort of organization is required?

What resources do we need?

Governance Requires Clarity of purpose:

Consider a curling team.  What happens if everyone thinks the stone should land somewhere different?  Desired outcomes are impossible without clarity on what we need to do, what’s required to do it, and how we will get the job done.  The parts of a rocket must all pull together.  What happens if pieces decided on their own where they wanted to go?

Organizations need to decide whether they will fund:

A group

An activity

An outcome

If we fund groups, we need organizational charts.

If we fund activities, we need series of business lines.  We need to know about programs and business lines within the organization.

If we want outcomes, we need clarity on outcomes, first.  We must have clear, measurable goals, and a definite picture of what we don’t like about the current state before we can work at achieving an outcome.

Stakeholder needs, wants and preferences determine what we hope to accomplish.

We make decisions using available information, not timely, accurate, or relevant information.

Available information comes from experience, reading, and conversations.

Assumption becomes surrogate for truth; assumption based on available information.

Where does your mental model, for what a governance unit, or person, should be doing, come from?  Does your mental model fit with the current issue?

Form follows function and Function follows purpose.

How do you define Fairness:  everyone gets the same vs. everyone gets what they need?

Culture + process + structure feeds into governance.  Governance itself is authority, process, and capacity

Levels of engagement in decision-making:

  • A – decision
  • B – involved
  • C – consulted
  • D – informed
  • E – no involved

From Building Better Boards, by David Nadler, 2004 HBR

 

We Serve Patients Because It Is Hard

moon speechIt’s easy to talk about customer service when patents are nice. Our real motivation surfaces when patients demand narcotics, CT scans, or useless antibiotics.  Patient threats, intimidation, and entitlement wear down the fiercest advocates of patient service.

Unless we commit to great service for our toughest customers, we will start to question whether any patients deserve our attention.

In the 1960’s race to the moon, John F. Kennedy said,

“We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Why bother?

1. Patients matter.

Nurses and doctors entered training to help patients.  Nearly 100 years ago, Peabody complained that new physicians relied too much on science and had lost “an interest in humanity”.  It’s been said recently that medicine has become “far more interested in diseases than the people who suffer from them” (A. Miles, 2009). Cassell’s classic book on medicine advocates for ‘person centred care’. “The Nature of Suffering and the Goals of Medicine (Oxford University Press, 1991, 2004).

2.  Great service improves outcomes.

Waiting kills patients; over 400 articles demonstrate increased morbidity and mortality from waiting, just in the ED.  Qualitative aspects of service are harder to measure, but things like patients’ trust in their providers improves outcomes, too.  Trust requires great patient service.

3. Medico legal claims drop.

Long waits increase the chance of being sued. Again, waits get reported because they can be measured more easily than qualitative experience.  Virgin media found customers more satisfied with polite service that didn’t fix a problem than rude service that did.

Expectations

Some of us entered medicine thinking we would be textbooks of physiology, that we would have respect, and have grateful patients.  Instead, we trained in a field with ineradicable uncertainty, a society that leans toward general disrespect for all kinds of title and authority, and patients we often cannot help.

We choose to care for patients, not because it is easy, but because it is hard…

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(photo credit: rice.news.edu)

IF AIR TRAVEL WORKED LIKE HEALTH CARE – YouTube

While many fume at comparisons between air travel and healthcare, I think you’ll enjoy this video.  It makes technology out to be the problem, and its American perspective shows through, but the core message rings true.  Healthcare puts healthcare before patients.

My only major disagreement with the video relates to the lack of anger from the system…  Share what you think in the comments below!

IF AIR TRAVEL WORKED LIKE HEALTH CARE – YouTube.

 

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Thanks for watching!

Shawn