Accountability

Make life bigger than “Yes” versus “No”

by amiel · Aug 20, 2014

Many people want you to stop saying “Yes” to everything. It’s overloading your life, sapping your energy, and keeping you from doing the meaningful stuff. Jeff Goins calls this “the small but soul-crushing word you use every day.”

Their solution? Say “No.”

This recommendation isn’t wrong, just incomplete. What it leaves out are two other legitimate responses to requests. By incorporating these into your repertoire, you not only free yourself from overscheduling. You also live a bigger life.

But first…

The virtues of saying “No”

Let’s give “No” its due. If you’re the kind of person who agrees to everything, making more frequent use of “No” helps you: [Read more…] about Make life bigger than “Yes” versus “No”

$10K Phrases: “Help Me Understand”

by amiel · Aug 6, 2014

One of my favorite $10,000 phrases is “help me understand.” In this post, I describe why this phrase produces powerful leadership conversations, when to use it, and how to incorporate it into your day-to-day communication.

Why say “help me understand”

This phrase has three important purposes: [Read more…] about $10K Phrases: “Help Me Understand”

Prof. Samuel Cuthbert’s take-down of the performance review

by amiel · Jan 6, 2014

In an excellent interview with Mark Graban, Professor Samuel Cuthbert of UCLA has this to say about the performance review:

Performance reviews, in my mind, are a dishonest, fraudulent practice carried out and justified on grounds I have no idea, they never hold any water and they work against everybody.

It sounds at first like hyperbole…that is, until you realize that he has been studying this the performance review for decades and has quite a case to make. Here is my summary: [Read more…] about Prof. Samuel Cuthbert’s take-down of the performance review

Unpacking the HealthCare.gov crash

by amiel · Dec 17, 2013

On November 22, the New York Times ran a long article detailing the organizational and managerial problems behind the crash of HealthCare.gov. Art Kleiner, editor-in-chief of strategy+business, calls this “one of the most important articles on management this year.” I agree. Kleiner goes on to suggest that the Affordable Care Act (ACA) is a test case for the idea that the private sector needs effective government, and that the way to get effective government is to free it to learn and reform. In short, let’s demand and support effective management in our public sector agencies.

What exactly does it mean to manage effectively in the public sector? And how do you produce accountability? In recent posts on this blog, I’ve begun introducing the practices of promise-based management, like making effective requests and reliable promises. The recent experience of HealthCare.gov as described by the Times presents a brilliant opportunity to illustrate these practices through a real-life example that everyone is talking about. Let’s give it a shot.

Knowing how long it would take to complete and test the software, the company’s officials and other vendors believed that it was impossible to open a fully functioning exchange on Oct. 1….Government officials, on the other hand, insisted that Oct. 1 was not negotiable.

Accountability and reliable promises, pt. 3

by amiel · Dec 16, 2013

Part 3 in a 3-part series

In part 1 and part 2 of this series, we used the example of nurses filling foam canisters in hospitals (to increase the odds of hand washing that protects patients from infection) to demonstrate what it takes to build accountability in an organization. Accountability requires promises, which in turn require effective requests (or offers) and acceptance of those requests. If the goal is for everyone involved to follow a similar process, i.e. standardized work, then it’s important that they all explicitly promise to do this. But what do you do if a nurse isn’t following standardized work? According to Mark Graban, the first thing to do is to ask why. He proposes asking the following about a surgeon who fails to follow “universal protocol” before a surgical case, but the same applies to nurses who fail to refill canisters.

We can ask:

Is it a case where the person CAN’T do the work properly?
- Do they not know how? This might be a systemic training problem. The individual can’t be held accountable for that.
- Does the person not have the right resources? Maybe they WANT to do it right, but they just can’t. Leadership needs to help eliminate those barriers.
Is it a case where the person WON’T do the work properly?
- Is the situation one where the person truly has a choice and they made a bad choice?

Accountability and reliable promises, pt. 2

by amiel · Dec 16, 2013

Part 2 in a 3-part series

Read part 1

What does it mean to have accountability? As we observed in an earlier post, piggybacking off of Mark Graban, if a hospital manager expect nurses to be responsible for filling foam canisters to increase the odds of hand washing to protect patients, there needs to be an explicit promise between that manager and the nurses. Such a promise requires both a clear request (or offer) and an acceptance. Promise = Request + Acceptance.

Now, what can we say about the components of an effective request or offer? Let’s make explicit what was partly implicit in the above example. An effective request or offer consists of the following:

Clear conditions for satisfaction. There needs to be a shared understanding of what it means to restock a canister.
Clear timeframe or deadline. What days and what times of day will the nurse restock the canister—or at least check to see if it needs restocking?
A specific speaker. What do we mean by this? If a vague pronouncement comes out from “management” about who is responsible for restocking the canisters, there is not a specific speaker. The nurse doesn’t have anybody to respond to (by accepting, declining, counter-offering, or promising to promise). Another way that a speaker can be “missing” is if a manager holds uncommunicated expectations; they want the nurses to refill the canisters, and maybe even mention it in passing, but never actually make a request.
A specific listener. On the other hand, let’s say a particular manager makes the request but communicates it vaguely to a full team of nurses. Now, we have a specific speaker but not a specific listener.
A shared “background of obviousness.” This is a fancy way of saying that when the manager says “restock the canisters in the middle hallway”, both the manager and the nurse understand which canisters these are and which hallway is the middle hallway.

Accountability and reliable promises, pt. 1

by amiel · Dec 13, 2013

Part 1 in a 3-part series

What do we mean by accountability? In a recent post, I suggested that it’s silly to hold someone responsible for fulfilling a promise when they never actually made a promise. After all, request + acceptance = promise.

Let’s connect this to an insightful take on the same question provided by Mark Graban of Lean Blog. He suggests that it’s unfair to hold accountable someone who isn’t responsible and quotes Deming’s advice to “fix the processes, not the people.”

Can we hold nurses and other staff accountable for not always following proper hand hygiene procedures when coming in and out of patient rooms?

Let’s say the foam canisters are empty outside a few rooms in a row (something I’ve seen recently). We can’t hold the nurses accountable. This is a system problem. “Writing up” or punishing the nurses would be counterproductive. We need to ask why the canisters are empty? Is there somebody to hold accountable for not restocking the canisters? Maybe not – what if it’s a bad process, where there’s no “standardized work” and no clear cut assignment of who refills the canisters (“everybody?”).

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