Your Clinic Huddle Is Lying to You... Here’s What It Hides

WEBVTT

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All right, let's do it.

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All right,

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most healthcare organizations think they

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have a communication problem.

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Larry here thinks they have an information

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problem because the people closest to the

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work, well, they know what's happening.

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Leadership might not just be hearing about

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it.

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In his latest article on the operator,

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Larry brings forth that most healthcare

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huddles have become broadcasts.

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theater or what he calls a metrics huddle,

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where the venue that was supposed to be

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the platform's eyes and ears has become

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just a daily reminder to hit budget.

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And when that happens,

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the platform learns none of it.

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So Larry, let's start there.

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What is a huddle actually supposed to do?

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What is a huddle supposed to do?

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A huddle is absolutely supposed to,

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it's easier, actually,

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let me back up a little bit by

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saying

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Organizations don't really have this sort

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of communication problem.

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As you said,

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they have an information problem.

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I'd like to start out with what is

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the fundamental difference between those

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two.

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A communication problem is when the

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message doesn't get through.

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An information problem is when the message

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that is needed to get through never even

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makes it to the room,

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never even makes it to the thought that

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I should be communicating this.

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We have too much data,

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not enough information.

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We have too much information,

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not enough communication.

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Most healthcare platforms communicate

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constantly.

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Email, Slack, Teams, channels, dashboards,

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monthly all hands, weekly newsletters.

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There's no shortage of talking happening.

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What is missing is the small,

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really what I would say hard,

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specific information that lives on the

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clinical floor.

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The chair that's been broken for eleven

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days,

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the new hygienist who feels like she's

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bothering someone every time she asks,

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the senior clinician who has been quietly

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looking for job postings since February,

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nobody knows that they might be a flight

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risk.

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That information doesn't move through

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email, Slack and channels.

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It moves through trust, through proximity,

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through a venue where it's safe to raise

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what we call psychological safety.

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If the venue does not exist or people

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don't feel safe,

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it sits on the floor and the platform

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obviously doesn't see it.

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So you can have crisp communication

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and zero information they're not the same

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thing and we get in troubles when we

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conflate the two so the huddle is the

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venue specifically not to get to your key

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question the huddle is the venue

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specifically designed to surface that

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information that's its purpose when it

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works you have both communication going

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down information going up when it doesn't

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you have a lot of well-designed slide

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decks and data describing a reality that

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the leadership team fortunately doesn't

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really even see

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In the article you opened with this line,

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I even made a note about it,

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the meeting happened, the huddle did not.

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How can two organizations really run the

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same exact meeting,

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yet one learns something valuable and the

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other learns nothing?

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Yeah, well,

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because the meeting is the visible,

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you know, ten percent,

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the other ninety percent is the system

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around it.

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So two huddles can look identical from

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across the room, same time, same people,

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same checklist, same length.

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The difference is what's happened in

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eighteen months leading up to that point.

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So I've been through huddles.

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I've been to a lot of daily huddles

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when I visit locations,

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whether it be a PT clinic,

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a dental clinic, primary care clinic,

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occupational health, you name it.

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The huddles oftentimes will have that same

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checklist.

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And it is whether or not you're just

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checking the box,

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whether or not you're having meaningful

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conversation.

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In the organization that learned

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something,

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the floor was watched over and over what

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happens when they raise a hard issue.

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So issues get sort of logged,

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owners get signed, but by Wednesday,

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the chaos is either fixed or it's

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replaced.

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By Friday,

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somebody walks to the back of the clinic

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and says, we got this done.

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That's a system that's earned the right

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information from its floor it's actually

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resulted in actions that are measurable

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and held accountable in the organizations

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that learn nothing the floor has watched

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the opposite happen issues get raised

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issues get parked nothing happens by the

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third or fourth time when that happens the

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floor has decided without anybody

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announcing it that the huddle is not the

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right venue to tell you things that are

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really worth telling you they just show up

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and they check the box

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And then they go back to seeing patients.

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So the meeting still happens,

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but the huddle is dead.

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It's just, yeah,

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did we do a huddle today?

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Yeah, in fact, we certainly did.

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But it didn't serve any real purpose.

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And so the difference between those

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organization was not the meeting.

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Both organizations had the meeting.

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The difference are not what surfaced in

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that meeting reliable.

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reliably catches someone who enacts on it

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you know there's a psychological term

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called habituation we get used to things

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we get desensitized to things over time

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that are rote and what you have to

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have is you have to have a meeting

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czar somebody that's frequently like

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what's the purpose here are we really

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surfacing issues that's going on in here

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and maybe that meetings are changes every

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couple months or every quarter or whatever

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but you have to have somebody who keeps

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meeting accountability otherwise it

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becomes rote habituated and accomplishes

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effectively nothing

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Yeah.

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To go back to sort of making sure

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we know your terms,

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most people think a huddle exists to

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communicate information.

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But in the top of the show,

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in the article,

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that feels more like a broadcast or

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performance theater.

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You argue that it exists to gather

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information, uncovering things,

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a place that leadership might not have

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visibility.

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So how would you,

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if someone was starting tomorrow in

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leadership,

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how would you describe to them, hey,

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this is what a huddle is actually supposed

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to do so you know what it needs

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to achieve while you're in it,

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what the goal is?

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Yeah, that's right.

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And again,

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you have to go for what is the

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purpose of the meetings.

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And so there are meetings where you're

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meant to broadcast information and

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headlines and updates,

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those kinds of things.

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But a huddle is not a broadcast.

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It is a sensor.

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So if you really think about it and

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you trace this historically,

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I think it was around the nineteen forties

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that Toyota really,

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really perfected all this.

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And by the way,

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the guy's name really was Toyota.

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It was just spelled a little bit

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differently than I think the car is.

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And he built it as a daily stand

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up on the manufacturing floor designed for

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one problems,

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surface problems that are small and

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fixable when they're cheap.

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Right.

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Health care.

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Imported this practice in the early two

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thousands after the Institute of medicine

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to air is human report.

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That was kind of a famous report and

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HQR formalized it into the team steps

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documented this results from across

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multiple settings, fewer medical errors,

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fewer near misses and fewer adverse

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events.

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So basically we took manufacturing this on

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darn cord where something goes bad.

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We got to fix it right before bigger

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problems happen later.

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We imported into medicine and it was

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effective.

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And it was effective because the mechanism

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was not the meeting.

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The meeting was the upper flow of weak

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signals,

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something we can notice is out of source

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when it's small and weak and closest to

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the problem really reporting it.

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before those signals become events.

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One of the meetings I absolutely hate in

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any organization is when you have an

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operational meeting and those that aren't

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closest to the report are reporting the

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meeting.

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So the way that manifests itself like a

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large physical therapy or healthcare

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organization or dental organization,

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you don't have the local operators,

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regional directors,

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regional business partners,

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whatever you call them,

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And the practice managers in those

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meetings, you have their direct reports.

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So think of the information flow.

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You're having direct reports of direct

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reports trying to relay information.

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And when all that things start to happen,

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it just doesn't work.

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And so that's why you have these huddles

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at the most local level where information

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could flow up.

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You know,

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the tow factory floor and the operating

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room,

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have one thing in common,

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silence is never the absence of any kind

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of issue.

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It's almost always the presence of a

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system that has trained people closest to

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keep quiet.

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You want people closest to speak.

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In the Toyota world,

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they had an on-down cord that they

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actually pulled the cord because they were

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so scared to speak.

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think of that same mechanism,

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but get people to talk and in small

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huddles, if you do in a, you know,

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psychological safety, you know,

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correctly enough and you emphasize it

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becomes cultural, people will speak.

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Yeah.

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Well,

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I think that's one of the strongest ideas

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in the article is that, as you said,

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the people closest to the work actually

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know what's going on.

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They understand why a broken chair

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matters.

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They understand why being down one person

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matters.

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The platform might just never hear about

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it because we're sort of playing that game

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from third grade, telephone.

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By the time it gets transmitted,

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you've lost some meaning.

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So what kinds of problems are frontline

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employees seeing every day that maybe

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through that telephone game that

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leadership might miss?

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Yeah, I like to call them patterns,

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not events.

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So the dashboard,

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back to the KPI and the metrics,

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will tell you that Mrs.

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Jenkins didn't come in.

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It will not tell you that the front

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desk has now had to apologize two or

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three times about the same scheduling

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glitch that took place in the EMR,

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the scheduling system.

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The dashboard will tell you production was

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down four percent in a region.

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or no-show cancellation was up,

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but it will not tell you, for example,

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in a dental world that the hygienist,

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you know, with twelve years of tenure,

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spent her lunch yesterday updating her

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resume and left, right?

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The floor sees things that metrics,

00:09:52.214 --> 00:09:53.554
that precede metrics.

00:09:53.615 --> 00:09:55.296
They're like leading indicators.

00:09:55.316 --> 00:09:58.418
They see the patient coordinator who's one

00:09:58.477 --> 00:10:00.759
bad week away from quitting because we

00:10:00.798 --> 00:10:02.759
keep superimposing and creating more

00:10:02.799 --> 00:10:04.480
responsibilities to the patient

00:10:04.520 --> 00:10:04.961
coordinator.

00:10:05.940 --> 00:10:07.402
They see the chair in the op,

00:10:07.442 --> 00:10:07.601
you know,

00:10:07.621 --> 00:10:09.625
in the op three department area that has

00:10:09.644 --> 00:10:11.706
been broken for eleven days and now

00:10:11.726 --> 00:10:13.649
affecting two clinician schedules because

00:10:13.708 --> 00:10:15.250
nobody's taking the time to get it fixed

00:10:15.270 --> 00:10:17.673
because nobody has escalated it well

00:10:17.714 --> 00:10:18.014
enough.

00:10:18.033 --> 00:10:19.635
They see a new dentist who's really,

00:10:19.676 --> 00:10:20.256
really good,

00:10:20.657 --> 00:10:22.599
but culturally just not fitting in.

00:10:23.360 --> 00:10:25.182
They see supply and ordering and it

00:10:25.221 --> 00:10:25.542
happened.

00:10:25.562 --> 00:10:26.743
This is where I see a lot of

00:10:26.763 --> 00:10:28.384
this stuff happening and all this stuff

00:10:28.404 --> 00:10:29.985
gets mad and everybody then gets mad at

00:10:30.025 --> 00:10:30.706
procurement.

00:10:31.106 --> 00:10:32.629
And procurement's not the problem.

00:10:32.708 --> 00:10:34.431
It's the problem occurring at the front

00:10:34.490 --> 00:10:36.231
and it's never surfaced.

00:10:37.192 --> 00:10:38.313
None of that stuff, Jimmy,

00:10:38.354 --> 00:10:39.414
is on a dashboard.

00:10:39.495 --> 00:10:40.976
And if it is,

00:10:41.037 --> 00:10:42.839
it's six months from now and it manifests

00:10:42.879 --> 00:10:44.559
itself downstream in the form of a

00:10:44.620 --> 00:10:45.000
problem.

00:10:45.888 --> 00:10:48.609
The thing the floor has that no other

00:10:48.668 --> 00:10:51.370
layer in the platform has is the time

00:10:53.150 --> 00:10:54.392
spent next to the work.

00:10:54.471 --> 00:10:55.491
It is right there.

00:10:55.532 --> 00:10:56.513
Six hours a day,

00:10:56.533 --> 00:10:57.993
eight hours a day in the same place,

00:10:58.033 --> 00:10:59.374
watching the same patterns,

00:10:59.453 --> 00:11:01.235
noting the same things going slightly

00:11:01.254 --> 00:11:01.575
wrong.

00:11:02.936 --> 00:11:04.658
And anybody, you know,

00:11:05.099 --> 00:11:06.880
you got to have things go wrong before

00:11:06.921 --> 00:11:07.782
anybody could see it.

00:11:08.503 --> 00:11:10.085
So you can't get that information in the

00:11:10.125 --> 00:11:12.307
room with people who act on it.

00:11:12.368 --> 00:11:13.769
If you're not getting that information,

00:11:13.809 --> 00:11:15.030
you're operating blind.

00:11:15.191 --> 00:11:16.673
So I view those things, again,

00:11:16.712 --> 00:11:19.297
as patterns, not events.

00:11:20.562 --> 00:11:22.344
Well, if the meeting goes well,

00:11:22.403 --> 00:11:23.946
it should be quiet, right?

00:11:24.105 --> 00:11:24.806
No problems.

00:11:24.865 --> 00:11:26.988
But you say that silence is almost never

00:11:27.347 --> 00:11:28.788
the absence of issues.

00:11:28.849 --> 00:11:30.551
It's usually evidence of a system that has

00:11:30.591 --> 00:11:32.292
trained people not to speak,

00:11:32.331 --> 00:11:35.533
to have that psychological, that fear of,

00:11:35.995 --> 00:11:37.836
I don't know if this reaches the threshold

00:11:37.895 --> 00:11:39.576
of being worthy of being brought up in

00:11:39.657 --> 00:11:40.357
a sacred meeting.

00:11:40.758 --> 00:11:41.600
So how's that happen?

00:11:41.620 --> 00:11:42.982
Because I don't think many leaders wake up

00:11:43.043 --> 00:11:46.210
trying to create that type of environment,

00:11:46.250 --> 00:11:46.429
right?

00:11:46.450 --> 00:11:47.852
We always hear from leaders,

00:11:47.873 --> 00:11:49.054
I've got an open door policy.

00:11:49.917 --> 00:11:50.618
So how's it happen?

00:11:51.163 --> 00:11:52.725
Yeah, it's an unintended consequence.

00:11:52.745 --> 00:11:53.384
You're absolutely right.

00:11:53.404 --> 00:11:54.846
It's an unintended consequence.

00:11:55.706 --> 00:11:56.886
Nobody decides to build it,

00:11:56.907 --> 00:11:58.067
it just accretes.

00:11:58.847 --> 00:12:00.369
And I think it happens in sort of

00:12:00.548 --> 00:12:01.428
small moments,

00:12:01.688 --> 00:12:03.990
none of which happen in isolation.

00:12:04.169 --> 00:12:05.730
The first time somebody on the floor

00:12:05.770 --> 00:12:09.092
raises a real issue and gets the, oh,

00:12:09.273 --> 00:12:11.274
let's discuss that offline with no

00:12:11.313 --> 00:12:11.793
follow-up.

00:12:12.274 --> 00:12:15.076
Let's take that offline as a classic one.

00:12:15.854 --> 00:12:17.674
The first time a regional person rolls

00:12:17.695 --> 00:12:19.816
their eyes at a suggestion,

00:12:19.875 --> 00:12:21.096
somebody makes a suggestion,

00:12:21.116 --> 00:12:23.097
the feedback is the eye rolling,

00:12:23.217 --> 00:12:24.239
like you're a little kid.

00:12:25.078 --> 00:12:27.039
The first time an assistant brings up a

00:12:27.100 --> 00:12:28.640
safety concern, somebody says,

00:12:28.681 --> 00:12:30.081
let's not get into that right now.

00:12:30.101 --> 00:12:30.863
Let's just defer.

00:12:31.462 --> 00:12:32.543
We got too much going on.

00:12:32.562 --> 00:12:33.403
That's a bigger issue.

00:12:33.423 --> 00:12:34.865
We need to discuss that separately.

00:12:35.424 --> 00:12:35.585
You know,

00:12:35.605 --> 00:12:37.687
the first time a COO visits a clinic

00:12:37.708 --> 00:12:40.331
and the team is told to clean up

00:12:40.371 --> 00:12:42.956
the room before he or she arrives, right?

00:12:43.155 --> 00:12:44.999
Oh, we know Larry's showing up today,

00:12:45.038 --> 00:12:46.701
so let's make sure everything looks good.

00:12:46.861 --> 00:12:49.424
And you know, those are symptoms.

00:12:50.422 --> 00:12:51.923
Again, single moments.

00:12:52.063 --> 00:12:54.826
Each one of those teaches sort of this

00:12:54.866 --> 00:12:55.647
small lesson.

00:12:56.268 --> 00:12:57.109
But by month three,

00:12:57.149 --> 00:12:59.792
the lessons accumulate into a normalized

00:12:59.831 --> 00:13:01.493
behavior in an operating environment.

00:13:01.533 --> 00:13:03.534
By month six, the rule is invisible,

00:13:03.875 --> 00:13:04.777
internalized,

00:13:04.897 --> 00:13:06.197
and it doesn't get brought up.

00:13:06.818 --> 00:13:08.801
Interesting study done by a lady by the

00:13:08.821 --> 00:13:10.621
name of Amy Edmondson at Harvard.

00:13:11.488 --> 00:13:13.350
She did all this incredible research.

00:13:13.450 --> 00:13:14.471
I had to leave this out of the

00:13:14.530 --> 00:13:14.932
article.

00:13:15.731 --> 00:13:17.433
And she's the one who really termed all

00:13:17.474 --> 00:13:19.235
this, by the way, psychological safety.

00:13:19.275 --> 00:13:22.038
But the catastrophic finding that she came

00:13:22.099 --> 00:13:24.740
up with is that in environments where you

00:13:24.760 --> 00:13:26.582
do not have psychological safety,

00:13:27.923 --> 00:13:29.225
They don't reduce problems.

00:13:29.264 --> 00:13:31.265
They reduce the reporting of problems.

00:13:31.605 --> 00:13:32.506
So think about that.

00:13:33.206 --> 00:13:34.628
It's not the problem.

00:13:34.847 --> 00:13:36.067
It's the source of the problem.

00:13:36.087 --> 00:13:37.528
It's the lack of reporting it,

00:13:37.629 --> 00:13:38.690
how it surfaces.

00:13:38.990 --> 00:13:40.571
And when you have low psychological

00:13:40.610 --> 00:13:41.091
safety,

00:13:41.410 --> 00:13:44.451
you actually decrease the reporting of

00:13:44.491 --> 00:13:45.072
problems.

00:13:45.413 --> 00:13:47.594
What really good leaders have figured out

00:13:47.734 --> 00:13:49.534
is they're problem solvers and they want

00:13:49.615 --> 00:13:51.576
more and more and more reporting problems.

00:13:52.015 --> 00:13:53.216
of problems to happen.

00:13:53.256 --> 00:13:54.717
So you have to have a platform that's

00:13:54.758 --> 00:13:56.918
flying through clouds with instruments off

00:13:57.058 --> 00:13:58.879
when you don't believe there are problems.

00:13:58.899 --> 00:14:00.581
It's not that they're not problems,

00:14:00.600 --> 00:14:02.581
it's not that they're being reported.

00:14:04.043 --> 00:14:05.283
And there's a lot of time pressure and

00:14:05.303 --> 00:14:06.245
all the other kinds of things.

00:14:06.284 --> 00:14:07.846
But the good news is that the same

00:14:07.885 --> 00:14:09.787
dynamic actually works in reverse.

00:14:10.366 --> 00:14:12.628
Five months of visibly acting on every

00:14:12.687 --> 00:14:15.208
issue raised will build a floor's

00:14:15.408 --> 00:14:16.688
willingness to speak.

00:14:16.989 --> 00:14:17.928
It's not the magic,

00:14:17.969 --> 00:14:19.690
it's the patience and the follow through.

00:14:20.070 --> 00:14:21.691
It's just like what they found years ago

00:14:21.750 --> 00:14:25.091
in putting the alert system in a hospital

00:14:25.152 --> 00:14:25.471
bed.

00:14:26.211 --> 00:14:27.773
When they first started doing that,

00:14:27.812 --> 00:14:29.873
they were worried that the alerts would go

00:14:29.994 --> 00:14:30.734
off all the time.

00:14:30.754 --> 00:14:31.313
And you know what?

00:14:31.653 --> 00:14:32.293
They did.

00:14:32.774 --> 00:14:33.875
And each time they went off,

00:14:33.894 --> 00:14:35.056
a nurse would have to come in and

00:14:35.096 --> 00:14:35.855
respond to it.

00:14:35.895 --> 00:14:37.336
But over time,

00:14:37.537 --> 00:14:40.418
when you could preemptively solve problems

00:14:40.457 --> 00:14:41.418
and surface them,

00:14:41.898 --> 00:14:44.538
then the alerts started to get less and

00:14:44.558 --> 00:14:46.799
less frequent, and they served a very,

00:14:46.840 --> 00:14:48.020
very valid purpose.

00:14:48.400 --> 00:14:50.981
So early warning signs and on SCAR,

00:14:52.221 --> 00:14:53.302
all those things are really,

00:14:53.342 --> 00:14:54.163
really beneficial.

00:14:54.663 --> 00:14:55.604
Reward people.

00:14:56.183 --> 00:14:58.705
for reporting yeah yeah this reminds me of

00:14:58.725 --> 00:14:59.684
my dad told me a story he was

00:14:59.705 --> 00:15:01.466
a new york city fireman and after every

00:15:01.505 --> 00:15:03.927
big fire everybody would go get showered

00:15:03.947 --> 00:15:05.326
and come down to the kitchen and they

00:15:05.346 --> 00:15:06.668
would just go in a big circle and

00:15:06.807 --> 00:15:08.048
whether you were the guy who was there

00:15:08.087 --> 00:15:09.489
for thirty years or you're the guy that

00:15:09.509 --> 00:15:11.809
were there for the first thirty days what

00:15:11.830 --> 00:15:13.450
did you see what did you learn why

00:15:13.470 --> 00:15:14.610
did you do it what do you think

00:15:14.630 --> 00:15:15.850
we should do next time and they talked

00:15:15.870 --> 00:15:18.011
it out in public and there being open

00:15:18.032 --> 00:15:20.253
and honest was rewarded because lives run

00:15:20.273 --> 00:15:22.014
a lot absolutely absolutely

00:15:23.407 --> 00:15:24.447
So reading this article,

00:15:24.567 --> 00:15:25.827
I kept thinking it doesn't sound like a

00:15:25.868 --> 00:15:26.687
meeting problem then.

00:15:26.727 --> 00:15:27.889
It sounds like a leadership, right?

00:15:27.908 --> 00:15:29.448
This should be a reflection of leadership.

00:15:29.908 --> 00:15:32.990
So what's the difference between a manager

00:15:33.009 --> 00:15:36.010
who gets information and a leader that

00:15:36.051 --> 00:15:37.572
people are actually willing to tell the

00:15:37.631 --> 00:15:38.812
truth in front of?

00:15:38.831 --> 00:15:40.832
I'm going to guess it's absence of eye

00:15:40.873 --> 00:15:41.192
rolling.

00:15:41.212 --> 00:15:42.173
It's got to be on the list.

00:15:42.494 --> 00:15:43.313
A hundred percent.

00:15:43.614 --> 00:15:44.354
A manager,

00:15:44.394 --> 00:15:45.434
the way I look at it is a

00:15:45.495 --> 00:15:48.056
manager builds the venue,

00:15:48.775 --> 00:15:51.797
but a leader earns the audience, right?

00:15:52.253 --> 00:15:54.014
They are the heart and soul of the

00:15:54.095 --> 00:15:55.035
people side of it.

00:15:55.076 --> 00:15:57.359
The manager side of it is just studying

00:15:57.719 --> 00:15:59.761
the physical environment oftentimes.

00:16:00.743 --> 00:16:02.284
So the venue is necessary,

00:16:02.424 --> 00:16:03.466
but not sufficient.

00:16:03.505 --> 00:16:05.368
You can have a perfectly structured

00:16:05.408 --> 00:16:07.571
huddle, a perfect cadence to the meeting,

00:16:07.610 --> 00:16:08.932
the right people, the right prompt,

00:16:08.972 --> 00:16:09.813
the right cadence.

00:16:10.702 --> 00:16:12.663
run by a leader that nobody on the

00:16:12.683 --> 00:16:15.544
floor trusts and nothing ever real comes

00:16:15.605 --> 00:16:16.004
out of it.

00:16:16.605 --> 00:16:17.884
And the floor will smile,

00:16:17.904 --> 00:16:19.446
there's no concerns and everybody will

00:16:19.505 --> 00:16:20.765
kind of go back to work and it'll

00:16:20.785 --> 00:16:21.947
be a very quick huddle.

00:16:22.027 --> 00:16:23.706
And that's what happens over time if you

00:16:23.726 --> 00:16:25.827
don't do this thing appropriately is to

00:16:25.868 --> 00:16:26.368
become very,

00:16:26.388 --> 00:16:28.188
very short while nothing goes on.

00:16:28.229 --> 00:16:28.568
Let's just,

00:16:28.749 --> 00:16:31.190
you get positive reinforcement to end

00:16:32.070 --> 00:16:33.171
meetings way too quickly.

00:16:33.811 --> 00:16:36.052
But what earns trust is actually

00:16:37.972 --> 00:16:40.094
mechanical and somewhat unglamorous.

00:16:40.134 --> 00:16:41.674
It's the leader who gets the truth from

00:16:41.715 --> 00:16:43.995
the floor with the same set of habits

00:16:44.616 --> 00:16:45.136
every time.

00:16:45.177 --> 00:16:47.158
They show up consistently.

00:16:47.197 --> 00:16:49.179
They listen without interrupting.

00:16:49.200 --> 00:16:51.301
They are genuinely curious.

00:16:51.701 --> 00:16:53.322
When something hard surfaces,

00:16:53.361 --> 00:16:56.083
they're adult and they want to embrace

00:16:56.124 --> 00:16:56.264
them.

00:16:56.283 --> 00:16:57.544
They don't get reactive.

00:16:57.565 --> 00:16:58.625
They don't get defensive.

00:16:58.666 --> 00:17:00.527
They react with curiosity.

00:17:01.006 --> 00:17:02.568
They don't shoot the messenger.

00:17:02.948 --> 00:17:05.010
When they are wrong, they say so publicly.

00:17:05.090 --> 00:17:05.511
I was wrong.

00:17:05.571 --> 00:17:06.393
I should have listened to you.

00:17:06.413 --> 00:17:07.534
If I would have just held on,

00:17:07.574 --> 00:17:08.535
if I would have had a little more

00:17:08.595 --> 00:17:10.416
patience, I would have listened.

00:17:10.757 --> 00:17:13.039
This problem would never become a problem.

00:17:13.630 --> 00:17:15.230
that's what good leaders do and they also

00:17:15.290 --> 00:17:17.212
explain it none of this by the way

00:17:17.272 --> 00:17:20.715
is exotic right all this is uh all

00:17:20.736 --> 00:17:22.676
this is hard because the gravitational

00:17:22.738 --> 00:17:26.701
pull on a busy leader is to multitask

00:17:26.740 --> 00:17:29.262
it's to dismiss inconvenient information

00:17:29.303 --> 00:17:31.365
it's to defend it's to over compromise

00:17:31.384 --> 00:17:33.465
it's to try to be more efficient rather

00:17:33.486 --> 00:17:35.988
than to be effective but the leader who

00:17:36.028 --> 00:17:38.589
resists all of those instincts over and

00:17:38.671 --> 00:17:40.192
over in small moments

00:17:41.589 --> 00:17:43.592
accidentally builds an organization,

00:17:44.011 --> 00:17:47.295
which the truth reliably travels up.

00:17:47.474 --> 00:17:49.696
And overall they do truly have less

00:17:49.737 --> 00:17:50.198
problems.

00:17:51.018 --> 00:17:53.039
The manager who follows the playbook gets

00:17:53.079 --> 00:17:53.980
it right in the venue,

00:17:54.000 --> 00:17:55.122
but gets no information.

00:17:55.162 --> 00:17:58.084
The leader that builds the relationship

00:17:58.265 --> 00:17:59.285
gets the information,

00:17:59.345 --> 00:18:00.826
whether or not the venue is perfect.

00:18:00.866 --> 00:18:03.709
The leader is the relationship manager.

00:18:04.190 --> 00:18:05.550
If you want to know whether you're,

00:18:05.730 --> 00:18:06.692
you're one or the other,

00:18:07.574 --> 00:18:08.773
You really want to know what the litmus

00:18:08.814 --> 00:18:09.275
test is?

00:18:09.315 --> 00:18:10.835
Look at what's being raised to you.

00:18:11.275 --> 00:18:12.395
If it's all good news,

00:18:12.776 --> 00:18:14.816
polite questions and well-formulated

00:18:15.476 --> 00:18:17.156
updates, you're managing a venue.

00:18:17.576 --> 00:18:20.337
You're not leading anybody willing to risk

00:18:20.417 --> 00:18:22.278
telling you the hard thing.

00:18:22.298 --> 00:18:24.078
What I tell folks all the time is

00:18:24.558 --> 00:18:25.200
a good leader,

00:18:25.220 --> 00:18:26.680
and I would say this to a friend,

00:18:27.059 --> 00:18:29.381
a good friend is somebody who's willing to

00:18:29.441 --> 00:18:32.021
risk their friendship to tell you what

00:18:32.041 --> 00:18:32.701
they need to.

00:18:32.821 --> 00:18:34.461
And that takes a lot of trust and

00:18:34.481 --> 00:18:35.903
a lot of psychological safety.

00:18:35.942 --> 00:18:36.083
Yeah.

00:18:36.416 --> 00:18:37.397
You were sort of preempting my next

00:18:37.417 --> 00:18:37.637
question,

00:18:37.657 --> 00:18:38.598
which was going to be if someone's a

00:18:38.659 --> 00:18:40.519
CEO and they think their organization

00:18:40.559 --> 00:18:41.540
communicates well,

00:18:42.161 --> 00:18:43.521
what are the signs that they're actually

00:18:43.582 --> 00:18:44.923
operating with a false picture?

00:18:45.063 --> 00:18:46.664
One of them right there would be you're

00:18:46.704 --> 00:18:48.486
not just getting smiles and nods.

00:18:48.506 --> 00:18:49.807
You're not just getting good news.

00:18:49.866 --> 00:18:51.107
People are telling you different things.

00:18:51.127 --> 00:18:54.009
Are there other things that would sort of

00:18:54.049 --> 00:18:56.172
let you know that you are actually

00:18:56.251 --> 00:18:58.753
operating with a good organization and

00:18:58.773 --> 00:18:59.253
good leadership?

00:19:00.111 --> 00:19:01.231
Yeah, I would say there's, you know,

00:19:01.251 --> 00:19:02.373
I can think of a handful.

00:19:03.192 --> 00:19:03.933
One, you've not been,

00:19:04.094 --> 00:19:06.315
if you've not genuinely been surprised by

00:19:06.375 --> 00:19:08.317
anything until say the last ninety days,

00:19:09.570 --> 00:19:11.472
You know, I mean, really surprised.

00:19:11.792 --> 00:19:13.074
You're probably not seeing it.

00:19:13.114 --> 00:19:13.733
Number two,

00:19:13.854 --> 00:19:16.737
no bad news ever reaches you first.

00:19:16.997 --> 00:19:17.237
Right.

00:19:17.277 --> 00:19:18.597
Like by the time you hear a problem,

00:19:18.617 --> 00:19:19.999
it's already been resolved by someone

00:19:20.038 --> 00:19:23.501
below or it's metastasized into a crisis.

00:19:23.561 --> 00:19:24.301
The middle window.

00:19:24.321 --> 00:19:25.864
Here's the thing that is going wrong.

00:19:25.903 --> 00:19:26.844
We have time to fix it.

00:19:26.884 --> 00:19:27.585
We need your help.

00:19:28.005 --> 00:19:29.686
Has gone missing from your inbox.

00:19:31.548 --> 00:19:32.048
Additionally,

00:19:32.128 --> 00:19:34.690
I think your one-to-ones with your folks

00:19:34.750 --> 00:19:35.790
are all upbeat.

00:19:36.270 --> 00:19:38.212
There never is any, you know,

00:19:38.232 --> 00:19:39.894
what I call creative abrasion,

00:19:40.013 --> 00:19:41.515
anything going on there that you're in

00:19:41.535 --> 00:19:42.635
disagreement about.

00:19:42.655 --> 00:19:44.836
And you can't have that.

00:19:45.438 --> 00:19:46.659
If it's only good news and the only

00:19:46.679 --> 00:19:48.180
people reporting to you because they know

00:19:48.220 --> 00:19:49.540
you only want to hear good news or

00:19:49.560 --> 00:19:50.582
they're in fear of you,

00:19:51.501 --> 00:19:52.782
that is a telltale sign,

00:19:52.843 --> 00:19:53.683
as you alluded to.

00:19:53.743 --> 00:19:54.344
And then, you know,

00:19:54.443 --> 00:19:56.365
I think when you visit a place,

00:19:56.405 --> 00:19:56.846
you know,

00:19:57.866 --> 00:19:58.126
You know,

00:19:58.146 --> 00:19:59.848
if everything is looking perfect and it

00:19:59.868 --> 00:20:01.611
was all brushed up for the regional

00:20:01.631 --> 00:20:04.354
leader, the manager, everybody's smiling,

00:20:04.413 --> 00:20:06.175
everybody's putting on a show for the

00:20:06.215 --> 00:20:06.895
management.

00:20:07.257 --> 00:20:08.258
That's not a good thing.

00:20:08.278 --> 00:20:09.419
And then maybe lastly,

00:20:11.240 --> 00:20:13.742
the CFO is a different operating structure

00:20:13.782 --> 00:20:14.763
than your COO.

00:20:14.804 --> 00:20:16.125
And neither one of them has a picture

00:20:16.165 --> 00:20:17.928
that matches your like chief marketing

00:20:17.968 --> 00:20:19.189
officer or something like that.

00:20:19.798 --> 00:20:21.339
So when the three folks sit in a

00:20:21.400 --> 00:20:23.583
room and describe the same platform,

00:20:23.603 --> 00:20:25.705
the description should be dramatically

00:20:25.967 --> 00:20:26.446
different.

00:20:26.647 --> 00:20:27.648
That's not normal.

00:20:27.868 --> 00:20:30.673
This is the platform's nervous system

00:20:30.772 --> 00:20:32.234
disagreeing with itself.

00:20:32.275 --> 00:20:33.877
So the CMO has heard one story,

00:20:33.917 --> 00:20:35.200
the CFO has heard another.

00:20:35.619 --> 00:20:37.701
And if all these things are going on

00:20:37.761 --> 00:20:39.782
disparately, you've got a problem.

00:20:40.763 --> 00:20:42.065
And so it's time for you to get

00:20:42.144 --> 00:20:43.526
out and walk the floor yourself.

00:20:43.566 --> 00:20:46.048
So it's the inconsistency in your C-suite

00:20:46.087 --> 00:20:47.328
reporting things to you.

00:20:47.709 --> 00:20:51.432
That's not a good, that's a telltale sign.

00:20:52.152 --> 00:20:52.853
So for the big finish,

00:20:52.873 --> 00:20:54.394
if you walked into a healthcare

00:20:54.433 --> 00:20:55.034
organization,

00:20:55.055 --> 00:20:56.935
doesn't really matter what they provide.

00:20:57.903 --> 00:20:59.685
and could observe only one thing to

00:20:59.726 --> 00:21:00.946
determine whether it's healthy or

00:21:01.008 --> 00:21:03.250
unhealthy, would you watch the financials,

00:21:03.289 --> 00:21:04.912
culture, outcomes, or watch the huddle?

00:21:05.211 --> 00:21:06.594
And which would you watch and why?

00:21:07.054 --> 00:21:08.015
It's not even close.

00:21:08.055 --> 00:21:08.776
I'd watch the huddle.

00:21:09.896 --> 00:21:11.618
The financials are a trailing metric.

00:21:11.659 --> 00:21:14.122
By the time they show distress,

00:21:14.843 --> 00:21:16.825
things are already structural and down the

00:21:16.865 --> 00:21:17.885
road by six months.

00:21:19.607 --> 00:21:20.890
Those are the outcomes, right?

00:21:21.329 --> 00:21:23.973
Quality metrics run on annual cycles or

00:21:24.034 --> 00:21:25.055
quarterly cycles.

00:21:25.075 --> 00:21:26.477
So definitely the huddle.

00:21:26.537 --> 00:21:27.939
The huddle is happening now.

00:21:27.979 --> 00:21:29.020
It's happening today.

00:21:29.682 --> 00:21:31.183
Honestly, in ninety seconds,

00:21:31.223 --> 00:21:32.905
you can tell whether information moves out

00:21:33.226 --> 00:21:34.067
or whether it doesn't.

00:21:34.327 --> 00:21:36.029
I once listened to a marriage expert,

00:21:36.049 --> 00:21:37.231
Gottman, I think his name is.

00:21:37.612 --> 00:21:39.113
been published more than anybody else

00:21:39.133 --> 00:21:40.752
saying he could tell whether the first X

00:21:40.792 --> 00:21:41.593
number of seconds,

00:21:41.633 --> 00:21:43.294
whether a marriage is going to have a

00:21:43.594 --> 00:21:45.213
have a high rate of divorce or not.

00:21:45.233 --> 00:21:45.314
Well,

00:21:45.334 --> 00:21:47.835
how do they tell that a marriage when

00:21:47.855 --> 00:21:49.115
they're talking to one another?

00:21:49.175 --> 00:21:49.655
How are they?

00:21:49.796 --> 00:21:50.796
How are they respecting?

00:21:50.816 --> 00:21:51.855
What are they saying to each other?

00:21:51.875 --> 00:21:53.237
Are they looking themselves in the eye?

00:21:53.277 --> 00:21:55.057
What is the trust that's going on?

00:21:55.817 --> 00:21:56.238
So really,

00:21:56.278 --> 00:21:58.038
the huddle is that nervous system on

00:21:58.097 --> 00:21:58.637
display.

00:21:58.698 --> 00:22:00.098
I'd rather watch one of them.

00:22:00.919 --> 00:22:03.842
for ninety seconds than read a whole board

00:22:03.922 --> 00:22:05.183
deck of PowerPoints.

00:22:06.105 --> 00:22:07.185
When I visit clinics,

00:22:07.266 --> 00:22:09.748
I usually ask to participate in their

00:22:09.788 --> 00:22:11.730
morning huddle or to be able to observe

00:22:11.769 --> 00:22:14.192
their morning huddle in an unambiguous

00:22:14.272 --> 00:22:14.512
way.

00:22:14.593 --> 00:22:16.095
I break the ice at the beginning and

00:22:16.115 --> 00:22:18.257
then they know I'm not going to lead

00:22:18.277 --> 00:22:18.376
it.

00:22:18.518 --> 00:22:19.337
I just want to watch.

00:22:20.380 --> 00:22:21.840
And that will tell you from two years

00:22:21.901 --> 00:22:23.242
hence what's what's actually going to

00:22:23.262 --> 00:22:23.522
happen.

00:22:24.616 --> 00:22:25.396
Most leaders think they have a

00:22:25.416 --> 00:22:26.377
communication problem.

00:22:26.397 --> 00:22:27.978
And as you've figured out from listening

00:22:27.998 --> 00:22:30.058
to this, many have an information problem.

00:22:30.078 --> 00:22:31.220
The question probably isn't,

00:22:31.380 --> 00:22:32.140
are people talking?

00:22:32.160 --> 00:22:32.779
The question is,

00:22:33.500 --> 00:22:35.381
are leaders hearing what they need to

00:22:35.421 --> 00:22:35.740
hear?

00:22:35.901 --> 00:22:38.142
If today's conversation made you rethink

00:22:38.201 --> 00:22:39.722
how information moves and make you

00:22:39.762 --> 00:22:40.903
uncomfortable, good.

00:22:41.242 --> 00:22:41.782
That's the point.

00:22:42.243 --> 00:22:43.804
And you'll love the deep dive in the

00:22:43.903 --> 00:22:45.565
article with it's available in the show

00:22:45.605 --> 00:22:45.805
notes.

00:22:45.845 --> 00:22:49.046
Subscribe on Substack using the link in

00:22:49.086 --> 00:22:50.386
the show notes attached here.

00:22:50.606 --> 00:22:52.768
Subscribe to the podcast and we'll see you

00:22:52.788 --> 00:22:53.167
next time.

00:22:53.228 --> 00:22:53.728
Larry, thanks.

00:22:54.776 --> 00:22:55.124
Awesome.

00:22:55.144 --> 00:22:55.636
Thank you, Jimmy.