Recently in Culture Category

The July-August issue of Harvard Business Review is far from light holiday reading. Through a wide range of lenses, it aims squarely at business strategy and leadership challenges to be faced in the post-2009 recession world. Leadership in a (Permanent) Crisis by Ronald Heifetz and his colleagues at Cambridge Leadership Associates, reflecting the volume as a whole, is all about national and global post recession trends in the broader business environment that will shape industries over the next several years. As physician and health care leaders we owe it to ourselves, our patients, and our organizations to examine how these will impact us...

I was reading two issues of the Harvard Business Review simultaneously (a hazard of being overly busy), so I rapidly became aware of complementary articles that appeared in successive months addressing the related issues of candor (What's Needed Next: A Culture of Candor by James O'Toole and Warren Bennis a full article in the June HBR) and transparency (Heed the Calls for Transparency by Sam Wilkin in the Forethought section of the July-August issue). The latter was just received by subscribers so the online link is not yet available so if you don't subscribe watch the HBR web site in the coming week for it. Both are essential business reading for health care leaders...

The monthly Harvard Business Review opens with Forethought - a section of short pieces that typically pack a lot of punch in a page or less each. I am always tempted to write about each of them but I'd have to blog daily to hit these in addition to everything else that's potentially relevant to health care leaders from the business press. But if you pick up the HBR, do read the short stuff. The shortest this month, and the most concentrated value per word for health care leaders, is provided in Ten Fatal Flaws That Derail Leaders by Jack Zenger and Joseph Folkman. It's a great list of "don'ts" that serves up way more impact than the few minutes of your reading time it takes...

The May 13 May 14 issues of The Wall Street Journal ran multiple stories about the current NTSB investigations into the tragic February 2009 Colgan Air crash in Buffalo. While the agency has not yet ruled on the cause of the accident, there's been a lot of testimony and documentation focusing on the role of pilot training, pilot error, and the interactions between crew members that prevented correction of what a senior test pilot for the airplane manufacturer termed a "recoverable stall." In medical safety terms, "a near miss." So it should be no surprise that I found these articles both riveting and highly connected to the dilemma of health care leaders charged with safeguarding patient safety. Since airline safety practices, especially crew resource management (CRM), are seen as models for medical error reduction, the failure of airline safety practices should teach us something important. These articles are rich and provocative so I'll hit on just a few points and leave it to you to read them and more fully relate them to health care...

The Economist runs a regular column, Guru, in its Management section. The column, which is a quick read and worth glancing at regularly, reviews management theorists, researchers, or academics who have had significant impact on thought in the fields of leadership, organizational dynamics, economics, or similar business related disciplines. Last week's Guru column (May 1) commented on the research of the organizational psychologist Elliott Jaques (1917-2003). The topic was differentiation between "the boss" and "the real boss" in business systems. If you are a regular reader of this blog, you won't be surprised to learn that I was drawn to consider whether, and how, this distinction applies to health care leaders...

I thought I was pretty good at connecting the dots to make relevant connections between seemingly unrelated stories and experiences. That's the thesis of this blog - connecting the general business press to relevant learnings for health care leaders. Well, August Turak has trumped me with his Forbes.com series entitled Business Secrets Of The Trappists - lessons gleaned from his many years of making primarily spiritual visits to Mepkin Abbey, a Trappist monastery in South Carolina. Part 1 and Part 2 (of four) parts were published online on April 14 and the others are forthcoming on a daily basis later this week. Of course, it's only fair that I now use a wild card to one-up him by taking the connections between monks and business and extending them to relevant learnings for health care leaders...

I may be slow. It took two hits about Sergio Marchionne before I got him on the blog. The impetus to take the leap came when Business Week published the April 2 article, How Fiat's Marchionne Can Help Chrysler by Carol Matlack. But I do take credit for noticing and not forgetting when I first thought there was something here for health care leaders -after reading the Harvard Business Review's Fiat's Extreme Makeover in December of 2008, which was authored by Mr. Marchionne himself. Read the HBR piece first, for its strong focus on leadership culture, to see why Marchionne may be able to teach Chrysler - and health care leaders - a few things...

How Toxic Colleagues Corrode Performance is a short sidebar article with a big impact by Christine Porath and Christine Pearson in the April 2009 Harvard Business Review. The authors also wrote the upcoming book: The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do About It. The article is a 3 minute read, at most. But it provides data that drives home a haunting point for health care leaders - and more specifically physician leaders. Namely that the misbehavior of physicians, executives, and managers extracts a far greater toll on organizations than the pain felt when complaints are made.

Porath and Pearson have made a study of incivility in the workplace for years. The results of their poll of several thousand organizations revealed that common "benign" misbehaviors such as rumor mongering, berating management, unfairly taking credit for the work of others, blaming others for one's shortcomings, etc. take a severe toll on co-workers. The article states the following results:

• 48% decreased their work effort,
• 47% decreased their time at work,
• 38% decreased their work quality,
• 66% said their performance declined,
• 80% lost work time worrying about the incident,
• 63% lost time avoiding the offender, and
• 78% said their commitment to the organization declined

As we all know, health care workplace settings are far from immune from these. We see incivility by physicians, nurses, and clerical employees in office, hospital, and corporate settings. The bar for intervention into benign misbehavior is high. It is largely seen as the result of "personality quirks" that are grey areas for managerial intervention since they fall outside of the ethical and professional guidelines set up to deter and correct "malignant" misbehaviors such as dishonesty, sexual harassment, overt intimidation, falsification of data or documentation, discrimination, etc.

But these results suggest that "mere" incivility is far from a benign condition. Given the increasing pressures we are under to maintain an efficient and productive workplace, it is critically important for health care leaders to be aware of the measurable collateral damage that can result from these behaviors.

Then comes the challenging task of developing awareness, behavioral guidelines and both peer and managerial intervention strategies that result in a culture of civility. And doing this in a fashion that avoids two undesirable situations: (1) the creation of a juvenile code of behavioral rules; and (2) failure to clearly set limits on destructive "benign" behaviors.