Kendall L. Stewart, M.D. September 22, 2007

1. Leadership Team (LT) Process1,2Some Practical Suggestions for Achieving and Sustaining Exceptional Organizational ResultsA Presentation for SOMC Leaders Kendall L. Stewart, M.D. September 22, 2007 1This presentation assumes that we value the LT structure and intend to improve it. 2The LT process is still only partially deployed. Why is that?

2. Why do leadership teams exist?1,2 To Produce Exceptional Results For Patients 1There is still abundant evidence that SOMC leaders believe teams exist to make the members feel good. 2Claudia has a great story about the desire to “dumb down” Kendall’s expectations for Ethics Committee members.

3. Exactly how do leaders achieve and sustain results that matter? They focus on results. They improve the processes that produce those results. They clarify the behaviors that make those processes work. They hold people accountable for their behavior. They select people for the abilities and attitudes that produce desired behaviors.1,2 They create the energizing discomfort that catalyzes improvement. 1This idea that everybody is not equal makes people very uncomfortable. 2But our differences are the team’s potential strengths.

4. Decide that the leadership team is the organizational structure that will serve me best. Make the case. Design and deploy an organizational Leadership Team Process that will produce exceptional results for me. Select an executive champion. Identify key decision-makers who will see clearly, speak frankly, select the best option and hold themselves accountable for producing results Select the best-possible chair who will always put my best interests first. Arrange for appropriate staff support. Conduct an annual SWOT analysis as a part of the Strategic Planning Process. Draft a scope document. Decide what results you intend to produce for me. Draft a dashboard and set performance targets for each indicator. Slide 1 of 2 What patient-centered1 leadership team process am I proposing? 1Remember the Four Ws. “What Would We Want?”

5. Organize tabbed-meeting notebooks. Agenda Minutes for past 12 months Current performance results (Dashboard) including enabling processes. Continuously-updated annual TaskList with a ParkingLot Annual Calendar Most recent “scope” document Educational presentations for past 12 months Utilize a timed agenda. Stay focused on results that matter to me. Design, deploy and continuously improve processes that will produce results that matter to me. Continuously monitor and update the LT’s TaskList. Hold each other accountable on my behalf. Provide actionable education at every meeting. Remembering that you are serving me, utilize business travel to learn and complete team projects. Slide 2 of 2 What patient-centered1 leadership team process am I proposing? 1Remember the Four Ws. “What Would We Want?”

6. When multiple leaders are involved1 When physician involvement is critical When different departments or disciplines are involved When obtaining approval through different organizational levels is a challenge. When meetings have become an unbearable drudgery When you are having trouble sustaining leaders’ focus When building consensus among key leaders is critical When repetitious meetings are driving you nuts When you are having trouble executing plans When leaders are reluctant to take a firm position others can depend on When you have found it difficult to hold key leaders accountable When you don’t know what else to do When might a leadership team (LT) be the best organizational approach? 1It is actually easier to have one meeting than multiple meetings, but leaders can’t hide behind their power in LT meetings.

7. To whom must you make the case? • To yourself1 • To the people you intend to lead • To the people you want to serve on the leadership team • To other organizational leaders • To executives 1Personal enthusiasm and commitment are prerequisites.

8. Why is it critical to recruit an executive champion? • You need to remove the executives as barriers right from the start. • You want this team to be a decision-making group, not just a deliberative body. • Having an executive present will minimize the need to check with others before launching your action plans. • The executive’s presence will make the importance of the work clear. • The executive will bring a global perspective that other leaders may not have considered. • The executive will assist you in holding team members accountable.

9. Stay focused on results. Select people based on their demonstrated ability to work with others to produce results—not to make them feel included. Accept your responsibility to always field the best possible leadership team. Limit the participants to 8-10 people. Ask disruptive people to leave. Be clear about your expectations up front. Consider asking people to sign a letter of commitment. Consider conducting a 360-degree evaluation of each other. Recognize exceptional teamwork. Build strong relationships through team travel and the appropriate resolution of conflict. Find effective ways to hold yourself and your colleagues accountable. How can you get and keep the right people on the bus?

10. What are you looking for in a chairperson?1 • Someone with a lot at stake • Someone with energy • Someone with focus • Someone with drive • Someone with enthusiasm • Someone who will ask the right questions • Someone who can explain how 1Responsible leaders are obligated to field the best-possible LT chair.

11. Why is it important to arrange for adequate staff support? • Constraining structure limits wasteful distractions. • Careful staff preparation helps to compensate for committee members’ laziness. • Available resources encourages timely decisions and discourages procrastination. • Crisp agendas demand attention and encourage conformity. • Documentation holds people accountable and shores up weak memories.

12. What is the SWOT analysis process? • This is a facilitated brainstorming process that documents the participants’ perceptions about the business unit’s • Strengths • Weaknesses • Opportunities, and • Threats. • This business process adds value to the annual strategic planning retreat.1 1And since this is mostly about perceptions, everyone can contribute.

13. What is our mission? Why do leadership teams exist? What were our results last year? What results will we achieve and sustain this year? Why have we selected these indicators? What customer-centered processes will enable us to succeed? What kinds of team members do we seek to recruit and retain? What will a typical meeting agenda look like? What are some of our anticipated projects and tasks? What questions should be answered in the LT scope document?

14. How can you select performance indicators that matter most to me? • Choose performance indicators that matter most to me. • Be able to explain why these indicators matter. • Measure key processes. • Find comparative data. • Find true benchmark performance. • Never, ever permit yourselves to feel satisfied.

15. Why should you utilize tabbed meeting notebooks? • Because these tools will increase focus and keep the group on task • Because this structure will clarify your expectations • Because people rarely prepare for meetings • Because without constraining structure, attendees will just show up and talk about how they feel • Because the information people need to make good decisions should be readily available • Because such preparation will enhance the group’s effectiveness • Because your colleagues will appreciate it • Because using these tools is an organizational best practice

16. How can you keep the LT focused on the results that matter to me? • Begin each meeting with the results you have achieved. • Ask the questions you would want answered if you were in my shoes. • Review and revise 90-day action plans religiously. • Go over the team’s TaskList, timelines and accountable leaders at each meeting. • Get and keep the right people on the bus. • Get the wrong people off the bus. • Remind each other regularly why you are there—to achieve and sustain exceptional results.

17. Insist on writing a straightforward process (or group of processes) to support each performance indicator. Make sure each process is embraced as accurate by the process owners. Use unexceptional performance as a stimulus to improve the enabling process(es). Identify a champion for each process. Make process improvement a part of each 90-day action plan. Organize a formal PI team when necessary—but only when necessary. Always ask whether the process owners were intimately involved in any process improvements. How can you keep the LT focused on the processes that will produce results that matter to me?

18. Use the tool to capture each task, to set a timeline and to hold people accountable. Limit aimless discussion about feelings by asking whether this matter can be reduced to some meaningful task(s). Table emerging issues for further discussion on the ParkingLot section of the TaskList. Use the list as a way to document accomplishments. Go over the updated TaskList and ParkingLot at every meeting. List all 90-day action plans as tasks to increase focus and accountability. Make tasks and projects simple and concise. Always insist on a deadline and at least one accountable LT team member. Always ask about the progress being made on unfinished tasks. Update the TaskList and ParkingLot at every meeting—and between meetings if necessary. How can you use the TaskList and ParkingLot effectively?

19. Why does an annual calendar make sense? • This encourages planning and increases focus. • This decreases the likelihood that things will slip up on the team. • This forces team members to take a more organizational view. • This forces the group to set priorities. • This facilitates continuous improvement.

20. How can you hold yourself and your colleagues accountable? • Clarify your expectations. • Write them down. • Seek informed consent. • Insist on a personal re-commitment each year. • Ask slackers to leave. • Refuse to add log knots to the team just because they want to be there or because of their rank. • Decline to lower your expectations to make coasters more comfortable. • Insist that the chair field the best possible team. • When you see that you are unable or unwilling to pull your weight, be a good example and leave the team.

21. Explain why it is important. Make it pertinent. Make it practical. Make it understandable. MISEQ. Explain exactly What needs to be done, Why these things need to be done, How to get them done, Who will do them, and How they can get them done. Break it down into simple tasks. Break the tasks down to simple steps. Invite clarifying questions. Select effective presenters. Tell me only what I need to know, not everything you would like me to know. Take the time to understand my needs; seek to meet them instead of your own. Extrude the unmotivated. How can you provide actionable education at every meeting?

22. Invite all travelers to propose a project. Choose a project that everyone sees as meaningful. Select the best possible project leader. Pick a project that everyone can contribute to. Explain why this project matters. Explain how you are going to complete the project. Reassure everyone that this will be enjoyable and satisfying; then make it so. Avoid lectures of any kind. Seek opinions based on the participants’ experiences, not their formal education. Choose a project that can actually be completed on the trip. Limit the “work” to the formal meeting and working meals to allow for some personal relaxation and group bonding. Attempt to deliver a draft of the project to attendees before the trip ends. Explain what will happen to the completed project after the trip. Thank everyone for investing time and energy in the trip. Make sure each participant gets a copy of the completed project. Take and share some pictures to create mutual history. How can you complete a LT project while you are traveling on business?

23. Where can you learn more?1 • Stewart, Kendall L., et. al,, A Portable Mentor for Organizational Leaders, SOMCPress, 2003 • Ali, Moi, et. al., Successful Manager’s Handbook, DK Publishing, Inc., 2002 1How do we want to make this learning available to our leaders?

24. Are there other questions? www.somc.org SafetyQualityServiceRelationshipsPerformance 