Corporate culture – the tidy phrase that is the sum of corporate beliefs, values and top-to-bottom actions of everyone who works for the enterprise – has always been important but it will become even more critical as healthcare transitions with a new set of rules covering how we deliver care, how we are paid, how we manage the health of our market.
Health systems, hospitals and related healthcare delivery companies are notorious for operating within silos. These silos add cost and thwart sustainable improvements in patient care and safety. Why do they exist? Well, it usually has to do with the ego of the leader at the top of the organization and his or her partners in crime, those subordinate executives that are responsible for the silos.
Perhaps healthcare organizations should take note of how Ford Motor Company overcame this affliction. Joe Nocera, a New York Times columnist, addressed this on Saturday, arguing that the new leadership at GM should take note Ford, given their abysmal handling of the Cobalt ignition switch affair. He referenced that infamous “GM nod” where executives seemed to agree on a course of action in a meeting and then did nothing about it. People died as a result.
A recent report on the Cobalt scandal also disclosed the ‘GM salute’, “arms folded and pointed outward to others, as if to say the problem is someone else’s responsibility,” Mr. Nocera wrote.
Mr. Nocera argues that it is useful to look at GM’s cross-town rival, Ford Motor and the book by Bryce Hoffman, a former reporter for The Detroit News, “American Icon: Alan Mulally and the Fight to Save Ford Motor Company.”
When Mr. Mulally took the CEO job in 2006, Ford was a mess. They had just lost $12.7 billion and the hemorrhage was continuing. That he saved Ford is not at dispute. Last year, Ford made $8.6 billion.
Mr. Mulally came up with a plan. Ford had become famous for changing its plan every six months, but Mr. Mulally’s vision was to simplify their portfolio of products, making smaller, more fuel-efficient cars all the while emphasizing quality and customer satisfaction. Seeing tough times ahead, he borrowed ever last cent Ford could pry from lenders, including mortgaging the Ford logo, to weather the tough times of the Great Recession, avoiding the government bailouts.
A key to Ford’s success today is that Mr. Mulally did not waiver from his plan. He repeated his vision for the company at the start of every meeting, regardless of the audience.
Ford then, like GM today, was riddled with a cutthroat culture that fostered silos in which executives would do almost anything to make themselves look good and a rival look bad.
He started a mandatory Thursday morning meeting at which all of Ford’s top executives were expected to attend. Executives were tasked to give an update on their divisions and raise any potential problems. For the first several meetings everyone reported that all was good. When the first executive decided to admit a major problem, most of his colleagues assumed he would be fired. Instead, Mr. Mulally actually applauded. “Great visibility,” he is quoted as saying. The executive who broke ranks and risked his career, Mark Fields, will replace Mr. Mulally on July 2 when he retires.
Mr. Mulally kept pressing the point and designed a compensation plan in which the majority of every executive’s compensation plan was based on the corporate goals, forcing everyone to invest in each other’s success, Mr. Hoffman reported.
A critical piece of this great American success story can be attributed to the silos being torn down, the CEO’s constant emphasis of his vision, the importance of his goals, forcing transparency and the elimination of the cutthroat culture.
When it comes to hospitals and improving quality and safety, I know there are a whole host of complex issues that must be addressed. But that complexity should not be an excuse for us not to address the silent underlying reason we struggle so with this horrendous problem: we too often tolerate a culture that while not embracing medical mistakes, allows us to accept them.
What other reason could there be for the escalating number of preventable hospital deaths each year?