In the previous blog post, we went through the first six questions, now let’s continue with the discussion of Jim Collins’ 13 questions.
7. How can we better blend empirical creativity AND fanatic discipline, and thereby scale innovation?
Collins describes a tripartite formula for success in another one of his bestsellers - Great by Choice: Uncertainty, Chaos, and Luck–Why Some Thrive Despite Them All:
Fanatic discipline: extreme consistency of action—consistency with values, goals, performance standards, and methods (remember the 20 Mile March?); utterly relentless, monomaniacal, unbending in their focus on the goals.
Empirical creativity: decisions are made primarily on empirical evidence, based on direct observation, practical experimentation, and direct engagement with tangible evidence. Bold, creative moves are derived from a sound empirical base.
Productive paranoia: maintain hyper-vigilance in order to detect and react to threats and changes in their environment, even when—especially when—all’s going well. Assume conditions will turn against them, so they channel their fear and worry into action, preparing, developing contingency plans, building buffers, and maintaining large margins of safety.
Great innovators fire “bullets” first and correct their aim before firing big fire balls to hit their targets.
What is a bullet? For Collins, a bullet is “an empirical test aimed at learning what works and that meets three criteria: 1. A bullet is low cost. Note: the size of a bullet grows as the enterprise grows; a cannonball for a $1 million enterprise might be a bullet for a $1 billion enterprise. 2. A bullet is low risk. Note: low risk doesn’t mean high probability of success; low risk means that there are minimal consequences if the bullet goes awry or hits nothing. 3. A bullet is low distraction. Note: this means low distraction for the overall enterprise; it might be very high distraction for one or a few individuals.” Thus, innovation is not about home runs, it starts with singles!
How do you accomplish this in healthcare? By creating a culture of curiosity, testing, and improvement – with the discipline to stay the course.
8. What is our BHAG – our Big Hairy Audacious Goal?
In their book Built to Last: Successful Habits of Visionary Companies, Collin and Porras state: ”A true BHAG is clear and compelling, serves as unifying focal point of effort, and acts as a clear catalyst for team spirit. It has a clear finish line, so the organization can know when it has achieved the goal; people like to shoot for finish lines.” An example of a BHAG is SolarAid‘s mission: to eradicate the kerosene lamp from Africa by the end of the decade.
In healthcare, a now famous BHAG for the entire industry was Dr. Ezekiel Emanuel‘s “limit per capita cost to 0% + GDP by 2020.”
Has your organization developed a meaningful BHAG that resonates at every level of the company?
9. What is the right 20% to change, so as to best Preserve the Core and Stimulate Progress?
Collins advice here is to stimulate progress and innovation, while retaining your core purpose and values.
The Yin and Yang approach, as Collins describes it, makes organizational values the exacting standards that drive the organization. These principles are the DNA of an organization. Change is embraced, but only as it furthers organizational purpose and values. The tension between these two forces is what keeps an organization healthy.
This is a great way to approach the healthcare transformation. How else is meaningful change possible?
10. How can we increase our Return on Luck (ROL), adapting our strategy to both good luck and bad?
Most companies have their share of good and bad luck. What matters is what they do with their opportunities. It’s called Return on Luck (ROL).
How can you get a high return on luck at work? Here’a an answer to that question from Collins’ co-author Morten Hansen. The point: “prepare intensively, commit all the resources you can, and be maniacal about execution when the good-luck moments arrive!”
11. Do we show any signs of the Five Stages of Decline, and what should we do about them?
Collins explains why it’s a good idea to know where your organization stands on the road to doom and gloom:
“With a road map to decline in hand, institutions heading downhill might be able to apply the brakes early and reverse course. We’ve found companies that recovered—in some cases, coming back even stronger—after having crashed down into the depths of Stage 4.”
Where do you stand?
12. What should we Stop Doing?
If you have to-do list, then you should also have a NOT-to-do list!
An exercise worth doing: take your long to-do list (both at home and at work) and divide it into the following categories:
- Start doing
- Stop doing
- Continue to do
What have you learned? Remember, saying no to something actually is saying yes to the things that matter most.
13. How will you Change the Lives of others?
This is the promised bonus question that is not on Collins’ website. How will you Make A Difference today? (I call it “go MAD”!)
The best leaders find ways to be useful with real people in the present. Think beyond your life as a physician. As a leader, how do people feel that you changed their lives? How can you be helpful, useful to others?
Remember, people don’t care how much you know until they know how much you care. It was John Quincy Adams who said: “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” The job of the leader is to serve.
And now for some criticism. There has been some criticism of Collins’ Good to Great, most notably from Phil Rosenzweig, a professor at IMD, Lausanne. In his book, The Halo Effect, he explains that the problem with business books like Good to Great is that they are based on faulty data. Rosenzweig urges leaders to develop their critical thinking skills, and be driven by evidence, not stories. Here’s his take:
How does the halo effect manifest itself in the business world? Imagine a company that is doing well, with rising sales, high profits, and a sharply increasing stock price. The tendency is to infer that the company has a sound strategy, a visionary leader, motivated employees, an excellent customer orientation, a vibrant culture, and so on. But when that same company suffers a decline—if sales fall and profits shrink—many people are quick to conclude that the company’s strategy went wrong, its people became complacent, it neglected its customers, its culture became stodgy, and more. In fact, these things may not have changed much, if at all. Rather, company performance, good or bad, creates an overall impression—a halo—that shapes how we perceive its strategy, leaders, employees, culture, and other elements.
In our experience, we find that despite the criticism, the Good to Great model does serve as a useful transformation blueprint for most organizations. Of course each organization does need to examine its own case, its own circumstances, and act accordingly. But that is another story – we call it terrain-based strategy.