Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated? Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.
Amy Edmondson of Harvard Business school has crafted a practical
evidenced based book on how leaders and organizations must approach the
increasing complexity of problems they face. Unlike the mindset of
execution, which was successful in the past, Professor Edmondson
demonstrates that in an increasingly competitive global economy a
different approach is needed.
Organizations must learn by teaming.
It is a must read for physician leaders or other leaders in health care.
provides leaders a clear understanding of how individual and
organizational psychology, the reality of hierarchical status, cultural
differences, and distance can and do separate team members which can
prevent successful teaming. Leaders can close these gaps by
understanding the existence of these obstacles and by adapting their
leadership style to support and facilitate teaming successfully. She
demonstrates the challenges as well as the solutions where teaming has
gone well and not so well (the "impossible" rescue of miners in Chile
and space shuttle Columbia tragedy) with numerous case studies and
Professor Edmondson also notes that leaders
must also thoughtfully identify where the challenges they face fit on
the Process Knowledge Spectrum (routine, complex, or innovation).
Routine operations could be a car manufacturing plant where outcomes and
certainty are known. At the other extreme, innovation operations, like
an academic research lab, the outcomes and certainty are quite unknown.
Hospitals are considered complex operations. Although the teaming
framework applies in each of these three cases, the leader's specific
behaviors and actions change. Having excellent outcomes and teaming
necessitates matching the right approach to the correct operation.
to maximize learning, conflict and failure are necessary for teaming to
be successful. These can only occur if leaders create an environment of
psychological safety. Learning thoughtfully from these failures and
framing them as essential for continuous improvement and innovation is
key for organizations to benefit from teaming.
Most importantly, the learning never stops.
Professor Edmondson provides many examples from health
care as she has "spent an inordinate amount of time studying people in
hospitals." In one example, she notes how two of four cardiovascular
surgical teams studied successfully implemented Minimally Invasive
Cardiac Surgery (MICS) because of how the leader framed the challenge.
It was a shared learning experience. The other two teams failed because
they focused on the individual surgeon rather than on the team. For
doctors, being able to ask others for help is culturally difficult and
yet vitally important given the increasingly complexity of hospitals and
medical knowledge. She notes that the "single most powerful factor
explaining success" among the the four teams was how the leader framed
She notes that for 23 hospital ICU improvement teams, those most
successful in changing were those "who engaged in the interpersonal
learning behaviors crucial to teaming".
One of the three
case studies is about leading teaming in a complex operations at
Children's Hospital. The goal of Julie Morath, the chief operating
officer, was to harm no patients and achieve a 100 percent in patient
safety. She engaged her staff to solve the problems. She eliminated the
tendency of the medical culture to view and blame a medical error as the
fault of the individual. Instead via "blameless reporting", observers
merely communicated what they saw and analysis followed. aBy creating a
culture of psychological safety, the hospital learned from their
"accident" and explored ways to improve the their care. As a result, the
hospital became nationally recognized as a leader in patient safety.
over a century, we've focused too much on relentless execution and
depended too much on fear to get things done. That era is over...human
and organizational obstacles to teaming and learning can be
overcome...Few of today's most pressing social problems can be solved
within the four walls of any organization, no matter how enlightened or
extraordinary... Generating ideas to solve problems is the currency of
the future; teaming is the way to develop, implement, and improve those
Although at times, the conclusions from her
twenty years of research and observation seem counterintuitive, her
findings and stories woven into a actionable framework and structure
makes Teaming--How Organizations Learn, Innovate, and Compete in the
Knowledge Economy compelling. It is destined to be a classic reference
for leaders today and in the foreseeable future as they lead their
colleagues and organizations into confronting and solving increasingly
complex problems and challenges.
Professor Edmondson hopes
that her book will enable organizations to execute at a higher level
only "when leaders empower, rather than control; when they ask the right
questions, rather than provide the right answers; and when they focus
on flexibility, rather than insistent on adherence... When people know
their ideas are welcome, they will offer innovative ways to lower costs
and improve quality, thus laying a more solid foundation for meaningful
work and organizational success."
She succeeds at every level.