HCI3 Update from the Field: Be Habitually Excellent

Submitted by francois.debrantes@hci3.org on Friday, June 7, 2013 - 12:35

Newtown, CT – June 7, 2013

"You're either habitually excellent, or not."
                                    Paul O'Neill, former CEO of ALCOA and Treasury Secretary

Disproving the it-can't-be-done crowd has been a hallmark of Paul O'Neill's career. And he reminded us this week that excellence – zero defects – can be achieved, should be achieved. For example, central line infections in several hospitals in Pennsylvania were eliminated (or got real close to zero), and the reductions were sustained. But the journey to get to that point was more than a bit difficult. Surgeons and other leaders in these hospitals insisted that "it can't be done". In other words, they thought of these events as "accidents", something that happens and is almost unavoidable. That attitude of inevitability of negative events permeates through the culture of an organization, and attempts to change it are fiercely resisted. Sometimes it's because of hubris…if I can't get it done, no one else can. Sometimes it's because of a fear that the cost simply isn't even close to the benefit….in accounting terms, of course, not human terms. And yet, what Paul O'Neill, John Toussaint, and many others who are applying LEAN/Six Sigma in health care have shown is that putting the person first always pays off. That's true whether the person is the employee or the patient. When HCI3 submitted definitions for Potentially Avoidable Complications (PACs) to the NQF for endorsement as comprehensive outcomes measures (and they are endorsed), one of the members of a Technical Expert Panel pushed back hard on comas being defined as PACs for stroke. The point made was that it was almost unavoidable, and so I asked whether it was absolutely unavoidable or not. The answer was that, of course, some comas are avoidable.

What this means to you – If you're passionate about excellence, then it should be apparent in everything you do, and the inevitability of defects should be banned from the culture of your organization. For Paul O'Neill, that meant starting with ensuring the absolute safety of employees by targeting zero workdays lost to injury at ALCOA. And ALCOA has maintained a near perfect rate on that metric for way over a decade. The point is that if you take employee safety seriously, then you have a chance to become good in many other aspects of your business. Play this out in healthcare and the point becomes quite obvious. How can hospitals and other health care organizations (who on average have one of the worst records of workplace safety) achieve perfect patient safety if they can't even provide a safe workplace environment for their employees? While ALCOA and other large, complex companies publicly publish their work injury rates, hospitals and health care organizations don't, in much the same way they don't publish their real prices, or their patient safety record. We've heard a lot of rhetoric about ACOs and the new culture of accountability they're embracing, but until these organizations act like ALCOA and become fully transparent, it's pretty clear that the rhetoric will remain just that. That's because you're either habitually excellent, or not.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org