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Transcript

Your Clinic Huddle Is Lying to You... Here’s What It Hides · The Operator | Healthcare Business

• 0:01
  All right, let's do it.
• 0:03
  All right,
• 0:03
  most healthcare organizations think they
• 0:06
  have a communication problem.
• 0:08
  Larry here thinks they have an information
• 0:10
  problem because the people closest to the
• 0:12
  work, well, they know what's happening.
• 0:15
  Leadership might not just be hearing about
• 0:17
  it.
• 0:18
  In his latest article on the operator,
• 0:20
  Larry brings forth that most healthcare
• 0:23
  huddles have become broadcasts.
• 0:26
  theater or what he calls a metrics huddle,
• 0:29
  where the venue that was supposed to be
• 0:31
  the platform's eyes and ears has become
• 0:33
  just a daily reminder to hit budget.
• 0:36
  And when that happens,
• 0:38
  the platform learns none of it.
• 0:40
  So Larry, let's start there.
• 0:42
  What is a huddle actually supposed to do?
• 0:47
  What is a huddle supposed to do?
• 0:49
  A huddle is absolutely supposed to,
• 0:54
  it's easier, actually,
• 0:55
  let me back up a little bit by
• 0:57
  saying
• 0:59
  Organizations don't really have this sort
• 1:01
  of communication problem.
• 1:02
  As you said,
• 1:02
  they have an information problem.
• 1:04
  I'd like to start out with what is
• 1:05
  the fundamental difference between those
• 1:07
  two.
• 1:08
  A communication problem is when the
• 1:09
  message doesn't get through.
• 1:11
  An information problem is when the message
• 1:13
  that is needed to get through never even
• 1:16
  makes it to the room,
• 1:17
  never even makes it to the thought that
• 1:19
  I should be communicating this.
• 1:21
  We have too much data,
• 1:23
  not enough information.
• 1:24
  We have too much information,
• 1:25
  not enough communication.
• 1:27
  Most healthcare platforms communicate
• 1:30
  constantly.
• 1:32
  Email, Slack, Teams, channels, dashboards,
• 1:36
  monthly all hands, weekly newsletters.
• 1:39
  There's no shortage of talking happening.
• 1:42
  What is missing is the small,
• 1:44
  really what I would say hard,
• 1:46
  specific information that lives on the
• 1:48
  clinical floor.
• 1:50
  The chair that's been broken for eleven
• 1:52
  days,
• 1:53
  the new hygienist who feels like she's
• 1:54
  bothering someone every time she asks,
• 1:56
  the senior clinician who has been quietly
• 1:59
  looking for job postings since February,
• 2:01
  nobody knows that they might be a flight
• 2:03
  risk.
• 2:04
  That information doesn't move through
• 2:06
  email, Slack and channels.
• 2:07
  It moves through trust, through proximity,
• 2:11
  through a venue where it's safe to raise
• 2:13
  what we call psychological safety.
• 2:14
  If the venue does not exist or people
• 2:17
  don't feel safe,
• 2:18
  it sits on the floor and the platform
• 2:21
  obviously doesn't see it.
• 2:22
  So you can have crisp communication
• 2:25
  and zero information they're not the same
• 2:27
  thing and we get in troubles when we
• 2:29
  conflate the two so the huddle is the
• 2:31
  venue specifically not to get to your key
• 2:33
  question the huddle is the venue
• 2:35
  specifically designed to surface that
• 2:37
  information that's its purpose when it
• 2:40
  works you have both communication going
• 2:42
  down information going up when it doesn't
• 2:45
  you have a lot of well-designed slide
• 2:47
  decks and data describing a reality that
• 2:51
  the leadership team fortunately doesn't
• 2:53
  really even see
• 2:55
  In the article you opened with this line,
• 2:56
  I even made a note about it,
• 2:58
  the meeting happened, the huddle did not.
• 3:01
  How can two organizations really run the
• 3:03
  same exact meeting,
• 3:03
  yet one learns something valuable and the
• 3:06
  other learns nothing?
• 3:09
  Yeah, well,
• 3:09
  because the meeting is the visible,
• 3:11
  you know, ten percent,
• 3:13
  the other ninety percent is the system
• 3:15
  around it.
• 3:17
  So two huddles can look identical from
• 3:19
  across the room, same time, same people,
• 3:22
  same checklist, same length.
• 3:24
  The difference is what's happened in
• 3:26
  eighteen months leading up to that point.
• 3:28
  So I've been through huddles.
• 3:29
  I've been to a lot of daily huddles
• 3:30
  when I visit locations,
• 3:31
  whether it be a PT clinic,
• 3:32
  a dental clinic, primary care clinic,
• 3:34
  occupational health, you name it.
• 3:36
  The huddles oftentimes will have that same
• 3:38
  checklist.
• 3:39
  And it is whether or not you're just
• 3:41
  checking the box,
• 3:42
  whether or not you're having meaningful
• 3:44
  conversation.
• 3:46
  In the organization that learned
• 3:48
  something,
• 3:48
  the floor was watched over and over what
• 3:50
  happens when they raise a hard issue.
• 3:53
  So issues get sort of logged,
• 3:56
  owners get signed, but by Wednesday,
• 3:57
  the chaos is either fixed or it's
• 4:00
  replaced.
• 4:00
  By Friday,
• 4:01
  somebody walks to the back of the clinic
• 4:02
  and says, we got this done.
• 4:04
  That's a system that's earned the right
• 4:07
  information from its floor it's actually
• 4:10
  resulted in actions that are measurable
• 4:12
  and held accountable in the organizations
• 4:15
  that learn nothing the floor has watched
• 4:17
  the opposite happen issues get raised
• 4:19
  issues get parked nothing happens by the
• 4:22
  third or fourth time when that happens the
• 4:24
  floor has decided without anybody
• 4:26
  announcing it that the huddle is not the
• 4:28
  right venue to tell you things that are
• 4:30
  really worth telling you they just show up
• 4:31
  and they check the box
• 4:34
  And then they go back to seeing patients.
• 4:36
  So the meeting still happens,
• 4:38
  but the huddle is dead.
• 4:39
  It's just, yeah,
• 4:39
  did we do a huddle today?
• 4:41
  Yeah, in fact, we certainly did.
• 4:43
  But it didn't serve any real purpose.
• 4:46
  And so the difference between those
• 4:48
  organization was not the meeting.
• 4:49
  Both organizations had the meeting.
• 4:51
  The difference are not what surfaced in
• 4:53
  that meeting reliable.
• 4:55
  reliably catches someone who enacts on it
• 4:57
  you know there's a psychological term
• 4:58
  called habituation we get used to things
• 5:01
  we get desensitized to things over time
• 5:03
  that are rote and what you have to
• 5:05
  have is you have to have a meeting
• 5:07
  czar somebody that's frequently like
• 5:09
  what's the purpose here are we really
• 5:10
  surfacing issues that's going on in here
• 5:13
  and maybe that meetings are changes every
• 5:14
  couple months or every quarter or whatever
• 5:16
  but you have to have somebody who keeps
• 5:18
  meeting accountability otherwise it
• 5:20
  becomes rote habituated and accomplishes
• 5:23
  effectively nothing
• 5:24
  Yeah.
• 5:25
  To go back to sort of making sure
• 5:27
  we know your terms,
• 5:28
  most people think a huddle exists to
• 5:30
  communicate information.
• 5:32
  But in the top of the show,
• 5:33
  in the article,
• 5:34
  that feels more like a broadcast or
• 5:36
  performance theater.
• 5:37
  You argue that it exists to gather
• 5:40
  information, uncovering things,
• 5:42
  a place that leadership might not have
• 5:44
  visibility.
• 5:45
  So how would you,
• 5:47
  if someone was starting tomorrow in
• 5:48
  leadership,
• 5:49
  how would you describe to them, hey,
• 5:50
  this is what a huddle is actually supposed
• 5:53
  to do so you know what it needs
• 5:55
  to achieve while you're in it,
• 5:57
  what the goal is?
• 5:58
  Yeah, that's right.
• 5:59
  And again,
• 5:59
  you have to go for what is the
• 6:00
  purpose of the meetings.
• 6:01
  And so there are meetings where you're
• 6:03
  meant to broadcast information and
• 6:05
  headlines and updates,
• 6:06
  those kinds of things.
• 6:07
  But a huddle is not a broadcast.
• 6:10
  It is a sensor.
• 6:12
  So if you really think about it and
• 6:13
  you trace this historically,
• 6:14
  I think it was around the nineteen forties
• 6:17
  that Toyota really,
• 6:19
  really perfected all this.
• 6:21
  And by the way,
• 6:21
  the guy's name really was Toyota.
• 6:23
  It was just spelled a little bit
• 6:24
  differently than I think the car is.
• 6:26
  And he built it as a daily stand
• 6:28
  up on the manufacturing floor designed for
• 6:32
  one problems,
• 6:33
  surface problems that are small and
• 6:36
  fixable when they're cheap.
• 6:38
  Right.
• 6:39
  Health care.
• 6:40
  Imported this practice in the early two
• 6:42
  thousands after the Institute of medicine
• 6:46
  to air is human report.
• 6:47
  That was kind of a famous report and
• 6:50
  HQR formalized it into the team steps
• 6:54
  documented this results from across
• 6:56
  multiple settings, fewer medical errors,
• 6:58
  fewer near misses and fewer adverse
• 7:00
  events.
• 7:00
  So basically we took manufacturing this on
• 7:03
  darn cord where something goes bad.
• 7:04
  We got to fix it right before bigger
• 7:06
  problems happen later.
• 7:07
  We imported into medicine and it was
• 7:09
  effective.
• 7:11
  And it was effective because the mechanism
• 7:14
  was not the meeting.
• 7:15
  The meeting was the upper flow of weak
• 7:18
  signals,
• 7:18
  something we can notice is out of source
• 7:20
  when it's small and weak and closest to
• 7:23
  the problem really reporting it.
• 7:26
  before those signals become events.
• 7:28
  One of the meetings I absolutely hate in
• 7:29
  any organization is when you have an
• 7:31
  operational meeting and those that aren't
• 7:33
  closest to the report are reporting the
• 7:35
  meeting.
• 7:36
  So the way that manifests itself like a
• 7:37
  large physical therapy or healthcare
• 7:39
  organization or dental organization,
• 7:41
  you don't have the local operators,
• 7:42
  regional directors,
• 7:43
  regional business partners,
• 7:44
  whatever you call them,
• 7:46
  And the practice managers in those
• 7:47
  meetings, you have their direct reports.
• 7:50
  So think of the information flow.
• 7:52
  You're having direct reports of direct
• 7:54
  reports trying to relay information.
• 7:57
  And when all that things start to happen,
• 7:59
  it just doesn't work.
• 8:00
  And so that's why you have these huddles
• 8:02
  at the most local level where information
• 8:05
  could flow up.
• 8:06
  You know,
• 8:06
  the tow factory floor and the operating
• 8:08
  room,
• 8:09
  have one thing in common,
• 8:11
  silence is never the absence of any kind
• 8:14
  of issue.
• 8:15
  It's almost always the presence of a
• 8:17
  system that has trained people closest to
• 8:19
  keep quiet.
• 8:20
  You want people closest to speak.
• 8:23
  In the Toyota world,
• 8:24
  they had an on-down cord that they
• 8:26
  actually pulled the cord because they were
• 8:27
  so scared to speak.
• 8:30
  think of that same mechanism,
• 8:31
  but get people to talk and in small
• 8:33
  huddles, if you do in a, you know,
• 8:36
  psychological safety, you know,
• 8:38
  correctly enough and you emphasize it
• 8:40
  becomes cultural, people will speak.
• 8:42
  Yeah.
• 8:42
  Well,
• 8:43
  I think that's one of the strongest ideas
• 8:44
  in the article is that, as you said,
• 8:46
  the people closest to the work actually
• 8:48
  know what's going on.
• 8:49
  They understand why a broken chair
• 8:51
  matters.
• 8:51
  They understand why being down one person
• 8:54
  matters.
• 8:55
  The platform might just never hear about
• 8:56
  it because we're sort of playing that game
• 8:58
  from third grade, telephone.
• 9:00
  By the time it gets transmitted,
• 9:02
  you've lost some meaning.
• 9:03
  So what kinds of problems are frontline
• 9:06
  employees seeing every day that maybe
• 9:08
  through that telephone game that
• 9:10
  leadership might miss?
• 9:12
  Yeah, I like to call them patterns,
• 9:15
  not events.
• 9:16
  So the dashboard,
• 9:18
  back to the KPI and the metrics,
• 9:20
  will tell you that Mrs.
• 9:21
  Jenkins didn't come in.
• 9:22
  It will not tell you that the front
• 9:24
  desk has now had to apologize two or
• 9:26
  three times about the same scheduling
• 9:28
  glitch that took place in the EMR,
• 9:31
  the scheduling system.
• 9:33
  The dashboard will tell you production was
• 9:35
  down four percent in a region.
• 9:37
  or no-show cancellation was up,
• 9:39
  but it will not tell you, for example,
• 9:41
  in a dental world that the hygienist,
• 9:43
  you know, with twelve years of tenure,
• 9:45
  spent her lunch yesterday updating her
• 9:46
  resume and left, right?
• 9:48
  The floor sees things that metrics,
• 9:52
  that precede metrics.
• 9:53
  They're like leading indicators.
• 9:55
  They see the patient coordinator who's one
• 9:58
  bad week away from quitting because we
• 10:00
  keep superimposing and creating more
• 10:02
  responsibilities to the patient
• 10:04
  coordinator.
• 10:05
  They see the chair in the op,
• 10:07
  you know,
• 10:07
  in the op three department area that has
• 10:09
  been broken for eleven days and now
• 10:11
  affecting two clinician schedules because
• 10:13
  nobody's taking the time to get it fixed
• 10:15
  because nobody has escalated it well
• 10:17
  enough.
• 10:18
  They see a new dentist who's really,
• 10:19
  really good,
• 10:20
  but culturally just not fitting in.
• 10:23
  They see supply and ordering and it
• 10:25
  happened.
• 10:25
  This is where I see a lot of
• 10:26
  this stuff happening and all this stuff
• 10:28
  gets mad and everybody then gets mad at
• 10:30
  procurement.
• 10:31
  And procurement's not the problem.
• 10:32
  It's the problem occurring at the front
• 10:34
  and it's never surfaced.
• 10:37
  None of that stuff, Jimmy,
• 10:38
  is on a dashboard.
• 10:39
  And if it is,
• 10:41
  it's six months from now and it manifests
• 10:42
  itself downstream in the form of a
• 10:44
  problem.
• 10:45
  The thing the floor has that no other
• 10:48
  layer in the platform has is the time
• 10:53
  spent next to the work.
• 10:54
  It is right there.
• 10:55
  Six hours a day,
• 10:56
  eight hours a day in the same place,
• 10:58
  watching the same patterns,
• 10:59
  noting the same things going slightly
• 11:01
  wrong.
• 11:02
  And anybody, you know,
• 11:05
  you got to have things go wrong before
• 11:06
  anybody could see it.
• 11:08
  So you can't get that information in the
• 11:10
  room with people who act on it.
• 11:12
  If you're not getting that information,
• 11:13
  you're operating blind.
• 11:15
  So I view those things, again,
• 11:16
  as patterns, not events.
• 11:20
  Well, if the meeting goes well,
• 11:22
  it should be quiet, right?
• 11:24
  No problems.
• 11:24
  But you say that silence is almost never
• 11:27
  the absence of issues.
• 11:28
  It's usually evidence of a system that has
• 11:30
  trained people not to speak,
• 11:32
  to have that psychological, that fear of,
• 11:35
  I don't know if this reaches the threshold
• 11:37
  of being worthy of being brought up in
• 11:39
  a sacred meeting.
• 11:40
  So how's that happen?
• 11:41
  Because I don't think many leaders wake up
• 11:43
  trying to create that type of environment,
• 11:46
  right?
• 11:46
  We always hear from leaders,
• 11:47
  I've got an open door policy.
• 11:49
  So how's it happen?
• 11:51
  Yeah, it's an unintended consequence.
• 11:52
  You're absolutely right.
• 11:53
  It's an unintended consequence.
• 11:55
  Nobody decides to build it,
• 11:56
  it just accretes.
• 11:58
  And I think it happens in sort of
• 12:00
  small moments,
• 12:01
  none of which happen in isolation.
• 12:04
  The first time somebody on the floor
• 12:05
  raises a real issue and gets the, oh,
• 12:09
  let's discuss that offline with no
• 12:11
  follow-up.
• 12:12
  Let's take that offline as a classic one.
• 12:15
  The first time a regional person rolls
• 12:17
  their eyes at a suggestion,
• 12:19
  somebody makes a suggestion,
• 12:21
  the feedback is the eye rolling,
• 12:23
  like you're a little kid.
• 12:25
  The first time an assistant brings up a
• 12:27
  safety concern, somebody says,
• 12:28
  let's not get into that right now.
• 12:30
  Let's just defer.
• 12:31
  We got too much going on.
• 12:32
  That's a bigger issue.
• 12:33
  We need to discuss that separately.
• 12:35
  You know,
• 12:35
  the first time a COO visits a clinic
• 12:37
  and the team is told to clean up
• 12:40
  the room before he or she arrives, right?
• 12:43
  Oh, we know Larry's showing up today,
• 12:45
  so let's make sure everything looks good.
• 12:46
  And you know, those are symptoms.
• 12:50
  Again, single moments.
• 12:52
  Each one of those teaches sort of this
• 12:54
  small lesson.
• 12:56
  But by month three,
• 12:57
  the lessons accumulate into a normalized
• 12:59
  behavior in an operating environment.
• 13:01
  By month six, the rule is invisible,
• 13:03
  internalized,
• 13:04
  and it doesn't get brought up.
• 13:06
  Interesting study done by a lady by the
• 13:08
  name of Amy Edmondson at Harvard.
• 13:11
  She did all this incredible research.
• 13:13
  I had to leave this out of the
• 13:14
  article.
• 13:15
  And she's the one who really termed all
• 13:17
  this, by the way, psychological safety.
• 13:19
  But the catastrophic finding that she came
• 13:22
  up with is that in environments where you
• 13:24
  do not have psychological safety,
• 13:27
  They don't reduce problems.
• 13:29
  They reduce the reporting of problems.
• 13:31
  So think about that.
• 13:33
  It's not the problem.
• 13:34
  It's the source of the problem.
• 13:36
  It's the lack of reporting it,
• 13:37
  how it surfaces.
• 13:38
  And when you have low psychological
• 13:40
  safety,
• 13:41
  you actually decrease the reporting of
• 13:44
  problems.
• 13:45
  What really good leaders have figured out
• 13:47
  is they're problem solvers and they want
• 13:49
  more and more and more reporting problems.
• 13:52
  of problems to happen.
• 13:53
  So you have to have a platform that's
• 13:54
  flying through clouds with instruments off
• 13:57
  when you don't believe there are problems.
• 13:58
  It's not that they're not problems,
• 14:00
  it's not that they're being reported.
• 14:04
  And there's a lot of time pressure and
• 14:05
  all the other kinds of things.
• 14:06
  But the good news is that the same
• 14:07
  dynamic actually works in reverse.
• 14:10
  Five months of visibly acting on every
• 14:12
  issue raised will build a floor's
• 14:15
  willingness to speak.
• 14:16
  It's not the magic,
• 14:17
  it's the patience and the follow through.
• 14:20
  It's just like what they found years ago
• 14:21
  in putting the alert system in a hospital
• 14:25
  bed.
• 14:26
  When they first started doing that,
• 14:27
  they were worried that the alerts would go
• 14:29
  off all the time.
• 14:30
  And you know what?
• 14:31
  They did.
• 14:32
  And each time they went off,
• 14:33
  a nurse would have to come in and
• 14:35
  respond to it.
• 14:35
  But over time,
• 14:37
  when you could preemptively solve problems
• 14:40
  and surface them,
• 14:41
  then the alerts started to get less and
• 14:44
  less frequent, and they served a very,
• 14:46
  very valid purpose.
• 14:48
  So early warning signs and on SCAR,
• 14:52
  all those things are really,
• 14:53
  really beneficial.
• 14:54
  Reward people.
• 14:56
  for reporting yeah yeah this reminds me of
• 14:58
  my dad told me a story he was
• 14:59
  a new york city fireman and after every
• 15:01
  big fire everybody would go get showered
• 15:03
  and come down to the kitchen and they
• 15:05
  would just go in a big circle and
• 15:06
  whether you were the guy who was there
• 15:08
  for thirty years or you're the guy that
• 15:09
  were there for the first thirty days what
• 15:11
  did you see what did you learn why
• 15:13
  did you do it what do you think
• 15:14
  we should do next time and they talked
• 15:15
  it out in public and there being open
• 15:18
  and honest was rewarded because lives run
• 15:20
  a lot absolutely absolutely
• 15:23
  So reading this article,
• 15:24
  I kept thinking it doesn't sound like a
• 15:25
  meeting problem then.
• 15:26
  It sounds like a leadership, right?
• 15:27
  This should be a reflection of leadership.
• 15:29
  So what's the difference between a manager
• 15:33
  who gets information and a leader that
• 15:36
  people are actually willing to tell the
• 15:37
  truth in front of?
• 15:38
  I'm going to guess it's absence of eye
• 15:40
  rolling.
• 15:41
  It's got to be on the list.
• 15:42
  A hundred percent.
• 15:43
  A manager,
• 15:44
  the way I look at it is a
• 15:45
  manager builds the venue,
• 15:48
  but a leader earns the audience, right?
• 15:52
  They are the heart and soul of the
• 15:54
  people side of it.
• 15:55
  The manager side of it is just studying
• 15:57
  the physical environment oftentimes.
• 16:00
  So the venue is necessary,
• 16:02
  but not sufficient.
• 16:03
  You can have a perfectly structured
• 16:05
  huddle, a perfect cadence to the meeting,
• 16:07
  the right people, the right prompt,
• 16:08
  the right cadence.
• 16:10
  run by a leader that nobody on the
• 16:12
  floor trusts and nothing ever real comes
• 16:15
  out of it.
• 16:16
  And the floor will smile,
• 16:17
  there's no concerns and everybody will
• 16:19
  kind of go back to work and it'll
• 16:20
  be a very quick huddle.
• 16:22
  And that's what happens over time if you
• 16:23
  don't do this thing appropriately is to
• 16:25
  become very,
• 16:26
  very short while nothing goes on.
• 16:28
  Let's just,
• 16:28
  you get positive reinforcement to end
• 16:32
  meetings way too quickly.
• 16:33
  But what earns trust is actually
• 16:37
  mechanical and somewhat unglamorous.
• 16:40
  It's the leader who gets the truth from
• 16:41
  the floor with the same set of habits
• 16:44
  every time.
• 16:45
  They show up consistently.
• 16:47
  They listen without interrupting.
• 16:49
  They are genuinely curious.
• 16:51
  When something hard surfaces,
• 16:53
  they're adult and they want to embrace
• 16:56
  them.
• 16:56
  They don't get reactive.
• 16:57
  They don't get defensive.
• 16:58
  They react with curiosity.
• 17:01
  They don't shoot the messenger.
• 17:02
  When they are wrong, they say so publicly.
• 17:05
  I was wrong.
• 17:05
  I should have listened to you.
• 17:06
  If I would have just held on,
• 17:07
  if I would have had a little more
• 17:08
  patience, I would have listened.
• 17:10
  This problem would never become a problem.
• 17:13
  that's what good leaders do and they also
• 17:15
  explain it none of this by the way
• 17:17
  is exotic right all this is uh all
• 17:20
  this is hard because the gravitational
• 17:22
  pull on a busy leader is to multitask
• 17:26
  it's to dismiss inconvenient information
• 17:29
  it's to defend it's to over compromise
• 17:31
  it's to try to be more efficient rather
• 17:33
  than to be effective but the leader who
• 17:36
  resists all of those instincts over and
• 17:38
  over in small moments
• 17:41
  accidentally builds an organization,
• 17:44
  which the truth reliably travels up.
• 17:47
  And overall they do truly have less
• 17:49
  problems.
• 17:51
  The manager who follows the playbook gets
• 17:53
  it right in the venue,
• 17:54
  but gets no information.
• 17:55
  The leader that builds the relationship
• 17:58
  gets the information,
• 17:59
  whether or not the venue is perfect.
• 18:00
  The leader is the relationship manager.
• 18:04
  If you want to know whether you're,
• 18:05
  you're one or the other,
• 18:07
  You really want to know what the litmus
• 18:08
  test is?
• 18:09
  Look at what's being raised to you.
• 18:11
  If it's all good news,
• 18:12
  polite questions and well-formulated
• 18:15
  updates, you're managing a venue.
• 18:17
  You're not leading anybody willing to risk
• 18:20
  telling you the hard thing.
• 18:22
  What I tell folks all the time is
• 18:24
  a good leader,
• 18:25
  and I would say this to a friend,
• 18:27
  a good friend is somebody who's willing to
• 18:29
  risk their friendship to tell you what
• 18:32
  they need to.
• 18:32
  And that takes a lot of trust and
• 18:34
  a lot of psychological safety.
• 18:35
  Yeah.
• 18:36
  You were sort of preempting my next
• 18:37
  question,
• 18:37
  which was going to be if someone's a
• 18:38
  CEO and they think their organization
• 18:40
  communicates well,
• 18:42
  what are the signs that they're actually
• 18:43
  operating with a false picture?
• 18:45
  One of them right there would be you're
• 18:46
  not just getting smiles and nods.
• 18:48
  You're not just getting good news.
• 18:49
  People are telling you different things.
• 18:51
  Are there other things that would sort of
• 18:54
  let you know that you are actually
• 18:56
  operating with a good organization and
• 18:58
  good leadership?
• 19:00
  Yeah, I would say there's, you know,
• 19:01
  I can think of a handful.
• 19:03
  One, you've not been,
• 19:04
  if you've not genuinely been surprised by
• 19:06
  anything until say the last ninety days,
• 19:09
  You know, I mean, really surprised.
• 19:11
  You're probably not seeing it.
• 19:13
  Number two,
• 19:13
  no bad news ever reaches you first.
• 19:16
  Right.
• 19:17
  Like by the time you hear a problem,
• 19:18
  it's already been resolved by someone
• 19:20
  below or it's metastasized into a crisis.
• 19:23
  The middle window.
• 19:24
  Here's the thing that is going wrong.
• 19:25
  We have time to fix it.
• 19:26
  We need your help.
• 19:28
  Has gone missing from your inbox.
• 19:31
  Additionally,
• 19:32
  I think your one-to-ones with your folks
• 19:34
  are all upbeat.
• 19:36
  There never is any, you know,
• 19:38
  what I call creative abrasion,
• 19:40
  anything going on there that you're in
• 19:41
  disagreement about.
• 19:42
  And you can't have that.
• 19:45
  If it's only good news and the only
• 19:46
  people reporting to you because they know
• 19:48
  you only want to hear good news or
• 19:49
  they're in fear of you,
• 19:51
  that is a telltale sign,
• 19:52
  as you alluded to.
• 19:53
  And then, you know,
• 19:54
  I think when you visit a place,
• 19:56
  you know,
• 19:57
  You know,
• 19:58
  if everything is looking perfect and it
• 19:59
  was all brushed up for the regional
• 20:01
  leader, the manager, everybody's smiling,
• 20:04
  everybody's putting on a show for the
• 20:06
  management.
• 20:07
  That's not a good thing.
• 20:08
  And then maybe lastly,
• 20:11
  the CFO is a different operating structure
• 20:13
  than your COO.
• 20:14
  And neither one of them has a picture
• 20:16
  that matches your like chief marketing
• 20:17
  officer or something like that.
• 20:19
  So when the three folks sit in a
• 20:21
  room and describe the same platform,
• 20:23
  the description should be dramatically
• 20:25
  different.
• 20:26
  That's not normal.
• 20:27
  This is the platform's nervous system
• 20:30
  disagreeing with itself.
• 20:32
  So the CMO has heard one story,
• 20:33
  the CFO has heard another.
• 20:35
  And if all these things are going on
• 20:37
  disparately, you've got a problem.
• 20:40
  And so it's time for you to get
• 20:42
  out and walk the floor yourself.
• 20:43
  So it's the inconsistency in your C-suite
• 20:46
  reporting things to you.
• 20:47
  That's not a good, that's a telltale sign.
• 20:52
  So for the big finish,
• 20:52
  if you walked into a healthcare
• 20:54
  organization,
• 20:55
  doesn't really matter what they provide.
• 20:57
  and could observe only one thing to
• 20:59
  determine whether it's healthy or
• 21:01
  unhealthy, would you watch the financials,
• 21:03
  culture, outcomes, or watch the huddle?
• 21:05
  And which would you watch and why?
• 21:07
  It's not even close.
• 21:08
  I'd watch the huddle.
• 21:09
  The financials are a trailing metric.
• 21:11
  By the time they show distress,
• 21:14
  things are already structural and down the
• 21:16
  road by six months.
• 21:19
  Those are the outcomes, right?
• 21:21
  Quality metrics run on annual cycles or
• 21:24
  quarterly cycles.
• 21:25
  So definitely the huddle.
• 21:26
  The huddle is happening now.
• 21:27
  It's happening today.
• 21:29
  Honestly, in ninety seconds,
• 21:31
  you can tell whether information moves out
• 21:33
  or whether it doesn't.
• 21:34
  I once listened to a marriage expert,
• 21:36
  Gottman, I think his name is.
• 21:37
  been published more than anybody else
• 21:39
  saying he could tell whether the first X
• 21:40
  number of seconds,
• 21:41
  whether a marriage is going to have a
• 21:43
  have a high rate of divorce or not.
• 21:45
  Well,
• 21:45
  how do they tell that a marriage when
• 21:47
  they're talking to one another?
• 21:49
  How are they?
• 21:49
  How are they respecting?
• 21:50
  What are they saying to each other?
• 21:51
  Are they looking themselves in the eye?
• 21:53
  What is the trust that's going on?
• 21:55
  So really,
• 21:56
  the huddle is that nervous system on
• 21:58
  display.
• 21:58
  I'd rather watch one of them.
• 22:00
  for ninety seconds than read a whole board
• 22:03
  deck of PowerPoints.
• 22:06
  When I visit clinics,
• 22:07
  I usually ask to participate in their
• 22:09
  morning huddle or to be able to observe
• 22:11
  their morning huddle in an unambiguous
• 22:14
  way.
• 22:14
  I break the ice at the beginning and
• 22:16
  then they know I'm not going to lead
• 22:18
  it.
• 22:18
  I just want to watch.
• 22:20
  And that will tell you from two years
• 22:21
  hence what's what's actually going to
• 22:23
  happen.
• 22:24
  Most leaders think they have a
• 22:25
  communication problem.
• 22:26
  And as you've figured out from listening
• 22:27
  to this, many have an information problem.
• 22:30
  The question probably isn't,
• 22:31
  are people talking?
• 22:32
  The question is,
• 22:33
  are leaders hearing what they need to
• 22:35
  hear?
• 22:35
  If today's conversation made you rethink
• 22:38
  how information moves and make you
• 22:39
  uncomfortable, good.
• 22:41
  That's the point.
• 22:42
  And you'll love the deep dive in the
• 22:43
  article with it's available in the show
• 22:45
  notes.
• 22:45
  Subscribe on Substack using the link in
• 22:49
  the show notes attached here.
• 22:50
  Subscribe to the podcast and we'll see you
• 22:52
  next time.
• 22:53
  Larry, thanks.
• 22:54
  Awesome.
• 22:55
  Thank you, Jimmy.