It was a series of fitful yet fateful nights of sleep, amidst leading a massive and failing project, when I'd awake in strikes of anxiety, asking myself some version of the question: Why is work the way it is?
Providers were upset. Patients waited. Employees wanted to quit, and did, or called-in sick, or said things in frustration to each other. My inbox and voicemail were overflowing with colleagues wanting answers. Word was getting out. And to the top. As in all the way to the top.
We'd been expanding an existing contact center to allow for centralized appointment scheduling for each of the more than 200 primary care providers employed by the organization. Our project team had a plan, a budget, and a deadline. And we'd been making it happen. Quickly.
That is until I realized the providers weren't okay with transitioning their schedules to a standardized template. It's obvious now, but this wasn't a realization that occurred in the moment. No. It seeped out slowly and the project withered.
We did the only thing we felt like we could do: abandoned the idea of a scheduling template and attempted to find the solution on the operations side.
It was a disaster.
We made some progress; though mostly limping along implementing just a fraction of what the original vision had been. My confidence as "someone who got things done" was significantly shaken. My ego took a hit. I moved on to a different role in the organization.
The experience started a professional transition for me that's only recently arrived at a new beginning. Feeling failure, and feeling like a failure, made me want to explore what the heck went wrong and what I needed to do to prevent it from happening again.
But that's a realization I wouldn't come to for a few more years.
And little did I know that contact center project—what we were attempting to do, the environment we were doing it in, and the people we were doing it to—was emblematic of what's happening in organizations everywhere.
A Pattern of Struggle
The new role provided a brief reprieve following the contact center debacle. There was some success. We implemented meaningful programs. I added a few bullet points to my resume.
But I also experienced more of the same big vision, mediocre results loop playing out. A year later I accepted an offer to do something different.
Or so I thought.
Our consulting company worked with healthcare administrators to implement strategy. We had customers around the country and across the healthcare continuum.
And here's what happened: I. Saw. The. Same. Thing.
Big visions. Mediocre results.
Projects languished. And not for a lack of effort, or a lack of expertise, or a lack of experience. It was because of the milieu. It was systemic. It was a pattern!
I feel bad sharing I was excited but I was excited! Misery was everywhere! The results were routinely mediocre! It wasn't just me who struggled to make projects happen—many organizations were struggling to make them happen. The bigger the project, the worse it often was.
But this too wasn't a realization that arrived overnight. It was slow. And painful.
Yet it was this opportunity to see many projects, in diverse contexts, across dozens of organizations, and staffed by a variety of competent professionals that provided the knowledge that failing projects weren't just a me problem. They're an all of us problem.
Failing projects touch everything everywhere and the consequences cascade across our work. Here are just three examples from my consulting travels:
- We'd agree to a $25,000 project with a departmental leader in an organization with multi-billions in annual revenue and wait six weeks for contract approval and vendor set-up. The project should have been finished by the time we even started.
- On a twelve-week engagement, for a project that required two working sessions each week, the project sponsor would attend the first several working sessions before bowing out to attend to more pressing matters. Once that happened, other project team members also started missing working sessions to attend to more pressing matters. The project schedule would be extended and extended.
- We'd spend the first six (unplanned) weeks of a project listening to team members discovering their workflows and business processes that just a few months before they promised they had been experts on.
It's not to say any of these realities are wrong or right. It's just to say they exist and, because of their existence, they create additional problems.
And it's our ways of doing things, realities we accept with little consideration, that we navigate to make change happen. It means we're all attempting to solve problems without even considering the actual problems that are causing the problems we're trying to solve!
This conclusion—that how we work is the real problem worth solving if we desire for ourselves, our teams, and our organizations to fulfill a vision worth fulfilling—is the one I arrived at as a result of the work experiences I've had.
Yet it's eye opening to consider how much reflection was required to get to it.
It was time and space that let it happen. I didn't have an overflowing plate of responsibilities. I wasn't asked to drink any information from a firehouse. I was only asked to be effective. I was asked to think and learn.
Thinking about our thinking isn't something our jobs require, nor is thinking about how we work. Turning our thinking into learning isn't either. But I've come to believe we must do much more of it if we want to break the cycle of big visions and mediocre results.
So why is work the way it is?
In a word: complexity.
In a few more words: our system of management isn't fit for an increasingly complex operating environment.
We've come to believe in an approach to managing the work of organizations that actually solves fewer and fewer problems and—this part is crazy—often creates more and more problems as we use it. That's right: how we work is making work harder.
That's what I found in more than five years of study and practice—even though once I'd figured out where to look, every available resource says essentially the same thing.
It's usually a look around your current work environment that allows this picture to be painted.
Consideration must be given to the needs of patients, providers, employees, and the community (or shareholders if you're working in a for-profit outfit) in a modern healthcare delivery organization and that consideration must be delivered with a finite set of resources.
This is accomplished through an annual cycle of planning, budgeting, and goal setting; then the delivery and monitoring of services; and then the assessment of performance as it relates to the plan, budget, and goals—whether individual, departmental, or organizational.
It's a logical approach. It's so, so logical. In fact, it's so logical we have a hard time imagining, let alone believing, there may be any other way.
What happens when we work the way we work, an approach they call command and control, is we often promote the opposite of the behaviors organizations actually need from their employees and teams to excel in a complex environment.
The 737-Max debacle at Boeing is an extreme example. An administration flubbing a pandemic response is another. That situation at Away Travel is also a representative case. And what was going on in the basement of the Children's Hospital of Philadelphia is another.
These are all examples of managing in a complex environment as if it weren't. A problem may be solved in the short term—such as in this situation in a healthcare delivery organization—but what happens after that?
Better thinking and learning
Whether or not we realize it, we already operate in complexity. We just do it very clunkily.
To reduce the clunk, to break the big visions and mediocre results cycle, we must improve our thinking and learning.
A prescription like this—think and learn better?—is antithetical to our industrialized model of improving performance.
That's the point.
The annual goal setting and performance review process is a good example here. It's had, and continues to have, enormous consequences for organization performance while very few of us ever take the time to consider what those consequences might be.
This method—setting individual goals and appraising individual performance—is followed year after year in an attempt to ensure "alignment" across the enterprise and distribute annual pay increases despite the knowledge indicating our accepted method of assessing performance can be detrimental to the organization's creation of value.
Sometimes those consequences are significant, sometimes they are less so; the point is they exist, are often more misaligning than aligning, and very few of us have ever stopped to think about it.
I had a boss, one of the best I've worked for, share his thoughts: "Show me someone who leads by their annual goals,' he said, "and I'll show you a bad leader."
Yes, exactly! But why do we even set individual performance goals if that's reality?
I'm not here saying that accepted practice when it comes to performance management is wrong, although it wouldn't be how I'd do things if asked for my input; I'm saying we should orient ourselves around thinking about the consequences of our practices and improving them as a result of our learning.
How we work creates problems. We attempt to solve those problems through a variety of organizational initiatives. This is much of what work is for many of us.
But these aren't real problems. They don't need to be, anyway. They are problems of our own creation and if we worked differently they wouldn't exist.
The reason they do exist is because we rarely think about how we work nor use learned experience as an opportunity to change it. We just work. We just use the tools and methods we've picked up along the way and hardly ever give consideration to their consequences.
That hasn't always been the case. How we work—an improved implementation of command and control—was a creation of some very smart people based in the context of the industrial revolution. They did an extensive amount of thinking and learning to create it. And it worked. Really well. For a long time.
But when we use the tools and methods of command and control management in a complex environment, without appropriate thinking or necessary learning, we're using them in a way they weren't necessarily designed for. We're using them out of context.
A critical realization
Big visions and mediocre results are exhausting personally and detrimental to the organization.
When we realize it, we can recognize the cause of it, and everything can change.
For a long time, the most important pursuit of any healthcare delivery organization has been efficiency. It was an important pursuit. Much good has come of it.
But our context has changed.
We're realizing our organizations and the environment they operate in are increasingly more complex. And how we work isn't fit for such an environment.
In fact, it's impossible. A CEO can't make enough decisions to keep the organization operating in an efficient enough manner. An executive team can't either. Neither can the project leader of a critical contact center implementation.
(Nor is top-down decision making even a viable management choice, for that matter.)
While most organizations will probably be fine, whatever the pace of transition to a more natural way of working may be, the individuals inside those organizations will run themselves ragged trying to keep up with a long list of demands using the existing way of doing things.
We'll attempt to do more and more with less and less in the pursuit of ever increasing efficiency and solving problems of our own making.
That is until you decide to make a different choice. A choice to improve your thinking and learning and realize for yourself what I've shared with you here through a professional transition of your own.
It's then you'll be able to answer the question: Why is work the way it is?
It's the only way to figure it out.