Episode Synopsis:

Welcome to the second episode of Habitual Excellence, presented by Value Capture.

Today, Ken Segel, co-founder and managing director of Value Capture, reads a blog post that he recently published. It's a thought-provoking examination of what's needed from leadership if we're going to create safety in healthcare organizations.

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Automated Transcript:

Mark Graban (2s):
Welcome to Habitual Excellence presented by Value Capture. This podcast and our firm is all about helping you and your organization achieve Habitual Excellence via one unifying focus, one value based structure in one performance system. In other words, it's about helping you capture dramatically more Value through achieving perfect care and perfect safety for patients and staff. To learn more about Value Capture and our services, visit In the Habitual Excellence podcast series, different episodes will feature various formats.

Mark Graban (42s):
We'll have interviews and discussions. Some episodes will share audio from the archives of the late Paul O'Neill and today we have a different format where Ken Segel from Value Capture reads a fantastic blog post of his that's both timely and thought provoking. If you'd like to get a link to the blog post, if you want to read it or share it, you can go to the blog post for this episode, which you can find at

Ken Segel (1m 15s):
This is Ken Segel Value Capture managing director reading my piece, "Healthcare wasn't safe for patients or caregivers before Covid-19, so what can Leaders learn, what can leaders do?" For years before Covid-19 our industry accounted for the largest number of injuries and illnesses related to the work of any in the United States. The fact is scale of covid harm to our team's as well as our patients has been greater because of our pre existing weaknesses when it comes to safety and improvement. But now in this extraordinary moment that forces and inspirations for change have been unleashed. Clinicians and other health care workers on the front lines have demanded their safety and responded urgently and cooperatively to figure out what works for patients and how to keep themselves safe.

Ken Segel (2m 3s):
They have blown past awkward and unclear top down edicts and institutional boundaries to share and seek learnings. They have shown that what really matters is what happens at the point of care between human beings. Leaders with humility and strength can seize this moment to help shape much better futures for their institutions. In a post Covid world, as the immediate thread of the first wave receives in the community, leaders can help their organization's leap ahead. If cultural healing is fed by a new determination and discipline towards the habits of excellence anchored by safety. The tag I've been using on social media post during this time, #LeadershipForCovid19 #LeadershipPastCovid19 tries to capture this sense.

Ken Segel (2m 48s):
Of course there are not bright demarcations to a Covid period. Change starts now. Here are just a few learnings I see to start the conversation. I offer them humbly as leaders and front line workers alike face life and death risk and decisions every day during the present crisis. Safety matters the most. Start there when people don't feel safe. They can't do their best work,, not even close. Literally every American now understands this truth in their bones. Conversely, when people in health care workplaces feel safe, they will give all they can. Workers who know that their leaders are demonstrably committed to their safety and their patients' safety as a precondition of any other work and not a tradeoff with other goals are empowered to perform at their highest level.

Ken Segel (3m 39s):
For these reasons, safety has always been an ideal focus for leaders in a complex high risk industry to dig in and focus on at the deepest levels with every individual who works for them. It can be the anchor of high performance, but only if leaders model the way and making safety an unarguable goal and demonstrate it every day. Sadly, the number of healthcare leaders who lead that way when it comes to workplace safety before Covid could be counted on one hand, coming out of Covid 19 what deeply reflective conversations can leaders in their entire workforces go through to generate an actionable mutual commitment to ensure that we will all work together every day to try to harm to zero?

Ken Segel (4m 25s):
What vulnerability can leaders show admitting that we weren't ready to protect our teams and that we will learn how to do better alongside them every day.? The conversation has to happen even when we feel less globally threatened because otherwise harm will still occur every day. A pact anchored in the deepest human aspiration to be safe and to create safety for other's can be the bedrock for powerful relationships and powerful performance transparency and rapid learning cycles make them real. Since the seminal 1999 Institute of Medicine report To Err is Human. There's been an explosion of rhetoric about the need to report and share transparently information about injuries to patients and workers, their causes and solutions so others don't have to fall prey to the same injuries for the same causes.

Ken Segel (5m 18s):
There has been an explosion of duplicative data collection and data collection organizations with the word safety in their names, but they're has been precious little effective learning, a little information getting to where are used by front line care givers even from within their own organizations. We haven't led from purpose on safety and we let bureaucracy in our own organizations and outside takeover the loop isn't being closed so there was a little learning and still less improvement. Now in this Covid moment, front line care givers, desperate to discover things that might help their patients and keep themselves safe are sharing and seeking lessons learned in real time from others doing the same work across their own organizations, across artificial institutional borders, even across national borders.

Ken Segel (6m 7s):
My doctor colleagues have learned a lot from physicians in their fields from across the globe. They are pushing the stories forward into rapid experiments that will build in rigor as time goes on. The New York Times and many other publications have captured learning that emerged in near real time about repositioning Covid patients and delaying ventilation and much else to drive these learning cycles from people actually doing the work. They have in many cases blown right past top down directives from institutional leaders that were not based on data or learning. In so doing, they are echoing other moments where the principals of high performing organizations had burst forward in memorable lessons accessible that the general public with the American top-down and wrongly chosen battle strategy to fight the Iraqi insurgency in the early 2000s wasn't working.

Ken Segel (6m 58s):
The field lieutenants took matters into their own hands. They created a real time learning network where every patrol was structured as a learning opportunity in reports were filed immediately and transparently for all the troops on the ground to learn soon enough through lieutenant networks, lessons in the strategies that emerged became the strategy for the conflict with rapid learning as a core component, transparency and real time learning about harm that has contributed to and learn from by everyone everyday as an anchor system. Not only for making safety as a precondition possible, but feeding the culture of commitment and excellence that drives believe in a high performance.

Ken Segel (7m 40s):
Therefore, how can health care leaders reflect on Covid with their teams and decide to fundamentally strengthen how they share and learn from safety incidents? Everyone every day will we reinforce the hero complex or a commit to Habitual Excellence. One characteristic that has always gotten in the way of creating true excellence and safety and health care is the concept of heroism. Americans are happy to hold front line care givers up as heroes because they often are as we're seeing everyday during the Covid crisis. The trouble inside our institutions is the hero mindset in individuals can lead to willing self-sacrifice that can excuse conditions that unnecessarily placed the caregiver in harm's way, like lack of personal protective equipment or a lack of a way to get help when a health care worker confronts and unsafe condition.

Ken Segel (8m 34s):
Sadly and incredibly many healthcare workers even face gag orders preventing them from discussing their Covid related safety concerns with patients are the public. It can also lead to a love of workarounds instead of problem solving and a cowboy mentality where a critical habits for excellence like working in discipline and experimentation in teams are ignored. The bottom line is the hero complex can let leaders off the hook for excellence in normal times. Healthcare workers too. What conversation can leaders have with their teams coming out of covert that celebrates their true heroism, but then terns the power of that heroism to even deeper habits of excellence driven by the caregivers themselves, not top down edicts.

Ken Segel (9m 17s):
The extraordinary team work where you're seeing everyday on the news, gives plenty of the platform, the teams know they can be excellent under even the worst circumstances. Seize it for a better circumstances as well as a final thought. Toyota's revolution and in the modern operational excellence movement. Were launched coming out of a devastating recession after World War II when the company's future was on the line, a pact between leaders and staff resulted in what was equal parts cultural. How do we want to be together and operational, a commitment to be excellent by a disciplined approach followed by everyone every day. Alcoa's turnaround in 1987 came when a new leader made a similar pact with every worker or in the entire organization by making safety a precondition of all other work and everyone working everyday and visible discipline weighs to make safety a precondition.

Ken Segel (10m 10s):
We can not only survive as a company, but become the best in the world at everything we do. A model of Habitual Excellence. We lost that Alcoa leader last week. Paul O'Neill was Value Capture's non-executive chairman and a constant source of inspiration and guidance, but it is as he would be the first to remind the leadership compact he forged and Toyota's remain open to all of us who are the healthcare leaders who will connect with their teams to create their own equivalent revolution coming out of this crisis. I hope that it is you.

Mark Graban (10m 44s):
Thanks for listening to Habitual Excellence presented by Value Capture. We hope you'll subscribe to the podcast and please also rate and review it in your favorite podcast directory or to learn more about Value Capture and how we can help your organization on this journey to habitual excellence visit our website at

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