The Responsibility of Leaders to Create An Ambitious Vision

In this series of short videos (with transcripts following each video), the late Paul O’Neill talks about the need to create an all-encompassing vision for your organization and the power of aiming to be the best at everything you do.



Paul O'Neill: It's possible, even in a well-established industry -- I would say in any kind of an industry -- for an organization to live at a different place than most other organizations through a realization of some important tenets of leadership and organizational expectations.

For me, it's useful to start with a little definition of leadership in the ideal world. In the ideal world, a leader has several important responsibilities. One responsibility is to create, oftentimes with the help of others, maybe even many others, an agreed ambitious vision for the organization.

It's a subject that people spend a lot of time thinking about and talking about. What's the proper vision for our organization?

I've spent a lot of time doing this in a lot of different settings. I've come to believe that, in a way, there is an all-encompassing vision that I would say ought to be the default position for all organizations. Some organizations may argue this isn't appropriate for them, but I've been spending a lot of time thinking about it in different contexts.

My belief is every organization should articulate a vision that says:

"It's our ambition to be the best in the world at everything that we do."


Paul O'Neill: Because in something less than best in the world at everything we do and stepping down to a norm of in the top 10 percent of some things that we do, one begins to find satisfaction for being OK as compared to normed behavior.

It's something we've seen in health and medical care when we started working on the idea of eliminating a central line associated bloodstream infections (CLABSI) in intensive care units and found in Allegheny General Hospital where we worked that they were better than the national average in terms of the incident rate for a central line associated bloodstream infections.

Their beginning rate was about two percent of their patients in a baseline year had a central line associated bloodstream infection, which meant 39 out of 1,753 patients.

In most conventional organizations, people would say performing at the 98th percent positive level is as good as it can be.

If you hold yourself to the idea of no one here ever gets an infection, then it opens up the eyes to see the potential of moving towards zero.


Paul O'Neill: It's important to go and visit people in their natural habitat and to meet them on their own footing, because it gives them the upper hand because they're the expert there and you're not. It's a way of communicating an important message.

Also, in effect, saying to people, "Expect to see me a lot, because I'm going to be here for you. Yes, I'm going to have to have meetings in my office and in conference rooms, but I'm not going to be a stranger.

When I'm walking through the place, even if I look like I'm in a hurry, it's appropriate for you to tug on my sleeve and tell me things that are on your mind about, how are things going and what are the problems that you've got today?

Not only because you want to do that yourself because it's a way of learning, but because you want other people in the hierarchy to practice the same behavior so that other people begin to learn from your own behavior or what your expectations are for what it means to be entrusted with responsibility for leadership in the organization."

We who have the trust to provide leadership have a quality in the way we deal with people and a respect for people without regard to what they do that goes with their being part of our organization.

After setting the tone for how to work in the organization, it's important, I believe, eventually, every organization needs to come to an ambition for every part of the organization to be the best in the world at everything that they set out to do.

It's necessary for the ultimate leader, if you will, to have that conversation, not in a dictatorial way with other people in the hierarchy, but, in effect, to cause the rest of the people who are in leadership positions to come to agreement that when we say these words, we all mean it, and we all know what it means.

It's not something we say because you told us we have to say it, but because we believe it, and we're all dedicated to work in our own way, in our own sphere of responsibility to achieve this purpose that we're going to be the best in the world at everything that we do.

Until people have wrestled with this concept together, you don't have ownership. You may have acquiescence, but that's not the same as ownership.


Paul O'Neill: I personally believe most strongly by, on day one, articulating the notion that people who work here will never be hurt at work, because it's common to everyone. It's an unarguable proposition. No one can say, "I want to be hurt at work. It's my right to be hurt at work."

If the leader takes away the excuse that, "We can't afford it," then it makes it an imperative.

It's not a dictated imperative as people begin to understand, "We can only achieve this outcome if each of us accept the responsibility for our own behavior and accept the responsibility for helping all of the people in the team to follow the right behaviors every day.

"To begin observing every day, what are the things that could cause us to fall short of this goal so that everyone begins picking up a paper on the floor, and calling some appointed place if there's a coffee spill on the floor, or water from someone's galoshes on the floor?

"That everyone accepts the responsibility for identifying things that could keep us from achieving our everyday goal of people never being hurt at work." In fact, I believe it's important for things that are essential, like the absence of injury in the workplace, for them to be considered preconditions, not priorities.

In fact, the more things that can be identified as preconditions in an organization rather than priorities, the faster it will be possible to move toward organizational excellence.

On a medical care basis, a precondition for the medication pathway should be that there's never an illegible or an incomplete medical order. That ought to be a precondition.

It should not be a priority, because the word priority suggests that it could change, or maybe there's some other things contending for the same level of attention. The more an organization can identify, are characteristics of expected behaviors preconditions, the faster the movement toward excellence can be, particularly for workplace safety.

Again, because it's not arguable. No one can argue that it's not desirable to have an incident-free workplace. Attendant to that, a necessity to create a transparent environment for recognizing potential for injury, recording it in a way that's available to everyone in the institution.

Ideally, in a real-time basis, with an expectation that when incidents have happened, or potentials for injury have been identified, that within a very rapid time sequence, ideally less than 24 hours, there be an analysis of what needs to be changed.

There be a root cause analysis under that so that there is, in effect, an experimental basis for knowing whether or not, with the change we make, it works as we go forward in time. Then, a rapid sharing of a root cause analysis and change the expectation for behavior practiced across the whole institution.

If there's a finding, for example, that we have a water on the floor problem in one part of the building, that once we've discovered that problem, we'll look at every entrance to the building, and if it's appropriate to have a rubber mat, we'll instantaneously have rubber mats at every entrance.

We won't wait for people to fall at alternative entrances in order to discover the same lesson over and over again. Ideally, in a great system where people are getting better all the time at everything they do, there be a dedication to observation of things that could cause us not to reach our potential.

There be a root cause analysis. There be rapid disbursement of root cause analysis findings and implementation of change. We'll do it about everything everyday, not just about safety, but about everything that falls short of the ideal.

In this world of great expectations, it's not OK to record and fail to act.

Identifying things gone wrong and not systematically acting on them, there's almost a guarantee that organizational performance is not going to improve.



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