By Kevin Meyer
A couple of articles in The Wall Street Journal last week made me think a bit about how we should look for and evaluate results and experience when choosing a leader… not just personality. And no, I'm not thinking about our favorite community organizer from Chicago. The articles, interestingly enough, had to do with our mess of a health care system. Having just spent the last three weeks dealing with a very difficult family medical situation, the topic is close to my heart.
The first is a great read on the impact of medical errors. As interesting as that is in itself, the few statements on how we tend to choose doctors is what stood out for me:
I've asked patients how they decided to come to the hospital where I was
working (Georgetown, Johns Hopkins, D.C. General Hospital, Harvard and
others). Among their answers: "Because you're close to home"; "You guys
treated my dad when he died"; "I figured it must be good because you
have a helicopter." You wouldn't believe the number of patients who have
told me that the deciding factor for them was parking.
A survey of New Yorkers found that approximately 60% look up a
restaurant's "performance ratings" before going there. If you won't sit
down for a meal before checking Zagat's or Yelp, why shouldn't you be
able to do the same thing when your life is at stake?
You might be surprised at the different quality levels of doctors and hospitals – which we apparently select with no meaningful data. Just one example from the article:
In 1989, the first year that New York's hospitals were required to
report heart-surgery death rates, the death rate by hospital ranged from
1% to 18%—a huge gap. Consumers were finally armed with useful data.
They could ask: "Why have a coronary artery bypass graft operation at a
place where you have a 1-in-6 chance of dying compared with a hospital
with a 1-in-100 chance of dying?"
No kidding. The second article is an interview with Leslie Michelsen, who runs Private Health. His firm basically does very deep, and very expensive, data analysis on physicians, facilities, and treatments to provide the ultimate in healthcare for those that can afford it.
"People do not know how to choose doctors. It's one of the most
important things you can do to promote your own health and that of your
loved ones, and it's: 'My friend's cousin's relative went to Dr. Smith,
and he was terrific.' Well, how do you know he's terrific?"
Once again, with some of the most important decisions we make, we resort to hearsay and personality, not results-driven analysis. Not that we're necessarily to blame – obtaining that data is difficult, which is why companies like Private Health exist.
So Mr. Michelson built a series of
proprietary algorithms to distinguish "the few who are the very best"
from "the many who are very good," based on "the factors that predict
excellence." For example, the premier caregivers for metastatic cancer
are usually academic researchers on the cutting edge, not general
oncologists. The best orthopedic surgeons perform many procedures as
they master the clinical learning curve, ideally for a single injury.
That's one solution – one that most of us don't have access to. The first article promotes greater transparency. Remember the difference in heart surgery death rates in NYC?
Nothing makes hospitals shape up more quickly than this kind of public reporting. Instantly, New York heart hospitals with high mortality rates scrambled
to improve; death rates declined by 83% in six years. Management at
these hospitals finally asked staff what they had to do to make care
safer. At some hospitals, the surgeons said they needed
anesthesiologists who specialized in heart surgery; at others, nurse
practitioners were brought in. At one hospital, the staff reported that a
particular surgeon simply wasn't fit to be operating. His mortality
rate was so high that it was skewing the hospital's average.
Administrators ordered him to stop doing heart surgery. Goodbye, Dr.
Earlier in that article you learned that "Dr. Hodad" was what other professionals in that hospital called a particular surgeon that was exceedingly popular, a shortened version of "Dr. Hands of Death and Destruction." Popularity with patients didn't equate to quality.
His operating skills were hasty and slipshod, and his patients
frequently suffered complications. This was a man who simply should not
have been allowed to touch patients. But his bedside manner was
impeccable (in fact, I try to emulate it to this day). He was charming.
Celebrities requested him for operations. His patients worshiped him.
When faced with excessive surgery time and extended hospitalizations,
they just chalked up their misfortunes to fate.
So, finally, to my point. How many of us have a "Dr. Hodad" in our organization? A supposed leader that talks a good talk, is loved by many, but is simply ineffective? Why? Why does he still have a seat on the bus? How do we make it obvious that he should get off the bus? The first article talks about the power of visibility and transparency – recording results and making them public.
Do you measure the results of your leaders? Do you make them public? Then what do you do when those results aren't what you expect – or need? Even when the leader is popular. Popularity and personality do not improve an organization. Results do. Yes, even if you're a community organizer from Chicago. Or a venture capital vulture from Michigan for that matter.