Notes from Paul O’Neill Speaking at the Lean Healthcare Transformation Summit

It was a real thrill to be able to meet Paul O'Neill in person yesterday at the Summit  (he was my guest for Podcast #124). His powerful message about leadership and patient safety was well received by the audience.

Below are my raw notes as I typed live in this Google Doc. I hope the notes do his talk justice…

Notes:

• How many of you work in an org. where you can, 24×7, see the real-time OSHA recordable injury rate, etc. for your org?

  • Are “people your most important asset?”

    • “Show me the evidence” and what has been demonstrated?

• Organizations are either habitually excellent, or they're not

  • One way to demonstrate you ARE (or on a journey)… is your goal to be the best in the world in everything you do?

  • Wouldn't REALLY caring about the people who work you be a good start? (safety)

  • The goal is nobody being hurt

  • Working in healthcare/medical is the most dangerous industry in the US

    • 5 in 100 have an OSHA recordable each year

    • Lost workday cases (this is a report that's hard to fudge unlike other measures) — 3 out of 100 have an injury (often serious) that causes them to miss a day of work or more

    • He was able to pull up CURRENT Alcoa data on his iPad today

      • “The culture owns workplace safety” (O'Neill has been gone 13 years now). Employees own each others' welfare

• Why do I care about workplace safety, beyond being morally important?

  • Part of habitual excellence

  • I'm not going to believe we are serious about lean or perfect patient care until every organization here (and all care giving orgs) can say we have REAL-TIME information about workplace injuries for the “people we say we care about.” — for improvement, not for blaming and shaming

  • “I'd trade in all my awards for a country that demonstrates it truly cares about the safety of its workers.”

• When he joined Alcoa, set a goal that nobody there get hurt at work

  • National average lost workday rate was 5 out of 100, across all workplaces (in 1987)

  • Alcoa, it was 1.86, they were really proud of this, given it could be a really dangrous industry and environment

    • “Now, our goal is zero”  – people were taken aback because they didn't think it was possible.

    • Behind his back, people said O'Neill doesn't know about our industry and about making aluminum

    • The excuses are all the same… it would cost too much to improve safety

    • People think God wants us to get hurt?

    • Wanted to use the term “incident” not “accident” (a term that makes people think they are inevitable)

    • People don't like to set goals they think they can't achieve

    • A non-zero goal is not OK… who wants to volunteer to get hurt?

    • Improved 30-50% a year for 13 years

    • 0.065 is the number today

• None of this can happen without “real leadership”

• Our education system doesn't spark people to think deeply about what leadership means

• “Do the people who clean the rooms get the same level of respect as the surgeons?”

  • I don't know many organizations where that is literally true. It cannot be true unless the leader is completely dedicated to the idea and starts a continuous process that eliminates abusive behaviors and things that are disrespectful.

• You can't get to zero safety incidents with cheerleading or writing it on the wall and believing, as a leader, you've accomplished the purpose.

• “Show me organization with a Vice President of equal opportunity & I'll show you an organization without equal opportunity”

• It's the duty of a real leader to articulate aspirational goals that are meaningful (the goals aren't from on high, but from a discussion about what the aspirational goals SHOULD be).

• “Alcoa will never again budget for safety.” If there is a need, I'll find a way to pay for it. People couldn't believe the CEO was saying we'll spend whatever it takes for safety. If somebody identifies anything, just fix it. That's the supervisors' responsibility.

  • O'Neill gave his home number to the workers… and told them to call if the supervisors weren't doing that. He got a call 3 weeks later… employee reporting a broken roller conveyor that had been broken for 3 days and people are having to lift 600 lb ingots to walk them around the broken conveyor and somebody will get hurt. “This isn't exactly what we thought you meant.”

  • O'Neill called the plant manager immediately, got him out of bed. Told him the story. I want you to go down to the plant and get that fixed and call me when it's fixed… and I don't want to ever get another call. 4 AM, it got fixed, and he got another call.

  • The story of that spread through the informal network… that he was serious and there could be no barriers to safety improvement. That was the beginning of a culture of safety.

• He told Wall Street analysts that safety numbers would be a “leading indicator” of how we are improving, in general. There was buzz that a CEO was talking to analysts about safety.

  • “Most organizations are just riding a log down a river.”

• Working to do things perfectly leads to better financial results than any sort of financial engineering.

• O'Neill told his finance people, “If you ever calculate the cost savings from improving safety, you'll destroy my moral authority on this…”

  • Internal politics, back biting, etc. is a waste of human energy that could be used to create value for customers.

• Who doesn't want to work at a hospital that's working toward zero infections?

• O'Neill had “Management Training” changed (the term) to “Leadership Training”

  • Root of management is manipulation in Latin.

• He credits early education in computer programming as a way to think more systemically.

• Back in the late 1960's, the VA was autoclaving hypodermic needles because it was deemed cheaper than reusable needles… instead of looking at the total experience of a system where patient was exposed to an infection they shouldn't have had.

  • “Accounting got confused with economics”

• Replaced Lawrence Summers as Sec. of Treasury (his staff assistant was Sheryl Sandberg, now COO of Facebook)

  • Transition meeting on a Saturday morning. Summers didn't know the lost workday rate in Treasury (didn't know the idea of the rate even meant)

  • “Floating on top of the organization versus really caring as a leader.”

  • Sandberg said she would get the data. Rate was about the national average.

  • Quickly reduced it 50%… what is the occupational risk of IRS workers?  O'Neill says people generally don't understand how there is safety workplace risk for hospital workers…

• It is possible, with empowered people who are doing the work, to achieve what we want – to have a perfectly safe medical enterprise.

• On theoretical limits, “If God doesn't stop you from doing it, you can do it!”

  • Compare everything you do to what perfect looks like. It's like draining the swamp.

• Alcoa market value increased 800% in 13 years by paying attention to the NON-financial measures… the finances took care of themselves

Below is a photo taken by Bobby Gladd. See his blog post about the Summit here.

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