Why Leaders Need to Go and See Front-line Work

I am starting this post with a very obvious statement. Leading a complex organization, such as a hospital or health system, is very, very difficult work. Healthcare leaders are continually confronted with problems to solve and must satisfy a myriad of often conflicting constituencies. At the same time, they are expected to define the vision for the organization and create the culture and systems to achieve that vision (and to continue achieving the vision, day after day and year after year). 

An essential element of creating a culture of excellence focused on mission is truly understanding the current culture, systems, and the processes that deliver services to the patients. Many leaders, especially those who have worked their way up the ladder of the organization they now lead, might be likely to say, “Of course I understand our culture and the systems we deploy to deliver our services.” We would respectfully ask this – How do you know? What data, facts and observations do you have that would answer the how-do-you-know question?  

Based on Value Capture’s own experiences and data, in order to actionably understand how an organization performs (and why performance gaps exist), leaders must rigorously and regularly observe work as it is being done by those doing the work. We refer to this as “going and seeing,” or going to the gemba (the place where work happens). This is the essential starting point for leaders to really understand whether the systems and processes that front-line staff work with enable or impede their ability to deliver to patients what they need, when they need it, every time and without defect.  

“Go and see” is perhaps a deceptively simple-sounding phrase. What we really mean is “go and see with purpose, humility, and respect.” Going and seeing is absolutely not a check-the-box exercise; it is a learning expedition. To go to the gemba with a "checklist mindset" is simply a waste of time, and nobody in a hospital has time to waste. Let’s take a quick look at our meaning of go and see. 

Purpose

Each time before going to the gemba, the leader should define why they are going to the work area. There are many possible purposes, so to maximize benefits of not only the leader’s time but also the time of the work area employees, the leader must have a clear objective and plan. 

For example, a nursing unit may be implementing a new process designed to reduce pressure ulcers. A leader could go to the unit with the new process standard work in hand to observe the process in action, silently following each step of the process as it is being done. Once the process is complete, the leader could then ask open-ended questions of the staff involved, to learn what the staff thinks of the process, difficulties encountered, obstacles the leader could help to clear, learnings that could be shared in other units, etc. 

Another possibility would be going to the gemba for the purpose of the leader’s own self-development. For example, a leader may have a personal development goal of asking questions that are less prescriptive and more open-ended to elicit more complete information. In this case, it might be helpful to the leader to bring a short list of questions, such as “What impact do you think this problem is having on patients?” and “What barriers are you facing in implementing this new process?” The leader could even bring a coach with them to observe and then reflect with the leader on progress toward this goal. 

Humility

There are some people who may chafe at the thought of demonstrating humility, thinking it may convey a lack of knowledge or even weakness. Humility actually conveys an interest in understanding something, as well as strength of character to show that a leader wants to learn from others. Moreover, a leader who demonstrates humility in seeking to learn from a front-line employee or supervisor (a physical therapist, a foodservice worker, a call center employee, for example) helps to inject confidence, ownership and pride in those employees. 

While going and seeing, a leader may demonstrate humility by asking how they can help support the front-line employee to more effectively do their job, versus telling the employee how to do a better job. (Paul O’Neill, Sr. used to describe this as “asking questions like a third grader.”) This powerful approach helps to develop the leader as well as the other employees (building a pipeline of future leaders). 

Respect

Respect, in my opinion, is the wellspring of a habitually excellent organization. We probably all have worked in a place where disrespect was the norm; the culture, lack of engagement and listless performance are palpable in such an environment.  

This is why it is so important for a leader to demonstrate respect for everyone they interact with during the gemba visit. Thanking people for their work and their contributions must be a part of each go and see. Additionally, respect is demonstrated by a number of other behaviors, such as listening carefully when others are talking (and not listening just to speak and steer the person speaking to the leader’s point of view). Respect is also demonstrated by asking questions in order to learn and understand (and not to judge). These are just a very few ways that a leader shows (rather than tells) people that they are respected, valued, and vital to the success of the organization. 

Go. See. Learn. Repeat.

There is no substitute for going and seeing with purpose, humility and respect. There is not a meeting or report or slide deck that can convey the depth and breadth of information that going and seeing can. There is no executive retreat or roundtable that can provide the insights into how systems are actually working, challenges employees deal with, whether work is aligned with the mission, and so many other critical elements of excellence. So get out of your office and conference room, go, see, learn, and lead.

If you would like to learn more about how to go and see with purpose, humility and respect, check out Value Capture's Executive Coaching and Daily Engagement System services, or contact us about a Guided Self-Assessment.