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Today, we're sharing another excerpt, on "Zero Harm," following the first excerpt about "a new approach to leadership."
[Paul] O’Neill’s tireless campaign for zero harm for employees and healthcare patients embodies respect for people. His desire to harm no one and feeling personally accountable if someone was harmed have become the stuff of legend, underscored by his October 1987 speech to investors and analysts as the incoming CEO of Alcoa: “I want to talk to you about worker safety,” O’Neill said.
“Every year, numerous Alcoa workers are injured so badly that they miss a day of work. Our safety record is better than the general American workforce, especially considering that our employees work with metals that are 1,500 degrees and machines that can rip a man’s arm off. But it’s not good enough. I intend to make Alcoa the safest company in America. I intend to go for zero injuries.”[1]
The audience expected to hear about financial projections and shareholder value, but O’Neill did not budge from the safety theme — for his entire time at Alcoa and onward. Kenneth Segel, Managing Director of Value Capture, was a co-founder of the firm, along with O’Neill and others (see The Founding of Value Capture further down on this page).
They met when Segel was an executive at the Jewish Healthcare Foundation in Pittsburgh, from which the Pittsburgh Regional Health Initiative (PRHI) emerged (also founded by O’Neill with Segel as founding director). He recalls an early critical meeting at PRHI and O’Neill’s fierce desire to get the region’s physicians committed to zero healthcare-associated infections.
As Segel recalls, one engaged but skeptical physician told O’Neill, “We don’t even know the biology of some of the viruses and some of the bugs to the extent that we know what to do to prevent them from transmitting. I would hate for you to sound stupid and uninformed to the medical community by advocating for this idea of zero healthcare-associated infections.”
According to Segel, O’Neill was unfazed, paused, and then said, “‘We don’t know the biology or the virology. That is wonderful! Why don’t we become the region that — because we set the right goal — goes out and gets the [National Institutes of Health] grants and anything else we need to do to figure out the biology and the virology so we’ll know what to do to get to zero, and why don’t we lead the way for the world on that?... ’
And so in that moment, he transformed our current deficits as humans and organizations into a gap worthy of our collective efforts to close. It was very powerful and very characteristic of how he would approach similar situations for the next 20 years and, of course, we know the 20 years before then.”
| The Founding of Value Capture Building upon the pioneering work of a community collaborative in Pittsburgh to prove that zero harm and perfect clinical outcomes were possible, Paul O’Neill, Jr. had a vision that this work could be accelerated and expanded around the country through partnerships with healthcare CEOs and their teams; they could use the same principles to run their entire organizations, not just succeed in individual projects. Prior efforts had produced strong evidence that it is possible to not only eliminate harm and quality defects, but make work easier and reduce the cost. Those efforts also revealed, however, that absent ongoing and direct involvement, even supportive leaders were less likely to lead successful transformation efforts. Founding members recruited by O’Neill, Jr. to help found Value Capture included Paul O’Neill, Sr. as non-Executive Chairman, whose principle-driven leadership inspired the firm; he served Value Capture until he passed in April 2020. Lisa Beckwith, Leslie Corak, Geoff Webster, and Kenneth Segel also were founding members and remain with the firm to this day. |
Richard Shannon, MD, Chief Quality Officer at Duke Health, met O’Neill in 1998 as “a typical academic physician, leading a large clinical department, but also running my research lab, doing what I call fundamental discovery research into human heart failure.” He eventually became involved with PRHI and O’Neill, and says he admires him more than any of the great minds he encountered in his 35 years of medicine as well as 17 years at Harvard Medical School and seven years at the University of Pennsylvania.
Dr. Shannon was so overwhelmed by O’Neill’s approach that he gave up his research career “because he taught me that discovery didn’t have to be confined to a lab. It was a daily exercise in human behavior and in leadership. So I literally gave up what was 40 percent of my effort and began to think along the lines of developing quality platforms in healthcare. By 2003 or 2004, I was a completely different person.”
As a senior leader in healthcare, Dr. Shannon says he has built everything in his organizations around the principles of quality and safety.
“Yes, we do have budgets, but I pay no attention to the budgets. I believe that if we do it right, the economics will follow.
That is an O’Neill lesson. I don’t want to be misleading.
There are people in the organization that spend a lot of time on the budget, but not me. Everything begins with quality, doing the right thing the first time, no defect, no error, no waste is the ‘economically good thing,’ the term that Paul coined of perfect patient care.
And so I lead with an agenda of quality, not mergers and acquisition, not growth, not cost cutting, but the idea that building better clinical outcomes, making our patients better by delivering perfect care the first time, is the economic secret sauce of healthcare. And that was an O’Neill-ism. That was something that emanated from Paul.”
James Anderson is a senior strategic and external affairs advisor for the law firm Taft Stettinius & Hollister LLP and President Emeritus of Cincinnati Children’s Hospital Medical Center. He agrees that leaders should manage focused on quality and safety. He was the President and CEO of Cincinnati Children’s when he met O’Neill at an Institute for Healthcare Improvement (IHI) event.
Anderson says one thing the two would talk about was “the notion that financial results are a trailing consequence of what we do as a business and that we should not confuse financial results as the thing that we do and manage to. But rather, do the thing that we do exceptionally well and understand financial results are the result of what we do and manage accordingly. If you follow that philosophy down through the organization, you really change radically the way most managers think they’re supposed to think about what they’re doing. It takes you away from cost reduction and budget sensitivity as a primary purpose, and, for us, to how do you take better care of kids, and where and how can we make this experience a better one for the family?”
The conventional thinking, especially for CEOs, is that financial results are what you’re trying to achieve, and shareholder value is what you’re trying to add, so leaders should focus on those numbers and deliver them, Anderson adds. “I didn’t believe that for the healthcare system. I believed we were strong enough financially. If we really focused on taking better care of kids, that was our purpose in life. And if we did that well, the financial results will be not just satisfactory but positive.”
Stephen Muething, MD, Chief Quality Officer at Cincinnati Children’s Hospital Medical Center, has always had an appreciation for the importance of safety, but it was O’Neill who brought him the insight that pursuit of zero harm was a fundamental way of showing respect and, if as a leader you don’t do it, you’re a “hypocrite or worse. It changed my perspective on safety from something that was right — definitely a key goal of an organization and definitely something that a healthcare organization should get right — to really a fundamental human respect issue. I’ve never gone back. He helped me make that transition from being a good technician of safety, probably a fairly good teacher of safety, to ‘No, this is fundamental to being a good human,’ not just a good quality improvement leader or those kinds of things.”
Dr. John Toussaint of Catalysis similarly had his idea of safety altered by O’Neill in the early 2000s.
“I was really impressed by his focus on employee safety... Those were the days when I didn’t necessarily equate employee safety and patient safety together, so I didn’t really understand why he was so focused on employee safety. Subsequently, after a few years, I finally got it: Patient safety starts with people being safe at work, and that was a real ‘aha’ moment for me. Why didn’t I understand that to begin with? But Paul was very instrumental in beginning to connect the dots for me on safety and safety mechanisms and procedures, and how it all starts with the leadership commitment to employee safety.”
O’Neill brought clarity around the fact that healthcare performance from a safety standpoint is incredibly poor compared to other industries, adds Dr. Toussaint, and that safety is not a benchmark or a performance metric, but living individuals who are injured and killed by medical errors.
“He had a very sharp stick around how information was reported, and wanted to make sure that it was clear that these were people. These were individual people that were being harmed. That actually led to some changes at ThedaCare from a True North metrics perspective — moving away from benchmarking and percentile rankings to actual numbers, individual patient numbers, on safety and quality.”
Rick Wartzman got to know O’Neill when he was a young reporter at The Wall Street Journal Pittsburgh bureau working the non-ferrous metals beat, covering the aluminum industry and Alcoa. Wartzman, author of The End of Loyalty: The Rise and Fall of Good Jobs in America, spent 15 years at The Journal and eventually became Executive Director of the Drucker Institute, with which he is still involved.
“Over the years, as I got to know Paul in another context, we talked quite a bit about his philosophy around [zero harm], and it always really impressed me, not only his vision, his strength, his courage as an executive, but just his goodness as a person, his humanity. I remember him talking over the years to me about ... conversations he had with managers who were used to having safety goals that were in many cases aggressive and, I guess, good on their face compared to whatever the accident rate was in that industry as a benchmark or what it had been in a facility historically. But for Paul, any injury, anybody hurt on the job, one was too many.”
Bill O’Rourke is a Senior Advisor at Value Capture and cofounder of Merit Leadership LLC, which provides ethical consultation and lectures. O’Rourke had many roles at Alcoa, starting as a patent attorney, and was eventually asked by O’Neill to run Alcoa’s environmental, health, and safety department: “Imagine, this guy is in charge of safety, not me, and everybody in the company thought they were responsible for safety. So it was a real joy to run an area of value to your corporation, especially safety. Talk about support at your job. It couldn’t have been better.”
O’Rourke says people initially were skeptical of O’Neill’s focus on safety above all else at Alcoa, believing it wasn’t legitimate and that when times got tough he would revert back to financial performance. “But that wasn’t the case. Paul never let up on safety. For the whole 13 years that he was there, that stayed foremost in his mind, the No. 1 value in his mind.”
“Paul taught me that safety is threefold,” says Cliff Orme, President of International Hospital Corporation. “The first one is the most obvious, physical safety. Nobody should get hurt on the job. People don’t go to work thinking that they’re going [to get hurt]. That’s not fair for them or their families. And that’s my responsibility.
But he expanded the definition of safety to professional safety, that people have to realize that their careers are safe with me and with this organization, and I’m going to do everything in my power to help them grow as professionals.
And thirdly, he taught me that my responsibility — and this is what I preach to the employees — is to create an environment of emotional safety, that nobody should be bullied, that nobody should come to work and get yelled at or made to feel badly.
There’s too much [of that] outside of the hospital, in communities, in domestic situations. But within the doors of the establishment, where I can control that environment, they are emotionally safe.”
Despite wide awareness of O’Neill’s commitment to safety in industry and healthcare, his drive for zero harm is likely still underestimated by some. Gary Kaplan, MD, Chairman and CEO of Virginia Mason Health System in Seattle, says O’Neill would “doggedly” drive home his focus on worker safety and respect.
“His passion — some would call it zealotry — around worker safety, ultimately, was all about respect... It wasn’t just something on a long list, it wasn’t even his top three. It was for him front and center — and not allowing senior leaders like me to make excuses for why we hadn’t gone where we needed to go to make this happen, to make it the norm.”