Hospital Command Centers: Keep What's Best and Improve the Rest

Your Crisis Operations System Works Because It Breaks Through What Doesn’t Work in Normal Operations. Now Make It Sustainable.

Healthcare organizations have a love/hate relationship with crises. A vice president at a prestigious health system noted that an eagerness to get into crisis mode is palpable in the culture. Caregivers and those who support them feel good and derive meaning from helping people, and help is never more needed than in an emergency.

However, crisis-operating mode is also attractive to healthcare teams because it gives everyone a respite from the symptoms of what I call “Big Organization Disease.”

Let’s start by defining this ailment. Paul O’Neill, the legendary Alcoa CEO and healthcare safety pioneer, said that one of a leader’s key responsibilities is to fight the tendency of big organizations to encourage power-building behaviors, such as hoarding access to information and political or “turf-centered” decision-making.

Such practices generate “boss-dependent” behavior where subordinates try to get their bosses to tell them what to do because it’s politically safer; this occurs even though leaders in this type of organization are poorly connected to what’s really going on at the front line.

These behaviors cause symptoms that drive everyone crazy, including leaders.

For example, it takes a long time to get important things done, and it’s awfully hard to determine cause-and-effect for why something is working or not. These linked phenomena are well documented in the organizational development literature. Unfortunately, this disease can be found in most large healthcare organizations.

The COVID Crisis Antidote

Going into crisis mode during COVID has revealed an antidote in the following ways:

Shared learning across the organization anchored at the front line. A Chief Medical Officer described how clinicians and others in the front line are more visibly driving the agenda and are learning rapidly from each other across and beyond organizational borders, while the rest of the  organization moves much more agilely than typical to support them.

Shared information and decision making up and down the hierarchy, in real time. One senior vice president explained to me that their hospital presidents, directors and managers love activating the crisis control center because they know that for the period it is up, they will have an intentionally designed forum to escalate problems to the right level of the organization and get help back, often the same day.

They also get to absorb learnings from across the enterprise at much faster rates than the calcified meeting structures which still dominate a manager’s life in many places. No wonder, then, that at this $3 billion system, the hospital presidents have pushed successfully to activate crisis command four times so far during the COVID period.

Rapid experiments vs. calcified planning. Another leader noted that in COVID’s early months of uncertainty and extreme peril, people were forced to stop the usual months-on-end “planning for perfect” and instead actually try things out in the units and clinics where the work is done. They then had to share their learnings and plans to adjust in near real time through the crisis communications structure.

In other words, they had to get into an experimental, rapid-learning  mindset – the key to organizational agility and innovation.

Less politics, better decision making. In crisis command center mode, when the inputs and outputs are clearer and more transparent to others every day, it is harder for leaders to hide information from others. Playing positional politics versus engaging with others in data-driven collaborative analysis is tougher to pull off. With more frequent and open information-sharing, more effective and more timely decisions are made.

Rapid alignment around “big dot” goals. Finally, in crisis, what is most important is clearer to everyone, and with greater alignment and clarity come great accomplishments at speeds that seemed unfathomable in “normal times.” Many CEOs cite as an example the stand-up of telehealth at scale in just weeks early in the crisis, a speed they can hardly believe themselves.

The Crisis Antidote is Unsustainable, As Is

The problem is that when these positive new behaviors are thought of as crisis-oriented, both the emotional crash and exhaustion become inevitable, and the new systems and their value become impossible to sustain. A reversion to “worse than normal” threatens amidst the exhaustion and the desire to let teams “rest.” This is the case today, as many healthcare organizations deal with COVID-induced physical and emotional exhaustion.

Recently, for example, a coach observed teams taking three weeks to debate and tweak a proposed improvement to a management system standard without actually testing a single aspect of it, fearful that it might not run perfectly the first time.

A year into the crisis, as we search for resilience for ourselves as leaders and our teams, Thomas Wedell-Wedellsborg has written convincingly that leaders must help their organizations identify the really vital work that has to be done for long-term vitality of the organization and energize their teams around that “critical path” work.

Healthcare leaders, to avoid the crash, and to accelerate and sustain the positive lessons learned during COVID, need to convert their crisis management structure to their daily operating structure, with purposeful improvements.

How to Convert Your Crisis Management Structure to Your Improved Daily Management Structure

Turn Your Command Center into the Visual Anchor of Your Daily Management System.

Your Command Center should not go away. Transform it to anchor the whole health system as a Visual Management Center to keep all the leaders linked and moving the same direction, every day. Evolve it beyond a COVID focus and keep it honed relentlessly on only the critical few most important goals for the organization. Leverage the essential crisis lesson -- the power of full organizational alignment to pursue, advance and achieve the “big dots.”

Great organizations tie linked management system huddles for each level of the organization to this Visual Management Center on a daily, weekly, and monthly cadence, weaving together these focused strategy cascades. Apply a focused flow to strategy deployment and great things are possible.

Embed the Rapid Information Flow Up, Down and Across the Organization, Every Day.

The rapid and free flow of learning, problem solving, and barrier-breaking information across the organization, and up and down the organization has been the most important benefit of crisis operations for most team members. It is what you have to bottle and continue in your normalized system. But to make it sustainable and even more effective, you have to stabilize the information flow, and add depth of problem solving.

Structure management interaction around the daily flow of information to explicitly produce a rapid-experiment and coaching-for-effective-problem-solving mindset.

In crisis operations, the standard work templates that guide how information is shared typically allow counter-measuring of problems (dealing only with today) without pushing deeper to solve their root cause (so they do not recur tomorrow). Crisis procedures also rarely embed long-term thinking about developing leaders as coaches.

As you convert your crisis system, you have the opportunity to build the templates that guide each level of the management team’s connections in your daily operating system to focus explicitly on the behaviors you DO want to encourage (rapid experiments and effective problem solving) and to discourage those you DON’T want (information hoarding, political control, endless planning).

For example, embed as a standard question “What will you test next and report learnings and adjustments from tomorrow?” Make sure the key process and outcome data are available to all, to serve as the basis of experiments and their impact. If they don’t have these capabilities yet, get your leaders the training they need to be able to coach scientific-method-based rapid learning.

It is amazing how rapidly building these coaching and scientific-method problem-solving patterns and capability expectations into the templates of your newly converted daily management system begins to produce better outcomes and better relationships, by design.

Lead with safety, always, not just in a safety crisis.

There is another lesson of the COVID crisis to preserve. Lead with safety, not as a priority but as a precondition, as the strongest foundation of your much more dynamic improvement and management system. A focus on safety for team members and patients alike starts everyone’s day with something that is unarguably most important, and focuses everyone on learning to be excellent on solving the problems that make a fundamental difference to all. Safety commitment, led by leaders, builds culture and belief in the organization, a belief that many organizations desperately need to rebuild. For all these reasons, pursuit of zero harm provides the perfect first input to each level of the management system, every day.

Better Systems for the Future

As John Toussaint, MD and I previously documented in Harvard Business Review, in Health Care Workers Protect Us. It's Time to Protect Them, and in Bureaucracy is Keeping Health Care from Getting Better, those few healthcare organizations that were truly advanced in these principles (safety first and for all, rapid experimentation and learning, front-line problem solving, and transparency) and accordingly had built powerful leadership systems PRIOR to the crisis, have achieved better results in COVID safety and patient outcomes.

Now COVID has forced virtually every health system to take on some of these desirable operating characteristics. The key for leaders is to crystalize the lessons for their leadership systems for the long haul, by converting the crisis structures and improving them to create sustainable, effective operating systems, as the way all work is done by everyone, every day.

When you do so, you may find your organization has started to rebuild trust with its workforce, with fewer symptoms of Big Organization disease, happier team members, better outcomes for your patients, and greater satisfaction all around, including for yourself.