Last year, I had the honor of compiling and editing three speeches by the late Paul O'Neill, Sr. into a book that we called A Playbook for Habitual Excellence. You can download this as a free PDF, or you can get it in Kindle or paperback formats.
Below is the text of a summary section that I wrote for the back of the book. I hope it inspires you to read the book.
When I first started studying Paul O’Neill’s speeches, my one reaction was that he was laying out a playbook that could be used by leaders, especially by CEOs who were new to an organization, in any industry.
When I interviewed retired Alcoa executive Bill O’Rourke in our “Habitual Excellence” podcast series, he spoke of using O’Neill’s “playbook” when he took on the challenging opportunity to lead Alcoa’s business in Russia.
“I think it’s easier when you are new, because people will expect the change and you expect yourself to be a new leader and to drive change. But, it can also be done with existing leaders who have an enlightenment when they decide, now, ‘I’m going to drive change in the organization.'”
O’Rourke was able to follow O’Neill’s playbook, which included starting with safety and aiming to be the best in the world at everything you do as an organization.
Many executives, including CEOs in healthcare, have been influenced by O'Neill's leadership example and playbook. One such example is Mike Bundy, CEO of two hospitals in the Prisma Health system. You can see a recent webinar (or download an eBook) where he shares specific examples of how a leader removes barriers, engaging managers and frontline staff to eliminate process problems that could lead to harm.
Across O’Neill’s speeches, a playbook emerges; what follows is my attempt to summarize this playbook. The playbook is a system that is built on principles. If you don’t share the principles (such as “nobody should ever get hurt at work”) then I wouldn’t expect his playbook to work for you and your team. If you try to copy just part of the system (setting a goal of zero), I also wouldn’t expect this playbook to work.
Elements of the playbook include:
Make a commitment that nobody should get hurt at work (the same could be said about patients in a health system).
State that you want to be the safest company in the world, and the best at everything that you do.
Stop the use of the word “accident” (which makes it sound inevitable or something God wanted) and use the word “incident” instead.
Realize that only the leader, as CEO, can create the environment and the culture that allow people to do great improvement work and take action toward that end.
Recognize that it’s a privilege with ultimate responsibility to be in a position of leadership.
Visit sites and where the work is done and make these commitments to workers in person.
Say that you won’t make anybody budget for safety improvement — you’ll find a way to pay for it.
Give out your personal phone number and tell employees to CALL you if the safety commitment isn’t being met by local managers.
When you get that first phone call, thank the employee and follow up immediately with the plant manager (or hospital CEO).
Note: Word will spread that you are following up on your words with action — this will be a big benefit to your culture change efforts.
Set goals at the “theoretical limit” (such as zero harm) but do not “bludgeon” people with that goal — use it as an inspirational and aspirational goal that aligns everyone to think and act toward the goals.
Encourage root-cause problem solving instead of papering over problems.
Take away excuses, such as “we don't have time,” “it’s not possible” and “it’s not in the budget.”
Practice extreme transparency with information across the organization, including reports about injuries that start with the worker’s name (to humanize the situation and keep it from being just numbers).
Publish employee injury data publicly on the company website. State metrics in ways that are easy to understand — use the number of infections, not the rate of infections per thousand line-days, for example.
Establish a “real-time safety information system” where any injury is identified and recorded within 24 hours. Share this information with the entire organization.
Learn to “ask questions like a third grader” and to keep asking “why?”
Create a more egalitarian culture, for example questioning why executives get perks like free coffee and danish that are not offered to factory workers.
Focus on safety is something that everybody can commit to — it’s “unarguable.” You’ll end up on the path to habitual excellence related to everything the business does.
I deeply admire the clarity of purpose that O’Neill had. I appreciate his playbook and his true respect for every employee, going beyond their physical safety. He wasn’t just about words. He was also about acting on and leading according to his principles.
Questions for Reflection and Discussion
- What elements of the playbook do you see that are missing from the list above?
- What would your hypothesis or expectation be if your organization got a new CEO, hired from the outside, who articulated and followed this playbook?
- Could a CEO who had been at an organization for a while suddenly start following this approach? What reaction would you expect from the organization? What challenges would the CEO face and how could they overcome?
We'd love to hear what you think! You can share a comment further down on this page.
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Mark Graban is a Senior Advisor for Value Capture and has served healthcare clients for over 15 years. Mark is internationally recognized as a leading author and speaker on Lean healthcare. He is the author of books including Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, and Measures of Success: React Less, Lead Better, Improve More. He is also host of our “Habitual Excellence” podcast. Mark's full bio