Open letter: Management tips to Dr Lillian

· March 15, 2015

I’ve just ended one of the hardest but also most rewarding gigs I’ve been part of. As often I was merely a coach, but this time I marveled at the result. We took a company (hospital) on the verge of dying to being self-sustaining and profitable in 7 months.

The leader of the hospital is called Dr Lillian, a young doctor that been very responsive to my tips and radical changes. I’m very grateful for her cooperative spirit and hard work. The same goes for many many people in the hospital. As I said; they are the people who made this possible. I just gave some hopefully helpful (although hands-on) pointers.

Last Friday (the 13th…) was my last official day at the hospital. Now, it’s ca 150 m from my house so I will keep it under close surveillance during my time here.

But I wanted to leave Dr Lillian with some advice for the future. Although this is about a hospital I think that it can teach us something, as it has taught me while I was uncovering them.

So, here we go:

Dear Dr Lillian,

Now that I leave you I wanted to give you some advice that builds on all the things that we have talked about and that can help you in the future. Don’t read this as instructions but rather inspiration:

Start with why

Tell your staff and colleagues WHY we are doing something. Make that reason refer back to your vision. Remember what we asked:

How will we know if this action will take us closer or further away from the vision?

This question will not only serve as a verification of the vision but also make sure that your activities actually contributes to the vision.

Make sure that everyone that cares knows the reason you are doing something. “This is the reason we now do project X before project Y.”

Think like a patient (customer)

What does a patient want in this scenario? What is hard to understand if you never been here before? Ask the patients for feedback - this is nuggets of gold for someone that wants to improve.

Look through your list of complaints and address them one by one. Your customer wants this improved and you exists because of them. A hospital without patients is less than useless.

Strive for more and more transparency

As we have done all along continue to show the real numbers on how you are doing as a hospital to all the staff. This will create a sense of belonging and “we’re in this together - good or bad”.

Hold daily morning meetings. Keep them short. Much easier to get people to a daily 15 minutes meeting than a 1 hour / week meeting. With shorter meetings often the questions will be smaller and easier. Or you can choose: long meetings with bigger, harder questions. That’s up to you :)

Show the status of your projects on the a board that everyone can see. This creates involvement from the people reading them and accountability for the people responsible.

Strive for smaller activities

Small improvements often are better than big improvements seldom. Because it gives us flexibility and chance to respond to changes in our environment and context.

If something (a project for example) is big in itself - consider changing the work so that it becomes several small things. Like we did with the renovations in the operation theater; first we fixed the roof, then the walls in the changing room, then the wash-sink and then… well maybe something else has become more important.

Striving for smaller things also helps us to avoid emergencies

Strive to trust more

Ask your the staff closest to a problem for suggestions on how to solve it. The ladies in the wash-roof probably have a pretty good idea how things are working there; they have been in that room for 15 years in average. If you wonder how to best solve a nursing problem; ask the nurses working there.

Give authority and trust them with accountability. Remember that the ultimate delgation is giving someone a task and NOT asking reports, status updates and follow-ups. With delegation comes trust. Tell them:

I trust you to take care of this area. Should you need my help - don't hesitate to call me. If I hear nothing I expect that everything is working fine.

Lead to create leaders. Who will be the next leader in your departments? Who will replace you? How can you behave to help them evolve. (Thank you David L Marquet for this advice!)

Efficiency in your organization

Efficiency (running as fast as we can, using the least amount of resources) if only interesting when we have grips on our effectiveness (running the right way). See my post.

But when you do use these simple advice for better efficiency in your organization:

  • focus on quality and care. Why does a patient come to a hospital? To be cared for. Meet that need with quality. Start with quality and you cannot go wrong.
  • focusing on shortening the overall lead time (from start to goal, from registration to the time when the bill is paid) for the patient. This will help the entire organization to keep their focus on the correct things. One slow department or stage might be ok, if the overall lead time is not affected negatively
  • strive to handle fewer physical things, like paper and cash. This will improve not only efficiency but also security and prevent corruption. For example:
    • Only print paper when absolutely required
    • Always ask patients for electronic payments. Maybe give discount for non-cash payments?

Continue to always ask Kenapa (Why)

Why is the mother of all knowledge. Encourage and continue to try to understand how a situation or event came about. Even when good things happens.

Continue to reemphasize for your staff that you ask to understand, learn and improve. Never ask Kenapa to punish! Same goes for any measurements and targets.

When in doubt

If you ever run into problems:

  • make sure you understand WHY you are doing something. Don’t start projects if you don’t know WHY. Say the reason out loud or write it down on the board, as we have done.
  • make projects smaller. Try to find ways to make your activities smaller and faster.
  • make sure that everyone understands where you are going. Ask people to state the Definition of Done of your activities. Make sure it’s Done, really Done and nothing but Done. The renovation of the second floor is not done until patients are being treated in our new beds.
  • call on me anytime you want.


Use this advices as a guiding star for the continued improvements of yourself and RS Bungsu.

I’m very proud to been part of the team that turned the hospital around.

See you soon!

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