Nov 5, 2017, 8 min read
Written by Julia Wagner
My interview partner this week is Maureen Bisognano, President Emerita and Senior Fellow of the Institute for Healthcare Improvement (IHI), an independent not-for-profit organization helping to lead the improvement of healthcare throughout the world. She was awarded the HRET TRUST award for being a “tireless advocate of change” and is an elected member of the National Academy of Medicine. She is a trained nurse, former hospital CEO and teaches healthcare delivery improvement at Harvard. A frequent world traveler and conference speaker, she encourages various audiences to “flip” standard solutions in healthcare.
In our interview, I talked to Maureen about shortfalls of the healthcare system, uncomfortable questions related to coffee and how the elder generation should trust the younger generation in taking over responsibility.
Let me tell you a story!
The first time I see Maureen is on stage. I am at a healthcare data analytics summit in Salt Lake City. It’s an inspirational conference with real-time audience interaction via voting app and engaging speakers. Yet Maureen’s speech touches me more profoundly than all the others. Thinking back, I am wondering why that is. I am going back to her slide deck: it is filled with stories - that is what makes her messages stick. And what I call “giving it a name”. She has tangible frameworks of how to understand the world: “Curiosity quotient”, “Exnovation”, “Flipping it”, “Reablement”. Catchy concepts, easy to understand and incredibly useful. But there is more below the surface. It’s not a coincidence that she is telling stories. The science of improvement is Maureen’s field of study and teaching. The IHI has developed frameworks and methods of how to innovate, adapt and spread existing knowledge and Maureen has contributed to these insights during her 20 plus years leading the institute. “Discover locally, spread globally”. “Engage using the power of storytelling”. She is a walking archive of best practices and inspiring creative solutions that she came across in a life dedicated to radical healthcare improvement. Maureen is the right person to engage a 1000+ audience on stage. Or for a spontaneous coffee at Stanford with two people she has never met but who would love to exchange on innovation in healthcare with her (that’s how I met her).
How do you move your mind from iterating incrementally to developing a radically different solution? Maureen suggests to ‘flip it’: turning the status quo upside down.
Maureen telling the story of her brother Johnny and how it motivated her to become a healthcare changemaker.
Harvesting great ideas, all year long.
“10x” is the silicon valley rule-of-thumb that says a solution is only truly good if it is ten times better than everything else in the market. It can be cheaper, deliver more value or save time. Both radical rethinking and unorthodox approaches are required in order to achieve this ambitious target. Maureen lives in Boston but she shares the vision of improving healthcare in a 10x dimension. Yet there are obstacles: How do you move your mind from iterating incrementally to developing a radically different solution? Maureen suggests to ‘flip it’: turning the status quo upside down. She has a discovery method for such solutions which she calls ‘harvesting’: Constantly be curious and on the lookout in the real world in order to uncover creative, novel answers to problems. As a hospital CEO, she explored the methods and solutions of companies in the manufacturing space, learning about lean and total quality management. Now, whenever she is travelling, she makes a point in exploring hospitals and outpatient centers, be it in the city or in the country, the US or Norway. She simply walks in and observes. Asks people for their perspective, be it the CEO or a child with a chronic disease. Doing this, she has come across some truly amazing examples of how healthcare can be innovated, oftentimes by shifting power to the patient and their families. The outcomes improvements are measurable. Some examples:
A dialysis center in Sweden that allows patients to do their own treatment – night and day.
A pregnancy program at a US hospital that puts women in charge of taking their vital signs and ‘walking’ the doctor through them.
A recovery program in Norway that puts emphasis on patients’ independence in performing small tasks that are important to them, such as putting on make-up.
Sticking with silicon valley lingo, Maureen is like an angel investor using the law of big numbers to eventually find a venture worth a billion dollars. And she is willing to share the upside by telling as many people as she can, figuratively shouting: “Look at this, please copy!”. Of course, smart adjustments and further improvement are encouraged.
The system is broken, we need to fix it!
I am looking at Maureen’s bio, fourteen pages filled with impressive responsibilities, publications, speeches, honors, teaching engagements and so forth. She started out in healthcare early in her life and has made great contributions. Empathy is her strong suit; as a young nurse, she would sometimes drive her patients home from the hospital. Heartbreaking moments have shaped her early on in her life and triggered a call to action. Her nephew, Robbie, died from an allergic reaction to a vaccine when he was only four months old. It was the second time he had a bad reaction to the vaccine; this time it was fatal. The doctor did not listen to her sister’s concern that the last procedure has caused a reaction. What is more, the child’s hospital medical record was kept in a different place, leading to assumptions based on incomplete information. “What stuck with me is the clear insight that the system is broken and needs to be fixed.” This is her mission until this day.
Persistency in pursuing the greater cause.
Not only is Maureen tireless in living her ‘harvest and spread’ practice, she also sees persistency as the key to implementing innovative ideas. Another story: As a charge nurse, she saw an opportunity to give a better purpose to an underutilized pediatrics unit. Albeit a relief to the colleagues in the intensive care unit and the emergency room, the pediatrics staff would have to move to a smaller, older locality.
The idea was good for the hospital overall, but how would she convince the colleagues to give up their rooms? Perseverance turned out to be the key. “I attended their monthly meetings on a regular basis for half a year, constantly pitching the idea. In the end, I think they simply gave in so I would not show up anymore.”
Maureen has a strong urge to see the positive in things. When her brother, Johnny, died of cancer at the age of only 21, she was amazed by the empathetic behavior of his physician. When recognizing that death was to arrive soon and inevitably, he asked Johnny what would make him happy. “I want to go home” was his answer. Against the rules and protest of several nurses, the doctor then took Johnny’s things and brought him to Maureen’s’ car. Johnny died a few weeks later in the company of his family. Everyone was happy to take care of him and enjoy the little remaining time together. As with everything, Maureen has drawn a lesson from this: Don’t ask only “What’s the matter with you?”. but also ask “What matters to you?”. That is an important change of perspective that will lead to better outcomes; or at the least, a better peace of mind.
When in doubt, call your children.
At 34, Maureen became a hospital CEO. Later she led the IHI’s strategic and operational management together with Don Berwick for 15 years before becoming its president. When they wanted to run a campaign to make care safer and prevent unnecessary deaths, she and Don turned to their children. “We did not know how to run a campaign, but they worked in politics. So, we called them and they taught us how to design a campaign.” It meant learning from the young and then, handing over responsibility to a very young team without experience in healthcare, but the older generation trusted the younger one. And it worked out well. Another lesson Maureen learned in the process is that in order to achieve targets you must make them precise and measurable. Their campaign eventually went from wanting to “save ‘some lives, soon’ to “100,000 lives in 18 months”. They engaged hospitals all over the US and these leaders and clinicians over-delivered: the campaign is estimated to have saved 122,000 lives.
What's your curiosity quotient?
Maureen is also aware of the subtle things when it comes to leadership. “There are some visual cues that tell you something about the leadership of a place.” When she explores a new place, she usually has a look at the lunch cafeteria. Do they serve fruit and veggies? How is the atmosphere at this place where the tired staff takes a break? There are some good examples but she has also seen many bad ones. “So the staff is stressed and you serve them piles of fried chicken?!” she asks laughing. She points out that this might well indicate that more things are going wrong apart from nutrition.
Curiosity is another important trait to Maureen that determines if an organization can stay innovative. You need intelligent staff and people who are sensitive to the emotions of others. But rather than IQ or EQ, she suggests the CQ (curiosity quotient) is an even more important indicator whether or not you should hire a person. Employees must be inquisitive and constantly look for improvements – both incremental and radical. Discover, implement, spread, monitor, and improve. That’s what a leader must teach his organization to practice.
“Can you get me some coffee, hon?”
Maureen did not only become a leader at a young age, she also became a leader as young women. As a hospital CEO, she was working with a team of men, many of them in their 60s and with a traditional attitude toward women. “When I had one of my first meetings, an older male colleague asked “’Can you get me some coffee, hon?’. I replied: ‘Sure. How about I get you some now and next time it’s your turn?’ Everyone laughed.” Wit and repartee paired with humor are tools that have helped her a lot over time. “You have to deal with people who challenge you, but you also want to keep up the relationship with them. Take it with humor and a smile.”
“When I had one of my first meetings, an older male colleague asked “’Can you get me some coffee, hon?’. I replied: ‘Sure. How about I get you some now and next time it’s your turn?’”
When asked what special strength women have, Maureen points out that they are “natural team builders”. In her opinion, women have the intuition to not only direct without questioning. Instead, they inquire the best solution or how everyone can contribute in an optimal way.
One interesting challenge ahead: There are now five distinct generations who live, interact and work together. How does one reconcile the different thinking patterns and approaches to deal with innovation and radical change? Maureen mentions that there is the danger of burnout and resentment, particularly among the elder generation. But she suggests that women can offer a solution by leveraging their empathetic strength. Certainly there are already some female role models and good solutions out there; their stories just need to be uncovered and spread. Let’s go harvesting?