leanhealthcare_leadershipstandardwork2A few years back when working with an executive team, the team asked why they needed not only to write down their daily, weekly and monthly Leadership Standard Work (LSW) but track their compliance with what they said they were going to do and share with their peer group and direct reports. There was a degree of irritation noted in the question’s delivery so I gave my best answer:

  1. You are modeling new leadership behavior for middle management and front-line staff.
  2. You are holding each other within the peer group accountable.
  3. The LSW you develop is part of an interlocking, bi-directional chain of accountability from front-line staff to you.
  4. The LSW process is critical to sustaining improvements.

The answer was incomplete. Yes, the four points are correct; however, in addition there is a personal change process at play. Willpower and personal control (self-control) are essential to the creating and adhering to new routines (habits).

The level of willpower is not innate to an individual. It is developed through practice and conditioning. It is the same process as when we increase our physical endurance through cardio and strength training routines. It is essential to personally develop and document the new routine, track and measure adherence, and create the countermeasures to the noise that may prevent adherence to the new routine in advance of implementation.

British researchers studied elderly patients pre- and post-hip and knee replacement surgery.* Prior to surgery each patient was given a booklet detailing their rehab schedule. Within the booklet were blank pages that each patient was asked to write their personal daily and weekly activities as well as their daily/weekly goals. Three months post-surgery, the researchers found that those who wrote and tracked progress to their plan and goals in the blank pages had, among many positive outcomes, started to walk twice as fast as those who left the pages blank.  Interestingly, the patients who wrote, tracked and rewarded themselves for accomplishing daily and weekly goals also documented in advance when they might anticipate pain and what they would do about it in order to stay the course with their plan. By acknowledging in advance the barriers (pain) to adhering to their planned daily activity, the patients were prepared to address the barrier; hence, the patients were conscious of these inflection points which derail the best of plans and emerging routines.

In other words, the patients who took control of their rehabilitation by writing down their own plan, checking off their success each day, and implementing already identified countermeasures to overcome barriers, consciously established a new routine that delivered positive outcomes.

Yes, my answer to the executives a few years ago was correct and incomplete. Writing one’s own Leadership Standard Work is an act of personal ownership and conscious leadership. Measuring compliance to the plan establishes a positive feedback loop that encourages more of the new positive behavior. Lastly, anticipating barriers and countermeasures in advance provides the leader a conscious alternative to reactive, firefighting behaviors certain to derail the developing LSW routine.


KirkwoodBillRSToday’s blog was written by Bill Kirkwood, Ph.D., senior consulting director at HPP.

Bill has 30 years of healthcare leadership experience in both system and individual hospital settings across the United States.  His experience includes change management activities, Lean transformation engagements and serving in an executive capacity in quality, operations and human resources. He holds a Master’s Degree in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University.

*Charles Duhigg, The Power of Habit, 2012 [Sheina Orbell and Paschal Sheeran, “Motivational and Volitional Processes in Action Initiation: A field Study of the Role off Implementation Intentions,” Journal of Applied Social Psychology, 30, no. 4 (April 2000): 780-97]

Image by Freepik

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