• Stephen Harden

Effective Leaders Take Massive Imperfect Action

Updated: Jul 20, 2021



After leading over 225 performance improvement initiatives in the last 20 years, it's clear to me that it takes about six to nine months for healthcare leaders to decide if they want to improve performance in their organization.


One hospital I worked with had a series of several serious wrong surgeries. After the third one, and in desperation they called me, asking for an immediate callback. They knew their culture was broken. They knew their checklists weren't being used correctly, if at all. They knew that no one was speaking up when they perceived a problem with patient care.


Despite what they knew about their hospital and that they were harming patients, it took them over 24 months to decide to take the steps to fix it.


You don't need more time, you just need to decide. Can you stay where you are, or not? If not, have a bias for action and make a decision.

Read the history of the original Mac and you'll be amazed at just how fast it got done. Willie Nelson wrote three hit songs in one day. To save the first brand Seth Godin was responsible for, he redesigned five products in less than a day.


Seth says It takes a team of six people at Lays potato chips a year to do one product redesign. Healthcare leaders don't have the luxury of acting like they leading at Lays potato chips. Here's a list of reasons why leaders don't have that luxury.


If you are in a leadership position and you know the organization must change, the urgent dynamic is to take massive imperfect action and ask for signoffs from your executive team and to push forward, relentlessly. Proceed as if success were inevitable.


Keep telling your boss, "I can make this happen. I've got it."


Seth Godin, one of the best project innovators out there says you can feel this relentless move forward happening when you're around it.


"It's a special sort of teamwork, a confident desperation... not the desperation of hopelessness, but the desperate effort that comes from being hopeful."

Being hopeful comes from knowing how to make change happen in an organization. If you are not sure how to do that, here is a primer on three important steps to successful change initiatives. You might also find this amazingly simple checklist for creating sustainable performance improvements useful.


Your patients would be shocked to find out it takes you nine months to decide to take action when you already know action must be taken. They expect you to relentlessly improve how you provide care.


Are you?


What decision are you dwaddling over? How many patients are you willing to affect before you take action?


Remember, Willie Nelson wrote three hit songs in one day. What process or outcome are you improving today? You don't need more time, you just need to decide. Get moving.

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