On Leadership, Toyota, and Successfully Implementing Change

Medical Robot

I am a medical doctor and Professor of Medicine. I treat human beings. I also understand how they behave. Humans are creatures of habit. And when it comes time to improve performance, many of us fear, or even reject, change.

However, maintaining the status quo rarely leads to improvement.

And in the practice of medicine, improvement should be a priority.

Through trial, error, and eventual success, I have found that effective change requires unique skills often not taught in standard leadership courses.

Gatorounds 1.0

My first significant experience with implementing change came when I decided to improve teamwork during hospital work rounds at the University of Florida (UF).

Modern medical care has become too complex for one person to manage.

When faced with complexity, the business world assembles multidisciplinary teams in which members effectively share their expertise and work together to achieve their goal.

I had found that caregivers were not enamored with business models, and my attempt to use the Toyota Production System as the guiding set of principles met with resistance.

Learning From Athletics

I realized that virtually everyone can relate to a successful athletic team, even if only as a spectator. Modeling our rounding system on athletic principles proved to be a more practical and accessible model. The use of athletic principles allowed me to draw on every caregiver’s past experiences to improve their teamwork.

I embraced this approach with great enthusiasm, so you can imagine my dismay when my colleagues exhibited a lukewarm response to my concept of Gatorounds (named for the university’s mascot, the alligator).

I didn’t understand that proposing this seemingly straightforward approach would force a dramatic change in the way work rounds were conducted.

The physician would no longer be the captain of the ship, but rather become the team coach.

This meant that physicians would have to give up some of their power and empower others to truly assist in the care of their patients.

This challenged the concept of the lone heroic practitioner managing every detail of his or her patient’s care.

Creating Social Disequilibrium

I did have the backing of the Chairman of Medicine, so I began to implement Gatorounds, and I experienced firsthand the effects of creating social disequilibrium. I’d created playbooks that defined the role of each caregiver and established a schedule for arriving at patient rooms.

The idea of scheduling was met with great resistance by one of the chief residents.

When bedside nurses were encouraged to be active participants on the multidisciplinary teams, one resident folded her arms and refused to enter the patient’s room.

I pointed out that, as the quarterback, she needed to be on the field.

Unfortunately, this metaphor was lost on her, and she remained in the hallway, scowling.

In the midst of implementing these changes, I failed to recognize the degree of resistance I was generating and blindly forged ahead. Physicians began talking behind my back. I was viewed as a troublemaker. The Chairman of Medicine became displeased and suggested I was a poor leader, even threatening to discharge me from my role as Division Chief.

Realizing that my good intentions were being misinterpreted, I went on sabbatical.

Studying Leadership

I joined the Harvard Business School’s Advanced Leadership Initiative, and for the next year, I studied leadership, teamwork, organizing people to bring about cultural change, and healthcare delivery systems.

The mistakes I made in implementing Gatorounds quickly became obvious.

As luck would have it, my absence from UF eliminated some of the friction I’d caused. Some of the physicians had appreciated the positive effects of Gatorounds, and once I was no longer pushing this system on them, the concept of using athletic principles to promote teamwork became part of the status quo.

Gatorounds 2.0 

When I returned to UF, a new Chairman of Medicine and Vice Chairman for Clinical Care had been appointed, both of whom saw the potential benefits of Gatorounds.

They encouraged me to reinitiate my pilot program.

Actively keeping in mind what I’d learned at Harvard, I began to quietly implement Gatorounds 2.0.

This time, while coaching new physicians on the fundamentals, I repeatedly asked questions and listened to their concerns. I was profuse in my praise when the proper procedures were followed.

When the appropriate protocol wasn’t being followed, I gently suggested a better way.

Occasionally, I invited physicians for a cup of coffee, creating a comfortable environment where I could describe the successful approaches of other physicians that they might consider emulating.

I carefully managed these relationships, encouraged everyone to help with the implementation, and recruited a group of physician champions.

I’m proud to say that Gatorounds has now been fully implemented, and staff satisfaction has steadily increased.

Rounding now takes 2/3 of the time it once did, and without any decrease in patient satisfaction.

The Adaptive Leader’s Playbook

For an adaptive leader to successfully implement change, he must be fully cognizant of the challenges he faces. People try to prevent change in one of two ways: procrastinating and personally attacking the leader. Change creates smoke, and people think where there’s smoke, there must be fire.

The key skill for an adaptive leader is to generate smoke without a destructive fire.

Disequilibrium should be monitored, and change slowed, when emotions run high.

The Ideal Leader

The ideal leader coaches others and trains them to be effective leaders. The creation of a leadership team responsible for making decisions and implementing change can diffuse the responsibility and protect the individual leader from becoming the sole target for those in favor of the status quo.

By identifying like-minded employees to create a leadership team that develops strategies, the adaptive leader will be able to establish more effective approaches.

3 Steps to Change

There are three elements to keep in mind when approaching change:

  1. Trust others to design strategies for change, and encourage everyone to act.
  2. Continually compliment and reward those who create, and support effective strategies for change.
  3. Keep your eye on the goals; accept that change will make people uncomfortable, and understand there will be discord.

A leader who is knowledgeable, encouraging, and patient can orchestrate fruitful change. Indeed, they’re the only ones who ever have.


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Dr. Frederick Southwick is a Professor of Medicine at the University of Florida
He is the author of “Critically Ill: A 5 Point Plan To Cure Healthcare Delivery”
Email | LinkedIn | Twitter | Blog

Images Source: blogcdn.com

2 responses to “On Leadership, Toyota, and Successfully Implementing Change

  1. Pingback: Leadership updates for 06/04/2012·

  2. Vital Smarts has done much research in the health field and found that almost all error is because of systems and not people. I so appreciate your work being an ex RN and working in the team leadership arena.


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