Cheryl Proval

How many CEOs have the humility to institute the practice of nameless, rankless debrief?

Many ideas resonated in the hall where an ex-fighter-pilot-turned-CEO of a motivational company held an audience of the nation's top practice managers rapt during the Radiology Business Management Association's Radiology Summit 2006 keynote in Miami recently. Clearly, many of the practice managers in the room could relate to the problem of task saturation. And the requirement in health care for flawless execution is fairly compelling. Juggling turf battles, the DRA, technology upgrades, data deluge, center operations, billing issues, and more, this audience easily could relate to the task of flying an F-15 in the midst of a dogfight with more than 350 switches to monitor, while moving at the speed of sound with up to 9 g's of force pressing down on them.

But the idea that gave many attendees pause was the notion of nameless, rank-less debriefing, the final step in the company's trademarked Flawless Execution Model: plan, brief, execute, and debrief, the model's linchpin.

The planning model is simple but effective. Begin with a plan, but include at least three levels of rank: C-level, mid-management, and field commanders. This is essential. As described by Jim Murphy, CEO and founder of Afterburner, Atlanta, open planning is the key to flawless execution.

1. Determine a mission objective that is clear, measurable, and achievable, and supports the future picture.
2. Identify the threat, both external and internal.
3. Identify your valuable resources.
4. Evaluate lessons learned (obtained from the aforementioned debrief).
5. Develop a course of action:
   • Brainstorm, giving separate groups 20 minutes; people plan a lot better on a short time frame with less time than they think they need.
   • Bring in the Red teams, people who were not part of the planning team,and let them rip it apart.
   • Draft a final plan: who does what and when, and how do you know it was accomplished?
6. Plan for contingencies: What if we shut down and billing drops into a 60-day hold?

Let us move on to the nameless, rankless debrief, and please be frank here: in this land of the free and the brave, aside from the military, there is probably no other American institution as rife with rank as the hospital (or the medical practice, for that matter). Neither is there an environment less forgiving of mistakes.

"If it works in my world where rank is so important we wear it on our shoulders, it can work in yours," Murphy said. "We have a place we go where you can say anything. If a general walks in and doesn't admit he made a mistake, I am going to point it out...Otherwise, when we go back out there, all of us could get killed. Think about what that could do for health care."

If you have the courage to institute the practice of nameless, rankless debrief, work to create a culture in which there is no fear of recrimination in your team. Then go forth and achieve your mission. Good luck!

Cheryl Proval
Editorial Director