Flawless execution is not enough

How managers can enable learning and problem solving at the front line

MONDAY, SEPTEMBER 29, 2008

 Can a relentless focus on execution hurt an organization's performance? It can, according to studies by Professor Amy C. Edmondson reported in the July-August 2008 issue of Harvard Business Review.

What's needed in knowledge-based work such as health care, she says, is not "execution-as-efficiency," with its single-minded attention to controlling work processes, but rather "execution-as-learning...a radically different organizational mindset." In traditional work, she explains:

"Underlying the notion of a simple, controllable production system was the notion of the simple, controllable employee....Because the work itself was not terribly interesting or motivating in its own right, managers...used a combination of carrots (more pay for more tasks completed) and sticks (reprimands or the threat of job loss) to motivate employees."

However, when knowledge is paramount and the state of knowledge changes quickly, efficient execution is not enough; long-term success requires employee engagement and continuous improvement:

"Performance is increasingly determined by factors that can't be overseen: intelligent experimentation, ingenuity, interpersonal skills, resilience in the face of adversity....People rely on their own and their colleagues' judgment and expertise, rather than on management direction, to decide what to do."

Especially in team-based knowledge organizations such as hospitals, she says, employees have to feel safe "to give tough feedback and have difficult conversations—which demand trust and respect—without the need to tiptoe around the truth."

Leading health care systems, including the Cleveland Clinic and Intermountain Healthcare, were among the organizations she studied to develop four steps to support continuous learning and innovation:

• Provide process guidelines: Developing guidelines for how work gets done based on best practices is a key concept in health care. Edmondson points to Intermountain Healthcare's treatment protocols for 60 diseases. (Likewise, Kaiser Permanente's evidence-based approach improves the quality and consistency of care, while allowing physicians to use their judgment and experience.)
• Encourage collaborative decision making: In medicine, where complex, unforeseen occurrences are common, teams often must make decisions on the fly. One tool to give them vital information in real time is the electronic medical record. (Edmondson cites the Cleveland Clinic's system; KP HealthConnect is another example.) Face-to-face collaboration and personal networking are also key to growing an organization's knowledge base, she adds.
• Collect process data: To improve performance, you have to study how work unfolds, not just the outcomes. For instance, caregivers and frontline workers should have a way to provide feedback on process breakdowns or alternative solutions
• Identify process-improvement opportunities: Learning organizations have a formal process for reviewing the data they collect and apply the lessons learned. At Kaiser Permanente, the Plan, Do, Study, Act cycle, which unit-based teams use in their rapid improvement work, provides such opportunities.

Old-school execution-as-efficiency still has its place, she says, but even in a high-volume call center or production facility, "employees must learn if they are to improve." That requires a new mindset where "managers empower rather than control" and employees "offer innovative ways to lower costs and improve quality."

Performance is increasingly determined by factors that can't be overseen: intelligent experimentation, ingenuity, interpersonal skills, resilience.

Amy C. Edmondson, Harvard professor

Order article reprints of "The Competitive Imperative of Learning," at The Harvard Business Review website.