Who’s on first? – Is it the patient?  The doctor?  The hospital?  The payer? In our everyday clinical (and non-clinical) practice we need to remind ourselves it’s the patient. When the patient is first, safety is first, quality is first, the care experience is first, and access is first.  Soon cost will be more of a consideration as individuals become increasingly responsible for the cost.

What’s on second? – If the patient’s on first, then what’s on second? Is it the doctor? The hospital? The payer?   It must be one of those, right? Wrong. Knowledge, information, and data are on second. It’s a huge “What” in health care and we’re not so good at managing, using and communicating it.  We simply have to get better at it. It will take technology and its proper application to disrupt our current system. There is good news.  We’re on the early part of the slope.

I don’t know who’s on third – Yes, we often don’t know and it’s a problem.  Once again, it’s not the doctors, the payers or the hospitals.  Culture is on third.  Culture defines and drives performance. And most of us don’t know much about it or how to influence it, let alone manage it. Culture is the end result of the behaviors, processes, strategies, values and visions put forth by leadership.  Its the driver of organizational behavior.  And culture is really what you are trying to influence when you make decisions and act as a leader. Putting in place a new process isn’t in of itself going to do much. Its what it does to the culture that really matters in the long run.

Baseball as a metaphor: Health care delivery is a team sport, and each position must be played well for the team to win. The physician, although not “on first” is certainly in the position of being captain, or at least the pitcher. The catcher is the advanced practitioner or nurse who helps manage the patients. And there are others on the team that the patient relies on.  Increasingly we are using medical assistants to assist us in collecting data, navigating patients and monitoring adherence.  The culture of the team is as important as the competence of each individual. We’ve seen that play out in major league sports time and time again.

So, what’s the secret sauce for creating a strong culture of excellence and reliability in health care? The evidence would suggest that its leadership.  I recently suggested in our organization that we have a leadership credo for our clinical transformation initiative. Someone on the work group asked why.  A fair question.  The reason is because leadership sets the tone, it’s the key to culture. If the leaders aren’t consistent, reliable, mindful, committed to transformation, committed to our chosen improvement tools, and committed to culture shift, then the effort fails. If we aren’t all rowing in the same direction as leaders, then the effort fails.

What’s your leadership credo?  And does each person on your leadership team share and live the same credo?