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The Premise

There is broad agreement on the fundamentals of organizational and business success: a clear and effective strategy; a focus on execution; a culture driven by performance and high standards; talented people, especially managers; and effective and adaptable structures, systems and work processes. Success is driven by the ability to execute. And the ability to execute is driven by a set of basics that make up a healthy organization.

A lack of success is often attributable to the absence of these building blocks. But there is another list, the “granular” items that support the building blocks. The items on this list are often ignored or given short shrift. They are blind spots. Why is it hard to spot them? Here are four big reasons:

  • We’re all leaders now: In an age that glorifies “leadership,” dealing with these issues can seem to be beneath the pay grade of the leaders. These are primarily managerial and operational concerns.
  • Hard to spot cultural issues: These prerequisite issues and themes are often cultural, normative or behavioral. As a result, most people are not even aware that they are an issue, just “the way that we do things here.”
  • Outside our comfort zone: Because they are cultural, dealing with them can be uncomfortable. Why should we get out of our comfort zone when things seem to be going okay?
  • Organizational health devalued: Because “bottom line” and “business” ethics have now permeated all organizational sectors – business, government and non-profit – organizational health and the concepts related to productive workplaces have been devalued.

At FS & A, our purpose is to re-focus on these prerequisites. The clearest statement of this premise can be taken from The Advantage by Patrick Lencioni: “Organizational health will one day surpass all other disciplines as the greatest opportunity for improvement and competitive advantage.” These prerequisites are key ingredients to achieving organizational health.

The Healthy Organization

What is a healthy organization? Based on our experience, health organizations have the following qualities:

  • Clarity: In a healthy organization if you ask 10 people the same question, you will get a single answer. It is a simple formula: the greater the degree of clarity, the less ambiguity, the healthier the organization, the more assured the success.
  • Support: Workers at all levels are motivated by the belief that, when they run up against a problem, their managers and leaders will support them and help find a solution. In their bones, they feel that they – and their organization – are making progress. Money and other incentives are secondary to this quality.
  • Trust: High levels of trust contribute to organizational effectiveness and health in all kinds of ways. Conversely, a lack of trust, has a crippling effect.
  • Learning: In healthy organizations, people listen to and learn from one another and from their customers, constituents, patients and clients. They are models for achieving what Ken Blanchard calls “raving fans.”
  • Talent: Especially in our unhappy age, healthy organizations are magnets for talent, and, once there, talented people stay.
  • Change management: Because these organizations are based in trust and have talented people, they are able to get the emotional commitment needed to effectively initiate and manage change.

A List of Prerequisites

The list of prerequisites is deceptively simple. Typically, when leaders and managers look at it, they groan, groans that reflect recognition of deficiencies in their organizations. Here is the short list:

  • Right people in the right jobs: Jobs are clearly defined, the right people are recruited and hired, and, once on board, they are supported and remain motivated.
  • Decisions: Decisions are clear, everyone is committed, and, once made, they are implemented until they “stick.”
  • Planning: Planning is a core function, and plans lead to effective execution.
  • Meeting quality: Meetings are productive and serve multiple purposes.
  • No silos: Individuals and groups work well within and across unit lines. They trust one another and are willing to acknowledge errors.
  • Systems/work processes: Basic systems and core work processes function well.
  • Delegation: Managers and supervisors delegate effectively.
  • Zero tolerance: Disruptive people and poor performers are not tolerated, and people hold one another accountable for achieving reasonable results.
  • Conflict is essential: Healthy conflict is encouraged, and unhealthy conflict and blaming are not tolerated.
  • Project management: The difference between operations and project management is clear, and projects are effectively managed.
  • Learning: People are learning, and, in the process, go beyond “what” to “why.”
  • Communication as a discipline: Internal communication processes, especially the communication of change, are highly effective.

These are the nuts and bolts of a healthy organization. There may be other items, but these are the most important. No organization would get “A”s for every item, but identifying those that are impediments to success and organizational health is the starting point to solving the problems.

The Approach

The HSMI approach flows from a single unhappy fact: most change efforts fail, and organizations are worse off for these failures. They fail for a number of reasons, and our approach, based on decades of experience and lessons learned, is designed to overcome these barriers. The approach consists of:

  • Naming the problem: There is no point in solving the wrong problem. Define the problem to be solved accurately and gain an understanding of why it is a big deal: what happens because of this problem?
  • Alignment and commitment: Get the right people in the room and agreement and commitment on action
  • “Vision”: Nothing “soft” here. What do we want to look different after we fix this problem?
  • Case studies: Case studies work. They help us understand how we are the same, and how we are different. They drive understanding and customization.
  • Checklists: Checklists work. They get everyone moving in the same direction, clarify actions and provide a platform for accountability.
  • Customization: All organizations are the same, more or less. It is the “less” that makes customizing solutions essential.
  • One at a time: It’s better to solve 3 problems fully than 10 50%. To be successful with these organizational problems, its better to take one at a time.
  • Linear process that ends with full implementation: The goal is a healthy organization. The path is linear, although there are always adjustments and detours, but the goal is defined and measurable change.

Are We Dysfunctional?

The Case: The Functional Organization

The partners in the Gotham City Consulting Group were in a bit of a panic. They had identified a truly functional and healthy organization, and its model seemed highly replicable. GCCG’s bread and butter was dysfunction in organizations, and now its meal ticket seemed threatened. What if everyone became functional?

Big Box was managing its vast new distribution center with high productivity, virtually non-existent lateness and absenteeism, very high six sigma scores, and none of the “nut and bolts” problems that bedevil most organizations. GCCG had proposed doing an in-depth analysis of Big Box operations, the kind that typically produced vast numbers of cool Power Point slides. But Big Box said “no,” it didn’t need the analysis. It knew the answer: it had replaced almost all of its workers with robots. It had solved the problem of dysfunction in human organizations. It had gotten rid of the humans. Well, at least most of them.

Post script: Trouble at the Big Box distribution center. When one of the five human maintenance workers at the center was informed that he was receiving a pay cut that would bring him down to minimum wage, he bought a flame -thrower from a local militia group. In a rage, he torched eight robots, costing Big Box several millions of dollars and disrupting operations for three days. All of the robots went to their deaths silently and with dignity. None complained of having had a bad day.

The Nature of Organizational Dysfunction

Nobody wants to be dysfunctional. But the reality is that all organizations are dysfunctional in some way. And, particularly problematic, most of these organizations either ignore or misdiagnose the sources of their deficiencies, often with the assistance of outside consultants. The reasons for misdiagnosis fall into identifiable categories:

  • The Tolstoy Quote: Many of these problems are normative, buried in the subconscious of the organization’s culture. They are “the way we do things here.” People are so used to them that they seem normal. As Tolstoy said in Anna Karenina, “There are no conditions to which a person cannot grow accustomed, especially if he sees everyone around him living in the same way.”
  • The Kennedy Assassination: For many people, one of the most troubling aspects of the Kennedy assassination was that a non-entity, the assassin Lee Harvey Oswald, could have such a profound impact on history. Similarly, in organizations, it seems absurd to think that “nuts and bolts” issues such as meeting quality, hiring interviews, work process “handoffs,” could profoundly affect the success of the organization. But they do. They are a big deal, and they merit the attention of leaders and managers.
  • The Comfort Zone: Life is stressful enough without adding to it by addressing uncomfortable issues at work, especially if they imply change in the way we do things. So people avoid difficult issues, often adapting a version of the French model: we want fundamental change, the sole prerequisite being that everything remains the same. A typical outcome is some form of misdiagnosis or evasion, and, as Descartes once – correctly – said, “the most corrupting lies are problems misstated.”

Self Assessment

We believe that the checklist that follows is comprehensive with respect to the managerial and operational problems that are barriers to organizational success. All organizations face some mix of these problems. In each category, score your organization or unit/work group on a scale of 1-5. “1” means this is a big problem area for us, “5” that this is a function or activity that we do really well. Experience tells us that the impact of the problems that are flagged by a low score is almost always greater than we believe. For that reason, low scores should become “action items.”

Recruiting, hiring and managing people
maximum score: 35, our score: ____
• Do we hire the right people – committed high performers – for clearly defined jobs? ( )
• Do we effectively train, support, motivate and reward them once they are hired? ( )
• Do managers, delegate effectively, or are we better as “doers”? ( )
• Do we deal effectively and in a timely manner with poor performers and “difficult” people? ( )
• Do we manage conflict and handle differences among individuals and groups well? ( )
• Do we focus on results and hold each other accountable for meeting commitments? ( )
• When people face a challenge, do managers support them in finding solutions? ( )
• Do people feel that we are making steady progress? ( )


maximum score: 35, our score:____
• Are the right people in the room when we make decisions? If not, can we make this decision? ( )
• Do we understand and agree upon the decision’s context: simple, complex, urgent/emergency? ( )
• Are our decisions clear? Does everyone fully understand the actions that will flow from this decision and who is responsible for producing what outcomes? ( )
• Do we effectively execute decisions once they are made? If not, what happens? ( )
• Are decisions and follow-up actions clearly communicated to others who are affected but not in the room? ( )
• Do we avoid “backtracking” on decisions that have been made? Do people tend to view decisions as being provisional and subject to change? ( )
• Do we always consider relevant legal and ethical issues related to our decisions? ( )

Meeting quality

maximum score: 25, our score: ____
• Are we satisfied with the quality of our meetings, or do we see boring and unproductive meetings as a normal part of life? Do meetings have clearly defined outcomes? ( )
• Is it always clear why we are meeting and what the agenda is?
• Is it always clear who is in charge of a meeting? ( )
• Are our meetings tailored to specific needs and situations, e.g., tactical/operational vs. strategic? ( )
• Do meetings have outcomes that are understood by everyone? ( )
• Are meeting used as planning tools? Do we use them to eliminate ambiguity? ( )

Internal communication

maximum score: 20, our score: ____
• Do we – individually and collectively – see internal communication as a basic management function? ( )
• Are communications clear: content, target audiences, most effective sender, most effective vehicles? ( )
• Do we overuse e-mail as a vehicle, and, if so, what are the consequences? ( )
• Do we encourage feedback and active listening? ( )


maximum score: 40, our score:____
• Do we engage in planning on a systematic basis? ( )
• Do we always have the right people in the room? ( )
• Do we use available information effectively and do we systematically test our assumptions? ( )
• Are we clear on the impacts that we are measuring and their connection to our plans? ( )
• Are our goals time-targeted, measurable and realistic/achievable? Do we test them for reasonableness? ( )
• Are decisions, tasks, assignments and timetables all clear? ( )
• Do our plans get implemented? If not, what are the barriers to effective implementation? ( )
• Do we have systems in place to track progress and assure accountability? ( )

Project planning and project management

maximum score: 30, our score: ____
• Do managers share a common approach to project management? How do we know? ( )
• Have we identified all of the stakeholders, and do we understand their needs/wants? ( )
• Do we use a set of formal project management and tracking tools? ( )
• Is the project trajectory always clear to those involved? ( )
• Is it always clear who is in charge of what functions? ( )
• Do we have defined measures for each stage of the project? ( )

Working groups and teams

maximum score: 20, our score ____

  • Are roles in work groups always clear and clearly understood? ( )
  • Do the following descriptions apply to our work groups: high levels of trust among members; effect use of conflict/openness; commitment to agreed-upon actions; willingness to hold one another accountable for achievable outcomes; and a strong focus on execution and results? ( )
  • When confronted with a problem, is our dominant response problem-solving or some form of blame/blame avoidance? ( )

Work processes

maximum score 15, our score: ____

  • What are our core work processes, and have we critically examined them during the past year? ( )
  • Do we effectively differentiate among systems issues, performance issues and work process issues? ( )
  • Do we avoid breakdowns in inter-unit communication, collaboration, implementation processes and respond quickly when they do occur? ( )


The Decision Series:

(1) What is the Problem?

Themes in this Series

1) What is the problem? What are we deciding?
2) Discussion, decision, implementation
3) We need a consensus
4) It’s too complicated
5) What did we decide? Who will do what?
6) Why process is important

The Case

Our Lady of Confusion was a highly regarded skilled nursing facility. In good times and bad, it had maintained its stellar reputation. In recent years, however, small cracks had appeared in the façade of excellence. What was the problem? Management tended to blame leaders of certain units for not managing their operations effectively, and there was some evidence to support this view. Medicine felt that the patient mix had changed over the past ten years, and that the facility’s skills sets, systems and processes no longer matched a more complex reality. This assessment was also accurate.

These divergent views were never effectively reconciled, in part because the facility’s departments operated in silos and never collectively asked: what is the most important problem? What was particularly striking, but not all that unusual, was that the leadership did not have a forum for addressing this kind of question.

The Problem

The hardest part of solving any problem may be defining or naming it. As the case study tries to demonstrate, understanding and agreeing upon what the problem is becomes the platform for successfully solving it. This is a big deal. A strong case can be made for the premise that the most important “product” that leadership and management produces is decisions.

Solving the wrong problem – or being immobilized by not being able to define the problem to be solved – has a lot of negative consequences, many of which were surfacing at Our Lady of Confusion. Three of these consequences stand out:

  • A culture of drift develops over time, an acceptance of the notion that we are not moving forward, a real motivation killer, especially in mission and values driven organizations
  • Ambiguity fueled by divergent problem definitions fuels conflict and breakdowns in basic systems and work processes
  • Silos are reinforced because “we just can’t work with those people,” i.e., people who don’t even share our view of what the problems are.

Solution: Naming the Problem

If you have read this far, you are more than half-way there. You are ready to answer checklist question number one: Do we have a problem in accurately naming our priority issues and problems as an organization?

The remaining checklist:

  • Do we have a forum/meeting setting to get all of the right people in the room to formulate our issues/problem definitions? If not, let’s do it. (This may seem awkward, and, in conflict averse organizations, is going to take some people out of their comfort zones. It is a small price to pay, and people will quickly get used to it and embrace it.)
  • Set a basic groundrule: no blaming, no blame shifting. This is about problem solving, and problem solving is about the future, not who did what wrong in the past.
  • Make the problem explicit through discussion, including asking the critical question: what happens because of this problem?
  • Once the problem and its consequences are made explicit and there is broad agreement, begin the process of exploring the range of responses