I made it a habit to meet with my directors on a monthly basis to update them on news from the senior executive team and CEO. We used the opportunity to prepare for our annual budget and set management goals. There was always some trepidation about execution of our goals, as our annual bonuses were linked to achieving them. During the year, we also used those meetings to assess our progress in achieving our goals.

In a previous post, I described the importance of writing SMART goals. SMART is a good start. Goals must be clear. And they must allow us to envision what accomplishing the goals will look like.

But the so-called holy grail is not simply the statement of a clear goal, but having processes in place to achieve execution of those goals. The purpose of writing and executing them is to produce results that advance the mission and vision of your organization. 

In 2012, Chris McChesney, Sean Covey and Jim Huling released The 4 Disciplines of Execution (sometimes called 4DX). In it, the authors have written a detailed summary of their approach to articulating and achieving “Wildly Important Goals” (WIGs) that can drive the success of just about any organization. To do so requires adopting the four disciplines of execution.

I’d like to spend this and a future post discussing their recommendations, and using an example in healthcare that demonstrates the success of their process. Along the way, I will describe some of the mistakes I made in trying to implement some of the goals I pursued during my time as Chief Medical Officer.

I find the approach described in 4DX compelling. It is not very different from the way my team approached the topic. But if we had been more effective at following some of the recommendations made by the 4DX authors, I think we could have been even better at executing our plans.

Describing the Whirlwind

I loved the authors’ description of the distractions that get in the way of achieving important goals. The whirlwind is described as the daily work that we do just to achieve the core mission of our organizations. In a hospital setting it includes:

• nurses assessing their patients and safely administering medications,
• pharmacists processing medication orders and responding to questions from the nurses on the floors,
• respiratory technicians providing ventilator care and administering dozens of respiratory treatments each day,
• physicians rounding, assessing, and treating dozens of patients and documenting their treatment,
• housekeepers cleaning rooms and public areas,
• staff cleaning and sterilizing surgical instruments in the sterile processing department, and
• hundreds of others doing their daily work.

As 4DX recognizes, these activities – the whirlwind – must continue day in and day out. But growth and movement into new service lines and new locations depends on carving out time, away from the whirlwind, to identify new goals and to execute those goals.

“The whirlwind is urgent and it acts on you and everyone working for you every minute of every day.”

4DX starts by defining the first discipline: identifying the WIGs – the Wildly Important Goals – that must be accomplished in spite of the whirlwind.

What is a Wildly Important Goal?

To me, this is a goal that either must be achieved to ensure survival, or one that will take an already successful organization to a new level of success.

In 1987, when Paul O’Neill took over as CEO of Alcoa, the organization was struggling financially. It was also experiencing more than its share of worker injuries. As the new CEO, rather than focus on revenues or profits, he announced his wildly important goal: to reach zero injuries in his workforce.

At the time, injuries were running about 1.86 lost work days per 100 workers. He was able to reduce it to 0.2 by the time he left the company. So he made the company 8 times safer. As a result of focusing on a goal that inspired his workforce, not only did injuries goes down, but morale and productivity increased. And revenues and earnings rose dramatically as the share price skyrocketed. All as a result of successfully executing a single WIG.

The authors suggest selecting a WIG by answering this question: “If every other area of our operation remained at its current level of performance, what is the one area where change would have the greatest impact?”

What Makes a Good WIG?

As the organizational WIG is being developed, each subunit must develop its own WIG(s). The subunit's WIG will help to promote the organizational WIG. An example in the  hospital setting of a series of cascading WIGs might look like this:

These goals exemplify what the authors' of 4DX describe as the features of an effective WIG:

• No more than 2 per team,
• A WIG selected by a team MUST align with the WIG of the organization itself,
• The WIG of the teams must be selected by the teams, not dictated from above, and,
• WIGs must follow the format: “from X to Y by when.”

Looking back, our executive team made several errors over the years. Sometimes our executive team would present over 70 management goals to the board for review and approval. We achieved many of them, but certainly not all. Perhaps we could have made bigger strides if we had been able to really focus on 2 major goals.

We sometimes found it difficult to align our goals. Although we might have a goal focused on growth for the organization, we might have a goal focused on quality, safety or satisfaction at a department level that didn’t necessarily relate to the growth goal.

I was personally not always successful at defining goals with a clear deadline. Sometimes department goals would all be due by the end of the year. It would have been better to stagger them: one due by the first half of the year, with the second to be completed by year-end.

How Do We Take a WIG to Execution?

Defining a proper WIG is only the first discipline. 4DX describes three additional disciplines:

• Act on Lead Measures
• Keep a Compelling Scorecard
• Create a Cadence of Accountability

Next Steps

I recommend that you look at your goal setting process. How well does it lead into execution of those goals. Purchase the book  The 4 Disciplines of Execution and begin to think about how to apply its principles.

Then watch for upcoming posts in which I apply provide an example of how the four principles can be applied to a healthcare setting.

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See you in the next post!