Tanveer Naseer

Leadership Coach, Speaker, and Writer

Why Leaders Shouldn’t Lose Sight of the Basics

Last week, my wife and I decided to take advantage of the kids’ being off from school for March Break (what we call here la semaine de relâche) to go on a family vacation at a nearby resort. On the day we headed out from the city, we drove straight into one of this season’s biggest snow blizzards, turning a typical road trip into a more daunting and worrisome affair.

To give you some perspective on what it was like, visibility conditions went very quickly from being able to see about 20 feet ahead to barely seeing past the car in front of us. And as if that wasn’t bad enough, the highway looked more like a country back road thanks to the fast-accumulating snow obscuring the road’s surface and lane divisions.

For the most part, the other drivers on the road took the necessary precautions of leaving more space between cars and slowing down to a more manageable speed. However, there were some drivers who made no adjustments to their driving in response to the poor weather conditions. This was especially true among some of the truck drivers that were out on the road that day.

On several occasions, these truck drivers had no qualms using the left lane to overtake the impromptu convoy of cars on the adjoining lane, at speeds that caused the trucks to bob slightly from side to side. At one point, this unintended side-to-side movement caused one of these fast-passing trucks to swerve dangerously close to our car.

Angry at the irresponsible driving of these truckers, my wife questioned why they were driving so carelessly under such poor conditions. My initial response was to point out how truckers spend a lot of time on the highways and as such, they probably have a good feel of the road and how their vehicles react/respond to various conditions.

At the same time, though, I had to admit that news reports on these kinds of snow storms often feature footage of overturned trucks by the side of the road. After seeing these truckers ignoring the basic rules of safe winter driving, I can’t say my wife and I are surprised at how often these accidents occur during such storms.

Fortunately, this was the only dark spot in what turned out to be a relaxing and memorable vacation with my wife and daughters. Another bright side to this story is how it lead to some thoughts about one of the hazards we inevitably face on the leadership road.

Like these truck drivers, it’s understandable that ‘seasoned’ leaders will start to rely more on their past experiences to guide them through challenging situations as well as the more mundane ones. While their years of experience can certainly help leaders to understand and anticipate issues they’ll need to address, it can also cause them to overlook or fail to appreciate the importance of some of the more basic aspects involved in leading their organization.

Consider, for example, this story of the simple approach Dr. Peter Pronovost at the John Hopkins Hospital used to prevent infections associated with using catheter lines.

Dr. Pronovost created this basic checklist for medical staff to follow when applying catheter lines into their patients:

  1. Wash their hands with soap.
  2. Clean the patient’s skin with chlorhexidine antiseptic.
  3. Put sterile drapes over the entire patient.
  4. Wear a sterile mask, hat, gown and gloves.
  5. Put a sterile dressing over the catheter site.

When Dr. Provonost first created this list, he asked the nurses to note if the other doctors were following these five basic steps. Given how these measures are rather obvious, one would naturally expect that the hospital’s medical staff implemented each of them on a regular basis. And yet following a month’s observation, the nurses reported that doctors skipped at least one of these steps while treating over a third of the ICU patients.

After hearing the nurses’ findings, Dr. Provonost got the hospital’s administration to make it the hospital’s policy that nurses be allowed to stop doctors if they skipped any one of these five steps. They also made it a new policy for nurses to ask doctors each day whether the catheter lines were still necessary.

By allowing the nurses to monitor and respond to whether the doctors had applied these basic measures when using catheters, Dr. Provonost and his colleagues found that the ten-day line infection rate dropped from eleven percent down to zero. Encouraged by these results, they monitored catheter usage for another fifteen months during which the hospital had only two catheter-related infections.

On the basis of these findings, they concluded that the hospital’s doctors had prevented forty-three infections, eight deaths and saved the hospital $2 million – all because their medical staff had adhered to applying these five basic steps when using catheters.

By creating this simple five-step checklist, Dr. Provonost reminded medical practitioners that while managing life and death situations is par for the course, it’s still important not to lose sight of the basic measures which are necessary to protect those whose lives are literally in their hands.

As is the case with the truck drivers and the doctors at John Hopkins, it’s easy for leaders to start taking basic measures or responses to situations for granted, in large part because of the belief that their years of experience can guide them to make the appropriate decisions or adjustments.

What these stories help to illustrate, though, is that this belief about our experience can also create a blind spot that obscures our perception, causing us to overlook how taking the most simplest of steps can help us to prevent serious problems from arising.

While organizations are understandably anxious to get themselves back in the game thanks to a revitalizing economy, it’s important that this eagerness does not cause them to overlook the presence of these blind spots.

After all, the last thing any leader wants to see is their organization being featured on the news lying upturned by the side of the road.

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7 Comments
  1. On March 8th, 2011 at 8:01 AM Strada said:

    Tanveer,

    Very often trucks operate on a tight schedule to accommodate "just in time", that rain, sleet, or snow will not stop or slow them down to uphold the "just in time".

    In the case of the truck getting the shipment at its destination on time is a basic requirement.

    How often humans practice "just in time" leadership to fulfill a basic requirement?

  2. On March 8th, 2011 at 10:52 AM Tanveer Naseer said:

    Hi Tino,

    That's a fair point, however I'd like to counter with the motto of one of the more successful transportation carriers, FedEx, who emphasize their goal is not to have you worried about whether your shipment will get there, as you can trust them to take the necessary care and attention to making sure the service they provide is done right.

    Consider, as another example, BP who as we've found out, chose to overlook many basic safety requirements simply because they wanted to get their oil wells drilling sooner than later. We all know how that turned out for them in putting the time factor ahead of more basic considerations.

    That's why I have to disagree with you that "just in time" is a basic requirement as these stories all clearly show that all this does is cause us to overlook or dismiss ensuring basic steps are taken which will go further to ensuring we reach our goals.

    Thanks again, Tino, for sharing your thoughts on this piece.

  3. On March 8th, 2011 at 7:05 PM Ken said:

    Hi Tanveer,
    I believe it's also human nature to "cut corners" to speed up the process of things. When an expert in is or field knows a procedure by heart they tend to start "cutting corners" in order to get the job done faster and feel like they're being more productive. This type of behavior can often lead to something being overlooked which can lead to disaster. I know that when I'm doing something that I've done a million times I'll skip the steps that I know I can get away with skipping and it usually causes me to go back and do it all over again.

  4. On March 8th, 2011 at 10:23 PM Tanveer Naseer said:

    Hi Ken, I think that's exactly what this study by Dr. Pronovost demonstrated to medical professionals – that in their push and at times understandable need for urgency, they can overlook or skip what seems like elemental steps that would have negligible impact. And yet, by overlooking these basic steps, doctors ended up putting their patients more in harms way, making any notion that doing such improves the situation or saves time a misleading perception.

    They might be basic steps, but they are there for a reason and no matter how experienced we may be, we can't compensate for the value lost by choosing to skip or overlook them. Thanks again, Ken, for adding your thoughts to the discussion.

  5. On March 9th, 2011 at 3:27 PM Vipul Seth said:

    Related read:
    The Checklist Manifesto: How to Get Things Right
    by Atul Gawande

  6. On March 9th, 2011 at 5:59 PM Sonia Di Maulo said:

    Hi Tanveer!

    Love how you connected two very important topics to make your point.

    And I am in 100% agreement on both! My family and I were in the same storm… and when the snow turned to rain… we had a few near-misses and witnessed several accidents. To continue the analogy, people will often make decisions because of what other people are doing (not doing) or what the environment provides (does not provide).

    As the other cars slowed down, we slowed down. If we saw a car passing, we figured it may be safe. And as the rain started, we took necessary steps to change our behaviour. In complex systems such as our organizations, following and changing behaviors occurs both positively and negatively.

    In the case of Dr. Provonost’s study, if nurses or other doctors saw others skip a step then it communicates acceptance to skip a step (without seeing the bigger picture and effects). They may have saved time (as the other readers commented) and perceived the results to be the same (without knowing for sure because no one was truly monitoring the consequences of their new behavior). As we become experts in our respective fields, we will naturally begin to skip steps and see only 3 when there should be 5 (mastery level in the phases of learning). When I develop performance improvement interventions, my goal is to help the experts re-construct a process so that a novice can perform it with success: the basics!

    Wouldn’t it be great if in all our tasks (leadership or otherwise) we had someone helping us stay within the integrity of the task, knowing that the steps we are meant to perform are there for a reason… someone somewhere has thought them through with an eye on the entire system.

    There would be saved lives, dollars, time, customers, employees, and leaders everywhere!

    Lovely post, Tanveer. Thank you for sharing it!

    Sonia

  7. On March 10th, 2011 at 1:24 PM Tanveer Naseer said:

    Thanks Sonia; it was quite the storm to drive through, wasn't it? Glad to hear your family also arrived at your destination without incident.

    Those are some great additional points you make as well about maintaining the integrity of the process, of understanding why our organization is doing it outside of the typical "that's the way we've always done things" attitude. As business continues to speed up in response to growing global competition, it's becoming even more important for leaders to ensure they stay connected with the basics to avoid such pitfalls.

    Thanks again, Sonia, for sharing your insights on this piece.

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