The Silicon Valley mindset that could serve healthcare C-suites

Amazon CEO Jeff Bezos says the company's culture and operating model revolve around a Day 1 mentality: "constantly curious, nimble and experimental," with the customer at the center. He fears the descent into a Day 2 mentality: when decision-making slows as a company grows, and the focus turns to internal issues over the customer. 

As health systems continue to grow, executives might share Mr. Bezos' concerns.

One way a company can skirt a Day 2 mentality — and instead maintain agility as it scales — is by proceeding despite disagreement, per Mr. Bezos. In his 2016 letter to shareholders, he writes that using the phrase "disagree and commit" saves him lots of time. He sometimes greenlights projects he isn't sure of, allowing initiatives to move forward without employees having to convince him of them. 

"If you have conviction on a particular direction even though there's no consensus, it's helpful to say, 'Look, I know we disagree on this but will you gamble with me on it? Disagree and commit?' By the time you're at this point, no one can know the answer for sure, and you'll probably get a quick yes," Mr. Bezos wrote. 

Alex Dang, a former Amazon product leader who designed and launched new businesses for the brand, calls this the "venture mindset" (and wrote about it in his forthcoming book by the same name). Mr. Dang — now a senior advisor for McKinsey with experience leading healthcare clients through digital transformation programs — believes more productive disagreement could be fruitful for health systems. 

"One [thing health systems can] learn from venture capitalists and technology companies is that they appreciate, they love conflict," Mr. Dang told Becker's. "They understand that conflicting opinions are the only way to learn more, to listen to each other and to find the truth."

For routine operations, executives will likely adopt a traditional mindset that allows them to minimize conflict. When establishing a baseline process, like a method of scheduling appointments (or in Amazon's case, a delivery method), this is the way to go, Mr. Dang said. 

But when entering an area of high uncertainty — "anything innovative that as an executive, you've never had a chance to see results of before" — it's better to adopt a venture mindset. Maximizing conflict could be useful as health systems launch new services or digitize operations. 

Mr. Dang argues that compromise should be avoided on uncertain ground: "If you are dealing with something truly innovative, you're looking for an outlier. An outlier by definition, is rarely understood by everyone. This is exactly the reason why this kind of dissent is so critical." 

To cultivate healthy dissent, Amazon first establishes agreed-upon tenants so there are foundational principles to refer to in an urgent situation. Sometimes, venture investors assign a blue team and a red team to discuss and debate high-stakes decisions from both sides of the issue. Oftentimes in large technology companies, a big believer in a novel idea has the chance to test it, even if the rest of the group is not on board. And upper management is slow to weigh in at the start; when Mr. Dang recruited for the company, he could not discuss his opinion with direct reports or peers before everyone had submitted their decision, ensuring that they could voice a different view. 

The culture of an innovative company will stimulate disagreement, Mr. Dang said; but after the choice is finalized, all team members must commit wholeheartedly. 

Matthew Heywood, president and CEO of Wausau, Wis.-based Aspirus Health, agreed that varying perspectives are vital in today's healthcare environment; the "speed and degree of [industry] change" often require a "disagree and commit" mentality, he told Becker's

"Things are moving so fast that there isn't time to reach 100% certainty or 100% alignment when making a decision," Mr. Heywood said. "But inactivity is lethal. You make choices based on robust discussion, data and perspectives, then you execute and leverage process improvement techniques to rapidly evaluate your results and adjust as needed."

During meetings, Aspirus has a ground rule to guide dissent: presume positive intent. It's rare that a new idea or initiative isn't "unpopular to someone" in today's world, Mr. Heywood said, but "healthy disagreement is built on trust." 

The system's executive team does not always reach consensus, but "tend[s] to be in a good place," once people have made their case, using data to support their rationale. Part of the CEO's job is stepping in and ending the discussion once every perspective has been debated, Mr. Heywood said.

"I guess you can never be completely confident that any idea is the right choice. Our world and our industry are too full of ambiguity and complexity and, quite frankly, changing too fast for that level of confidence," he said. "But I believe if we have created the culture that allows leaders to build a case and present ideas aggressively, with trust that everyone has the best intentions, we will make the best choice possible."

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