Former police commissioner William Bratton and Harvard Kennedy School's Zachary Tumin underscore the vital strategy of reaching across boundaries in "Collaborate or Perish!" Here's an excerpt.
Chapter 5: Make It Pay
In collaboration folks come together, give something up, and get something back that’s even better. They achieve something together that none can alone, and are better off for it.
A good platform makes collaboration easier, but only if people want to collaborate. “The availability of Lotus Notes,” Thomas Davenport and Laurence Prusak write in Working Knowledge, “does not change a knowledge- hoarding culture into a knowledge- sharing one.”
In other words, to be successful, you have to make collaboration pay. There’s always an “ask” and a “get.”
Sometimes the negotiating is best done machine to machine and takes milliseconds once the infrastructure and rules are set. That’s what a credit card authorization swipe is all about. But figuring out the architecture for that platform so that when the time comes the execution is flawless— that’s the work of humans collaborating. Everyone on the authorization platform has to want to be part of the deal— the customer, the merchant, and their banks. For agreement to happen, collaboration must pay— and pay better than the status quo.
Sometimes the negotiating is best done face-to-face, such as at Comp-Stat crime reviews, for example, which tracked progress and shared innovations at One Police Plaza in New York. Figuring out how to scale innovation, assure uptake and adoption, and improve performance on the streets is the work of humans, too. For shared discovery to translate from lab to the field, collaboration must pay across the entire platform— not just for commanders at meetings, but for patrol officers on the beat who deliver innovation on the street. Change has to pay better than doing nothing— the status quo.
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A blue-sky vision offers others something better. But as deep blue as that sky may appear to you, it’s still your vision. People will weigh the give and the get of making it theirs. They will always ask, “What’s in it for me?”
The fact is every collaboration has its own currency. It might be money or job advancement and prestige; it might be the deep satisfaction of a mission accomplished, a job well done, a world made better. Often it can be all of those at once.
Whatever currency matters, collaboration has to make sense in that currency. It has to pay. The costs and benefits of collaboration may well start with hard dollars and cents— and end there, too. But often the currency of “yes” goes right past the world of reason into the world of emotions. Once there, collaboration has to make sense to the head and the heart.
WHEN COLLABORATION FAILS
A few years back hospital administrators in Cambridge, Massachusetts, thought they had a sure winner— a new system that would save lives, money, and reputations. Harvard researchers had just added up the shocking numbers on “medical errors,” everything from wrong diagnoses to surgical mistakes to medication missteps. In the United States alone, they found, medical errors injured 900,000 patients and killed nearly 200,000 each year— more than all the people killed by car crashes, breast cancer, and AIDS combined.
If you wanted to change this dynamic fast — and who wouldn’t? — one right-sized piece of the problem looked especially ripe for action: adverse drug events, or ADEs. It turns out that ADEs from allergic reactions, bad cocktailing of drugs, or overdose caused the most patient injuries. Right-sizing further, one might tackle ADEs that were caused by prescription error, which accounted for half of all ADEs.
Researchers touted a solution: computerized prescription order entry systems, or POEs. POEs, they said, promised to prevent nearly 100 percent of prescription errors. A test at Boston’s famed Brigham and Women’s Hospital had proved it: a POE had virtually eliminated prescription errors and reduced serious ADEs by half.
Coalitions of employers and health professionals endorsed POEs as “breakthrough” essentials. The economics of POEs suggested that a hospital like Brigham and Women’s might reap annual net savings of $5 million to $10 million. Also, there was ample motivation to get this problem fixed; years earlier but still fresh in memory, a prescription error killed the Boston Globe’s own health beat reporter when doctors wrote up her four-day course of chemotherapy as a single-day dose.
A POE system could mean fewer injuries and deaths, lower costs, and enhanced reputations. If ever an investment screamed “Just Do It!,” this was it.
In 2002, administrators at the hospital in Cambridge moved into action. The vision was clear, the problem right-sized, the platform understood. It seemed to be a perfect storm of collaboration.
Except it failed.
Physicians complained that the POE system that replaced their handwritten prescriptions with online orders was slow. That it was inconvenient. That the built- in error checking didn’t work. They resisted mightily, slowed adoption, and limited its rollout to a few departments. Most doctors wanted to keep writing prescriptions by hand and faxing them to the hospital pharmacy.
Habits aren’t broken easily.
Presumably, everyone had shared the vision: sound medicine, reduced risk, improved performance, and cost savings. But not everyone experienced the loss of the pad-and-fax system, or the gain from computerizing, in the same way. Not everyone added up the switch to be an unalloyed good.
It turned out that the collaboration “ask” of the physicians, in particular, was high compared to the physicians’ “get.” The hospital was taking something away from the doctors they already had and held dearly. Handwritten prescriptions were time honored, steeped in tradition, under doctors’ direct control, and called upon their judgment as physicians just as doctors’ judgment had been called upon for hundreds of years. The loss of the pad-and-fax method would be painful— signifying, perhaps, all sorts of negative things about the old, familiar, comfortable way of practicing medicine, a changing of the guard, the new digital world.
The ask of physicians— that they give up the pad- and- fax and accept and use the POE— turns out to have had unexpected costs. The doctors’ get— in terms of benefits that the hospital promised them— could not begin to match up. None really dropped to the doctors’ bottom line—not financially, emotionally, or professionally. With a lot of ask and little get, the prospect for collaboration plummeted from “easy sell” to “sure fail.”
By assuming everyone was aligned on a shared rational goal, and not recognizing the hidden but deeply felt costs to doctors, administrators turned physicians from potential supporters into opponents.
How could administrators have made that mistake?
It happens all the time.
Copyright © 2012 William Bratton and Zachary Tumin. From the book "Collaborate or Perish!", published by Crown Business. Reprinted with permission.
© 2012 MSNBC Interactive