Adjusting Expectations

Posted on January 18, 2012

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Communication between two ordinary, random people can be difficult. Communication between two intelligent individuals who share a similar lexicon of industry language (jargon), background, are culturally similar, and who are also well-educated, can still be a big challenge. This is so primarily because the definition of words do not mean the same to everyone, and thus expectations from those words tend to diverge greatly.

For instance, in November 2010 I spoke with the CEO of a critical access hospital about his next capital project, a Hill-Burton era replacement project.  We covered the budget, funding, schedule, regulatory hurdles, etc.  He said he was “ready to begin” his project. To me, “ready to begin” means, ‘start architectural design, cut civil loose to secure its permit, and set the ground breaking ceremony date’. To me, that means a couple months max before mild frustration sets in due to lack of progress.  After six or eight months, if nothing happens I am probably ready to fire the design and construction team.

I heard through the grapevine last month his project had not gone anywhere, so I called him up again. He told me, in a non-frustrated manner, he was “getting ready to break ground within the next 30 days.” That phrase may be administrator-speak for ‘get off my back’, akin to ‘the check’s in the mail’—I’m not sure. 

What I find sometimes is that some hospital administrators begin with project expectations that are too low—too low for level of service, too low for pace of work, too low for quality. In the case above, maybe it is partially the rural mindset:  ‘I’m just happy to get something’ rather than ‘I demand the best for me, my employees and my community’.

When you demand the best, you will do the research to find the best.  This takes initiative. Yet, it is worth it because the best does not always mean the biggest hit to the wallet.

What is the best option worth? Is it worth hiring someone from a few hours away instead of the local architect and general contractor? If it meant you could be in your new facility right now, fifteen months later, instead of ‘breaking ground in the next month’—would that count for anything?

When a company that delivers the best meets an administrator that demands the best, that is a match made in heaven:  everyone shares the same language and expectations are clear—success!  When high expectations meet low achievement, there is often a culture clash:  frustration, unhappiness, and sometimes lawsuits—no one is on the same page. And then when low expectations meet up with low achievement, like in the case above, everyone is happy but gigantic opportunities are lost:  wasted resources (time, money) and market-lagging outcomes (out-of-date facilities) among other things—the kind of outcome that inflates healthcare costs unnecessarily.

Expectations are about knowing what’s available, knowing what’s possible, and not settling. Steve Jobs drove this message home in spades in his famous 2005 Stanford Commencement address (look it up on YouTube). No matter what the industry and especially in healthcare, the best want to work with the best.  I want to work with the most forward-thinking, challenging, innovative hospitals and healthcare systems out there. And the best become the best by executing their high expectations. When high capability meet high expectation, great results occur—and woe to the person or firm who goes to work with low expectations.  Such hospitals, and firms, will be trampled under foot. Expect more.

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