What nurses can learn from Starbucks
Organizations need your capacity for reinvention, not just efficiency
Back when I was a director at Insight Labs, the philanthropic think tank, we took on lots of issues of creativity in organizations. As a naive Millennial who came up in the days working for Google still sounded like a dream gig, I imagined that a creative culture was highly valued by executives. I still remember the day Matt Wallaert set me straight.
Wallaert is founder of BeSci.io, which specializes in embedding behavioral science in organizations. I asked him what a CEO dreams of when they dream of the ideal creative company. Matt told me that CEOs don’t have that dream — executives, he explained, only dream in outcomes.
“They dream about good answers,” Matt said. “I can tell you they’re not dreaming about the culture of the company or what employees are actually like. All they are dreaming about is a world in which every time something crosses their desk, they say, ‘Wow, that’s an amazing idea.’” (I’ve republished the full interview here — Matt worked for Microsoft at the time.)
Matt’s perspective aligned with an Insight Lab we had recently completed in collaboration with Starbucks. A design leader at the company had approached us with the question of how to safeguard creativity as an organization grows. So we convened a team of creative officers from an array of organizations to help us address the question.
Like Matt, the team was skeptical that the organizational role of creativity was about listening to weird music or having a kooky haircut (though there were plenty of offbeat personalities in the room). Instead, they saw the problem as one of balancing two internal forces within a company: reinvention and maximization. The CEO and other executive officers are constantly trying to most effectively manage the organization they’ve got. The chief creative officer and their unruly pals are the most likely to dream up what the company will someday become.
The group came up with four conceptual models for balancing reinvention and maximization, which I’ve shared at the end of the post. Video highlights from the Lab are also available here. But lately I’ve been thinking about what this way of thinking about the C-suite means for nursing.
After all, in hospitals there is another character in the C-suite who doesn’t quite fit in: the chief nursing officer. Outsiders are sometimes surprised to find out this role even exists. It makes more sense when you realize that nurses are the most numerous employees in most hospitals but also one of the major cost centers. Furthermore, other executives have rarely worked as nurses, so they need someone with bedside experience to give them insight into one of the core functions of their facilities.
As an adviser to nursing organizations, I’ve sat through many a simulated conversation between CNOs and the rest of the executive team. The gulf between them has been characterized in a number of different ways, many of which are unfair to nurses. Nurses are sometimes dinged for being “too touchy-feely,” which seems like a weird critique for organizations that are supposed to be in the business of caring.
But it’s also true that nurses’ ideas sometimes need to be translated into the kind of outcomes Matt Wallaert described. To adapt his formulation, hospital executives don’t dream of a healthy work environment — they dream of the dollars that would be freed up by reducing turnover. That’s not because the hospital executive is some kind of Scrooge. It’s because like the hypothetical CEO in the Starbucks lab, they are trying to maximize results from the organization they already have.
So whose job is it to reinvent the hospital? I humbly submit that the CNO (and the nursing workforce behind them) is the best candidate. Yes, scientific breakthroughs change the way care is delivered in the long run, but that’s outside of the purview of your typical hospital team. Instead, the C-suite needs insights into what happens on the floor and how it might happen more effectively. Just like in a big company like Starbucks, the next big idea doesn’t come from trimming away at the margins. It comes from looking into the heart of the process of care and saying, “I know how we can do it better.”
That’s the kind of imagination that has powered concepts I have worked on with nurses like the healthy work environment standards or new approaches to staffing. But stereotypes about nurses prevent many people from seeing these as acts of creativity at all. They’re mentally downgraded to requests for more resources or “more complaining from the nurses,” even when that’s totally different from what’s in the nurse’s head.
Nevertheless, crossing that bridge between reinvention and maximization requires strategy. Here are the four approaches the participants in the Starbucks lab described. Right now, pretty much everybody in health care is stuck in “Church and State” (if they can be said to have a strategy at all). I’d love to find the team ready to try a better way.
Four Models to Balance Reinvention and Maximization
Church and State: Sure, the five-year plans of the guys who spend all day in Excel can ultimately be reconciled with the crazy dreams of the brand builders. But it's best to remember that these two ways of thinking access different parts of the brain and people with radically different skill sets. The people responsible for reinvention and maximization should be allowed to operate according to their own logic and given their own "sacred spaces." Then it should fall to a small team of organization leaders to reconcile the two sides. These leaders are also responsible for maintaining the "faith" that both sides are working for the greater good of the organization.
Turn! Turn! Turn!: The relationship between reinvention and maximization is a natural cycle like the changing of the seasons. There are times when the people who are itching to develop a new product or plan must sit back and come up with tactics to harvest the benefits of what has already been built. Similarly, the folks responsible for the next earnings statement or report to the board
need to remember that creative types always need some level of stimulus if they are to exercise their brilliance and bring about the next spring. Conversation between the maximizers and the reinventors is made possible by a common understanding of the organization’s place in the natural cycle.
Planned Obsolescence: We've perfected a new idea or product. Now it’s time to unleash it upon the world. We call our plan to do it together a "company," or perhaps a team within a company. But everyone will be happier if we recognize this is a temporary relationship. The people who prefer to spend all of their time hatching new concepts and those who are best at increasing market share agree to a temporary alliance to achieve specific goals. But they agree that after a set period, they'll switch to reinvention mode and rebuild the strategy from scratch. Known deadlines will bring a sense of urgency to both reinvention and urgency as well as give everyone involved in the venture the chance to exercise both skills.
The Star Within a Star: All of the elements that make life possible in the Universe resulted from previous stars going supernova. Creative concepts often reconfigure the strategies of organizations in similar ways; we've all run into the idea that seems so good that we should immediately devote the entire team to promoting it. But such sudden shifts can quickly lead everyone into a black hole. Instead, everyone in an organization should recognize that in the natural course of doing business, new centers of gravity will emerge and resources should be realigned around them gradually. The originators of new ideas can be recognized without forcing the whole world to revolve around them; the overall system is built in a way to blow things up again and again.
I suspect that the CNO and the nursing staff behind them are largely female and the executives to whom they report as well as the doctors with whom (and under whom) they work are largely male. When that gender gap eventually shifts, and it will as more men enter nursing and more women become doctors and hospital executives, the very definitions of reinvention and maximization may undergo a change that allows for more balance.