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EXECUTIVE SUMMARY
* The leader establishes the expectations and the organization follows.
* These expectations can be very permissive with no recognizable structure, or the expectations can be clear and reasonable.
* What the leader permits becomes the cultural norms of the organization.
* The leader must take a "no-compromise" position when actions violate values and standards.
* Passive leaders and leaders who are held hostage by the excuse of personal issues generate a rationale for challenging the no-compromise stance and create mediocrity.
* When staff own the organization's values and standards, they become the standard bearers, coaches, and enforcers of the drive to excellence.
WITHOUT A CLEAR PATHWAY to the future, people naturally wander around and seek the best solution as they see it. Lafley (2009) notes that in the absence of explicitly defined standards, people will establish their own standards. This can be a very dangerous option in health care because of the risk of harming patients if we vary from clearly delineated, evidence-based pathways and behaviors. High-reliability organizations are based on utilizing evidence and best practice standards and eliminating variation from these standards. The best outcomes for patients and staff happen in tightly synergized teams. When we allow deviations from evidence-based practice and from behavior that prevents people working together in tightly synergized teams, we set the stage for a dangerous situation for patients and an impossible culture for people to work safely. If leaders permit practices and behaviors that will not lead to safety, then they are promoting mediocrity and unsafe working conditions. Leaders must continually be conscious about what they are permitting. By making exceptions and lowering standards, leaders promote mediocrity.
Leading vs. Misleading
Values provide the parameters to guide behavior. Lafley (2009) reiterates that values determine an organization's identity and behavior. He describes how standards are the way the organization establishes the expectations and the way values are measured. He quotes Drucker as saying that leaders either "...lead or they mislead" (p. 61). The leader who permits behavior that deviates from the organization's values and standards misleads (Lafley, 2009). Creating an environment that is not value and standard driven will result in mediocrity. The outcomes will reflect a lack of direction and accountability for excellence.
To effectively lead,...