There are seven serious mistakes managers typically make when they work with their people and these mistakes all damage employee engagement. Improving employee engagement has become an important strategic initiative for most organizations, because it leads to enhanced customer experience, which in turn leads to improved loyalty, revenue and profit. This article addresses the first mistake.

The role of a manager has shifted, like the land during an earthquake, yet many managers still operate as if everything is the same. It’s almost as if managers are using smartphones to communicate while using a management approach akin to a rotary dial phone. The purpose of these articles is to help managers move out of denial into awareness and finally into competence.

Mistake #1: Not appreciating the concept of a system

A nurse in an Ohio Hospital accidentally discarded a kidney that was awaiting a transplant and had been provided by a living donor. The nurse had been on break and had been replaced by a different nurse, and was therefore unaware that the kidney was submerged in ice-filled sludge. She purposely dumped the contents into a disposal hopper, thinking the kidney was still in the operating room, because “that’s what usually happens”.

The hospital suspended the two nurses after the incident; one was later fired, and the other resigned. Furthermore, a surgeon was stripped of his title as director of some surgical services. What a tragedy on many levels.

The nurse who discarded the kidney had walked past a doctor and other nurses while carrying the container. Should someone have noticed? Should someone have said something? How was she to know? Was she incompetent? Did she purposely sabotage the surgery?

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In our typical industrial age management model, it makes sense that she was fired. The industrial age model holds people accountable for results and blames them for mistakes by evaluating them in an annual performance appraisal meeting. The message is, “Someone must be at fault! Someone must be accountable!” This is the first mistake of the typical manager. It is the philosophy that still dominates in our schools and our organizations, i.e., someone must be held accountable for the results.

In 1950, Dr. W. Edwards Deming explained his philosophy of systems thinking to the Japanese leadership. Dr. Deming’s philosophy helps us appreciate that it is probable that 94% of mistakes come from the organizational system design. Was the age of blaming people for mistakes dead? Unfortunately not – it is still very much alive today in America, as the nurses can attest.

There were probably a dozen or more hand-offs that occurred in that operating room between the preparation for surgery and the time the nurse returned from her break. Each of those hand-offs was an opportunity for either good quality or poor quality. Information about the location of the kidney was a hand-off. What to do with the slush was a hand-off. Each of those hand-offs was a process that could be improved. To blame the nurse does nothing to improve those hand-offs and, therefore, nothing to prevent a reoccurrence.

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Today, our children are failing to learn reading and math skills at their respective grade levels, yet we continue to embrace standardized testing and performance evaluations for teachers. We continue to attempt to improve the individuals by judging, grading, blaming, and firing them. We fail to fully recognize that our system of grading students destroys their passion for learning and steals their willingness to take responsibility for their own learning progress. We continue with the same flawed processes and hand-offs that make up the entire dysfunctional system. We blame and then expect different results.

A manager’s responsibility is to identify the real root causes in the system design and hand-offs. A manager, therefore, must evolve from being a judge of individuals to a proactive “process facilitator” of system (hand-off) improvement. Instead of damaging engagement with fear, they need to enlist employees to help facilitate positive change. The nurses’ engagement was damaged, but so was the engagement of every employee who worked in that hospital and feared they may be next. Our industrial age philosophy causes employees to hide flaws. The systems approach encourages them to cooperate and uncover real root causes.

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If we fired every nurse and every teacher in the country and replaced them all with highly trained substitutes, would anything improve? Couldn’t we expect that the same number of students would fail and the same number of kidneys would be discarded? Until we embrace a system view of the world, and stop blaming people, we will continue to see these tragedies and we will continue to have poor employee engagement.


263b5af075de4e1a2c5034c69ea0f0c6aa1e10cf3bc9f7400epimgpsh_fullsize_distrWally Hauck, PhD, CSP, helps leaders boost profit by unleashing the genius of every employee. He shows leaders how to get the best from their teams, with proven methods and by avoiding morale-busting mistakes, so they can achieve their strategic goals more quickly and with less waste.

For more than 20 years, Wally has worked with nearly 200 organizations, hundreds of leaders, and thousands of employees to optimize engagement and customer experience. Many have achieved significant transformational improvements.

Wally holds a doctorate in organizational leadership from Warren National University, a Master of Business Administration in finance from Iona College, and a bachelor’s degree in philosophy from the University of Pennsylvania. Wally is a Certified Speaking Professional or CSP. As a professor of Organizational Change and Development at the University of New Haven in Connecticut, Wally received the highest ratings of all professors in 2012.

Wally has been married to his lovely wife Lori for over 26 years. They have two daughters, one son, three grandchildren, two rescue dogs and a very dysfunctional cat. Wally has a passion for golf, family, politics, and good movies, not necessarily in that order.

Connect and collaborate with Wally on LinkedIn and Twitter (@wallyhauck).

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wally@wallyhauck.com