“How Can I Help?”
My wife and I started streaming the show "New Amsterdam" on Netflix about a month ago. The show aired on NBC from 2019-2023 (its last show was earlier this year).
As we began to watch the initial episodes of season 1, there was something familiar in the main character of the show, new Medical Director at fictional New Amsterdam Hospital, Max Goodwin (played by Ryan Eggold). I'm not a doctor, I've never worked in the medical field, I get squeamish around blood, and I don't particularly like to be in hospitals, yet something about Max Goodwin resonated quite strongly with me.
After two or three episodes, it finally hit me. Dr. Max Goodwin is leading an "agile" transformation at New Amsterdam and is the very definition of a change agent. Now, I know what you are saying - there are no sprint planning meetings, no software development, and no daily meetings, scrum or otherwise. Yet, there is no doubt that Max is one of the most effective agile change agents I have seen.
First, look at how customer-centric Max is. Traditionally, hospitals are operated to conform to what insurance companies will pay. This results in the creation of policies governing how things are done, driven by a fee-for-service payment structure. Often times, these get in the way of the hospital fulfilling its primary mission, improving the health and well-being of its patients and its community. This mission is even clearer at New Amsterdam as one of the few public hospitals in the country, meaning that it will treat people regardless of their ability to pay. Yet who is almost always missing when important decisions are being made by hospital personnel and leadership? The end customer, namely their patients! Max brings the "customer in the room", time and time again. If a policy is not serving the best interests of New Amsterdam's patients, Max gets rid of the old policy and develops a new policy that will provide more value to the patients and the community.
Max also exhibits the traits of a servant leader. When someone on his team approaches him with a problem, his first response is almost always, "How can I help?" He has a bias toward providing support to those in his purview. He is so consistent with this behavior that others in his staff eventually come to model Max's behavior and themselves began to ask, "How can I help?"
Even if Max doesn't have a canned solution, he understands when the status quo is not acceptable. To this end, he is willing to propose new ideas and experiment with them, even if it isn't clear that it will result in the desired outcome or that it won't have unforeseen side effects. After all, doing nothing is not an option if your current way or working isn't delivering the outcome you need. In fact, although "How can I help?" is Max's favorite question, his next favorite question is "What if I can find a better way?"
Max knows how to use his levers as a leader to make it clear what is acceptable behavior and what is not. One of his very first actions as medical director is to fire his entire cardiology staff because they are more concerned with maximizing their billings than maximizing their patients' well-being. That certainly made a huge first impression. No one could question what was important to Max and what his expectations were in terms of who they were there to serve.
Max values diversity of opinions, perspectives, and expertise on his teams. It is only through a diverse, cross-functional team that they are able to best treat patients, save more lives, and better serve their community. When doctors and other personnel, especially new doctors, exhibit individualistic behavior or disavow teamwork, the others on the team are there to reinforce the culture of everyone working together as a team. They let the new doctor know, "Everybody chips in! Everybody helps out." In other episodes, you see examples of where a few doctors or nurses are no longer concerned with patients once they are moved outside of their immediate purview, but are then reminded by other doctors on Max's staff that once someone is your patient, they are always your patient even if they are elsewhere at the hospital. There is an expectation that doctors and nurses work together in a holistic manner to ensure the well-being of patients. In other words, they work and think like a team working together to a positive outcome for their joint patient.
Max also likes to use metrics to pinpoint areas for improvement or to measure the effectiveness of changes that have been instituted. Of course, we all understand that the use of metrics has the classic duality of using them either as a tool or weapon. Max generally uses metrics as a tool to ask questions or investigate further, not as an end goal in its own right. We also know that sometimes we think metrics are well-designed and aligned with our desired outcomes, but then later come to discover that although we have positive-trending metrics, we are not achieving our desired outcomes. Max had this happen to him when trying to reduce the amount of opioids the doctors at New Amsterdam were prescribing. His policy did reduce the amount of opioids being prescribed, but it resulted in negative outcomes for their patients. Max had the humbleness to reverse his own policy and then come up with an alternate solution to achieve the originally desired outcome.
We could all benefit from modeling our behavior as agile leaders and agile coaches on Max's behavior, even given that Max is a fictional character in a fictional hospital. After all, when we establish a vision, we are creating a world that doesn't actually exist (yet)!
I am also sure that some of you are going to say that Max can only get away with some of the changes he institutes because he is in a position of authority. That is true to a certain extent, although you clearly see him banging heads with the head of the hospital's board of directors. He needs to influence those in a greater position of authority, just like the rest of us. I think the lesson I take out of this is that if you do have a significant amount of authority, use it thoughtfully to cultivate beneficial change to serve the people who work for you, your end customers, and your community. If you don't have that much authority, work to influence those that do have that authority. Work to express the benefits of your suggested changes in a language and perspective that they can relate to. If you want to be a change agent, you need to develop the skill to influence without authority and to influence those who do have authority. Regardless of your authority, modeling behavior and practices like Max does will undoubtedly positively influence those around you and, little by little, create a critical mass of behavior changes until you have many internal champions ensuring that the positive practices and continuous improvement culture propagate through your organization.
And did I mention that he brings about greater agility and value delivery at New Amsterdam without using a canned framework or requiring everyone to work in the exact same way? 🙂
My wife and I are now onto the third season of New Amsterdam. I heartily recommend it not only for the example of best practices but also for entertainment value. You can stream seasons 1-4 of New Amsterdam on Netflix, or seasons 1-5 on Peacock.