HARVARD BUSINESS REVIEW

Wicked Problem Solvers
Edmondson AC
Companies today increasingly rely on teams that span many industries for radical innovation, especially to solve "wicked problems." So leaders have to understand how to promote collaboration when roles are uncertain, goals are shifting, expertise and organizational cultures are varied, and participants have clashing or even antagonistic perspectives. HBS professor Amy Edmondson has studied more than a dozen cross-industry innovation projects, among them the creation of a new city, a mango supply-chain transformation, and the design and construction of leading-edge buildings. She has identified the leadership practices that make successful cross-industry teams work: fostering an adaptable vision, promoting psychological safety, enabling knowledge sharing, and encouraging collaborative innovation. Though these practices are broadly familiar, their application within cross-industry teams calls for unique leadership approaches that combine flexibility, open-mindedness, humility, and fierce resolve.
Leading the Team You Inherit
Watkins MD
Most leaders don't have the luxury of building their teams from scratch. Instead they're put in charge of an existing group, and they need guidance on the best way to take over and improve performance. Watkins, an expert on transitions, suggests a three-step approach: Assess. Act quickly to size up the personnel you've inherited, systematically gathering data from one-on-one chats, team meetings, and other sources. Reflect, too, on the business challenges you face, the kinds of people you want in various roles, and the degree to which they need to collaborate. Reshape. Adjust the makeup of the team by moving people to new positions, shifting their responsibilities, or replacing them. Make sure that everyone is aligned on goals and how to achieve them--you may need to change the team's stated direction. Consider also making changes in the way the team operates (reducing the frequency of meetings, for example, or creating new subteams). Then establish ground rules and processes to sustain desired behaviors, and revisit those periodically. Accelerate team development. Set your people up for some early wins. Initial successes will boost everyone's confidence and reinforce the value of your new operating model, thus paving the way for ongoing growth.
The Secrets of Great Teamwork
Haas M and Mortensen M
Over the years, as teams have grown more diverse, dispersed, digital, and dynamic, collaboration has become more complex. But though teams face new challenges, their success still depends on a core set of fundamentals. As J. Richard Hackman, who began researching teams in the 1970s, discovered, what matters most isn't the personalities or behavior of the team members; it's whether a team has a compelling direction, a strong structure, and a supportive context. In their own research, Haas and Mortensen have found that teams need those three "enabling conditions" now more than ever. But their work also revealed that today's teams are especially prone to two corrosive problems: "us versus them" thinking and incomplete information. Overcoming those pitfalls requires a new enabling condition: a shared mindset. This article details what team leaders should do to establish the four foundations for success. For instance, to promote a shared mindset, leaders should foster a common identity and common understanding among team members, with techniques such as "structured unstructured time." The authors also describe how to evaluate a team's effectiveness, providing an assessment leaders can take to see what's working and where there's room for improvement.
How to Preempt Team Conflict
Toegel G and Barsoux JL
Team conflict can add value or destroy it. Good conflict fosters respectful debate and yields mutually agreed-upon solutions that are often far superior to those first offered. Bad conflict occurs when team members simply can't get past their differences, killing productivity and stifling innovation. Destructive conflict typically stems not from differences of opinion but from a perceived incompatibility between the way certain team members think and act. The conventional approach to working through such conflict is to respond to clashes as they arise. But this approach routinely fails because it allows frustrations to build for too long, making it difficult to reset negative impressions and restore trust. In their research on team dynamics and experience working with executive teams, Toegel and Barsoux have found a proactive approach to be much more effective. In this article, they introduce a methodology that focuses on how people look, act, speak, think, and feel. Team leaders facilitate five conversations--one focused on each category--before the team gets under way, to build a shared understanding of the process, rather than the content, of work and lay the foundation for effective collaboration.
HOW I DID IT....THE CEO OF ATHENAHEALTH on ON THE ROLE OF ANGER IN STARTING NEW BUSINESSES
Bush J
As a boy, Bush watched Emergency! on television and was captivated by the romance and seeming magic of saving lives. As an adult, he found the reality of medicine to be very different: There wasn't much humanity in the way health care was actually delivered. Believing that he'd be daunted by the course work required for a medical degree, he decided to take an entrepreneurial route to improving the system. His first sense of the opportunity came while he was driving an ambulance in New Orleans one summer during college. Some patients with chronic disease who couldn't afford their medicines would repeatedly call the ambulance to take them to a hospital where they could be stabilized. What if the ambulance itself were outfitted with treatments for the five most common chronic diseases and carried EMTs who were trained to use them? Those patients could be treated in place, at a radically lower cost than what the hospital would charge. That idea didn't work out, and Bush moved on to think about a network of maternity clinics. He and Todd Park drew up a business plan at Harvard Business School--one that was "unbelievably complicated to execute and very risky." But in the process of pursuing it, they created websites for the paperwork with rules that prevented mistakes. That was the seed for athenahealth, which today supports electronic medical records and a suite of practice management and care coordination services, leaving doctors free to spend more time with their patients.
CORPORATE WELLNESS PROGRAMS MAKE US UNWELL
Spicer A and Scott B
How not to cut health care costs
Kaplan RS and Haas DA
Health care providers in much of the world are trying to respond to the tremendous pressure to reduce costs--but evidence suggests that many of their attempts are counterproductive, raising costs and sometimes decreasing the quality of care. Kaplan and Haas reached this conclusion after conducting field research with more than 50 health care provider organizations. Administrators looking for cuts typically work from the line-item expense categories on their P&Ls, they found. This may appear to generate immediate results, but it usually does not reflect the optimal mix of resources needed to efficiently deliver excellent care. The authors describe five common mistakes: (1) Reducing support staff. This often lowers the productivity of clinicians, whose time is far more expensive. (2) Underinvesting in space and equipment. The costs of these are consistently an order of magnitude smaller than personnel costs, so cuts here are short-sighted if they lower people's productivity. (3) Focusing narrowly on procurement prices and neglecting to examine how individual clinicians actually consume supplies. (4) Maximizing patient throughput. Physicians achieve greater overall productivity by spending more time with fewer patients. (5) Failing to benchmark and standardize. Administrators, in collaboration with clinicians, should examine all the costs of treating patients' conditions. This will uncover multiple opportunities to improve processes in ways that lower total costs and deliver better care.
Balancing "we" and "me"
Congdon C, Flynn D and Redman M
The open office is the dominant form of workspace design for good reason: It fosters collaboration, promotes learning, and nurtures strong culture. But what most companies fail to realize is that collaboration has a natural rhythm that requires both interaction and private contemplation. Companies have been trying for decades to find the balance between public and private workspace that best supports collaboration. In 1980 52% of U.S. employees lacked workspaces where they could concentrate without distraction. In response, high-walled cubicles took over the corporate landscape. By the late 1990s, the tide had turned, and only 23% of employees wanted more privacy, and 50% wanted more access to other people. Ever since, firms have been beefing up spaces that support collaboration and shrinking areas for individual work. But the pendulum seems to have swung too far: Once again, people feel a pressing need for privacy, not only to do heads-down work but to cope with the intensity of work today. To address these needs, according to the authors, we have to rethink our assumptions about privacy. Traditionally defined in physical terms, privacy is now about the individual's ability to control information and stimulation. In this article, the authors examine workspace design through the new lens of privacy and offer insights on how to foster teamwork and solitude.
Workspaces that move people
Waber B, Magnolfi J and Lindsay G
Few companies measure whether the design of their workspaces helps or hurts performance, but they should. The authors have collected data that capture individuals' interactions, communications, and location information. They've learned that face-to-face interactions are by far the most important activity in an office; creating chance encounters between knowledge workers, both inside and outside the organization, improves performance. The Norwegian telecom company Telenor was ahead of its time in 2003, when it incorporated "hot desking" (no assigned seats) and spaces that could easily be reconfigured for different tasks and evolving teams. The CEO credits the design of the offices with helping Telenor shift from a state-run monopoly to a competitive multinational carrier with 150 million subscribers. In another example, data collected at one pharmaceuticals company showed that when a salesperson increased interactions with coworkers on other teams by 10%, his or her sales increased by 10%. To get the sales staff running into colleagues from other departments, management shifted from one coffee machine for every six employees to one for every 120 and created a new large cafeteria for everyone. Sales rose by 20%, or $200 million, afterjust one quarter, quickly justifying the capital investment in the redesign.
The transparency trap
Bernstein E
To promote accountability, productivity, and shared learning, many organizations create open work environments and gather reams of data on how individuals spend their time. A few years ago, HBS professor Ethan Bernstein set out to find empirical evidence that such approaches improve organizational performance. What he discovered is that this kind of transparency often has an unintended consequence: It can leave employees feeling vulnerable and exposed. When that happens, they conceal any conduct that deviates from the norm so that they won't have to explain it. Unrehearsed, experimental behaviors sometimes stop altogether. But Bernstein also discovered organizations that had established zones of privacy within open environments by setting four types of boundaries: around teams, between feedback and evaluation, between decision rights and improvement rights, and around periods of experimentation. Moreover, across several studies, the companies that had done all this were the ones that consistently got the most creative, efficient, and thoughtful work from their employees. Bernstein's conclusion? By balancing transparency and privacy, organizations can capture the benefits of both, and encourage just the right amount of "positive deviance" needed to increase innovation and productivity.
J. Craig Venter the biologist who led the for-profit effort to sequence the human genome shares his thoughts on commercializing science
Venter JC and Beard A
Voices from the front lines. Four leaders on the cross-border challeng they've faced
Minguet L, Caride E, Yamaguchi T and Tedjarati S
Executives on the front lines of managing across borders share their insights: Luc Minguet, of France's Michelin, talks about the importance of cultural training not just for managers taking on assignments abroad but also for local employees who work with colleagues from around the world. He describes how his own experience learning to communicate across cultures reflects the tire-maker's broader practices. Eduardo Caride, of Madrid-based Telefónica, explains how the relatively young multinational is investing in a diverse talent mix as it strives to become a truly global company. Whereas early on, leaders relied on exporting Spanish managers abroad, he notes, the street now runs both ways. Takeo Yamaguchi, of Japan's Hitachi, details his efforts to create standardized global HR systems and processes across the conglomerate's 948 separate companies. "Three years ago, we had no systematic way of tracking employees, evaluating performance, or identifying future leaders," Yamaguchi says. "Today we do." And Shane Tedjarati, from the United States' Honeywell, talks about how the industrial powerhouse is shifting its strategy toward new regions, such as China, India, vietnam, and Indonesia. "We call these markets 'high-growth regions' instead of emerging markets," says Tedjarati, "because they now account for more than half of Honeywell's total growth."
Mastering the intermediaries
Edelman B
Almost every retailer looks to Google to refer customers, and it's rare to find a manufacturer whose products aren't sold on Amazon. But these and other big platforms can capture a disproportionate share of the value a company creates: Buy an app on iTunes, and Apple takes 30%. The author presents four strategies to help businesses reduce their dependence on powerful platforms. Exploit the platform's need to be comprehensive. American Airlines' strong coverage of key routes made its presence on the travel website Kayak indispensable to Kayak's value proposition. As a result, AA negotiated a better deal. Identify and discredit discrimination. Public complaints that eBay was giving search prominence to suppliers who advertised on the site forced a reversal of the policy. Create an alternative platform. When MovieTickets was on the verge of dominating phone and online ticketing, Regal Entertainment and two other large theater chains formed Fandango. Deal more directly. People ordering takeout through online platforms like Foodler and GrubHub have often already chosen their restaurant. Restaurants that deal directly can exit the platform.
Engaging doctors in the health care revolution
Lee TH and Cosgrove T
A health care revolution is under way, and doctors must be part of it. But many are deeply anxious and angry about the transformation, fearing loss of autonomy, respect, and income. Given their resistance, how can health system Leaders engage them in redesigning care? In this article, Dr. Thomas H. Lee, Press Ganey's chief medical officer, and Dr. Toby Cosgrove, the CEO of the Cleveland Clinic, describe a framework they've developed for encouraging buy-in. Adapting Max Weber's "typology of motives," and applying behavioral economics and other motivational principles, they describe four tactics leadership must apply in concert: engaging doctors in a noble shared purpose; addressing their economic self-interest; leveraging their desire for respect; and appealing to their sense of tradition. Drawing from experiences at the Mayo Clinic, Geisinger Health System, Partners HealthCare, the Cleveland Clinic, Ascension Health, and others, the authors show how the four motivational levers work together to bring this critical group of stakeholders on board.
Collective genius
Hill LA, Brandeau G, Truelove E and Lineback K
How can leaders build an organization that is capable of innovating continually over time? By creating a community that is both willing and able to innovate. To be willing, the community must share a sense of purpose, values, and rules of engagement. When Luca de Meo was Volkswagen's head of marketing communication, he fostered a sense of purpose in his team by asking its members to reflect on what being part of VW meant to them; strengthened their shared values by encouraging them to use the brand's three components-innovation, responsibility, and value-to guide their work; and built significant responsibility and autonomy into their rules of engagement. To be able, companies must generate ideas through discourse and debate; experiment quickly, reflect, and adjust; and make decisions that combine disparate and even opposing ideas. Bill Coughran, an SVP of engineering at Google, employed these capabilities both to solve the company's near-term data storage needs and to make progress toward a next-generation solution.
Career choices when life is short
Margolis JD and Gallo A
The Case for Capitation
James BC and Poulsen GP
Recent studies suggest that at least 35%--and maybe over 5o%--of all health care spending in the U.S. is wasted on inadequate, unnecessary, and inefficient care and suboptimal business processes. But efforts to get rid of that waste face a huge challenge: Under current payment methods, the providers who develop more-cost-effective approaches don't receive any of the savings. Instead, the money goes mainly to insurers. The providers, who are paid for the volume of services delivered, end up actually losing money, which undermines their finances and their ability to invest in more cost-saving innovations. To address this quandary, say two top execs from the nonprofit Intermountain Healthcare system, we need a different way to pay for health care: population-based payment. PBP gives care delivery groups a fixed per-person payment that covers all of an individual's health care services in a given year. Under it, providers benefit from the savings of all efforts to attack waste, encouraging them to do it more. And though PBP may sound similar to the HMOs of the 1990s, there are significant twists: Payments go directly to care delivery groups, and patients' physicians--not insurance companies--assume responsibility for overseeing and managing the cost of treatment. Provider groups are also required to meet quality standards that further protect patients. By applying PBP in just part of its system, Intermountain, which serves 2 million people, has been able to chop $688 million in annual waste and bring total costs down 13%.
Managing change one day at a time
Ferrazzi K
Becoming a first-class noticer. How to spot and prevent ethical failures in your organization
Bazerman MH
We'd like to think that no smart, upstanding manager would ever overlook or turn a blind eye to threats or wrongdoing that ultimately imperil his or her business. Yet it happens all the time. We fall prey to obstacles that obscure or drown out important signals that things are amiss. Becoming a "first-class noticer," says Max H. Bazerman, a professor at Harvard Business School, requires conscious effort to fight ambiguity, motivated blindness, conflicts of interest, the slippery slope, and efforts of others to mislead us. As a manager, you can develop your noticing skills by acknowledging responsibility when things go wrong rather than blaming external forces beyond your control. Bazerman also advises taking an outsider's view to challenge the status quo. Given the string of ethical failures of corporations around the world in recent years--from BP to GM to JP Morgan Chase--it's clear that leaders not only need to act more responsibly themselves but also must develop keen noticing skills in their employees and across their organizations.
The Employer-Led Health Care Revolution
McDonald PA, Mecklenburg RS and Martin LA
To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.
How to Pay for Health Care
Porter ME and Kaplan RS
The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters--at the individual patient level--and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the U.S. and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.