The word hardwire being more active again in healthcare is wonderful. I receive many nice notes about the impact my first book, Hardwiring Excellence, has had on people. So, what was my goal in using the word hardwire? It was to encourage organizations to install systems to ensure that certain actions took place. In 1993, it became apparent to me that there is a connection between employee satisfaction (today’s most-used term is employee engagement) and patient satisfaction (today most often called patient experience). Terms change as things evolve. As we learned more about what actions lead to better outcomes, we also found that a common issue was consistency—or perhaps a more accurate term is inconsistency. 

Lack of consistency is not only a challenge in healthcare but in every type of organization. If one studies how things improve, it’s clear that it often starts with an individual, a department, and/or an organization implementing an action, tool, or so forth that advances the desired outcome. After sufficient time passes to verify that the connection is real, the next step is determining how to make the action take place always. Most organizations achieve usually. Achieving always is more difficult. 

In my work, I studied techniques that ensured an always compliance. A key is to connect the action to the why. When people understand the why, the action takes place usually and at times always. However, at times, even understanding the why may not achieve the always behavior. For example, my uncle Wilbur lost two fingers as a punch press operator. Even knowing the danger of a punch press did not prevent injuries. It was only when safety systems were put in place in the machines to prevent such accidents that always took place. 

A term I heard in my search for consistency was the word hardwire. Thus, I adopted it and still use it in healthcare and beyond. All around us, we see systems that are put in place to ensure that an action happens. The more important the action, the more the action is hardwired. A common term is standard operating procedures or SOPs. The book The E-Myth Revisited by Michael E. Gerber details how organizations with SOPs outperform others. 

One of my early experiences with an action that produced better results was having people already in the department be part of the process of hiring their coworkers. It is called peer interviewing. We asked two departments to pilot peer interviewing. We found it had many positive results. When a new person began work, they knew people they had already met. The employees, being part of the hiring, were very engaged in helping the new hire adjust. And at times, after the interview process, the peers would say, “We would rather work short-staffed than hire this person.” All of these factors made hiring much more successful. 

After we had evidence that peer interviewing improved the selection process, all departments were encouraged to use this approach, and most did. We achieved usually. To then get to always, we put a system in place in which the hiring paperwork would not be completed unless there was a signed document by the peers who were part of the selection team. This ensured the process was followed, and we achieved always.

This works in many scenarios. I recently had Kristin Baird and Jeff Atwood on my Busy Leader’s Podcast. The topic of storytelling came up and how important this is in an organization. Kristin brought up the book The Secret Life of Bees by Sue Monk Kidd. She quoted a passage from that book: “Stories have to be told or they die, and when they die, we can’t remember who we are or why we’re here.” Kristin said this quote gives her chills when she thinks about it in the context of healthcare, because if we forget our stories, we’re going to forget our connection to purpose. Stories connect people to the mission and purpose of the organization. They are a way of recognizing the actions we want people to take, and what gets recognized gets repeated.

It may seem that there is not a need to hardwire a system to capture and build stories into the culture of an organization. But there is. Just recently, I was preparing to present at a hospital, and I asked the CEO if he would send me some letters from patients or family members or other stories on the great work being done in the hospital. As we talked, it was apparent that there was not a system in place to collect and share these stories. Stories are vital to an organization. They are too important to leave to chance.

There are many good reasons to hardwire systems. Some emails ask for receipt. This ensures that at a minimum the email was opened. Recently I was hit by a car while riding my bike. With each encounter in the healthcare process, I was asked my birthdate. Why? To ensure that the right treatment was provided. 

I have found the word hardwire works for most people to help them visualize putting systems in place to ensure always. However, I have gotten feedback from one person saying they did not like the word hardwire! Please don’t let this be a reason not to put systems in place. If you do not like the terms standard operating procedure or hardwire, come up with your own. The goal is to build in accountability to make sure what needs to take place does. 

Questions and suggestions:

1. Take time to look at your performance, both your department and the organization. Are you a neverseldomusually, or always performer? Most times we stop at usually, for usually will often create good results. That means we stop at good. Yet in some instances, good is not good enough. Good can cost lives. It’s often best to strive for always.


2. Map out a process currently followed. Take the selection and onboarding process for new hires, for example. Then evaluate what could be added to move the process to ensure always happens. 

3. Move on to other processes. Do not ignore important items such as storytelling and recognition. Hardwire these into the organization.

4. No matter what words you use, ask yourself, Are we currently achieving the desired outcome? One of the toughest messages I received in my career occurred when I was meeting with my supervisor. While we were not achieving the stated goals, we were working hard. After sharing with my supervisor how hard I was working, he said, “Effort does not excuse the lack of results.” Yes, effort is good; however, if it is not achieving results, it is time to look at the people, processes, and accountability that are in place. 

My research these many years has confirmed that those people and organizations that achieve high performance have systems in place that make sure the right actions are taken to achieve the needed outcomes. They also have systems in place to prevent the wrong things from occurring.

The takeaway? Do not run from hardwiring processes and accountability; instead, run to it. This creates better places for people to work and organizations that achieve their purpose.