Let’s talk about my friend Jesse Cole. The Savannah Bananas baseball team is arguably among the most remarkable teams in all of baseball—majors, minors, college—all of them. And not because it is a great team with great players. In fact, the players are all-star college kids who rotate every season. The team is constantly changing, and many of the fans don’t know the name of a single player on the team. Why? Because extraordinary baseball is not the Bananas’ QBR; extraordinary entertainment is.
As Jesse puts it, “Baseball is just the break between the entertainment.” And the entertainment must always be fresh. I mean, imagine watching your kid’s soccer game twenty weekends in a row; that would get draining. Wait a second, you already lived that. Their first game is fun. But when it starts repeating, it becomes somewhere between boring and frustrating. Just kick the damn ball, instead of picking daisies in the field. Just kick, kid. Just kick!
Jesse knows baseball is even worse. Everyone is just standing around waiting for someone to hit a ball, and in this case your kid isn’t even out there. So Jesse set the QBR to new fresh entertainment. Anything and everything gets stale. As a result, Jesse is constantly cooking up new ideas for crazy stunts the support staff can perform and fun games the fans can play in between innings.
Jesse invited me to throw out the opening pitch at a game this past summer in front of five thousand Bananas fans. What an honor! Except it wasn’t a baseball; I threw out a roll of toilet paper (in honor of my book The Toilet Paper Entrepreneur) and the crowd went wild: it was fresh, fun, silly entertainment. QBR served. For the Savannah Bananas, the QBR is served not by Jesse alone, but by everyone who entertains the crowd. And for that one game, for that one opening pitch of toilet paper, the QBR—for a few seconds—was served by me.
* * *
A couple of years ago, I met my friend Clyde and his wife, Bettina,* for dinner in Frankfurt, Germany. Clyde and I have been good friends for years, but this was my first chance to get to know Bettina. Over dinner, I discovered that she was one of fewer than fifteen hundred physicians in the United States who is licensed and board certified to practice pediatrics in an intensive care unit. To get to that point, she’d completed eleven years of school and training.
For most of us entrepreneurs, eleven years of higher education seems like forever and a day, but equate it with the early years of running your business. Or if you’re an employee who happens to be reading this book, equate it with the time you put in getting an education, training, and learning your industry from an entry-level position. Just as Bettina invested time and money into her career, you’ve invested time and money into your business.
Like us, Bettina was passionate about her work. Extremely so. She loved working with the most critical pediatric patients in the city she lived and worked in, and she loved teaching attending physicians. She even loved the research she was expected to do in her free time. The only problem was that she knew she wouldn’t be able to sustain it for much longer. She already had multiple years in the industry as a doctor, and with the relentless volume and variety of demands put on her, she figured she would be lucky if she made it ten years. Cumulatively.
Imagine this: You have five twelve-hour shifts, followed by a thirty-hour shift. In addition to patient care, you have training and mentoring related to your professorship. Then add two to three hours of patient and administrative documentation. Then pile on top of that billing and dealing with insurance company disputes. After your shifts, you have more admin work related to teaching interns. Then, when you miraculously have the energy to pull an unpaid all-nighter, you have to write research papers so that you can get promoted, if you’re lucky—a few years from now. You’re so exhausted you need to invent a new word for exhaustion, one that probably rhymes with “please help me.”
“I love my job, but I just don’t think I’ll be able to keep this level of intensity and maintain mental and physical health,” Bettina told me. “I had to come to grips with the fact that I won’t be a full-time practicing physician my entire life. And I’m not the only one. Ten years seems to be the burnout rate for physicians at the hospital where I work.”
It blew my mind that Bettina, who was an elite physician with specialized training, training that patients desperately need, had to come to terms with the fact that, unless something changed dramatically, she couldn’t stay in her position for much longer. It blew her mind, too. She is just entering her prime, yet she is in such drain pain that she is about to tap out.
“You plan for the eleven years of additional schooling, but no one tells you how the workload will affect you. It was a big shock, knowing how much time and money I’ve spent on my training. I just can’t keep up this level of intensity and stay healthy and sane, and I have to be okay with that decision.”
Bettina is being forced to change her life plan, and the hospital is losing one of its best doctors because it has set up a never-ending work flow—aside from patient care—that cannot be sustained. Would giving Bettina a productivity hack help to reduce her stress? No, because the hospital already has given her dozens of them, and with her “free time” it quickly finds a dozen new ways to fill it up with more work, with things like insurance claim disputes. Imagine that? You’re having life-saving heart surgery and your surgeon takes a break in the middle of the operation so that he can argue with an insurance agent why he used ten stitches during the last operation instead of the insurance-mandated three.
You know the saying “Don’t busy the quarterback with passing out the Gatorade”? This is because the QBR is so important. The quarterback has a job to do. He has got to move that ball down the field, not dole out drinks to rehydrate his teammates. Similarly, Bettina shouldn’t be bothered with tasks that interfere with serving the QBR. It’s so obvious that it is hiding in plain sight. Bettina needs to save lives first, last, and all the time in between, yet she is often stuck passing out Gatorade. It’s more than just a shame; it’s a sin.
And it’s a sin if you don’t cherish the QBR, either. In the next chapter, I’ll tell you how to make sure you and your team empower your quarterback—whoever is serving the QBR—to get that ball down the field and all the way into the end zone, with a “hokie” touchdown dance and all.
CLOCKWORK IN ACTION
I have only one action step for you: Identify and declare your QBR and who is serving it.
Yes, that’s it. If you have a small team, this exercise should take you less than thirty minutes to complete. If you have a big team, you may have to set aside a day to finish it or break the team into groups. But this process is critical, so please do it. Your company’s success hinges on it. Plus, once you declare your QBR, you will start to find your way out of the weeds and begin the process of becoming the designer you need to be. The QBR is the linchpin to a business designed to run itself.
CHAPTER FOUR
STEP THREE: PROTECT AND SERVE THE QBR
When your seven-year-old has a shard of metal in his eye, the twenty-two-minute drive to the Cape Cod Hospital emergency room is the easy part. The father, a trained emergency medical technician (EMT), knows the hard part is what’s coming. As painful as it is, his son’s condition is not life threatening, so they have a wait in front of them. A long, uncomfortable wait.
It’s a warm day in June, and the waiting room is packed with people. A siren outside grows louder as an ambulance approaches. The whimpering boy and his father settle in for a long day and night in the ER.
It does not go as they expected.
Rather than a holding tank, the ER is more like a busy beehive. Within five minutes, not only has the boy been admitted, he is receiving treatment. Fourteen minutes in, the shard has been removed using a special magnet and the boy’s eye has been thoroughly reexamined by a doctor to make sure it is free of any permanent damage. At nineteen minutes, the final check has been completed, the Tylenol prescription has been written, and the boy is released. Sixty minutes
after they left for the hospital, the father ushers his son through the front door of their vacation home. All is well. The vacation is back on track.
That same day, 256 miles away in Brooklyn, two EMTs bring a mentally ill forty-nine-year-old woman suffering from agitation and psychosis to the Kings County Hospital Center. The waiting room is packed. Five minutes later, the woman is sitting on a chair in the ER’s waiting room. Fourteen minutes in, she’s still waiting. Nineteen minutes after her arrival, still waiting. One hour. Four hours. Eight hours. Ten. The patient is still waiting, still sitting in the same chair. Twenty-four hours later, she is found dead on the waiting-room floor.
It was June 18, 2008, and the little boy who was back home within an hour of arriving at the ER was my nephew, Dorian. The woman who died tragically in the ER after a full day of waiting was Esmin Green. The cause of death was pulmonary thromboembolism, which are blood clots that form in the legs and work their way through the bloodstream to the lungs. And how did Ms. Green get the blood clots? The medical examiner concluded that the clots were due to “deep venous thrombosis of lower extremities due to physical inactivity.” In other words, she was sitting too long. Twenty-four hours too long. While Dorian was running on the beach, his eye healing and his brief experience in Cape Cod Hospital’s ER already a fading memory, Ms. Green was still waiting for medical attention—scratch that; she was dying for medical attention.
When I discovered that Esmin Green was admitted to an ER on the same day as my nephew and met a tragic end, I knew I had to share the story with you. If you’ve read my other books or heard me speak, you know this story isn’t one I would typically tell—no jokes to break the tension in this tale. Systems are a serious matter. When they work, they bring freedom. When systems fail, the outcome can be deadly.
When I first heard the two parallel stories, they didn’t compute. Cape Cod serves a smaller population than Brooklyn. Cape Cod couldn’t have the same equipment that Kings County had. (They didn’t.) But the police report* regarding Ms. Green’s death is revealing. The systems and the accountability were deadly horrible at Kings County Hospital. There is no question that systems played a central role in creating both outcomes. One hospital knew the key to moving patients quickly through the process, and the other hospital did not. Or, if it knew, it didn’t follow it.
What went wrong at Kings County Hospital Center that tragic day in 2008? They may claim an overcrowded waiting room, but Cape Cod Hospital also had a full waiting room that day. They may claim that they did everything within protocol. But I would bet serious coin that the reason Kings County failed and Cape Cod succeeded is that one protected the QBR and the other probably didn’t even know it existed. Cape Cod knows exactly what its QBR is—though they don’t call it that—and they do everything they can to protect it. Kings County Hospital Center may not know or care to know its QBR, and if they don’t know (or care), they can’t actively protect it.
In an emergency room, the QBR is very likely the role of diagnosing an emergency medical issue and determining the proper course of action. That is a role that only the doctors (and sometimes physician assistants) can do. The ER can see a patient through to resolution only when the doctor has availability to see a patient. If the doctor is not available, patients are forced to wait and then wait longer in a room designed specifically for one purpose—to allow people to wait even longer. Welcome to the purgatory of the waiting room, where all good intentions for organizational efficiency go to die. But if the QBR is fully served, all elements of the ER start to flow again. The waiting room empties out and patient after patient gets the medical attention required. But this only happens when the QBR is defended and the person (or people) serving the QBR is protected.
To make sure the QBR is protected, a well-run ER makes sure the doctors who serve the QBR do nothing but identify the medical issue and prescribe a course of action. If a doctor is filing papers, directing staff, or idly waiting on the patient to be assigned a room, he or she is not protected, and therefore the QBR itself is not protected. An unprotected QBR can result in dire consequences. In operating like an efficient beehive, the support staff must make sure that the QBR is running unabated, and that every other task, no matter how small or how big, no matter how important or insignificant, no matter how urgent or trivial, is handled by someone other than a doctor.
Running a business can feel like a life-or-death situation, especially when you’re overworked, overwhelmed, and overly tired. Sometimes it is a life-or-death situation—tragedies happen in many different industries. Really, though most of us aren’t dealing with ER-level drama in our businesses. Seven-day workweeks, demanding clients, employees who come to us for every little thing—these are the dramas most of us face. Still, while we may not have to worry about our companies causing a sudden death, the relentless stream of demand on us does cause a slow death. A slow, soul-sucking death. A death of passion for our business. A death of drive. A death of happiness. But that can all be turned around quickly and easily for any business. Two hospitals had two very different outcomes. Not because they are in a different business, but because one understood the path to the highest levels of efficiency and the other didn’t.
That’s why, once you’ve identified the QBR, everyone else on your team must prioritize protecting the QBR so that the role can be fulfilled. Then, and only then, can they focus on their Primary Job.
The number one goal for you, and for everyone on your team, is to protect the QBR so that the QBR can drive the business forward without distraction or interruption. That’s it. That’s the main goal. That’s the one thing that will make your business skyrocket to organizational efficiency. Protect the QBR. Always.
The strategies in this chapter will help you create a plan for protecting the QBR. You don’t need to knock it out of the park with your QBR protection plan on day one. You just need to get started with it, and notice the impact it starts to have. That will get the momentum going. As you and your team work to protect your QBR, your 4D percentages will naturally shift toward your target.
ALL HANDS ON DECK
Normally, I’d shift to a new concept next or explain it in a different way. But I want to tell you one more story first. Mrs. Wilkes’ Dining Room in Savannah arguably has the best family-style Southern cooking in Georgia, perhaps the world. It’s a great place to visit before you head off to a Savannah Bananas evening game. Mrs. Wilkes’ feels like two dozen of the world’s best grandmother cooks whipped up their favorite dishes for their family dinner, but instead of plopping it down on the dining room table, they scootered it over to the fabled Savannah restaurant. The food is that good.
In 1943, Mrs. Sema Wilkes took over a boardinghouse in historic downtown Savannah with the goal of making the area’s best Southern meals. The QBR was obvious: food that is remarkably delicious. The result speaks for itself. The typical line waiting to get in the restaurant is one and a half to two hours. People start to line up hours before the place opens, not just on a holiday or vacation week, but every day.
The job of the staff, just like yours needs to be, is to protect and serve the QBR. Every employee plays a role in either directly serving the QBR or protecting the QBR. The chef and team in the kitchen are directly serving the QBR by gathering the finest and freshest local ingredients. The rest of the team is protecting the QBR. The serving staff makes sure that when you arrive at your table the food is ready to go. They actually serve the table before you get seated. Food is rotated quickly to keep it warm and fresh. If a table’s food delivery is slow, another staff member will jump on it. Everyone knows what they are known for. And their job is to make sure the food is top shelf. Everyone’s job is to make sure the most important role of the business is protected, and everyone contributes to it in some fashion, either by complementing it or by stepping in when necessary, or both.
The servers exude Southern hospitality. The restaurant is basic, but spotless. The ambience is very
much family oriented; you better be ready to meet strangers because you will surely be sitting with them at the large tables that seat ten people. And when you are finished, you will be carrying your plates to the kitchen to be cleaned. Great food, good service, and fun times. All those things are necessary to keep you in the restaurant business, but you stand out on your QBR. If the food wasn’t exquisite, the restaurant would be more of a gimmicky place.
Sema Wilkes passed away in 2001. Her granddaughter runs the restaurant now, and she maintains strong relationships with the local farmers, ensuring top ingredients. The granddaughter knows that their business’s success hinges on serving the QBR, not Sema herself. And while Sema is sorely missed by all who loved and knew her, the QBR is served unabated. If the kitchen needs a hand with prep work, one of the serving staff will immediately take on the role. The entire staff helps with preparation and gives feedback if there is any problem. Is the chicken slightly dry? If a dish is even just a little off from perfection, the staff rushes that input back to the kitchen. It almost never happens, but it could, and the team knows the food, the QBR, is everything.
Protect and serve the QBR as though your life depends on it, and your business becomes the “must go there” for customers, just like Mrs. Wilkes’ Dining Room is for foodies. People travel the world to go there and consistently rave about the experience. And, if you didn’t know, Mrs. Wilkes’ is only open three hours a day, Monday through Friday. The place is packed. Always.
EXERCISE: HUB AND SPOKE
If you haven’t figured this out by now, the person or people serving your QBR are probably spending too much time doing everything but serving the QBR. Likewise, your other employees are also spending too much time doing other things when they could be protecting the QBR and serving their own Primary Job. And they are probably, although with good intentions, actually detracting from the QBR and their Primary Job.
Clockwork: Design Your Business to Run Itself Page 8