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by Jeff Olivet
Coleman Associates

Mike Leach is the football coach at Texas Tech. It’s an off-the-beaten-path kind of place, and he’s an off-the-beaten-path kind of guy. He does things his own way. He lines up players on the field in ways no one ever has. He runs far more plays per game than do his opponents. He experiments. And yet, Texas Tech finds itself in the thick of the top 25 in the college football polls, and professional football teams send scouts to take a look at his team. (Check out the New York Times article for the full story about Coach Leach—Football Lessons for Redesign on the home page section of this website.)

At Coleman Associates, we have been obsessed with football lately…well, not just with football, but more specifically, with Mike Leach’s brand of football. It is wild, creative, and innovative. And we think there are great parallels between Leach-ball and our work with Patient Visit Redesign™ and Patient Centered Scheduling™.

We believe in running plays, just like in football. A play is a set of moves a team can make in a specific situation to achieve specific results. For example, a Patient Care Team trying to improve team communication might invent the “Walk-Talkie Play,” and equip some or all team members with walkie-talkies. A Patient Centered Scheduling Team might conceive “The 5-Day Push,” and manually calculate no-show data for all sessions for five consecutive days to gather baseline data.

Just like a football team runs plays in order to score touchdowns, we coach our team to run plays to achieve their goals of reducing patient wait time or increasing access to appointments—in other words, to do whatever it takes to “win the game.”

In our intensive study of Coach Leach, we’ve learned eleven lessons, and we’d like to share them with you.

Now you might say to yourself, “Why are there eleven lessons? Shouldn’t there be ten?” Answer: there are 11 football players on a team…well, there are many more guys on the sidelines, but eleven on the field at any given time, and besides, we thought these were eleven very good lessons.

So let’s talk about them.

1. Extract Great Performance From Average Players

Mike Leach’s program at Texas Tech doesn’t recruit the best players. It is not a top-tier football school like Notre Dame, USC, Alabama, or Nebraska. But what Leach does with very average players is absolutely amazing. His four wide receivers in 2005 were the top four receivers in the conference. His quarterback led the nation in passing. His running back broke the all-time career record for receptions by a running back. Leach is somehow able to push average players to “superstar” performance.

In public health settings, there are some extraordinary people doing extraordinary work. But there are also some very average performers who, left to their own devices, will do average or below average work. The challenge of managers and clinical teams is to draw great performance out of average performers.

This is done by creating a culture of accountability, tapping into the staff’s heartfelt sense of why they’re doing this work, and—very importantly—keeping the patient at the center of all clinic operations.

It’s also done by turning average performers into stellar ones—through training them to be more formidable. The less you have, the more creative you have to be. Being short on resources doesn’t mean you have to be short on creativity—on the contrary, it can sometimes be very liberating. See Values-Driven Success for how one medical director fuels his management style with his belief in the power of relationships.

2. Use Innovative Formations

Mike Leach moves people all over the field. He’ll stack all the wide receivers on one side or spread the offensive line out with six feet between each player—formations that no other coach has ever tried. The effect is that the offense dictates the game. The defense is confused and reactive. By seeing the game in a new way, Leach is able to achieve stunning results—like 70 points a game.

How do you apply this lesson to clinical work? Think about how staff is stationed in a clinic—where do they do their work—is there a better way to use the space and deploy the staff to create a process that is more patient-centered? Another example: For scheduling, this might mean a total overhaul of the patient schedule to minimize no-show rates and create more availability for patients to see their own providers. See Simplified Patient Scheduling for some ideas.

3. Try A Lot of Plays to See What Works

Leach’s teams run lots of plays every game. A ton of plays. If a play works, Leach circles it on his laminated play sheet. If it doesn’t work, he puts an “X” over it and doesn’t run it again. He learns what works by using multiple tactics in many different ways.

We’re not very good at experimentation in health care. There is a pervasive attitude of “Yeah, we tried that.” Our response is: “Well, you haven’t tried enough different things.” Learn from Leach: if your clinic faces a challenge, try a whole bunch of different tactics. If one doesn’t work, scrap it, move on, and try something else. You might find the best solution is the most unexpected one.

4. Try Things That Others are Afraid to Try

Don’t be afraid to “go for it on 4th and 8”—pulling out all the stops, even when it feels like you’ve already tried everything, being focused on success, determined to achieve your goals. (See Football Lessons for Redesign.) Coleman Associates coaches teams to see each challenge as an opportunity to try something new and achieve results never before imagined—vastly reduced patient wait time, efficient utilization of limited space and resources, greater access to same-day appointments.

But those results will never be attained unless managers and teams are willing to try things that others have been afraid to try. And if you keep experimenting, as advised in the previous play, you’ll definitely be trying out some radically different ideas!

5. Keep the Big Picture in Mind to Move the Ball Downfield

With Coleman Associates methodology, managers set performance goals such as reducing patient visit cycle time (the total length of time a patient is in the clinic) to 45 minutes or less, or reducing no-show rates by 50%. Then we coach teams to come up with a game plan for achieving those goals.

This combination of goals and game plan constitutes the “big picture.” In a Texas Tech game, Mike Leach knows the goal is to score more points than the other team, and he has devised a game plan, such as “we’re going to run a lot of plays at the defense’s weak side, where they’ve got a defender who’s slow and short—we think we can win that way.” As the game goes on, the coaches keep the goal and the game plan in mind at every moment.

The same should be true for clinic teams who redesign patient flow or work to make scheduling systems more patient-centered. Have a big goal and then devise the tactics to get you there. But don’t lose sight of that big goal.

6. Only Worry About This Down

“Do your job!” says Coach Leach to his players just before they take to the field at the start of the game. “Do your job!” Each player must concentrate on the task immediately before him. For a lineman, that means blocking the guy right across from him. For the quarterback, it means finding the open receiver and throwing a perfect pass. The only thing any player can have any impact on is the play currently in motion. Not the play that just happened, and not the next play. In football, the team plays one play at a time.

In Patient Visit Redesign™, coaches push teams to solve problems one at a time, to stay focused, and to celebrate accomplishments as soon as they happen. This is the only way to keep from being overwhelmed by our goal of transforming the patient experience. This means focusing on the task at hand. If the task is to reduce the no-show rate, then the team thinks of nothing except reducing the no-show rate. If the task is to create consistent patient care teams, the managers do not let the teams be broken apart to supply staff in another area.

Dogged focus on immediate problems and dogged determination to achieve measurable goals is what drives teams to success. They’re only worrying about this down. This may seem to be in contradiction to play number 5, but, ah, that’s the art of good coaching and good teamwork—keeping your eye on the goal while tackling the task at hand, one task at a time. See Setting Goals for Patient Visit Redesign™ in Seven Steps for guidance.

7. Don’t Overanalyze the Situation or You’ll Get Sacked

Football is a game of milliseconds. If Leach’s quarterback throws the ball at just the right time, his team scores. If he holds the ball just a bit too long, he is sacked, fumbles the ball, and the other team scores the touchdown.

Leaders in health care must be decisive and take quick action to solve problems. Once the provider templates get out of control, with double- and triple-booked appointments, it’s impossible to run an efficient and effective clinic. If poorly-performing staff are not reprimanded, problems are compounded, with devastating impact on staff and patient morale. The lesson: Don’t overanalyze—take quick action to correct problems.

Read Meet a Real Management Team to glimpse a decisive management team in action.

8. Don’t Underestimate the Importance of Special Teams

In football, special teams are used for a particular task—typically for one play—like the punting team or the field goal team. As the Monday morning quarterbacks say, “special teams win ball games.”

At Coleman Associates, we use “special teams” all the time. In a Patient Visit Redesign™ collaborative, for example, we deploy a “launch team,” which oversees team selection and gets the project going. We have a specialized team to coach collaborative teams. And we pull in other special teams at certain times for very specific, defined tasks.

In health care, we have many special functions—such as information technologies, scheduling and call centers, medical records, labs, etc. Typically, the people who fill these roles are not viewed as “part of the team,” but rather outsiders. However, if forged into teams, they will greatly enhance the patient experience. They can serve as special teams, and as said before, special teams win ball games. For more related thoughts about the effectiveness of teams, see Changing Ourselves to Change Ourselves.

9. Play Together with Great Tempo and Great Teamwork

In addition to exhorting his players to do their jobs, Coach Leach tells them before the game to “play TOGETHER with great TEMPO.” What better parallel is there to a smoothly-running patient care team in a clinic? A solid, patient-centered care team works together to meet the needs of the patient, and not as individuals on an assembly line.

As clinic processes are redesigned and teams begin working well together, the whole tempo of the clinic changes. Staff works with urgency, the clinic session flies by, and all of a sudden it’s lunch time, the patients have all been seen, and the waiting room is empty. Patients are stunned—absolutely stunned—by how quickly they’ve been called back to see the provider, and how efficiently they were cared for.

That’s what is means to play together with great teamwork and great tempo.

10. Always Wear the Cup—Be Prepared for Anything

Football players wear padding just about everywhere. They’re prepared, just in case.

One of the principles of Patient Visit Redesign™ is “Prepare for the expected (and almost everything is expected).” Clinic managers and staff can predict and prepare for most of the curveballs (sorry for the baseball metaphor) that will come up during the course of a clinic session. The problem is that they usually don’t.

11. When in Doubt, Run Like Hell

We’re not sure what this one actually means, but it’s always worked for us.

So, whether you put on your jersey and paint your face every Saturday to watch your favorite college game; whether you refused to let your kids play because you were afraid they’d end up with no teeth; or whether you’ve simply had no interest in football at all…whatever the case, you can learn from Leach. You can apply the lessons of football to your everyday clinic work.

Just like Mike Leach’s teams from Texas Tech are seen as underdogs, many of our public hospitals and clinics are not given proper respect by the private healthcare sector. But just as Leach has been able to turn an unlikely football team into a national powerhouse, our vision for the public health system is it, too, will be transformed and become the model of how to provide care in the 21st century.

It’s just a matter of how many plays you are willing to make to achieve success.