Page 63 - Harvard Business Review, Sep/Oct 2018

Organizational Grit
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collaboration—gritty teams of clinicians who all relentlessly low-level goals are a means to an end, helping the cardiologist
push for improvement. Yet it takes more than that: Health accomplish mid-level goals, such as coordinating patients’ care
care institutions must exhibit grit across the entire provider with other specialists and team members. At the top would be
system. a goal that is abstract, broad, and important—such as increas-
In this article, drawing on Tom’s decades of experience as ing patients’ quality and length of life. This overarching goal
a clinician and health care leader and Angela’s foundational gives meaning and direction to everything a gritty individual
studies on grit, we’ve integrated psychological research at does. (See the exhibit “A Cardiologist’s Goal Hierarchy.”) Less
the individual level with contemporary perspectives on gritty people, in contrast, have less coherent goal hierarchies—
organizational and health care cultures. As we’ll show, in and often, numerous conflicts among goals at every level.
the new model of grit in health care—exemplified by leading
institutions like Mayo Clinic and Cleveland Clinic—passion for A Cardiologist’s Goal Hierarchy
patient well-being and perseverance in the pursuit of that goal In this simplified illustration, immediate, concrete goals sit at the bottom.
become social norms at the individual, team, and institutional These support broader goals at the next level, which in turn support an
levels. Health care, because it attracts so many elite performers overarching primary goal that provides meaning and direction.
and is so dependent on teamwork, is an exceptionally good
place to find examples of organizational grit. But the principles
outlined here can be applied in other business sectors as well. Top-level goal
Improve cardiac patients’
quality and length of life
Developing Individuals
For leaders, building a gritty culture begins with selecting
and developing gritty individuals. What should organizations Mid-level goals
look for? The two critical components of grit are passion and Prevent cardiac Treat cardiac Coordinate
perseverance. Passion comes from intrinsic interest in your conditions conditions care
craft and from a sense of purpose—the conviction that your
work is meaningful and helps others. Perseverance takes the Lower-level goals
form of resilience in the face of adversity as well as unwavering
devotion to continuous improvement. Encourage Encourage Prescribe Schedule Meet to Track
therapy
healthy
relevant
review
checkups
exercise
The kind of single-minded determination that character- eating as needed cases conditions
izes the grittiest individuals requires a clearly aligned hierar-
chy of goals. Consider what such a hierarchy might look like
for a cardiologist: At the bottom would be specific tasks on her It’s important to note that assembling a group of gritty
short-term to-do list, such as meetings to review cases. These people does not necessarily create a gritty organization. It
could instead yield a disorganized crowd of driven individuals,
each pursuing a separate passion. If everyone’s goals aren’t
► Idea in Brief aligned, a culture won’t be gritty. And, as we’ll discuss in more
detail later, it takes effort to achieve that alignment.
Take Mayo Clinic. It is unambivalently committed to a
► THE PROBLEM ► THE SOLUTION ► HOW IT WORKS top-level goal of putting patients’ needs above all else. It lays
Health care has long Hospitals and Sustaining a gritty out that goal in its mission statement and diligently reinforces
depended on the passion health systems must organizational
and perseverance of develop grit at the culture requires clear it when recruiting. Mayo observes outside job candidates for
individual doctors individual, team, and communication of two to three days as they practice and teach, evaluating not
and nurses. But with organizational levels. values by leadership, just their skills but also their values—specifically, whether
the advent of modern That requires ensuring programs that they have a patient-centric mission. Once hired, new doctors
medicine, providing that all participants are celebrate successes,
superior care has committed to pursuing and the promotion of a undergo a three-year evaluation period. Only after they’ve
become so complex a shared high-level “growth mindset” that demonstrated the needed talent, grit, and goal alignment are
that no lone caregiver, goal. Putting patients embraces continuous they considered for permanent appointment.
no matter how gritty, first is a common and improvement and How can you hire for grit? Questionnaires are useful for
can do it all. effective objective. learning from setbacks. research and self-reflection (see the sidebar “Gauging Your

100 HARVARD BUSINESS REVIEW SEPTEMBER–OCTOBER 2018