In this segment, Bob Sutton discusses how a strong sense of accountability—where individuals feel both owned by and owners of the organization—drives the spread of excellence within institutions. He illustrates this with healthcare settings, noting that hospitals with higher rates of correct organ donation decisions (around 75% of U.S. hospitals) foster a culture where nurses, doctors, clergy, receptionists, and even families collaborate, teach, and hold each other accountable. This mutual pressure to do the right thing, without silence, is presented as a hallmark of organizations that successfully propagate good practices.
Chapters
One thing that really struck us is in organizations where the workforce sort of propels the spreading of goodness, there's this real feeling of accountability. And by accountability, it's the feeling that I own the place and the place owns me, that everybody puts pressure on everybody else, if you will, to do the right thing and to switch to the medical organizations. We actually both Huggy and I got fairly obsessed with health care. It's really interesting to look at the difference between most hospitals where when they've got. I'm not supposed to go that far, when they've got somebody who is near death, usually with a head injury, and they want to harvest the organs and has given permission and everything. Most hospitals sort of get that right about 50% of the time. About 50% of U.S. hospitals get it right about 75% of the time. And in those hospitals, they have a set of norms where everybody's involved in making sure that everybody does the right things. The nurses, the doctors, the clergy, the receptionists, they pull in family members who have been in the same situation before. And there's this notion where they all teach and they all learn. And to us, that's a hallmark of organizations that spread excellence, is this feeling of accountability in organizations where there's not silence, where people feel compelled to tell other people when they're screwing up or to teach them or to help them.