Essentialism is clarity of purpose

Best-selling author, teacher, and speaker Greg McKeown published Essentialism: The Disciplined Pursuit of Less four years ago, but the book still resonates powerfully today. In this exclusive Accelerate podcast, surgeon Sam Finlayson learns how Essentialism helps individuals and organizations achieve clarity of purpose.

(Abridged transcript below)

Part I. The “why” and “how” of Essentialism (Questions 1-4)

1. [Introductions, Mari Ransco:] How did you get into your line of work?

[Sam Finlayson:] Part of it is exposure. I’m from a family with a lot of physicians, so growing up it seemed natural that I would become a physician. It is meaningful and has an element of service involved. Frankly, I couldn’t imagine growing up and not knowing how the body functioned. I was always very drawn to that area of knowledge. As for my choice of surgery within medicine, that was the only thing that I really liked [laughs]. The ability to very concretely fix something in somebody’s body and make it work again was very appealing.

[Greg McKeown:] It’s fun hearing Dr. Finlayson describe this idea of, “I couldn’t imagine not knowing how the body works.” It’s funny to me because I don’t know that I’ve ever thought that in my whole life. For me, it was a completely different thing. It was the impact—a fascination with human systems. Why do they work the way that they work? Why do people want to get certain results but consistently, individually, in pairs, teams, organizations, and societies, not get the results that they’re intending to get? Something complex, interesting, and, to me, fascinating is taking place. My attempt to understand is borne out of curiosity.

2. [Sam:] Many people have looked at how organizations function. You have a very distinct perspective on things. How did you arrive at Essentialism?

[Greg:] It grew out of working with companies in Silicon Valley, where I noticed a predictable pattern. Early in their existence, they were small by definition—small teams focused on a particular issue. Sometimes that was luck, but it ended up being the right issue at the right time. And that led to success.

Then I noticed, despite this predictable pattern, that success would often lead to this massive increase of options and opportunities. It led so often to what Jim Collins has called “the undisciplined pursuit of more.” If a once-successful organization falls into this undisciplined pursuit of more, that can undermine the very things that led to success in the first place. So actually, what I found was that success, as often as not, became a catalyst for failure.

To me, this was such a different idea and answer about success. This is a key reason why otherwise-successful companies don’t break through to the next level. It’s success itself. I suddenly noticed that this was true not just for organizations but also for the individuals inside those organizations.

I noticed it in a variety of ways, most notably with myself. In a similar period of time, I suddenly realized, “I was once more focused on what was more important—what was essential.” But somehow, in all the business and all the things that were going on because of the successes, I was finding that I was being pulled in a million directions. I was being busy without being productive.

3. [Sam]: I’ve encountered that idea a number of times in my reading—I have a hobby of reading books like yours. You mentioned Jim Collins. There is also The One Thing. The 7 Habits of Highly Effective People also talks about prioritization, as well as Getting Things Done to some degree. What I thought was distinguishing about your book is that you extend into personal life. To me, that makes it much more meaningful. Personal life has impact on one’s productivity and ability to succeed in their business. Can you comment?

[Greg:] My crescendo moment was when I got an email from a colleague who said, “Look, Friday would be a very bad time for your wife to have a baby because I need you to be at this particular planned meeting.” Maybe they were joking. But nevertheless, Friday comes along, we’re in the hospital, my daughter had been born the night before, and I am feeling torn to somehow keep everybody happy. To my shame, I went to the meeting. Afterward, my colleague said, “Look, the client will respect you for the choice you just made.” Maybe they did. But, the look on their faces did not evince that sort of confidence.

But even if they did, I recognize—and you do too—that I had made a fool’s bargain. If you don’t prioritize your life, someone else will. The issues that led to Essentialism are a human phenomenon, not just a business phenomenon.

4. [Sam]: I’m thinking specifically about the idea that we should be doing the “Hell yeah!” stuff and not the “no” stuff. But in a complex organization, there’s a lot of “nobody wants to do” stuff. How do we function as an organization that has tedious, menial tasks that really need to be done to provide the mortar for the more important stuff?

[Greg:] Let’s just start by emphasizing the fact I wrote a book called Essentialism. But sometimes what people hear—especially if they get caught up in the idea of saying no—is that they think I wrote a book called No-ism. The difference is really important.

The key is actually figuring out what’s essential. That’s where you have to begin. You have to get really good at asking that question yourself, you have to create space to be able ask it, and also in teams and in organizations. You need to be really clear: “These are the quality indicators that are actually critical.” Selecting those few things that will actually move the needle is the hard work. If you don’t have that and you start trying to eliminate non-essentials, that’s just as random as saying “yes” to everything. The key is to give permission to yourself and to the people around you to actually begin engaging in the wrestle of essentialism.

When people become clear about the work that needs to be done, you then have to get clear about who’s doing what. In that process, what I’ve found is that it is surprising what people really want to take on. We can assume a bit too quickly sometimes, “Well, no one will want to do all that work—everyone will want to do this work.” Sometimes that’s the case, but in my experience—in fact, the way the conversation began today—the premise of your life’s work is completely different to the intent of mine. I think it’s endlessly surprising to me how often that turns out to be case.

[Sam]: So diversity of roles becomes really important in an organization?

[Greg:] Something might appear too menial to you, but someone can become exceedingly good at it and feel very proud of the work that they’re doing because they see their role in the bigger picture.

"Instead of people being busy all the time but not productive, you get people that are immensely productive."

What I think is really disempowering to people is a sense of everyone has to do everything. What it leads to is people become overworked and underutilized. If you can create the space to have the conversations, which I think is the critical behavioral change here, you reverse that disempowerment. Suddenly, instead of people being busy all the time but not productive, you get people that are immensely productive. We’re not talking about a 2% or 5% improvement—this can be like 10 or 100 times improvement.

Part II. The importance of process in achieving clarity of purpose (Questions 5-6)

5. [Sam]: You mentioned alignment, and that’s been something we’ve done a lot of thinking about within our organization—the importance of having incentives aligned, mission aligned, and strategy aligned. What is the impact of appropriate alignment on the ability for an organization to function and focus on what’s really essential?

[Greg:] Especially in the ‘90s, the word “alignment” became a buzz word. What I always want to add to that conversation is, aligned to what? One of the breakthrough insights that made writing Essentialism required for me was this discovery that clarity was being underestimated in its impact. When you get a group of people with clarity, so many problems immediately take care of themselves. As clarity goes down, politics go up. That’s an almost endless trade-off that you can make, until organizations are flooded with low-trust cultures that just aren’t working. The busyness goes up, the stress goes up—people don’t know how to win in their jobs.

High enough levels of clarity takes a process that must be hammered out together. You’ve got to debate it, you’ve got to ask the hard questions, you’ve got to deal with the inherent trade-offs necessary to get to clarity. If you can do that, it’s more than 50% of the work.

"When you have clarity, so many problems immediately take care of themselves. As clarity goes down, politics go up."

Once people have high levels of clarity, they can start to self-organize. They can start to know which things to work on. I remember somebody at IBM once telling me, “I really believe in this idea of Essentialism because our organization decided on a single priority for the whole year.” He said the result of that year was absolutely breath-taking. And then, he said, the organization was so taken with the results that the second year they said, “This year we’re not going to have one priority—we’re going to have three because it worked so well last year.” They broke down the very thing that had led them to be able to work so well together.

This is still a highly misunderstood principle. People get the clarity. There’s almost no leader that will say, “Well, clarity doesn’t matter to me.” But often what they’ll say is something like, “Look Greg, I think we’re pretty clear.” And I wear glasses—we both do. I always think, the difference between pretty clear and really clear is REALLY different.

So we’ve got to get more clear. Be sure. What are we really, concretely trying to do? How will we know when we’ve got there? What is the essential intent—the thing that we are driving everything towards? Then, the most junior, newest employee is empowered from the second they walk in the door. If you don’t have that, hierarchy rules. All that inherent intelligence, that navigational intelligence that they had before they walked through the door, is gone. Hierarchy shuts down so much of the intelligence, the capability, and the drive inside of institutions. Clarity is still something within the reach of every organization. It’s not externally determined. You can do it internally to break through to the next level.

6. [Sam]: How does clarity of mission relate to employee’s sense of empowerment?

[Greg:] There’s no empowerment without clarity of mission, of intent, and of role. It is empowerment in my view. To simply say to somebody, “Hey listen, you’re empowered,” is not empowerment. To have clarity enables you to be able to self-organize—you’d know how you were trying to help and how you weren’t.

"There’s no empowerment without clarity of mission, of intent, and of role."

Here’s one of my experiences: I remember at business school, we had a terrific professor in strategic management of non-profits. He had us all bring vision statements from non-profit organizations and read them out in class. We’re reading out a hundred of these things, and at first, we start laughing—you’ve got a six-person organization and their mission is, “We’re going to end world hunger.” Whatever that statement is, it’s not your mission. Vision and mission statements are only intended to give clarity. And so many institutions, non-profit and for-profit create statements that are either neutral—meaning people just go, “I don’t know what that means” and put it aside—or they’re worse than that because they’re actually confusing.

Then somebody in the room says, “I’ve got Brad Pitt’s mission statement from his non-profit.” By this point, we’re all laughing. They read it out: “The mission of our institution is to build 250 storm-resistant homes in New Orleans by this date in this district.” It took the oxygen out of the room. Everybody knew the real mission. This is what I mean by an essential intent. You know what it really is—and what it isn’t. That’s empowerment personified. This allows any person in the institution to be able to take action.

Part III. Applying Essentialism to academic medicine and health care (Questions 7-8)

7. [Sam]: As an academic medical center, we have three missions–clinical, research, and education. Sometimes, within the context of limited resources, there’s competition. The education slows down the medical work, and the research clamors for resources from the clinical enterprise. How have you seen organizations navigate their multiple missions?

[Greg:] Let’s look at a totally different industry. Look at what Elon Musk is doing. At one level you could say, “What a non-essentialist. He’s just doing so many different things.” But each of those institutions has an explicit essential intent. It’s not a two- or three-year essential intent, as I recommend in the book—it’s like a 50-year essential intent. But you know exactly what it is; every person does.

Having dual missions doesn’t excuse two general mission statements—two general, ambiguous statements. You’ve got to define what we’re really trying to do in each. Then you’re looking for the synergies. What are the tension points? You’ve got to engage in that wrestle. Nobody can use as the excuse: “Well, we’ve got all these different competing priorities…” That’s the nature of this beast. Now, let’s engage in it so that we make sure that we still are choosing the very best allocation of these resources across these two things we care about. Sometimes people, after we talk about this idea of having by definition only one priority, will say, “Well hold on, you have four children—who’s your priority child?”

I think that’s similar to what you’re describing because I have four children that I love equally. But that doesn’t mean that I shouldn’t be engaging in the prioritization conversation. It doesn’t mean that I simply say, “Well, every day I have to spend exactly equal amounts of time with all four of them.” That’s not prioritization. It’s being aware and having the conversation, and engaging and listening and being thoughtful, and then still prioritizing. “Today, this child has a challenge, and this is what I need to be focused on.” You still prioritize. You maybe simply say, “Well, I’m going to make touch points with each of them, but I’m really going to invest in this issue today.”

[Sam:] My department has three children then: the education child, the research child, and the clinical care child.

[Greg:] That’s right. In health care, there’s one more layer that’s really tough. We can’t let the toughness turn us into non-essentialists. The toughness is life and death. How are we not going to do everything? That logic, of course, is absolutely true. But it’s also missing another equally true point, which is that you don’t have unlimited resources.

"It’s not magic. It’s going back to what you know for sure and building from there."

We have to say, “Ok, if there are three children, great, these are all important. Now how are we going to allocate the resources between them? Balance compassion and courage to actually produce the best breakthrough results?” We won’t be able to treat everyone. We will not be able to do everything.

That problem precedes Essentialism. What I am trying to do is draw attention to reality. Be honest about what we have and what we don’t have. What we can and what we cannot do. We have finite resources and infinite ways of spending those resources, we therefore have to make these decisions. We can either make them reactively—that’s the worst way to make them—or we can make them collectively, wisely, but really still do the prioritization work. That’s what I’m advocating. That’s what an Essentialist does. They don’t pretend they can do everything. They are honest, and therefore have the courageous conversations in a very gentle and wise way, but they still don’t avoid that responsibility.

8. [Sam]: What would you hope that an academic medical center such as ours would create as that clear, essential purpose?

[Greg:] Let me ask a question: can you remember the last time you were pulled over for a ticket?

[Sam:] Yes.

[Greg:] OK—visualize that moment. The police officer is coming to your window. And you’re thinking, “Is this going to be a positive ticket or a negative one?”

[Sam:] Well, I am thinking, “Is this going to be a ticket or a warning?”

[Greg:] Is it a ticket or a warning, and how can I try and persuade it to be a warning and not a ticket? The reason we don’t think positive vs. negative is because there’s a deep assumption—so deep that we don’t even think about it—that tickets are going to be negative, and that’s the only way to do policing. In fact, that is the purpose of policing. The point of policing is law enforcement. Somebody breaks the law, you catch them, and there is some punishment.

But that isn’t how policing began. Policing began in the United Kingdom, and it was about community building, if you can believe it. It’s so different than the version we have today. Ward Clapham was the police chief in Canada, and he discovered this completely misaligned purpose. His intent became the end of crime. If you really have that as your intent, suddenly almost everything they were doing becomes non-essential. Can you imagine how bold that was? You have to get out there into the community and build relationships and connect with people and catch them doing the right thing. Because our mission is about prevention, not about catching people afterwards. At the time, the recidivism rates in his city were about 60%. He reduced that over a 10-year period to 8%. That’s unthinkable. You’d never get there by just doing negative tickets. This reduced overall crime by 40% and reduced youth crime in half.

What’s the equivalent of that within the health care industry? You cannot simply catch people after the fact. I cannot imagine resource allocation to prevention is higher than 1%. Everything’s after the fact. Could we change the intent? What if the whole focus of what we’re trying to do really was, people don’t ever go to the hospital? That’s the chance to do something transformational.

[Sam:] What you’re talking about is accountable care. The challenging reality is that we profit from people being sick. I think what you’re talking about is getting to the point where we as a health system are benefitting and have alignment with our financial incentives around making people healthy.

[Greg:] What you said is so true. It was created a certain way based upon a certain set of assumptions, which means it can be recreated using different assumptions. The process for this—I don’t know why I’m talking about Elon Musk so much today—but it’s something that he’s used as a philosophical principle called First Principles Thinking. In a nutshell: there are three ways of making decisions. You can say, “What have we done in the past? Let’s keep doing that.” You can say, “What’s everyone else doing?” Benchmark against everyone else in your industry, which is sort of a similar version of the first question. Or you can go back to first principle, and first principle means, “What do we absolutely know for sure?” and make decisions and design from there.

It’s not magic. It’s going back to what you know for sure and building from there. What do we know for sure about health? And design from there. Then you can build new business systems, new incentive programs... I know what I’m saying sounds revolutionary. I think in hindsight, a hundred years from now, what will be crazy is our current system.

Podcast recorded at the November 30, 2017 University of Utah Health Leader Development Institute (LDI), Grand America Hotel in Salt Lake City, Utah.