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INTRODUCTION

A leader is one who knows the way, goes the way, and shows the way.

 —JOHN MAXWELL

 

UCLA Health System is among the most complicated organizations that you will ever encounter. In essence, it is at least three businesses in one: a world-class medical-care provider, an extraordinary medical training center, and a cutting-edge research facility where the future of medicine is being created today. Across all these lines of business, UCLA has the task of developing a culture of safety that integrates technology and human oversight to prevent harm and death to the customers it serves. Each business thrives through constant quality improvement, a responsibility for advancing outcomes, and a passion for streamlining processes to deliver customer-centric care. Despite its exceptional products, its leaders relentlessly call on staff members to increase customer satisfaction and maximize the consistency of service delivery. The leaders champion the message that transactional service is not enough and that human care and compassion are essential elements of every customer interaction. Finally, the leaders deliver their products and services in the context of highly regulated, politically volatile, and often economically challenging circumstances.

As I approached this summary, I realized that the best way to review key lessons and hopefully inspire you to take action on the concepts presented was to emulate the successful process of UCLA’s CEO, Dr. David Feinberg, who talks about patient care at seemingly every opportunity. To that end, please allow me to tell you a patient story—the story of Jay and Katherine Wolf.

Jay and Katherine were living in Malibu, California, where Jay was in his third year of law school at Pepperdine University. The couple had celebrated the birth of their first child, and both Jay and Katherine were in seemingly outstanding health. Katherine was a nonsmoker; she exercised regularly and had no weight-related issues. However, six months after the birth of their son, James, 26-year-old Katherine Wolf experienced a major hemorrhagic stroke secondary to the rupture of a blood supply malformation in her brain. Her neurosurgeon, Dr. Nestor Gonzalez, shares, “Katherine’s case is remarkable in many aspects. One of those was the technical challenge of the procedure that we performed. The arteriovenous malformation that she had was one of the worst I had seen in my life. It presented with associated bleeding that was producing a significant increase in the pressure in her head. Her brain was basically herniating into the spinal canal. That is a condition that usually is very, very difficult to reverse, and that in the majority of cases is lethal. The malformation was very close to vital structures of her brainstem. The brainstem, as you may know, controls many of the essential functions for living. My first challenge was to decide whether surgery offered enough hope to save Katherine’s life.”

Concluding that the risk of inaction was greater than ...

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