Closing the Execution Gap: How Great Leaders and Their Companies Get Results, by Richard Lepsinger. 2010. Jossey-Bass/A Wiley, hardcover $45.00.

The author of this book, Richard Lepsinger, is president of OnPoint Consulting. He became interested in what differentiated companies that got things done from those that did not. In a quest to find the answer, he and his team studied more than 400 companies. They found that 49% of the leaders of these companies reported a gap between the ability to develop a vision and strategy and their ability to get the desired results. The OnPoint group wanted to answer this question: "If a clear and inspiring vision, a realistic strategy, employee commitment, a skilled workforce, and high levels of quality and customer service don't lead to successful execution, what does? What sets the best apart from the rest?"

In conducting their research, the team looked at some well-known companies that all have a reputation for quality and success. These are companies that all of us know by name. Interestingly, the research found that the companies that managed to move from vision and strategy to execution could be described by 5 characteristics and competencies, which they called the 5 bridges. Although the research was conducted looking at companies, the lessons learned would also apply to health care, social service, and other types of organizations. I imagine that most of us can identify with both the successes that Lepsinger and his group identified as well as the limitations in execution. I will summarize the 5 bridges and I hope that you will think how your organization performs in each of these areas.

The first bridge is the ability to manage change. We all know that change is constant and inevitable and affects each of us in our personal and professional lives. Lepsinger's team found that successful companies were able to adjust to changes in the marketplace. They were able to bend with the winds of change like a bamboo tree rather than snap in the face of strong winds like a Bradford pear. He cited the example of Dell as a company that was highly successful then got stuck in the "Dell way" and now is working hard to recover its customers.

The second bridge talks about a structure that supports execution, and what Lepsinger means is finding the right balance between centralization and decentralization. The organizational structure must support the new strategy. He says that a good structure enhances accountability, coordination, and communication and fosters decision making close to the action. This is a bridge that can easily fit into health care and social service agencies. The third bridge is akin to the second one in that it deals with employee involvement in decision making. Good decisions typically have input from a wide range of people. Although this may be time consuming, it often pays off in employee support and implementation. It also helps foster the second bridge of involving the people close to the action. Does your employer make decisions near the top of the organization and send them down to the employee level or are there avenues for communication to also flow up the organizational structure and influence decisions. Lepsinger says "Involving employees in decisions gets them focused on generating solutions to problems rather than complaining or waiting to be told what to do."

The fourth bridge talks about leaders aligning their actions with company values and priorities. In essence, do leaders "walk the talk?" Followers do not trust leaders who say one thing and do another. The last bridge talks about the need for company-wide coordination and cooperation. Lepsinger says that most people want to do the right thing; however, more than words are necessary. Coordination and cooperation require shared goals, clear communication, and well-defined roles while simultaneously holding people accountable for doing what they are supposed to do.

The author gives some good examples of bridge builders. In the interest of space, I will cite one that I think has direct application to health care when he talks about teams not being able to afford working around poor performers. "I've been surprised by how tolerant many managers are of people who exhibit below-standard performance. It is almost as if they have come to accept the fact that work has to be done without the full contribution of the entire team. That acceptance is the heart of the problem"(p51).

-Jeanette Lancaster, PhD, RN, FAAN

Editor Family & Community Health