How much do you about what's really going on at the front lines of your company? I was talking to a retired physician the other night, and he told me a story that sums up how  a lack of knowledge can lead to disrespect for people -- especially in academic medicine. Forty years ago, when he was a 32-year old junior attending physician, he researched the possibility of having his hospital become a 911 center -- which means that they'd accept public EMS ambulances, not just private ones. To his surprise, he found that the hospital was already accepting them; in fact, about 1/3 of the ambulances were public.

At a meeting, he told both the president of the hospital and his boss, the chief of surgery, that the hospital should become a formal 911 center because they were already serving that function. The meeting didn't go well:

Roger: "We're already accepting public ambulances. We should just go ahead and become a 911 center." Chief of Surgery: "No, we don't accept them. Only private ambulances come here." Roger: "Actually, that's not right. I looked into it. About 1/3 of our trauma visits are from EMS ambulances." Chief of Surgery: "And I'm telling you that we don't accept them. I'm the chief of surgery, I've been here a long time, and I know: we only take private ambulances." Roger: "But I looked into it, and that's not the case." Chief of Surgery: "I'm telling you, you're wrong." Hospital President: "Son [he's from the south], when the President of the Hospital and the Chief of Surgery tell you that we don't accept EMS ambulances, then we don't accept EMS ambulances. Is that clear? Roger: No, it's not. It's wrong. And I'll get the data to show you.

Sure enough, Roger gets the hospital logs from the previous year and finds that, in fact, about 1/3 of ambulance visits were EMS vehicles. He sends his report to the hospital president and chief of surgery with a note that says, "Isn't data wonderful?" Shortly afterwards, they applied to become a 911 center.

You can take away a lot from this story -- not least of which is how much courage Roger had in standing up to his bosses, which in medicine (like the military) is pretty difficult to do. (Roger says that data made him brave.) But for me, the big lesson is how disconnected leadership can be from the daily activities of front-line work. They may think they know what's going on, but when they get to the rarified air of the executive offices, it's far too easy to lose track of what the customer service reps, or the sales team, or the credit department deals with daily.

Going to the gemba is the antidote. You have to see for yourself what's going on where the work is being done. If you don't know, you're at serious risk of disrespecting your workers.