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The Busy Reader


Pages in Motion. Passion for Stories.

The First 90 Days

Who Should Read It

Everyone who aspires to lead a team.

Why Should We Read It

This book gives us concrete behavioral and business cases to help us develop our own leadership potential.

What Will We Learn

Successful leaders consistently adjust their leadership style to appropriately address the current business environment.

Book Reflections

"...essential reading among business school graduates who wish to transition smoothly into a new role or promotion."

Hello Busy Readers! It's been a very long time since my last post because the calendar 2020 year has been, well, Busy. What have I been reading? Honestly- not much! At home, my son is becoming more mobile with a penchant for opening every possible door and drawer he can find. Gone are the days where he will be satisfied with just a clean diaper and full bottle. He must also be a bona fide genius, because he entered his terrible two's about six months earlier than expected. In the office, my professional life took an unexpected turn when my site manager stepped down and I was tapped to be her replacement in January 2020. This was to be my first managerial role, and in preparation I read Professor Michael Watkins' The First 90 Days, which is essential reading among business school graduates who wish to transition smoothly into a new role or promotion.

"The most successful leadership behaviors actually go hand in hand with first accurately understanding what business situation we will be entering."

I am a primary care physician in a large multispecialty medical group, and I am not a business school graduate. Whenever I peruse my wife's business books, I cannot help but feel that the contents are entirely "fluff". These books tend to bandy behavioral buzzwords like "create a vision" and "build trust", without actually detailing what they might mean. Professor Watkins' book avoids this pitfall by regularly sharing concrete behavioral business cases through which we can dissect and discuss critical business and behavioral principles in our transition into any leadership role. Certainly, we all have our individual personality preferences and styles. Professor Watkins argues that the most successful leadership behaviors actually go hand in hand with first accurately understanding what business situation we will be entering (his STARS model):

  1. Start-up: we must assemble the people, funding, and technology to get the new business up and running.

  2. Turnaround: the business is in freefall/crisis, and we need to make substantial changes rapidly and decisively.

  3. Accelerated-growth: The business is becoming successful, and we must work to scale up and expand its potential.

  4. Realignment: The business is stagnant/status quo. If it does not adapt or change in 3-5 years, it will decline.

  5. Sustaining-Success: The business is successful, and we are to maintain its vitality while taking it to the next level.

Understanding the STARS model was critical for me in surviving my first months as site manager. Healthcare systems across the nation are facing an increasingly untenable situation in which primary care physicians are burning out (and retiring) faster than what our medical schools can replace. A healthcare crisis looms over my medical group (and the United States) if we cannot find a solution to reverse this trend in the next 5-10 years ("realignment"). Fortunately for me, my medical group's chief medical officer had an ambitious plan to transform how we deliver primary care. My job was to implement that plan at my site. The challenge of realignment is that not everyone agrees that a crisis is brewing. Moreover, some of my physicians liked the status quo, and signaled that they would actively resist any proposed changes. The best leadership behaviors in this setting actually played to my strengths and preferences: taking time to understand my team members' individual hopes and fears of the future, and slowly building consensus regarding the path forward for our site. This didn't make my job any easier.

" a 'turnaround' environment, the proverbial world was burning and I had to take the 'ready-fire-aim' approach to management."

In hindsight, the first two months of working in a business undergoing "realignment" was relative bliss. I had barely two months of managerial experience before my team abruptly veered into a "turnaround" environment: by March 2020, the COVID-19 pandemic had hit the United States, and all of us were scrambling to adjust. In contrast to our previous "realignment" environment, I didn't have the luxury of time to slowly build consensus. Our proverbial world was burning, and I had to take the "ready-fire-aim" approach of making substantial decisions without having complete knowledge of the fluid situation. I still worked hard to continue to acknowledge my team's hopes and fears (and there were plenty); I just didn't always have time to elicit everyone's opinion, and I definitely didn't implement policy based on majority consensus. Fortunately for me, my team members generally gave me free license to move us where I thought we needed to go. This ~3 month period of "turnaround" by far remains my most difficult leadership experience to date.

"'...I now completely and inexplicably buy into all these "fluff" business buzzwords...[and this book] is a good place to start learning them."

The COVID-19 pandemic continues to dominate our healthcare landscape, but at this point, it is healthcare's new normal. In many ways, our medical group has successfully demonstrated our ability to thrive in this brave new world, and it is time to scale up what we have learned from the 2020 Summer of COVID-19 ("accelerated-growth"). This business environment is similar to a business in "realignment" in that I should transition back to the slower, more deliberate work of consensus building to successfully move my team forward (and addressing challenges left over and unresolved from our "realignment" days). Ten months after I started this managerial journey, I can also say that I now completely and inexplicably buy into all these "fluff" buzzwords. Of course I should be "creating alliances" and "negotiating success"! Professor Michael Watkins' The First 90 Days is a good place to start learning how.


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