This is the question Eric Cecava has spent his career trying to answer. He’s still working on it.
The Operational Definition
Running something well means that the people the organization is supposed to serve are getting what they’re supposed to get, reliably, and that the people doing the work can sustain it. That definition is simple enough to remember and specific enough to use.
“Reliably” is the word that does the most work there. Anybody can produce a good outcome once. The operational discipline is producing it consistently, across different staff, different circumstances, different patient presentations, different days. Consistency is a systems property, not an individual one. You can’t hire your way to it.
The sustainability clause matters as much as the consistency clause. An organization that produces good outcomes by burning out its staff is not running well. It’s running on a form of credit that eventually comes due. Eric Cecava has seen organizations manage quality by working their people harder instead of fixing their processes. That works until it doesn’t.
Why Financial Performance Isn’t Enough
Financial performance is necessary but not sufficient. An organization that is financially healthy but not providing reliable care to the people it serves is not running well in any meaningful sense. An organization that is providing excellent care but is financially unsustainable is also not running well, because it won’t be able to provide care for long.
The organizations Eric Cecava has seen run best treat financial performance as a constraint rather than an objective. The objective is what the organization exists to do: provide care, in this case. Financial sustainability is the condition that makes doing it possible over time. Getting those two things confused produces a different set of decisions.
This distinction matters in practice because it changes what gets measured, what gets talked about in leadership forums, and what gets celebrated. Organizations that measure only financial performance end up optimizing for financial performance. Organizations that measure what they’re actually trying to do for patients, alongside financial performance, tend to make better decisions.
The Test Applied to Every Unit
For any unit he’s responsible for, Eric Cecava asks three questions. First, do the people in this unit understand what they’re trying to achieve? Not the metrics. The actual goal. Second, do they have what they need to achieve it? Third, do they know when something is going wrong, and do they believe something will happen when they report it?
If the answers to all three are yes, the unit is in a position to run well. The leadership work is getting and maintaining those three conditions. Everything else follows from them.
These questions sound basic. They are basic. The operational work of maintaining them across an organization with hundreds of employees, multiple facilities, and constant turnover is not basic at all. It requires consistent attention, consistent communication, and consistent follow-through over time.
What’s Still Being Worked Out
The honest answer is that what it means to run something well is still being worked out, because the answer changes with context. Running a hospital well is different from running a skilled nursing facility well. Running a medical group well requires different things than running either of those. The underlying principles are similar. The application isn’t.
The thing Eric Cecava is most interested in now is the relationship between operational discipline and organizational adaptability. The organizations that run well consistently are also, in his experience, the ones that adapt best when the environment changes. Those two things seem related. The exact mechanism isn’t yet clear.
The work of running something well is never finished. That’s not a complaint. It’s the most honest thing to say about why this work remains interesting after all the years spent doing it.