“This was predictable - we predicted it ourselves.”

I’ve heard some version of that sentence in quite a few boardrooms, usually right after the crisis had already blown up and nobody in the room sounded surprised anymore.

I’ve heard something close to it from patients too - except there it wasn’t about a company, it was about themselves: “I knew this would end up like this, but I never managed to change.”

Both sentences describe the same failure, just in two very different rooms: the information was there, on time and in usable form, and it still didn’t move anything.

That’s where the idea started: an organization runs on the same principles a human body does. Not as a nice metaphor - the same mechanisms, just at a different scale. I’ve spent my career moving between both sides of that line, MD and MBA, hospital floor and boardroom, and it’s rare that anyone stops to ask what medicine could teach them before writing the next transformation plan.

That’s not just a nice parallel, either. “Organization” and “organ” share the same root - the Greek word organon, an instrument, a tool, a body part, literally “that with which one works.” And the people on an org chart aren’t called “members” by accident: a member is, etymologically, a limb. We built the vocabulary for organizations out of the vocabulary for bodies long before anyone thought to take the connection seriously.

The business case has been settled for a while

Organizational health paying off financially is a widely accepted idea today. Scott Keller and Colin Price, both McKinsey partners back then, built the case in Beyond Performance. I had the privilege to see that connection between business success and organizational health myself, over years as a McKinsey consultant: companies in the top quartile of organizational health do deliver roughly three times the total shareholder returns of those in the bottom quartile.
Patrick Lencioni made the same argument from a different angle in his book The Advantage. His claim is that it matters less how smart your leadership team is than if the organization is whole, consistent, and free of the politics (that eat a good strategy alive). And if you don’t trust two top consultants’ on this, there’s John Kotter and James Heskett’s decade-long study of more than 200 companies (published in 1992). Adaptable cultures outperform “strong” ones. Period.

Plenty of organizations already measure organizational health, one way or another - and some even try to react to it. That’s exactly the problem. It’s like prescribing iron because the lab value for hemoglobin came back low.

So the “org health matters” argument is done. What’s missing is the how. That’s what I actually want to give you here: not another reason to care, but the toolkit a doctor would use to take care of it.

Where I used to get it wrong

Here’s the trap, and a lot of corporate wellness programs are still in it. If health only means “not sick,” you spend your whole budget on prevention and react to findings. Just like as physician I have seen obese patients with metabolic syndrom, where diets didn’t help at all, I have seen the same in corporate transformations. (Funnily, “cutting fat” seems like a coined term there for “getting leaner” - think about it). It often doesn’t help to focus on mere “mass” reduction when the underlying root cause drives the craving for candybars. Also “running faster” doesn’t help the organs of the patient or the teams of the organ-isation (yes, this pun is intended!)

Medicine solved this problem forty-five years ago and mostly forgot to tell business about it. In 1979, the sociologist Aaron Antonovsky coined the term “salutogenesis” - the origin of health, as opposed to pathogenesis, the origin of disease. His research grew out of a study of Israeli women, a number of them Holocaust survivors, and the question that struck him wasn’t why some still carried the damage. It was why some of them did not. Why, decades later, a part of that group reported genuinely good health despite what they’d lived through. That’s not a comfortable question to sit with. Antonovsky didn’t treat it as one. But it’s the right question, and business still mostly hasn’t asked its own version of it.

The WHO caught up in 1986, in the Ottawa Charter: health is “a resource for everyday life, not the objective of living… a positive concept emphasizing social and personal resources, as well as physical capacities.” Not the absence of a crisis. It is the capacity to use what you have and grow.

That’s the definition I use for organizations now. And notice what it isn’t: it isn’t really about avoiding the next crisis. That’s still pathogenesis with a friendlier name. It’s about the resources an organization can draw on when the crisis comes anyway - because it will.

Salutogenesis is not another prevention program.

Three things that carry over almost without translation

What’s still working. The same question Antonovsky asked of those women, asked of your organization: not what’s failing, but what’s intact, what you could build on. Most change programs do the opposite - they scan for the broken part and staff a task force around it. Ask the inverse question in your next leadership meeting: which one thing is still working well enough that we should double down on it, not fix it. Or, if you will, “which muscles can we strengthen to mobilise our organisational body and improve circulation?”
I’ve watched that single question reroute an entire transformation, in a aerospace and defense supplier, in distress, struggling from immense competitive pressure. Typical reflexes came up - “cutting fat” to save costs, “run faster”, and “dieting” in the form of expense cuts. What helped them get back on track was eventually the idea of pushing fresh oxygenated blood to the brain. Through a holistic “back to health” program, they e.g. initiated talent rotation to those parts of the organisational body that needed it - in their case all units focusing on external challenges rather than focusing on internal issues.

What organs and organisations run on. A body needs water, glucose, oxygen, or nothing else works, no matter how good the strategy slide looks. A team runs on purpose, and on the basic things underneath it. Maslow had this right before it became a management cliché. I’ve sat in enough executive off-sites to know: you can present the most elegant operating model in the world, and it will fail quietly if nobody in the room believes it’s for something.

Stress isn’t the enemy, but the wrong kind is. Hans Selye split stress into eustress and distress in the early 1970s: the same hormonal cascade, and the difference is whether the load is matched by recovery and reward. Push a team hard and reward it - recognition, autonomy, money, visible impact and you get supercompensation, the same mechanism athletes use to get stronger from training. It’s stress, then just enough recovery, then growth. Push a team hard without the reward side, and you get what the sociologist Johannes Siegrist called effort-reward imbalance, a well-documented predictor of burnout. In my experience this is the single most common failure mode in “we’re doing more with less” programs.
Ask yourself: Imagine you could go to the gym for 2 hours, followed by 10 hours of recovery and sleep. Do you think reversing this, meaning you train for 10 hours and recover for 2 hours, will yield in stronger muscles? Even if you can’t see much - rest is when your body grows. Neurologists will tell you that sleep is actually one of the most active part of the day.
Same stress, but opposite outcome. The difference is one variable most transformation plans never look at.

The actual question

None of this is complicated. It’s also almost never asked. Not in the boardroom that told me it was predictable and predicted, and not by the version of me who used to hand out therapy plans without checking any of this first.

So here’s a real question, not a rhetorical one: which one is missing in your organization right now: the resource, the fuel, or the recovery?

I’ll put them under the diagnostic microscope, one by one, over the next few pieces. This is where I’m spending my attention these days: what keeps an organization healthy, using a field that had 150 more years than management to learn. If that’s useful for you, stay tuned.

I’m Jannis - MD, MBA, ex-McKinsey. These days I run the same diagnostic on organizations that I used to run on patients: keynotes, executive advisory, executive coaching, at the intersection of medicine, leadership, and longevity.

“Well, what would you look like if you had not been eating in four days?”

She had been on the operating list four days now. Nothing to eat from midnight each time. Each day she waited, just to hear from a new nurse or doctor that ‘we’re really sorry, there was an emergency coming up’ and that she’d been moved to tomorrow.

Nobody in that hospital did anything wrong, and nothing wrong to her. That’s the part I want to write about.

The number we were hired to fix

Many years ago, as a young and enthusiastic consultant (yes, the time when consultants wore cufflinks and no sneakers), I worked on a huge improvement program at a large hospital. The target was operating room utilisation, a reasonable thing to target. The OR is the machine room of a hospital. It bears the highest costs, the scarcest staff, and it is at the center of why many hospitals even exist.

We went after the usual indicators. On-time first start (it’s called “golden cut”). Turnover time between the cases. The metrics every hospital tracks and none of them is happy with.

And we did it properly. A full lean program, value stream mapping, dashboards, monitoring to six sigma standard, operational training to enable people to be able to work faster. If someone had audited our method they would have found nothing to criticize. I was proud of the high caliber consulting work we delivered.

However: the needle didn’t move.

Not “moved a bit less than hoped.” It didn’t move at all.

What we had actually been looking at

Haemoglobin of 9 is not a diagnosis. It’s a number. It could be iron deficiency, or B12, or chronic inflammation, or kidney disease, or a tumor in the colon bleeding quietly for months. Prescribe iron and you’ll be right often enough to feel competent, and the haemoglobin will climb. You will have treated a symptom. Not the underlying issue.

OR utilisation was our haemoglobin.

The system turned out to be communicating pipes. Patients were discharged late from the normal wards. Late discharge meant there was no option to downgrade patients from intensive care to the normal wards. No free intensive care bed meant the complex cases, so the ones that need a guaranteed ICU bed afterwards, couldn’t go ahead. So these patients were postponed.

The constraint has never been in the operating room. It was two rooms downstream, in a ward discharge process nobody had asked us to look at, because nobody viewed it as an OR problem.

Every hour we spent optimising turnover times was iron for anaemia.

If you don’t work in a hospital, don’t let the scrubs distract you. The shape of this is not clinical, it’s structural, and I’ve watched it hold in an army unit, in a factory, and in a back office that had never seen a patient in its life. The constraint is almost never where the cost is. Cost is loud and easy to measure, so that’s where the program goes. Meanwhile the actual limit sits one department downstream, in something nobody has been asked to look at. Or even worse, has decided to not look at, usually because the people who feel it every day don’t have the standing to call it a problem. Your sales team probably isn’t your bottleneck. Credit approval might be. Nobody measures credit approval.

If you work in operations I guess you’ve been shouting at this page for two paragraphs, because this is textbook theory of constraints. Goldratt, 1984. ‘Find the limit, stop polishing everything that isn’t it.’

Sure thing I’d have read the book. So had the people sponsoring the project, and several of those executives could have given you the summary over lunch.

We did it anyway.

That’s the part I’d ask you to sit with, because it isn’t a footnote to the story, it’s the whole story. If the mechanism had been surprising we’d have had an excuse. It wasn’t. Every one of us knew the theory. It sat in our heads. We could have searched for constraints across the organisation’s process map, if that had been the task. However, looking at a prominent KPI we did spend a year measuring the wrong thing.

That’s the case for using more than one lens, and it’s why I keep reaching for the clinical version of it. Data analysis is the lab panel. Value stream mapping is the ECG, it shows rhythm, and where the signal drops. A gemba walk is the x-ray imaging. Interviews are history taking, which is where most diagnoses actually come from, long before the labs are back. No competent doctor diagnoses based on only one of them. We had all diagnostic tools available and we had built a very sophisticated program around one, the lab sheet (the numbers).

The thing I understood later

There was a second error underneath the first one. It took me longer to see this one.

Imagine we had succeeded. Then imagine the processes really did get faster. What we were asking, at the end of the day, was that people do the same work in less time. And then, as a ‘reward’ to find themselves a reason to stay for an extra case in the evening.

They won’t. And they’re right not to.

If you make someone’s day denser and hand them a dashboard, they don’t feel improved, at least only a small part of people for a limited amount of time. They feel squeezed, and slightly betrayed by their employer who used to talk about patients and is now talking about turnover time. Efficiency, defined as “input per output”, without a reason reads as squeezing. I’ve never seen that not be true, in any organisation, in any sector, at any level of seniority. It was true of soldiers I led and it was true of consultants I worked beside, who should be immune to it. They are not.

What moved things was embarrassingly simple. We started rotating operating room staff onto the wards. At times they were the ones who had to go to a patient on the following day’s list and explain, apologetically, that the operation wasn’t happening today either. Vice versa, we had ward staff, who all had been through OR once during their training, help out at the patient prepping aisle - to experience the frustration caused by waiting for patients sent down for procedure.

That changes what a person on the table is. In the OR you meet people who are already asleep, draped, prepped, and reduced to the part of them you’re working on. On the ward you meet a woman who hasn’t eaten in four days, who has a name, who is somebody’s mother, and who is going to be told to go hungry again tomorrow. (If you’re in any other industry - I later saw this implemented succes across a lot of sectors. R&D talking to customers? Finance people along with sales reps in front of customers who tell them they can only pay less, not more?)

Everybody already knows this

Around 2019 I spoke at a surgeons’ conference in Germany about fast-track surgery. Henrik Kehlet described this idea in 1997. The argument has held up: no single perioperative change does much on its own, but if you bundle a dozen of them the effect is huge. Get people out of bed early after surgery. Feed them before the procedure and again right after it. Send them into the operation in the best physical shape you can manage, with ‘batteries fully charged’ rather than ‘sick anyway’.

The evidence is clear. A 2024 meta-analysis of 74 randomised trials across 21 countries and 9,076 patients found hospital stays shortened by about 2 days and a 29% lower risk of postoperative complications. Prehabilitation, the deliberate building-up of a patient before surgery, looks even stronger: a 2026 review of 23 trials reported that complications roughly decreased by 50%, with exercise-based programs doing most of the work.

Every surgeon in that room knew all of this. Very few of their hospitals did it.

Before the slides I asked them to put their hands up if they thought they performed ‘somewhat below average’. (If you know surgeons, you can guess what kind of curageous guy I was…)
Not a single hand went up.

So I said: “Someone should ring your hospitals and tell them to close the ORs, since obviously the poor performers are all on duty that day while you great guys are here!”

Good laugh. But look at what result of that test was. Statistically - that’s what ‘average’ implies - half of that room was below average, and the instrument said none of them were. We build whole programmes on that instrument. Engagement surveys. Self-rated maturity assessments. The department scoring its own department.

Back to the patient

The guidelines say: feed the patient before the operation and immediately after it. Build her up beforehand, so she goes in with as much reserve as she can get.

She went in with four days of starvation instead, inside a hospital that certainly had those guidelines in a folder somewhere. The scheduling process had quietly done the exact inverse of what you call ‘prehabilitation’ (good patient prepping) to her, and it had done it while every individual involved was doing their job well and kindly. Her surgeon wasn’t negligent, and her nurses weren’t careless. The anaesthetist noticed she looked unwell and said out loud.

I like these people. I’ve spent my career among doctors and nurses and I have almost never met one who didn’t have the best intentions. That’s exactly why blaming individuals is at the same time cruel and also useless as a method.

The organisation was sick, and nobody had examined it.

That’s what I want to write about here: treating organisations the way we treat patients. Diagnose before you prescribe. And more important: ask the question medicine took a century to start asking, which isn’t only what’s broken? , but what’s working? and can be built on and keeps the body healthy. I call that ‘Organizational Salutogenesis’.

One question, and I’m actually asking. In the last improvement project you participated in, was there a diagnosis before the therapy plan? Or did the treatment arrive first, and the evidence got assembled afterwards to justify it?

I’m an MD, MBA and a Leadership expert. I spent sixteen years as an army officer and several more in management consulting with McKinsey and Deloitte, and I work on transformation across various industries. I write here about what happens when you treat organisations the way medicine learned to treat patients. I keynote, advise and coach. If your organisation is being prescribed a treatment nobody diagnosed, or you want to work on the longevity of your business, that’s a conversation I enjoy: drjannis.vitzthums.de/termin

Jetzt abonnieren