Navigating the Really Long Road to Improvement

Can this be right? Do our patients really rate us at the 25^th percentile compared to other hospitals? Are our employees truly less satisfied than 90% of other facilities? Do our physicians actually score our quality of care at the bottom of the barrel?

Most people in health care are deeply committed to what they do. Receiving objective data that shows their organization’s performance as low can be a knife to the heart. Once the initial shock is over, most leaders will concede that the weaknesses identified in the results are issues they already knew needed attention. They just didn’t know how serious they were.

A variant of this is being stuck – going sideways or a little up, a little down in scores but ultimately showing no improvement. Staying at the same point for an extended period of time can also suck the energy out of an organization.

When clients receive results that shake them, they stand at a fork in the road. One road is marked “Detour – take another route.” That is, dismiss the validity of the scores or quickly turn to other priorities needing attention. Do you recognize any of these detours? We just won’t survey again until the EMR furor dies down/we recover from the layoff/the doctors are less incensed/we have a new CNO. It may seem too embarrassing or even dangerous to start down that alternate path.

The other road has a signpost indicating a daunting number of miles to distant destinations. I remember the first time I was on skis, overwhelmed as I looked down the steep drops of the mountain. I fell again and again, holding up everybody else. Finally the instructor came over and said, “Stop looking down the mountain; just point your skis to the next spot. Ski left to a place you pick, then to the right, and you’ll get to the bottom just fine.” It was some of the best advice I’ve ever gotten.

Following the principles of my instructor, here are some strategies I recommend to clients struggling with low results or who want to jump-start cultural change:

• Pick one thing to improve: Instead of trying to accomplish 10 goals or even three, pick one. It’s important to demonstrate that your organization can achieve a specific goal; that change is possible. Trying to take on too much as an organization runs the risks of losing focus and scattering resources. Instead of making great strides, working on too many goals can end up with “overpromising/under-delivering.”
• Leaders need to lead: A senior leader has to visibly back the initiative. When improvement efforts have stalled in the past, handing off another goal to a committee with little authority is a setup for failure.
• Select a goal you can achieve in 30-60-90 days: If you’re trying to create change, choose an initial goal that’s readily achievable and will have a noticeable impact. Set your sights on a goal you can start on today, not research for six months.
• Make your goal specific, measurable and with timelines: The more specific you are about the steps you’ll take, when you’ll have them completed, who’s responsible and how you measure success, the more likely you are to achieve change. For example, “improve communication this year” is so vague you can bet it won’t succeed.
• Consider “cascading” a goal across your organization: To achieve synergy, some clients select one goal that they ask every work group to adopt. For example, if an employee survey indicates that more input into decisions is a top organizational priority, every work group may be asked to develop an action plan to achieve that in their setting. Supervisors can share their plans with other supervisors, as well as what’s working well for them. Senior leaders can ask about decision-sharing initiatives when they’re rounding, further spotlighting the goal.
• Focus on the mean scores initially: If you statistically improve your mean scores, you’ve clearly improved the satisfaction or engagement of your patients, employees or physicians. Means are within your control, percentile ranks are not as they depend on the degree of improvement by others. In addition, focusing on a 13^th or 2^nd percentile rank can be demoralizing when you’re trying to create momentum for change. Move that mean and then celebrate it!
• Reward and recognize success:  Celebrate when you’ve achieved and sustained improvement. Put your progress in a newsletter, announce it on your intranet and talk about it in employee and supervisor meetings.
• Identify and develop the leaders who emerge as you achieve your first goals: Every organization needs those individuals who have the ability and desire to lead improvement.
• Ski to the next spot: Pick the next realistic near term goal, point your skis in its direction and keep skiing. Success breeds momentum and more success.

So is all this just “happy talk”?  No! One of the great rewards of consulting with our clients is seeing the pay-off for being determined to improve for their patients, employees and physicians – and then marching down that road to do it!

Read Teresa's full profile.