Northeast Georgia Health System Develops Leaders Through Experiential Learning

Added on Feb 6, 2020

skillsNortheast Georgia Health System Puts Experiential Learning at the Forefront of Leadership Development
By​ ​Lauren Keeley

In early 2018, Northeast Georgia Health System (NGHS) found itself in a revolving door of well-intended yet disconnected attempts to train leaders.

Across its four hospitals in 18 counties of northeast Georgia, NGHS uses an interdependent approach to continuous improvement that comprises Lean methodology, leadership development, High Reliability work, and patient experience initiatives. These elements form the foundation of the organization’s improvement work, its Quest for Excellence.

“We were throwing content at our leaders left and right,” said Sonja McLendon, Chief of Operational Excellence at NGHS. “We had computer-based learning, classroom-style learning, education around improvement work, you name it. Our training emphasis was an inch deep and a mile wide.”

Despite these well-intentioned efforts, however, McLendon and her team struggled to make the content stick. It was time to break with traditional methods and make room for innovation.

With the goal of delivering education that would allow leaders to use it immediately, McLendon and her team conceived the Quest Leader Institute (QLI), a yearlong program that combines didactic classroom training with experience-based learning opportunities. The unique experiences allow participants to grow their skillsets, toolsets, and mindsets to become better leaders while improving clinical and ancillary areas throughout the organization.

The program is organized into 20-person cohorts, each aligned with organizational value streams that measure patients’ experiences from the moment they enter the health system to when they exit. Over the course of a year, each cohort, which consists of leaders from multiple levels of NGHS, works toward improving its value streams. The program has seen great success in its first two years, leading to significant advances in various business-line-specific outcomes, improved retention and promotion of leaders from within NGHS, and an overall increase in leader engagement.

Investing in Leaders to Improve the Improvement

The early stages of the QLI were characterized by trial and error, McLendon recalls. “We had this great idea for leader education grounded in experiential learning but had no models for how to execute it,” she said. Executive buy-in and sponsorship proved to be extremely important for getting the program off the ground. For the QLI’s pilot cohort, Pharmacy Services, the Operational Excellence team took a broad swath of presidents and executives from each hospital campus in addition to their pharmacy leaders. These executives play a crucial role not only in developing the training content but also in ensuring that the participating leaders are fulfilling the requirements of the program, McLendon explained.

They also decided that the program would be one year long and broken into four cumulative levels, each with a distinct curriculum and deliverables. Because of the program’s long duration, interested service lines must exhibit organizational readiness, leadership availability and participation, and potential for high cross-functional impact and return.

“It can be difficult to get buy-in from staff for one year, so we spaced out the curriculum,” McLendon said.

Each level—bronze, silver, gold, and platinum—consists of one to two days in the classroom followed by “real-life” application time. This structure puts a greater emphasis on a commitment to immediately practice new skills, such as identifying readiness issues and creating and improving standard work, rather than stowing them away for later use. The in-class time is also nontraditional; leaders use Mr. Potato Head toys to learn how to create standard work, use paper airplanes to learn Lean principles of Pull and Flow, and observe processes in unfamiliar areas of the organization to learn the concept of value stream mapping. Coaches are integral to the program, serving as key touchpoints during the out-of-class experiences by helping participants refine and perfect their new skills before they advance to the next level.

Finally, although the length and breadth of the program necessitated a greater financial investment than that of traditional classroom education or computer-based learning, McLendon trusted that the investment on the front end would pay off on the back end, both literally and figuratively.

“You can’t have great patient experiences without engaged employees,” she emphasized.

Practice Makes Perfect, and Encourages Engagement

After a successful first-year trial run with Pharmacy Services, in which the graduating cohort designed their brand-new pharmacy in addition to conducting several successful Lean 5S events that serve to optimize workplace conditions, the program began its second iteration, this time with three cohorts: Perioperative Services, Heart and Vascular Services, and Human Resources. But before the new cohorts launched their leadership development journeys, some changes were in order.

“After the pilot year, we realized it’s not so much about teaching participants how to read financial reports or find something on their computers, but about guiding them in how to have difficult conversations, lead staff through change, and create a positive work environment,” said McLendon.

The program design team implemented more one-on-one coaching support, including a subset of coaches who specialized in emotional intelligence (EI) assessment delivery and facilitation. The team began using EI measurements in the silver and gold levels for both individual participants and the group as a whole, hoping to supplement traditional personality profiles with a framework that allowed for more growth.

To increase retention, the team was also more sensitive to participants’ schedules and other duties, clearly outlining expectations in each of the program’s four levels. Broadly speaking, the curriculum for each level is as follows.
  • Bronze—Participants learn the art of identifying and escalating readiness issues as part of their daily management system through intentional conversations with front-line staff.
  • Silver—Once leaders are comfortable identifying and raising the issues, they learn the process to develop metrics to track success on improving goals connected to strategy deployment. They also learn about tools to create standard work around improved processes followed by a confirmation process. Participants take an EI assessment and learn about the impact of EI on leading in a Lean culture.
  • Gold—Coaches introduce concepts of Flow, Pull, and Lean as a time-based system and teach participants how to go into the area where the work is being done, improve observation skills, and then map the process for improvement.
  • Platinum—Leaders are given the opportunity to define, scope, plan, and implement an improvement project in their own area, culminating in a formal report upon graduation.
Because levels get increasingly challenging, participants must complete each level with the corresponding deliverables before moving on to the next level. This is vital because each level builds upon the preceding one, McLendon noted.

Creating a Systemwide Culture of Engagement

Between the gold and platinum levels, cohorts visit other organizations, from neighboring hospital systems to product manufacturers, who have Lean implementations, are doing impressive High Reliability work, and have great leadership development. NGHS had been conducting these “field trips” with executives and physicians for many years, but with limited yield; many times they would visit and feel inspired by the improvements, only to find that NGHS was not doing improvement work in the same area or they didn’t have the skills to execute it, McLendon recalled.

Now, with the tools and resources from the QLI, the takeaways from these trips reach their full potential. The trips are a chance to share best practices and gain more actionable insights into Lean improvement work.

“These regional study trips aren’t just fun outings for the cohorts,” McLendon clarified. “Participants have to do research in advance, prepare questions, and be ready to integrate the relevant elements into their own improvement initiatives.”

NGHS has also opened its doors to other organizations, creating a culture of widespread, supportive, and collaborative improvement in the northeast Georgia region.

It is in this spirit that the QLI hopes to instill a virtuous cycle of improvement through leadership development across NGHS.

“As other staff members hear about us from their peers, it increases the pull, or desire and demand, for the leadership training,” said McLendon. “That has been a real culture change.”

McLendon and her team would one day like to offer the QLI to all 400-plus leaders in the organization, but for the moment they look forward to seeing what the next round of engagement surveys look like so that they can continue to improve the program, its content, and its size and scope.

Although the QLI is a young program, the QLI cohorts experienced improved outcomes for their value streams, with gains in employee engagement and reduced turnover in almost every area. Among many other cohort-specific outcomes, in 2019 a reduction in lab duplicate orders in the Perioperative Services cohort saved NGHS $200,000 annually, and there was a 66% reduction in unread EKGs from the baseline in the Heart and Vascular cohort. There have also been eight promotions of leaders who have completed the program.

However, McLendon is most excited about the renewed level of engagement within the organization and the pervasive enthusiasm for the improvement work. It serves as a source of momentum as NGHS moves into the third iteration of the program.

“These past two years developing and refining the Quest Leader Institute have been both challenging and rewarding,” stated McLendon. “But one thing is clear: The investment has paid off.”