Beyond Leadership: Five Factors to Sustaining Health Care Improvement

by David Levine, MD, FACEP, Vizient Group Senior Vice President, Advanced Analytics and Data Science

Julie Cerese, PhD, RN, MSN, Vizient Group Senior Vice President, Networks and Performance Management

Many health care organizations can achieve top performance across multiple domains for a short period of time. However, sustaining those achievements year after year has often proven elusive. For the past 15 years, Vizient has evaluated the performance achievements of academic medical centers in Vizient’s Quality and Accountability ranking and compared the practices of consistent  top performers with those of peer institutions with less consistent success. The rankings measure annual performance across six domains: safety, mortality, effectiveness, efficiency and patient centeredness and equity.

And we’ve learned that top performing organizations have common leadership behaviors, including a shared purpose that reinforces the vision that patient care comes first; a leadership style where the CEO is clear in defining and aligning others around a shared purpose; a results-focused accountability where clinical leaders accept responsibility for services, quality and safety; performance is measured and evaluated; and an environment of collaboration between senior leaders and staff.

Though these leadership behaviors have been (and continue to be) distinguishing factors, our most recent study found five key organizational characteristics that have led to sustaining top performance.

Five factors to sustain top performance

We identified those organizations that have been recognized as top performers in Vizient’s Quality and Accountability ranking for the past eight–12 years and sustained top performance during the last two years.

­­­People—Both clinical and non-clinical staff members throughout those organizations that have sustained top performance have a deep level of understanding of organizational goals/objectives, accountability, engagement and an intense focus on priorities. 

Staff understand that they have a role in achieving top performance and those expectations are clearly defined and communicated. Also, in those organizations, the vital role of staff is appreciated and expressed by leaders.

One top sustaining organization in the Mountain States identified that protecting and engaging their teams as a top priority. That means encouraging staff to take care of themselves, ensuring that they are healthy, so they can take care of their patients. The CEO and leadership team are committed to providing staff with adequate compensation, work-life balance and the tools they need to be successful.

Processes—At organizations that have sustained top performance, clinical practice is grounded in transparent data and evidence-based practices to assure the very best patient care and organizational priorities are cascaded to the unit/department level.

Performance is managed consistently with daily rounding, huddles, just in time coaching and transparent data. Innovation occurs at the unit/department level allowing for problem solving in real time with everyone becoming problem-solvers.

One top sustaining organization in the Midwest prides itself on taking the best and brightest performance improvement ideas from across a variety of methodologies and then identify what fits their culture best and adapt the ideas to their organization.

Decision making—At organizations that have sustained top performance, decisions at all levels of the organization are made based on delivering the best patient care and experience, and staff empowerment.

Leaders respect the decision-making process and support organizational decisions even when the decisions don’t go their way. Physician and nurse leaders show mutual respect and are empowered to make decisions collaboratively in the best interest of patients, even if those decisions cost more. Staff are comfortable making independent decisions with the best interest of the patient and with the autonomy to lead rapid improvement.

Board support—At organizations that have sustained top performance, board members know and understand quality metrics and performance indicators and play a strong role by assuming and creating accountability for advancing quality and safety performance.

The board has an articulated role in the quality agenda. Executives are intimately involved in the metrics, can speak to the current performance and understand in detail the actions that impact the outcomes.

An example of board support of bold decisions, comes from another top sustaining organization also in the Midwest that decided early in the COVID-19 pandemic to accept all patients who needed their hospital’s advanced pulmonary care, with transfers from hospitals that were unable to provide that level of care. It was a bold decision, but one that aligned with its clear set of values to use its resources to improve the health of the community. The CEO noted that board support of that decision was crucial, even though the financial implications were not known at that time.

Consistent goals and reliable metrics—At organizations that have sustained top performance there’s a focus and alignment on a “north star” and determination to achieve and sustain top performance leveraging metrics.

Goals are easy to understand and are measured and monitored daily, weekly and monthly to create alignment and accountability. Organizations clearly articulate their overall goals and everyone—from executives and managers to the bedside staff—knows what needs to be done to achieve continuous improvements.

A CEO at a top sustaining organization equated it to climbing a mountain. He says there is a lot of momentum as you are working on the problem, and after achieving the goal, it is important to continue tracking the data over time and monitoring outcomes to make sure you are not slipping back.

It can be more difficult than ever for hospital leadership to remain focused on maintaining the culture they are working to create due to organizational growth, disruption and turnover. What hospital leaders do regarding a shared sense of purpose, leadership system, result-focused accountability and collaboration remains critical in sustaining top performance. We’ve found that the best patient experience comes to life by how they do it—through a palpable intensity involving people, processes, decision making, board support and consistent goals and reliable metrics.

Vizient has a variety of data-driven solutions to help hospitals improve their performance. Feel free to reach out to learn more about how we can help you achieve sustainable results.