The following is based on content from Leading Healthcare Improvement: A Personal and Organizational Journey, a thought-provoking guide designed to help leaders achieve and sustain lasting improvement at both the personal and organizational levels. Authored by four Vizient subject matter experts and based on their experiences, the book is designed to help leaders better understand themselves and their organizations so they can fundamentally transform their organizations.
With departments and units often operating at cross purposes – behavior that leadership sometimes unintentionally sets in motion – the result can be frustrated staff and poor service to patients and other customers. How does an organization overcome this fragmentation? With so many moving parts in an organization, how do you effectively align everyone toward a common purpose and ensure all are working together to serve your ultimate customer – the patient? We’ve found the most effective way is connecting each layer of an organization — from division or service line to department or unit down to work teams and individual staff members — with the organization’s strategy. Here are five key takeaways from our research.
- Take the long view. The process of creating alignment begins with a strategic plan that looks forward at least three to five years. Creating a strategic plan for an organization is an undertaking in and of itself, but after a careful analysis of variables such as existing products and services, changing customer expectations, the competitive marketplace, as well as technological enablers, leaders will be in a position to identify a desired future state for the organization and articulate goals they believe should be pursued to move in the intended direction. Typically, this planning process proceeds and informs the budgeting process.
- Create short-term goals. Based on an organization’s longer-term strategic direction and goals, leaders must next identify the means for reaching these goals in the shorter-term. We’ve found that an annual plan — created to guide the short-term tactical initiatives and activities needed to move the organization towards its strategic goals — is an essential element for creating alignment.
- Measure and track progress. Equally important is the flow of information — about progress and results — from the front-line back up to senior leaders. It is this upward flow that creates a closed-loop system, enabling control and adjustment of the entire process.
Progress should be tracked continuously and reviewed formally on a regular basis. It’s important to display data visually to show the connection between front-line work and the strategic plan, especially when presenting to your board of directors. The display of data is of greatest value when it supports surfacing and solving problems, sustaining improvement and sharing knowledge. We recommend a format that includes showing data over time for the local outcome performance, followed by a Pareto analysis of the biggest problem, discipline problem solving and confirmed change with process metrics.
- Review tactics and adjust as needed. At each organizational level, checkpoints provide an opportunity to adjust tactics and their associated operational details, as well as reallocate resources if necessary to ensure the right work is being done to address key priorities. Gemba walks, which allow leaders to observe work practices and engage employees, should take on a mentoring flavor, with leaders asking questions, listening and coaching. Every Gemba walk is a learning opportunity for participants and leaders as asking open-ended questions in a manner of humble inquiry promotes further improvement. The shared responsibility for solving problems between leaders and teams who are doing the work, brings out the creativity of everyone, which in turn creates a happier and more engaged workforce.
- Coach and mentor. Coaching and mentoring should occur at every level to build the problem-solving muscle of an organization. A far cry from traditional management by objectives (MBOs), this element of Leader Standard Work is less about achieving specific objectives — although those remain important — and more focused on learning and growing every day. Such coaching can revolve around general performance (e.g., How did we make things better? What did you learn? What can I do to support you?) or it could address specific issues (e.g., What problem do you see? How is the customer affected? Where is the waste?). By developing individuals’ problem-solving capabilities, this type of coaching helps to build an army of problem solvers as well as contributes to the development of future leaders. Furthermore, such an empowering culture can be more engaging and satisfying on a personal level for both leaders and employees, and tends to attract and retain the most talented people.
Ensuring that an organization’s strategic goals drive progress and action at every level eliminates the waste that comes from inconsistent direction and poor communication. Leaders should strive to have every employee pulling in the same direction at the same time by aligning the goals of the company (vis a vis strategy) with the plans of middle management (initiatives and tactics) and the work performed by front-line employees (operations). In order for staff at each level to know how their work advances the organizational goals, leaders will need to communicate the specific actions that need to be performed, assure that staff have the knowledge and skills to perform those tasks, and provide feedback on an ongoing basis. Aligning everyone with the strategic goals and objectives also helps to prevent cross-divisional/departmental infighting that leads to dysfunctional and counterproductive behaviors.
About the authors
Aaron Fausz, PhD, Senior Consulting Director. Aaron Fausz brings more than 25 years of experience helping organizations align and improve their personnel and technical systems to accomplish strategic business objectives. Fausz has consulted with leading health care organizations across the country, including Denver Health, Mayo Franciscan Health System, University Health Services, Vanderbilt University Medical Center, Henry Ford Health System, and many others. His areas of expertise and professional skills include guiding organizations through strategically driven changes and enhancing business performance, with significant experience in needs assessment, best practice analysis, performance measurement, process improvement, and behavioral change management.
William Kirkwood, PhD, Senior Consulting Director. Bill Kirkwood has more than 35 years of leadership experience in the health care industry, having worked in both system and individual hospital settings in the Midwest and Northeast U.S. leading transformational change management initiatives. This experience includes leading service line redesign initiatives as well as serving in an executive capacity in quality, operations and human resources. His areas of expertise and professional skills include facilitating change management strategies and working with leadership teams in developing and implementing Lean management systems and organizational design efforts. Kirkwood serves as adjunct faculty in the University of Cincinnati’s Masters in Health Administration in addition to being a certified executive coach. He has presented at several national conferences, including the Institute for Healthcare Improvement, the Organizational Development Network and the American Society for Quality.
Blair Warman Nickle, MBA, MSLS, Senior Consulting Director. Blair Nickle brings more than 30 years of experience in the health care industry. She began her career in the nuclear utilities industry where she worked in information systems deployment, document control and systems improvement. Her areas of expertise include performance measurement and improvement methodologies, information systems implementation, strategic planning and deployment, and project management. Nickle is also an educated and experienced instructional designer and master trainer, having developed numerous performance-based training programs and trained novice trainers to a high level of competency in delivering educational offerings. She has consulted with hospitals, integrated health systems, physician group practices, payer organizations, and pharmaceutical companies across the U.S., Canada, and Mexico.
Maureen Sullivan, RN, BSN, Senior Consulting Director. With more than 35 years of experience in the health care industry, Maureen Sullivan’s areas of expertise include facilitation and training of quality and strategy deployment, process improvement, and management systems including coaching of leaders at all levels of the organization. She has consulted with a variety of organizations including small rural hospitals, large academic medical systems, primary and specialty clinics, quality networks and health care facility architects. Prior to her years in consulting, Sullivan filled a variety of leadership roles directing quality and Lean process improvement in a community hospital and as part of a larger health system. In addition, she also held advancing leadership roles in nursing management and medical surgical nursing within a not-for-profit teaching facility.