May 13, 2020

9 Steps to Build a Culture for Better Clinical Outcomes (Part 2)

Clinician Leadership | Leadership Development | Team Development

Reading Time: 4 minutes

Culture permeates all your organization produces. Whatever your culture prioritizes (or neglects) inevitably shows up in clinical, financial and satisfaction outcomes.

All organizations have a culture, of course, but is it a good one? We’ve recently covered the people aspect of building a strong culture (see part 1). In this follow-up post, we’ll focus on the next foundational steps: the structure and processes that enable consistently strong clinical outcomes.

Why culture beats strategy

Before we go further, it’s worth recapping why culture matters so much. “Culture’s all that invisible stuff that glues organizations together,” writes Nilofer Merchant, a Stanford lecturer, for the Harvard Business Review. “It includes things like norms of purpose, values, approach… It’s the stuff that determines how we get things done,” she explains. And how we get things done determines the results we get.

Neglecting culture isn’t just foolish or costly. In healthcare, it’s also dangerous.

Building a strong framework

Raising children, winning an Olympic medal, navigating traffic, and achieving great clinical outcomes all require clear boundaries, shared expectations, accountability, and the right tools to get there. Today we’ll zoom into the framework that enables a culture of continuous improvement.

We’ll break that into three parts:

  1. Developing an effective clinical improvement organizational structure
  2. Establishing a baseline care process
  3. Planning your strategy to minimize resistance
>> Developing an effective quality improvement organizational structure

Before you can hit performance goals consistently, people across your organization must be aligned and committed to your vision. An effective clinical improvement infrastructure makes that possible.

At a glance, that framework should include the following components with credit due to David Burton, M.D.:

Effective Clinical Improvement Infrastructure
Clinical Management Information Management
Measurement System Implementation Support
Physicians, clinical administrative staff and operations leaders needed to best practices. Support staff and systems required to measure clinical, financial and satisfaction outcomes for key clinical processes. Staff and systems necessary to develop, disseminate, support and maintain the clinical knowledge base for implementing best practices.

Let’s unpack that:

Clinical Management

When introducing an initiative into your organization, successful adoption requires buy-in from three key constituencies: physicians, clinical administrative staff, and operations leaders.

If physicians aren’t on board, they won’t push it, won’t order it, and the initiative will go nowhere. If nurses aren’t on board, they’ll push back with concerns about their workload or patient safety. If operations leaders don’t buy into the vision, they’ll tell you there’s no budget for it.

Measurement System

There must be a way to measure clinical, financial and satisfaction outcomes for key clinical processes. Those metrics, in turn, should guide decision-making and improvements. Reasonably, leaders across your organization need easy access to metrics that are relevant, current and actionable.

Implementation Support

One way to sustain the changes you want to see is through intentional, continuous education. In a healthcare organization, that includes creating educational materials to help frontline caregivers follow processes, examining data insights, and keeping up with field literature and developments. An effective IT platform is the conduit for that knowledge to flow and grow.

Putting it all together, a clinical improvement infrastructure helps ensure all stakeholders are in sync and equipped with the right knowledge and tools to move objectives forward.

In developing this infrastructure, we recommend:

  • An executive sponsor to whom project leaders report on a regular basis, and who provides the board with regular updates.
  • An annual evaluation of clinical improvement projects or focus areas.
  • A clear alignment between projects and your organization’s strategic focus.
  • Adequate budget and resource allocation.
  • Front-line, small-scale testing of improvement ideas, with successful ideas rising to approved organization initiatives.
>> Establishing a baseline care process

You can help ensure patients get no more or less care and tests than they need by establishing an effective baseline care process. The idea is to define an evidence-based protocol to facilitate decision-making, while recognizing that variances will occur.

We recommend six steps to building an effective baseline care process with credit due to Brent James, M.D.:

  1. Identify a high-priority clinical process.
  2. Build an evidence-based, best-practice guideline around that process.
  3. Blend it into the clinical workflow so it becomes second nature and doesn’t rely on human memory.
  4. Build a data system to track variations and outcomes.
  5. Place a thinking mind at the interface between the standardized process and the patient.
  6. Feed variation data in the context of patient outcomes back to the provider team.

Let’s acknowledge the elephant in the room: Some physicians shun protocols, reasoning that each patient is unique and demands a unique approach. They do have a point: From my experience, I estimate that two out of ten patients shouldn’t follow a guideline. The baseline care process isn’t designed to replace that individual approach, however.

Rather, it’s designed to facilitate decisions, so clinicians don’t have to remember all recommended tests and treatments. Instead, they can look at recommendations, then focus on: “Is there anything about my patient that says I should do this differently?”

The offshoot is that patients get what they need, and clinicians don’t waste time and resources on unnecessary care and tests.

>> Planning your strategy to minimize resistance

Change can be tough, and some resistance is expected. You can anticipate and minimize it, however.

Strong leaders build buy-in and excitement around a shared vision by…

  • Encouraging people to focus on the benefits of change.
  • Seeking to understand those who resist change.
  • Making it safe for people to raise concerns and honoring their input.
  • Looking for opportunities to remove friction, confusion or obstacles to the changes you want people to make.

Beckhard’s Change Model argues that you can make a compelling case for change when three elements exist: (1) dissatisfaction with the current state; (2) a compelling vision; and (3) agreement on first steps.

Altogether, if the pain of staying the same exceeds the pain of change and people in your organization agree on what needs to happen next, you can overcome resistance.

. . .

In our next post, we discuss a communications framework to help ensure employees at all levels are engaged, unified and committed to your vision.

Until then, don’t hesitate to contact us for clarification or further guidance on what you’ve read above. We’re happy to discuss how your peers have tackled similar challenges and help you identify next steps.


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About the author

Brent E. Wallace, MD

Brent E. Wallace, M.D. is a seasoned physician leader, having been the Chief Medical Officer of Intermountain Healthcare for 12 years.

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