February 14, 2024

Accelerating Efforts to Drive Organizational Improvement in Healthcare

Leadership Development

Reading Time: 6 minutes

Businessman touching to glowing increasing arrow for business pr

In the course of my coaching practice, particularly in this period when so many healthcare organizations are feeling significant financial pressure, a frequent frustration voiced by executive leaders has been the slow pace at which their organizations are realizing improvement in various performance metrics. Faced with that frustration, many have chosen to take the straightforward path of intensifying the pressure on those designated as accountable for those metrics. The implicit message is that continued failure to see results is likely to result in the removal of the leader in the hopes of replacing her or him with someone better equipped to drive results.  

This approach, while seemingly straightforward, often fails to generate the desired response because it doesn’t address the true impediments to driving better results, faster. While the capability of the leader designated as the owner of a metric may, in fact, be the root cause of the lack of progress, often there are more significant barriers standing in the way. Reducing the cause of the problem to the failure of an individual leader may not only fail to resolve the problem; it may damage the culture of trust essential for the organizational capacity to design and implement much needed operational changes.

From working with clients who are achieving improvements faster, I have compiled the following set of suggestions which you may find helpful.

Recognize that most metrics are the product of a process involving multiple essential functions and approach improvement from that perspective.  

While the “owner” of a metric may lead the most prominent function involved in delivering performance, most metrics involve the interdependence of multiple functions working together in support of a shared goal. In seeking to improve that metric, it is important to empower the “owner” to convene representatives of those functions and important for those representatives to recognize accountability to that owner for the success of the improvement effort. This spirit of “shared accountability” and teamwork is essential to effectively diagnose and address the changes needed to drive sustainable improvement.  

As an example, consider patient experience scores. The array of factors impacting patient experience scores is broad, involving multiple clinical and non-clinical functions. If the approach to improving patient experience scores resides solely with the nursing director and his/her department, it is quite possible the true root cause of unsatisfactory scores lie outside of the scope of the effort to improve on the nursing unit.

Dedicate the time needed to design and implement systemic improvement. 

Designing and deploying systemic improvement is a process that takes time: time to define and understand the problem, time to thoroughly map and analyze the existing way of doing things, time to invest the creative development of impactful change, time to work through the details of implementation, and time to invest in change management, helping work through the natural human resistance to letting go of the known and trying something new.  

Many times the leaders who are charged to lead the improvement process have inadequate capacity to commit the time required, spending most of their day addressing the various episodic problems and challenges that occur throughout the day. In some organizations this issue has become an even greater challenge as they work to reduce so called non-productive time by expanding leaders’ spans of control. It is important to recognize the difference between “managing” current operations vs. “leading” those operations to a new level of performance, and dedicate the capacity that improvement requires.

Provide the training, tools and support required to effectively design improvement.  

Successful efforts to drive improvement are the product of a thorough, methodical process to define the problem, analyze the process, define root cause or rate limiters, and develop new methods. The more complex the problem, the more important it is to apply the tools and science of process improvement rather than relying on anecdotally driven instinct which can lead to fixes that fail because they did not address the key drivers. Consider investing in building basic process improvement skills in team members charged with leading improvement efforts and augmenting those basic skills with support staff with advanced expertise in those skills.  

Consider a typical challenge faced by health system leadership: reducing readmission rates. Think about all of the functions which play a role in that process and all of the variables which might impact the results. In order to make improvement efforts both efficient and effective, it is necessary to apply the tools and analysis needed to generate well-reasoned insights about barriers to improvement and well-designed hypotheses around changes likely to achieve improved results. Failing that, significant effort can be expended on implementing change that has no meaningful impact on the desired outcome because it was aimed at the wrong issue.

It is also important to include the right stakeholders in the design process while guarding against being overly inclusive. It is optimal to build the design team with a small group of key influencers who have credibility with their colleagues and can help cultivate trust in and ownership of the work of the design team. And if at all possible, avoid the toxic naysayer. One cynical, toxic voice can destroy the creative dynamic you need to be successful, making it unsafe for others to enthusiastically embrace the process.

Develop mechanisms to feed the creative process and stimulate practical ideas for improvement. 

By definition, for an outcome to be improved, something must be changed. We are all painfully familiar at this point with the old saying that “doing the same thing over and over again and expecting a different result” is the definition of insanity. The problem is that the generation of breakthrough ideas isn’t easy and is a process which must be fed in a way that provokes new insight about familiar things.  

Human nature is such that the longer and closer we are to doing things one way the harder it is to see how it might be done differently.  It is important to develop simple tools to extract critical insights needed to recognize opportunities for improvement. Leaders need to ask higher level questions which draw out from frontline staff unharvested insights as to why processes perform as they do and where opportunities lie for meaningful change. For example, if a nursing unit concludes that a factor impacting patient experience scores is call light response time, the most basic level of inquiry is how to respond faster. The higher level question might be how to alter work practices to reduce avoidable instances of the use of call lights. 

It is also important for those who lead improvement to engage in practices designed to feed and stimulate the creative process. Leaders need to invest in a process of “staying open,” i.e., investing time to learn and explore innovative ideas of others in their field, or in related fields. By developing a regular practice of curiosity, through reading, networking, conference attendance or other means of learning, leaders gather the raw material required to get beyond the familiar and find the spark for something new.

Invest in the development of change leadership skills to equip leaders to work through resistance and cultivate commitment to change.  

As noted above, resistance to change is a natural, predictable and, thankfully, manageable human response to change.  There is comfort in the known even when the current state is not wholly satisfying. For many, predictable mediocrity is preferable to the possibility of greatness if that comes with the perception of personal risk. Given that, it is not enough to have a good idea.  It is essential that leaders be skillful in building commitment to the change among those whose support is required for its success. That involves diagnosing and working through the source of the fears behind their resistance, the essential skills of effective change leadership.

Start with a mindset of inquiry, not blame, but take respectful, but timely, action to transition leaders who are not equipped to drive improvement.  

While it is important to resist the temptation to respond to performance gaps by increasing pressure on a single responsible leader, the reality is that on occasion the root cause of the gap is a leader who is not equipped with the skills to lead an improvement process. When that is the case, it is important that senior leadership take respectful but decisive action to transition that person from the role. 

In my coaching practice I often see senior leaders who, in a misguided sense of compassion, leave an ill-equipped leader in the role while intensifying the pressure to perform on someone who lacks the skills to do so. While facing the need for transition can be hard, in the end it is far more compassionate to help someone recognize their lack of fit than to endure a prolonged experience of falling short despite their best efforts. Framing the transition as a matter of “fit” rather than “failure,” and supporting the person through the transition with temporal and emotional support is, in the end, the most compassionate thing a senior leader can do. 

Your turn: Identifying next steps for lasting improvements

The considerations we’ve covered so far are complex, but necessary for lasting organizational improvements. When you feel stuck, it can be difficult to discern next steps and implement change successfully, on your own — which is why many healthcare leaders lean on MEDI Leadership coaches for guidance and accountability. 

💡 What questions can we answer about what you’ve read today?

💡 What concerns, ideas or possibilities arise as you explore what should happen next?

We invite you to talk with a MEDI expert. Whether you have general questions about what you’ve read or specific questions about a situation you’re facing, we’re happy to discuss and help you clarify next steps.

Begin the conversation

Share this!

About the author

Robert "Bob" Porter, JD, MBA, PCC

Robert "Bob" Porter, JD, MBA, PCC is an accomplished organizational leader with over 30 years’ experience in health system leadership. Bob has extensive experience in working with senior leadership executives in complex organizational settings, with a proven track record for engaging diverse stakeholders in the redesign of organizational systems and processes to achieve breakthrough improvement in performance.

Related content