May 29, 2018

Leadership: From Compliance to Commitment

Clinician Leadership | Leadership Development

Reading Time: 5 minutes

Why tactical tools are not enough

Minimum Standards or Optimal Performance?
As an executive coach who works exclusively with healthcare clients, I frequently see organizations seeking breakthrough improvement in one or more performance indicators by implementing tactical programs that have proven successful elsewhere.  Examples of such programs cover a broad spectrum including patient experience initiatives, deployment of high reliability and process improvement programs, adoption of evidence-based clinical standards and efforts to redefine an organization’s market image and brand position. Often their hopes are disappointed when their adoption of “best practices” used by others results in limited if any, improvement. Leaders struggle to understand why what has worked so well elsewhere has not generated comparable results in their organizations.  They double down on monitoring to assure employees across the board are complying with the program directives and behavioral standards. And still, they see nominal impact on results.
What explains this failure of good ideas? Is it just that from one organization to the next people and circumstances are so different? Or is something missing in the deployment of these programs?
In my experience, the root cause is an approach to deployment in which organizations sow tactical “seeds” without first creating a fertile culture for those seeds to take root. The result is that employees and physicians focus on dispassionate compliance with minimum standards rather than the passionate pursuit of the purpose for which the program was created.  The first work, the most important work is to create a culture that fosters a deep, personal commitment rooted in the desire of each of us to do work that makes a difference.
Here are a few steps to keep in mind as you strive to move from compliance to commitment:
Look first at leadership and the environment: What leaders say is far less important than what they do. For organizations seeking to create a culture of commitment to transformation, the change begins in the C-suite. I often see leaders who are asking for radical change from others but make no changes in the way they spend their time, effort and financial resources. Leaders are the culture bearers and it is essential for the leadership team to re-examine every aspect of their work to assure it aligns with the transformation they are seeking. Careful attention must be paid as well to symbols, language, stories, celebrations and recognition of “heroes” whose efforts give form and expression to the desired cultural shift.

  • Focus on the “why”: If you are to capture the commitment of your staff and inspire them to invest their thoughts, ideas and passion in the effort, it is essential to connect the work of their hands to a sense of higher purpose. Much has been written and spoken recently, most prominently by Simon Sinek, about the importance of starting with “why.” That body of work captures the fundamental emotional (and, as it turns out, biological) reality that our feelings drive our decisions far more than rational facts. Connecting your team to the impact that their work has on the people you serve can inspire them to do more than comply, using best practice tools and tactics to their full effect.
  • Build a “covenant” around the “why”: Another mistake often made by leaders is the deployment of tactical programs that place the primary responsibility for breakthrough improvement on the shoulders of staff without a commensurate commitment to support them in their efforts. For example, it is not enough to define service standards and scripted conversations for employees to transform the patient experience if the organization does not have a parallel commitment to fix the systemic problems that stand in the way of their efforts to provide extraordinary care. Think of it as a covenant between the organization and its people in which each person is asked to do their best to drive performance while the organization commits to creating conditions that make it easier for them to do so. Without this balance and support, employees can quickly become cynical about the organization’s call for transformation.
  • Equip people to take ownership: Engaging staff to drive improvement can be powerful but it is important to equip them with the information, training and support required for them to do so effectively. Absent that, rather than feeling empowered staff can feel threatened, knowing that something is expected of them but not knowing how to deliver the desired result. The goal is not to make frontline staff subject matter experts but to provide enough information and support to make their knowledge and insights actionable and effective.
  • Lead through the transition: Change, even change with significant potential for positive impact, can be threatening for those who have to let go of the known to venture into uncertainty. Leaders play a vital role through this period of transition.  Engaging those affected by the change; honoring and bringing forward positive elements from the past; providing assistance and support through the awkwardness of adjusting to the new reality; listening and responding to what is learned as the change is deployed; these are just a few of the steps leaders can take to help the organization as it navigates through the turbulence of the transition.
  • Communicate, communicate, communicate: A critical part of leading through the transition is extensive, multi-channel, two-way communication. It is vital to share the impetus for the change, a compelling vision of the desired future state, a pathway to the future, and regular updates on the status of the effort. It is equally critical to listen and gather feedback to assess progress and adjust based on what is learned as the journey progresses. One of the harder things leaders must do is distinguish between negative feedback reflecting the unavoidable awkwardness of change from negative feedback about legitimate issues and concerns for which adjustments are required. Leaders must provide support and encouragement to push through the awkwardness long enough to experience the change at maturity. But leaders must be careful not to turn a deaf ear to legitimate concerns which, if left unresolved, could jeopardize success.
  • Measure and report in a spirit of improvement: Measurement is an important indicator of progress and source of learning, and any effort at transformation should define and closely track critical measures of success. Imbued with a spirit of learning and improvement, data is a powerful tool. Misused as an instrument of blame, however, data becomes a threat against which your team will seek to protect itself. This difference is subtle but powerful.  Think about it in the realm of clinical improvement.  Frequently, healthcare organizations seeking to eliminate unjustified clinical variation develop “compliance” reports on how often physicians adhere to an evidence-based, best practice protocols. Typically that “compliance” approach provokes resistance as physicians recoil against loss of autonomy and the notion of “cookbook” medicine. Contrast that with hospitals who use evidence-based standards as a tool for learning through variance analysis in the belief that practitioners desire and will use information which equips them to perform at their best.  In those institutions, reception among the physicians of the information that flows from the very same tools is typically far more positive.

Successful transformation of organizational performance starts with the transformation of culture. It is not enough to provide your team with tools and standards.  Leaders must reach and inspire the soul of the organization. Only then will tactical change, driven by personal passion, realize the promise of breakthrough improvement.

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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.

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