Managing What's Important in Healthcare – Guest Blog by David Gebler

Focus on What Matters – The One Thing that will Sustain Continuous Improvement in Healthcare

By David Gebler

“You cannot solve a problem from the same consciousness that created it. You must learn to see the world anew.” – Albert Einstein

Leaders are tired of perpetually “managing change,” yet so few organizations do it well. Healthcare systems are overwhelmed with so many well-intentioned initiatives that never seem to meet their expectations. Quality, Safety, Efficiency and Patient Satisfaction measures are not where they need to be. Everybody’s frustrated, morale is dropping and the problems only get worse.

Conventional wisdom is that change starts from the top. In most organizations that means leaders are the ones who adopt new programs and make new commitments, and cajole everyone to change their actions. Some short-term change does happen. But then the momentum dies and everyone reverts back to their old ways. Why?

So many organizations never evaluate why their initiatives don’t work because they are already on to the next one. And if they do, they look only as far as the process itself. Rarely do leaders dig deeper to evaluate whether the culture or the ability of their employees to live the values needed to sustain the continuous improvement effort are at the root cause of the failure. So if we are going to look at this problem in a new way, let’s take advice from Professor Einstein. Let’s try and see the world from a new perspective.

Let’s do a root cause analysis and dig down to the core of the problem.

Bottom-up

The first issue we need to confront is whether change can happen from the top-down. It can’t. The truth is that change only happens from the bottom-up. Yes, it’s mandated and must be supported from the top, but a new way of doing things only sticks if it’s owned and embraced by everyone. Employees have to see why the change matters to them and they need to see their role in the bigger picture. Organizations cannot impact quality, safety, cost-management or patient satisfaction if the employees who touch these areas are not fully engaged and committed to the efforts.

Values

So how do we engage employees? Again, the default is to approach the issue from the top down: launch a communications program to tell people how important the initiative is, and start a training program to tell people what they need to do. But this approach misses a critical step. Even before the trainings and the seminars leaders have to create the space for their employees to live their values at work. Everything else will fall into place if managers and leaders create an environment where employees, who likely embody the very personal values needed to effect the change, can feel that those values are respected and needed to help the organization.

Why values? Because values drive behavior. Most employees in healthcare organizations embody deep relationship values, such as caring and compassion. They also embody values that lead them to want to feel connected and valued by their peers and by the hospital. Healthcare employees seek to work in high-performing teams. Working together to save a life is why they chose this profession. But there’s a downside. These values also lead employees to feel vulnerable to not feeling respected or included when not included in the design or implementation of new initiatives or programs.

Hospital employees see themselves as problem-solvers, whether or not they serve in a clinical role. And best practices for continuous improvement requires each employee to feel a sense of ownership and empowerment to contribute suggestions and question assumptions.

So what’s the problem? If every employee wants to be empowered to be a problem solver, and if leaders want them to take the initiative to make improvements, what gets in the way? What keeps employees from living their values? Now we’re getting closer to the heart of the matter.

Mindset of Leaders

Leaders cannot change the environment in which their employees work without changing their own approaches to management and leadership. Leaders who understand the power of lean business practices know that they have to create a collaborative and open environment where employees can share their opinions and ask hard questions and answers emerge from the collective effort of new lines of teams. Leaders have to empower the employees who interact with the patients to develop new ways of serving those patients. And leaders who have worked their entire careers in a command and control environment recognize that these kind of transitions are very difficult.

Now we get to the very core of the issue: leaders who know they need to change their way of doing things, but struggle to do it. It’s hard.  And in the course of a day of crisis management and firefighting, changing management style remains number one on the list of very important but not urgent things to do.

So if organizations are going to effectively sustain continuous improvement, they must find ways to help insanely busy managers and leaders to change their way of managing. How?

The Keys to Change

The key is to take culture change out of the realm of the conceptual and make it measurable and manageable. Define small steps that become inviolable among all leaders.

Three steps have proven to be most successful in moving managers and leaders in the direction they want to go in:

Measure:

Identify within each department of division the key values that are needed and the key negative values that are holding people back. One tool that has been used successfully in healthcare organizations measures cultural entropy, the percentage of negative values in the current culture. Leaders do not like to be in the room when their boss shows the comparative levels of cultural dysfunction across their department or facility.

Focus on Employees’ Fears: 

In a values or culture assessment employees will reveal the one or two core issues that are holding them back. In some organizations it may be fear of blame or retribution. In others it might be perceptions of inconsistent treatment or confusion. Whichever it is, when leaders acknowledge their employees’ fears and frustrations back to them, they have an attentive audience waiting to hear what’s next.

Pick the “One Thing”

In every organization and sub-culture within a department or facility, there is “one-thing” that leaders can do that, like the first domino falling in a domino chain, can propel change. Not sure what that one thing is? Ask your people. Engage them in a discussion of what needs to happen first to build the path towards empowered and accountable employees. In some organizations it is manager rounding, requiring all managers of others to spend significant time with their staffs asking questions and learning how processes and decisions are being implemented. In other organizations it’s reducing the “to-do” list of most urgent projects to those that can be accomplished and then holding everyone, including themselves accountable to meeting agree-upon objectives. Whatever it is, it must be something that all leaders will commit to and agree to be held accountable to. So start small and don’t backtrack.

Change happens from the bottom-up, only if leaders allow it to happen.

David Gebler is a consultant on leadership and change management, and is part of the Kesterson Group.