I can’t take credit for this simple but brilliant query. Vincent Capasso, senior director of operational process design at Intralign, posted this in the LinkedIn ACHE members group and provoked a flurry of thoughtful and interesting answers:
- ….acknowledge, at every level, that creating that culture will also be a process of continuous improvement.
- …Recognize and accept that that the patient is in charge and reinforce/reward those that act accordingly.
- ensure quality ‘mind-set’ is ingrained in the culture of the organization and is beyond managing projects
- teach and model that improvement does not stifle innovation, rather it provides the media to increase it. And employees who have the culture support to innovate become more engaged to do so.
- …over-communicate to staff AND physicians that CI is a growth strategy; it is additive, not reductive and is based on eliminating waste, not merely cutting cost.
- encourage feedback from frontline employees. Create a great way to communicate with frontline employees! That’s where improvement begins, where innovation begins!
- have leaders who see it as a top priority.
- To have complete buy in from all stakeholders
- establish a directive that aligns with quality initiatives and customer satisfaction, and modulate management competencies to instill these traits continuously over time
- … engage all leaders, employees and physicians so they understand why the CI is important, then provide them with the tools and data to work collaboratively to achieve the desired outcomes.
- It starts at the top but the heavy lifting occurs at the management level. At the top, every day of every week or every month, the CEO and C-suite team must demonstrate that continuous improvement is a core belief and a cornerstone of the organization’s culture. They must talk about it, celebrate it and reward it. At the director/management level, where the real work of running the organization on a day-to-day basis occurs, this group people must be educated, supported and held accountable for executing.
- …open lines of communication.
- realize that management isn’t the end of the culture. We have to be able to sell the mission/vision to everyone so that they will be willing to strive for continuous improvement. If the person registering the patient or even taking their vitals doesn’t believe in the importance of improvement, then the initiative will fail.
- Management isn’t the end of the culture, it is the beginning, the role models for staff in how we want them to respond to patients. If it doesn’t seem important to all of your senior team the staff won’t see the importance. Also, celebrate the wins with all staff.
- We must build bridges of communication-upward and downward across any system’s leadership-(Joint Commission dictates that 80% of preventable errors come from mis-communication). A critical example is defective hand-offs which could also occur if the communication is broken resulting in delays in treatment, inappropriate treatment, increased LOS, serious physical and psychological injuries, and death. Healthcare leaders now-a-days must become transformational leaders–must work with physicians, and staff in changing their attitudes toward change, and their perceived self-involvement, etc. and in aligning them with the mission as a “declaration of purpose” and the strategic goals; thus, pursuing a common goal on quality. We must remain true to the mission, the patients, and the community we serve. These are just a few things we can do to create a culture of continuous improvement!
- ….have leaders role model, all the time and without exception, every one of the many elements of accountability that is at the core of such a culture.
- …show how it add value to all stakeholders, starting with individual employees since it is their work that ultimately creates improvement.
The comments came from hospital executives, healthcare operational consultants, front line caregivers and professionals from non-healthcare industries. The common themes are encouraging:
- Encourage complete organizational understanding and buy-in
- Executives must embrace culture change and lead and participate in continuous improvement
- Leaders must communicate openly and frequently with the front line caregivers, and listen to and empower them to overcome obstacles and focus foremost on patient care and well-being
In our experience as a partner with hospitals on their transformation journeys, these observations are right on the mark. And Capasso’s initial query is genius because it gets to the heart of what transformation means: Hospitals changing the way they do business. Caring for patients is what hospitals do. Hospitals must embrace new thinking–from the top leadership and across the organization–to reliably and predictably coordinate and deliver that care with the greatest quality and efficiency. That means continuous improvement becomes the business of exceptional hospitals.
Every measure of hospital performance improves when the core of operations–care coordination and throughput–becomes as consistently effective and efficient as possible. It’s about much more than improving length of stay. Physicians are happier and more loyal when communications and the ability to deliver quality care improve. Readmissions decline when teams can best assess, care for and plan for the discharge of patients. Care quality measures improve because well-coordinated handoffs and timely care dramatically reduce risks of falls, infections and preventable harm. Patients receiving timelier, better care are more satisfied. Increasing capacity defers significant capital expense to build new beds. Quicker responses and better coordinated admissions mean fewer patients leave without being treated. The big and the smaller metrics all get better when hospitals continuously improve the core activities of care.
So we present the same challenge to you: Finish this sentence: To create a continuous improvement culture we need to…