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“We achieved phenomenal results leading to an extremely efficient organization. The time required to process commissions with accurate results was reduced by more than 50% with the new process implemented. The capacity gained eliminated the need for additional resources to accommodate Cisco's growing sales force and transaction volume.”

JuneAn Lanigan
Director (former)
Cisco Systems


Aligning Performance Improvement, Strategy, and Daily work in Healthcare – Part One


Guest Blog by Mary Grace Gardner, MPH is a Director of Strategy and Performance Improvement in the San Francisco Bay Area


Have you launched a performance improvement project based on someone’s brilliant improvement idea only to see participation fizzle out by the third team meeting? You probably spent hours crafting the perfect kick off meeting agenda with the project leads, practiced your ten minute spiel on why performance improvement is the gold standard for transformation, and generated enthusiastic energy to tackle a problem head on. After you doled out action items and agreed on a meeting schedule, you noticed about half the team showed up for the second meeting. Disheartened but still hopeful, by the third meeting, you find yourself desperately trying to get participants to show up. When you ask your teammates what’s the deal, a typical response may be, “I’m swamped” or “I have other, more pressing priorities” or “The hospital census was high.” At that point, you begin to question if the month of work you put into this project was wasted. If this sounds like something you’ve experienced (and everyone who works in performance improvement will experience this deflating moment at some point), you probably were set up for failure from the get go. Why? This phenomenon is caused by one of three reasons:

  1. You were deployed to help solve a problem that was not aligned with a key organizational goal (i.e. A ‘nice to have’ instead of a ‘must have’ solution).
  2. The project was inappropriately resourced and the right people were not in the room to effectively solve the problem.
  3. The project was inappropriately sequenced and it couldn’t fit on the already full plates of the frontline staff and management team.

So, how do you prevent this from happening again? It all starts with leadership alignment at the top of the organization. But, this alignment doesn’t happen magically or organically. You need to have a performance improvement champion willing to bring up the hard questions and facilitate the difficult process of prioritizing what may feel like thousands of metrics, projects and initiatives. Here’s a road map on how to get cascaded alignment on improvement efforts:

  1. At the end of the performance year, have the leadership team agree on the top organizational priorities and their accompanying key metrics. This is a difficult process and may take hours (or even days) to arrive at a prioritized, narrowed down list. The fewer the priorities, the better. It may seem impossible, but your team (and the rest of the organization) will be thankful to have a clear, concise list of what’s most important to the organization.
  2. Identify the improvement work. Based on last year’s performance and where you want to be next year, the leadership team must identify what work needs to be accomplished to get you there. This should be informed by data, both quantitative data tracked by the organization and qualitative data gathered from the frontline. I do this by gathering and distributing to the team the high level dashboards for the organization aligned with key performance areas and ask each team member to gather dashboards that represent the work that is most important to them. Before the team meets to identify the work, I give each team member the following homework to collect qualitative data: spend time with your management team and frontline staff and ask about what worked well and what got in the way of reaching goals this year. The questions must be specific about projects, programs or initiatives. Otherwise, the responses will be general, and it will be difficult to discern what actions need to happen to create a system for improvement. Both quantitative and qualitative data is needed in order to have the most accurate picture of current conditions. Armed with this data, the team can now work on identifying the key opportunities to move the most important metrics and begin to articulate what is the problem(s) they are trying to solve.

Part Two of this blog with three more elements to the roadmap will be published in two weeks.

Mary Grace Gardner, MPH is a Director of Strategy and Performance Improvement in the San Francisco Bay Area.

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2 comments to Aligning Performance Improvement, Strategy, and Daily work in Healthcare – Part One

  • Hi Mary

    Good article … aligning and engaging people is key achieving transformation. I work for Promapp and it sounds like your thinking aligns with our philosophy- that successful process cultures depend on broad involvement and collaboration across business teams.

    Promapp’s cloud-based business process management (BPM) software makes it easy to create, navigate, share, and change business processes, enabling quality assurance, risk management, and business continuity.

    Providing an intuitive online process repository, an integrated process mapping tool, and a process improvement toolset, Promapp’s proprietary software supports the development of smarter and safer ways to work, while encouraging sharing of information by operational teams rather than limiting it to process analysts and technical specialists.

    I’m inviting you to take a look at … we have weekly webinars if you would like to join also.

    It would be great to get your feedback.

    Kind regards


  • Jim Wick

    Hi Mary,

    I liked your BLOG entry and definitely agree with your need for aligning to the strategy of the organization. I was fortunate enough to work for a Hospital back East that implemented a TQM-Phillip Crosby process across the organization. The executive sponsorship and commitment was definitely there and leadership walked the talk. It takes a culture change and time for an organization to be successful. Healthcare is one of the industries that would most benefit from these principals based on its complexity. Thanks for your insights. Jim

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