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“Shelley gave structure to the process team, guiding us and providing tools, so that we were more productive during the mapping and analysis of the current process and redesigning the new process.

The new process, the Abovehealth Modular Implementation, is a repeatable process with discipline and specific tools for each phase. We expect that the new sequence modular approach will not only reduce cycle time and rework, but be a real differentiator for us in the marketplace.”

Terri SenRoy
Director, Quality Assurance (former)


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

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

3D Character and FriendshipWhat is the rest of the roadmap to answer this question?

In Part One of this blog, Mary Grace Gardner asked the question, “What makes participation in an important performance improvement project fizzle after the third meeting?”  She answered, “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.

Then she provided the first two steps in a roadmap 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.
  2. Identify the improvement work.  See details on #1 and #2 in Part One of the blog.
  3. Appoint the teams. Everyone wants to be part of a winning team, and a winning team has the right people on it. The leadership team must identify the appropriate sponsors, champions, leads, strategic resources and stakeholders. Once these key constituents are brought together and informed of expectations, they will most likely identify additional key stakeholders who should be involved in this work.
  4. Sequence the work. When employees are overwhelmed, the work that’s most urgent gets tended to and the work that’s most important falls to the wayside. The top limiting factor for improvement work is not the bandwidth of the improvement facilitator, but the bandwidth of operations. And, oftentimes, the same departments and frontline leaders or employees are in high demand for multiple projects. If rapid improvement is what the organization is aiming for, remember that there are only so many hours in a day. Make the time so that what’s most important gets the attention it needs. Everything cannot have a start date of January 1. After I ask the decision makers to get input from their teams, I have the group decide what would be a reasonable number of projects to deploy. Then, I list all of the project ideas for the year along with other high impact projects that may be taking place throughout the year so that the team can visually see the potential timing and impact to operations. Seeing “Start date: January 1” twenty times on a list can have a stunning impact that results in a more reasonable spread of the work.
  5. Create an accountability system. If the improvement work is important enough to resource (Have you ever tallied how much it costs to actually hold a meeting? It can be astounding, so you better have a worthy ROI.), it should be important enough to track and monitor. All improvement work should report up through an appropriate oversight body and leaders should go to the Gemba on a regular basis to acknowledge the improvement work taking place.

This may sound like an incredible amount of work, and it is. However, if you want to ensure that improvement work is aligned with key strategic initiatives and set up to be successful, this is the upfront investment that must happen.  When the time, space and resources are provided to support problem solving, it’s the approach that’s most respectful to physicians, nurses, support departments and management staff. With these elements in place, you’ll break through that third performance improvement meeting slump in no time.

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

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