Archivi delle etichette: Quality Improvement

Great article about measurement for judgement versus measurement for improvement @Medici_Manager @helenbevan

More quality measures versus measuring what matters: a call for balance and parsimony

4 Breakthrough Leadership Strategies for 2013 @Medici_Manager @muirgray @LDRLB

soren —  January 14, 2013

The New Year brings about resolutions to redefine the status quo.  It’s usually an individual endeavor focused on fitness, friendships, or finances.

When it comes to business, great things can also happen when we apply the catalytic energy of the New Year to our teams and organizations. 2013 represents a great opportunity to leapfrog our mental models and innovate our way to breakthroughs for ourselves, our teams, our organizations and, of course, our customers.

Here are four strategies any leader can use to jump-start the New Year:

  • Strategy #1:  Define Your “Leapfrogging” Opportunity – promote big thinking that involves challenging assumptions and “changing the game” in whatever you’re doing.  It’s all about leapfrogging existing solutions and the competition.  Apple didn’t create the iPod because customers asked for it; they wanted it themselves.  Target didn’t become “Tar-zjay” by emulating Wal-Mart; they decided to be known for incredible design and become the leader in “cheap chic.”  Ask yourself:  In what ways are we holding onto the status quo?  What are the breakthroughs that we want to create and lead?
  • Strategy #2:  Leverage Data, then Go with Your Gut – When it comes to making resolutions, you instinctively know what you need to do.  Breakthrough innovation isn’t much different; there are no maps for uncharted territory.  Comprehensive data rarely exist.  The goal is to use whatever information you can find, and then apply your instincts to fill in the gaps.  A University of Amsterdam research study recently found the people made the best decisions when they actually ignored detailed data made quick decisions after “sleeping on it.”  Ask yourself:  Are we holding back because we’re missing data that can’t realistically be obtained in a workable timeframe?  What do we know deep down to be true that data can’t tell us?
  • Strategy #3:  Test the Waters with Your Pinky Toe – Research from the University of Virginia shows that entrepreneurs get their ideas out into market as quickly as possible (even if they’re not perfect), test them, and change their fundamental assumptions as needed.  And they’ll go through this same iterative process many times to get it right.  The goal is to sponsor and conduct low-risk experiments to test and validate a variety of new opportunities.  Using this approach, failure doesn’t exist, only learning.  Ask yourself:  What is the smallest step that would have the greatest impact?  What big assumptions can be tested with the least effort or investment?
  • Strategy #4:  Savor Surprise – The unexpected is a natural part of innovation.  And in today’s 2013 environment, uncertainty has never been greater.  When unanticipated things occur, rather than fight them, see what they’re saying.  The stronger our reaction – either positive or negative – the stronger our assumptions are likely being challenged or reinforced. Scott Cook, Founder of Intuit, credits this unusual mantra as one of the pillars of his company’s long-term success. Ask yourself:  What surprises have we experienced that influenced where we are today?  What can we do to remain open to the power of surprise when it occurs rather than resist it?

In many ways, “the soft stuff is the hard stuff” when it comes leading teams and organizations into the often ambiguous world of breakthroughs.  It’s not always easy to challenge existing assumptions, processes, and ways of working.  And so these strategies should be applied over time, through a journey that typically involves experimentation, setbacks and successes.  2013 is the year to recognize anyone who’s willing to push through to the other side of the status quo can become an innovation leader.

Soren Kaplan is the author of Leapfrogging and a speaker, educator, and managing principal at Leapfrogging Alliance, where he teaches leaders how to create business breakthroughs.

North Mississippi Health Services Malcolm Baldrige National Quality Award 2012 @Medici_Manager

North Mississippi Health Services (NMHS) is a nonprofit, community-owned, and integrated health care delivery system serving 24 rural counties in northeast Mississippi and northwest Alabama. The organization includes six hospitals, four nursing homes, and 34 clinics. It provides preventive and wellness services, hospital-based emergency and acute care services, post-acute care services, and a preferred-provider organization. The NMHS workforce of 6,226 employees and 491 physicians serve at health care facilities located in six Mississippi communities (Tupelo, Baldwyn, Eupora, Iuka, Pontotoc, and West Point) and one Alabama city (Hamilton). Net revenue in 2011 was $730 million.

North Mississippi Medical Center (NMMC), the flagship hospital and referral center in the NMHS system, was honored with a health care category Baldrige Award in 2006.

High Standards = Better Health Outcomes

  • Efforts to create healthier populations in the communities served by NMHS have led to outstanding results. For example, outpatient management of diabetes has met or exceeded the National Committee for Quality Assurance (NCQA) top-decile benchmark since 2008. Colorectal cancer screenings have increased since 2009 and consistently exceed the standard set by the state’s Medicare quality improvement organization. Additionally, data from NMHS’s Community Health Assessment demonstrate that the number of smokers in the region has declined 7 percent since 2004 to 15.6 percent.
  • For 2012, the NMHS flagship hospital, NMMC, has demonstrated performance at the 100 percent level for Joint Commission-accredited hospitals in 26 of 30 Surgical Care Improvement Project core measures. (The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States.)
  • A strong focus on patient safety has led to no central line-associated blood stream infections in its intensive care unit for two years. Slips, trips, and falls are below the National Database for Nursing Quality Indicators mean for both inpatient and long-term care settings across the system in fiscal year 2012.
  • Weighted patient satisfaction results for the NMHS system have been at or above the Press Ganey Associates 90th percentile since 2008. (PGA is a national consulting firm focused on improving health care performance.) Scores from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, a national, standardized, publicly reported poll of patients’ perspectives of hospital care, were at or above the 90th percentile for one or more dimensions at all six NMHS hospitals.

Maximizing Service and Improving Performance

  • NMHS uses a variety of methods to reach various stakeholders and capture their feedback on areas for improvement. These include the “Careline” free phone line, regular leader visits to work areas, face-to-face interviews, Facebook comments received, and surveys. The system’s customer service team reviews the data to identify where changes are needed.
  • NMHS shares performance results with its workforce, partners, patients, and other stakeholders through systematic, well-deployed performance score cards. Performance data and progress toward improvements are reviewed monthly by senior leaders. System-wide collaborative work groups share best practices on a regular basis.
  • NMHS utilizes an innovative “Ideas for Excellence” program to capture improvement suggestions from the workforce. The number of ideas submitted has more than doubled in the past five years to greater than 10,000 in fiscal year 2011, with approximately 40 percent accepted for implementation during that time.
  • Use of NMHS’s Integrated Community Health Record by both employed and affiliated physicians, including remote log-in capability from their homes when on-call, ensures access to needed patient data and information during transitions from home to the Emergency Services Department to inpatient status and back to outpatient status.

 Caring for Caregivers: Employee Satisfaction a Priority

  • The NMHS employee retention rate has been at or above 90 percent since fiscal year 2007, exceeding the Bureau of Labor Statistics’ benchmark for health care organizations by 10 percent.
  • To engage its workforce, NMHS links rewards and recognition to its EXCEL performance management system and the organization’s critical success factors. Survey results show that employee engagement was above 90 percent from 2008 through 2012, and that workers rated their job satisfaction as “best-in-class” in both 2010 and 2012.
  • NMHS’s core competency of “People Who Provide a Caring Culture” recognizes the role that the workforce plays in achieving the organization’s mission to “continuously improve the health of the people of our region.” Through its innovative “grow-our-own” strategy, NMHS employs a full-time career counselor to assist employees in identifying opportunities for career progression and provides tuition reimbursement for advanced education and training that approached $450,000 in fiscal year 2011.
  • Senior managers at NMHS have created a culture that emphasizes “people first” among its critical success factors. This “servant-leadership” philosophy enables managers to model the organization’s values and build trust with employees, sustaining an empowered, accountable, and high-performing workforce. Open communication and recognition are achieved through a “No-Secrets” culture and open-door policy, weekly e-mails from the chief executive officer, and regular rounds by senior leaders throughout the system.
  • NMHS’s physicians serve as key partners who are actively involved in the organization’s business strategy. In collaboration with staff and the administration, employed and independent physicians work together to develop the organization’s strategy, implement and improve its work systems, and accomplish its goals.
  • To support physician leaders in the organization, NMHS has developed an intensive Physician Leadership Institute. Graduates expand their leadership roles as advocates, mentors, and performance improvement champions. Physician leaders share operational responsibilities by participating in annual planning retreats, service line management, and supporting clinics and community hospitals across the system.
  • NMHS’s Live Well Employee Incentive Program educates and rewards employees for healthy and safe behavior choices on and off the job. The program has contributed to a trend where the annual increase in premiums for the employer-sponsored Live Well Health Plan dropped from 12 percent in calendar year 2009 to 2 percent in calendar year 2011.

Sound Management is a Prescription for Financial Health

  • NMHS leads its primary competitor in market share by 13 percent and all other hospitals combined by 8 percent. In addition, for selected procedures (e.g., cardiac catheterizations and open-heart surgeries), NMHS has led all other competing hospitals in market share from 2008 to 2010.
  • Despite its location in what has been called “the nation’s epicenter of poverty,” NMHS is the only health care organization in Mississippi or Alabama with a Standard & Poor’s (S&P) AA credit rating, which it has held for the past 18 years.
  • “Days cash-on-hand,” a financial indicator of available revenues used by organizations to plan future spending, has steadily increased since 2008 to 256 days in 2011, outperforming competitors and other S&P AA-rated organizations.

An Active Commitment to Healthier Communities

  • Dollars spent for charity care at NMHS rose to $80 million per year in 2010 and 2011. Employee contributions to United Way—providing meals, prescriptions, clothing, and utility assistance to the citizens of northeast Mississippi—increased from $475,000 in 2007 to nearly $600,000 in 2011.
  • To address the challenge of maintaining a highly qualified staff, NMHS has financially supported local schools of nursing, a pharmacology program at a local university, and created the Family Medicine Residency Program. NMHS builds relationships with students beginning as early as elementary school and offers a paid Physician Shadowing Program for college students.
  • NMHS community and regional outreach includes obesity prevention services, school health centers that provide nurses to 22 schools in six counties, the free Nurse Link Call Center, and free fairs for preventive screenings and health care promotion, including blood pressure checks, flu shots, and childhood immunizations.

For more information:

Marsha Tapscott
North Mississippi Health Services
830 S. Gloster St.
Tupelo, MS 38801
Telephone: (662) 377-3193 or (662) 377-3148

Per salvare il SSN, i politici devono dire ciò che non possono dire! @Medici_Manager @wricciardi

Come in Gran Bretagna, i politici devono dire “l’indicibile” per salvare il SSN: dobbiamo ristrutturate i nostri servizi per malati acuti. In sostanza, bisogna chiudere ospedali!

To fix the NHS politicians must say the unsayable

We need to restructure our acute healthcare services, which will involve district general hospital closures

Up to 50pc of deaths at Mid-Staffs NHS trust on Care Pathway

By Philip Lee

For a government to aim for constant popularity in a world of 24-hour news is surely pointless, especially when it comes to the NHS. The religiosity surrounding our health system, graphically displayed in the Olympics opening ceremony, has long prevented honest discussion of its shortcomings. Our continual blind faith in a system designed in the shadow of war to serve a stoic nation is perplexing — and has cost lives.

The realities on the ground, along with the poor clinical outcomes when compared with other equivalent countries, can no longer be ignored. The NHS has been showing signs of terminal illness for some time. Yet hospitals that are inadequate continue to be maintained. Any politicians who think that the current system, including the financing model and physical structures, can be sustained in the longer term, under the weight of increasing clinical demands, are deluding themselves.

Indeed, by doing so, they risk further undermining the trust of an increasingly cynical public. Continuing to pay lip service to failed systems is just not acceptable. Neither is a short-termist and timid five-year plan. It is high time that politicians told the truth about the NHS. The system we have is not the envy of the Western world and outcomes are not as good as they should be. It cannot be right that criticism of the status quo is a political taboo. Professional politicians should cease ducking the issue just because it fails to deliver short-term electoral gain.

Lives are worth more than votes. The last Labour government attempted to prop up the NHS by increasing spending significantly. Such financial largesse required the support of Middle England. As measurement was popular with the centre Right, targets were introduced to “guarantee” better care.

The bitter irony for the people affected by the Mid Staffordshire scandal is that this target culture created the environment in which managers chased financial goals at the expense of humane care. Instead of looking for figures to fill election pledge cards, the last administration should have been concentrating on changing the NHS for the longer term. Sadly, it didn’t. A feel-good solution was delivered that left us all feeling worse.

But we have no choice. Those of us who want to protect the fundamental principle of access for all need to make the case. The financing of health care also needs reform. I believe that the responsibility for funding should be moving slowly from the state to the individual. Technological advances, ageing, obesity and an increased appetite for medical treatments all load costs on to the taxpayer. New approaches to these challenges often fit poorly within old systems.

I want people to be free to choose any lifestyle they wish, while understanding that their choices may lead to health care costs later in life. I want to be able to give more to the truly deserving because we have spent less on those able to provide for themselves. I also want the very best 21st-century health care to be delivered in safe and appropriate clinical environments.

If politicians like me do not persuade the public of the need for these changes, then the vulnerable in our society will be put at risk. In return for this candour, the British people must accept this new reality. It is an untenable position for the public to demand politicians to tell the truth, only then to vote them out because what they’ve said is unpopular. If you really want a better NHS, then you will have to find the courage to vote for it.

Dr Phillip Lee is Conservative MP for Bracknell and a practising GP

Related Articles

Clinical Transformation: New Business Models for a New Era in Healthcare @Medici_Manager @helenbevan

Accenture research shows that independent physicians continue to dwindle and that those remaining will turn to subscription-based models to sustain profits and improve care.

Quality Matters Helping Patients Make Better Treatment Choices with Decision Aids @Medici_Manager @helenbevan

When patients are given decision aids, such as educational booklets, DVDs, or interactive tools, to help them make treatment choices, they are more knowledgeable and satisfied with their care. But the use of such aids as part of “shared decision making”—a communication approach that seeks to balance clinicians’ expertise with patients’ preferences—has until recently been limited to research trials. Now some health systems and public policymakers are supporting more widespread use of shared decision making in efforts to promote patient engagement, reduce inappropriate use, and control costs. 

By Martha Hostetter and Sarah Klein

Physician credentialing needs better standardization @Medici_Manager @kevinMD


There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting editorial ( in the New England Journal of Medicine provides some sobering details.

Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. They all communicate (inefficiently) with another army of insurance company employees and Medicare and Medicaid workers. What is the added cost of all this baked into the system? Do we have any idea? Can we do anything about it?

The Institute of Medicine, a component of the National Academy of Sciences, estimates the yearly administrative costs to be 361 billion dollars. This is a staggering sum — twice the amount of money we spend on heart disease and three times what we spend on treating cancer. Can we do anything about this?

Many have suggested that a single payer system would be the obvious answer, since providers would not be dealing with dozens of insurance and governmental entities. Although this is my view, I realize that right now it is just not politically feasible. It is the standardization of methods and procedures that matters most. The question, as well laid out by the editorial authors, is if we can reap some of the benefits of standardization without a single payer system? The authors think we can, and I agree.

One issue that really, really needs better standardization is physician credentialing. Each healthcare entity, be it a hospital or a payer, has its own way and standards of reviewing the credentials of physicians. And believe me, it’s a mess that just gets worse and worse. I have practice privileges at several hospitals and medical licenses in several states. Each one of these has its own, often idiosyncratic, standards for credentialing physicians, and these credentials need to be redone every couple of years. The process takes many hours and causes many headaches. There are national databases that keep relevant information about physicians — medical school and residency information, medical license information, information on disciplinary actions. You might think this would have made the process faster, but it just added another layer to the mess. Hospitals spend millions of dollars duplicating work that has already been done. It’s crazy.

Credentialing and other systems that are used to establish contracts between providers and health plans are riddled with redundancy, with many organizations collecting virtually identical information from providers. The typical physician spends more than 3 hours annually submitting nearly 18 different credentialing forms, with staff spending an additional 20 hours.

This sort of craziness is found all through the system (which really isn’t a system at all) that we have. The editorial’s authors go on to suggest several useful things which, if implemented in the context of the Affordable Care Act, would save billions:

The possibilities for reducing administrative complexity are immense. The reforms we describe could save as much as $20 billion annually for providers (roughly $29,000 per physician), or $40 billion annually for all stakeholders. And $2 billion of these savings would accrue to the federal government — a relatively small but valuable contribution to reducing the deficit. For the individual physician, these savings could translate into more time and resources for direct patient care — and therefore into improved professional satisfaction.

As we look for ways to make our healthcare system more efficient, this sort of thing truly is low-hanging fruit. It wastes resources we should be putting toward patient care.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must FaceHow to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

Don’t Ask Employees To Do These 8 Things @Medici_Manager @CEOdotcom

You’re the boss. You have the power.

Great — just don’t use your power to do things like the following:

1. Ask employees to evaluate themselves. Employees who do a great job always question why they need to evaluate themselves. Shouldn’t you already know they do a great job? Employees who do a poor job rarely rate themselves as poor, turning what could have been a constructive feedback session into an argument.

Self-evaluations may sound empowering or inclusive but are almost always a waste of time.  If you want feedback from the employee, ask them what more you can do to help them further develop their skills or their career.

2. Ask an employee to do something you already asked another employee to do.

You assign Steve a project. The day you needed it completed you realize Steve hasn’t finished… and probably won’t. You’re frustrated with Steve, and you really need it done, so you plop it on Susan’s desk. You know she’ll get it done.

Maybe so, but she’ll resent it.

Leave Susan alone. Deal with Steve.

3. Pressure employees to attend “social” events.  Any time your employees are with people they work with, it’s like they’re at work. Worst case, whatever happens there doesn’t stay there; it comes back to work.

Embarrassing behavior aside, some people just don’t want to socialize outside of work. And that’s their choice — unless you do something that can make them feel like they should attend. Then it no longer feels like they have a choice, and what you intended as a positive get-together is anything but.

And keep in mind that “pressure” can be as simple as saying, “Hey, Steve, I hope you can come to the Christmas party… I hope we see you there…” While you may simply be letting Steve know how much you enjoy his company, if he doesn’t want to go he hears, “Steve, you better be at the party… or I will be very disappointed in you.”

If you really want to hold outside social events, pick themes that work for your employees. Have Santa attend a kids’ Christmas party. Have a picnic at a theme park. Take anyone who wants to go to a ballgame. Pick one or two themes that cover the majority of your employees’ interests, and let that be that. Don’t try to force a spirit of togetherness or camaraderie. It never works.

4. Pressure employees to donate to a charity. The United Way was the charity of choice at a company where I once worked. Participation was measured; the stated company goal was 100 percent participation.

Pressure enough? It got worse; every supervisor reported results from their direct reports to the head of the fundraising effort… and the head of the fundraising effort also happened to be the plant manager.

I’m sure the United Way is a great charity, one worthy of support.

But don’t, even implicitly, pressure employees to donate to a charity. Sure, make it easy. Match their contributions if you like. But make donating voluntary, and never leave the impression that results are monitored on an individual basis.

And don’t do the “support my kid’s fundraiser” thing either, especially when you’re the boss. That’s tacky.

What employees do with their money is their business, not yours. Make sure they feel that way.

5. Ask employees to evaluate their peers. I’ve done peer evaluations. It sucks. “Peer” means “work together.” Who wants to criticize someone they have to work with afterwards? You can claim evaluations will remain confidential, but people always figure out who said what about whom.

As the boss, you should know your employee’s performance inside-out. If you don’t, don’t use an employee’s peers as a crutch. Dig in, pay attention, and truly know the people you claim to lead.

6. Reveal personal information in the interest of “teambuilding.”  I was once part of a transformational leadership offsite session where we were asked to make small boxes out of cardboard. (Yes, this was in the ‘80s when transformational leadership was the next big thing… until back to basics became the next big thing, followed by….)

Then we were asked to cut pictures out of magazines that represented the “outer” us, the part of us we show to the world.

Then we were asked to write down things no one knew about us on slips of paper, put them inside our box (get it?), and reveal our slips – and our inner selves – to the group when it was our turn.

I was okay with putting pictures on the outside of my poorly constructed box even though my lack of scissoring skill was pretty embarrassing. I didn’t want to create “reveal” strips, though, and said so.

“Why not?” the facilitator asked.

“Because it’s private,” I said.

“That’s the point!” he cried. “The goal is to reveal things people don’t know about you.”

“They don’t know those things about me because I don’t want them to know those things about me,” I said.

“But think about how much better you will be able to work together when you truly know each other as individuals,” he said.

“Sometimes I think it’s possible to know too much,” I said. “If Steve likes to dress up as a Star Wars character in his spare time that’s cool, but I’d really rather not know.”

I didn’t end up participating, a potentially career-limiting move that turned out fine when we went “Back to Basics” and I was back in vogue.

You don’t need to know your employees’ innermost thoughts and feelings. More to the point, you have no right to their innermost thoughts and feelings. You do have a right to expect acceptable performance.

Talk about performance, and leave all the deep dark secrets where they belong.

7. Ask employees to alert you when you “veer off course.” One of my bosses was really long-winded. He knew it and asked me to signal him when I thought he was monopolizing a meeting. I did that a couple times; each time he waved me off, probably because what he was saying was just too darned important.

Never ask employees to monitor your performance. To the employee it’s a no-win situation.

8. Ask employees to do something you don’t do. Not something you “wouldn’t” do, but that you don’t do. “Would” is irrelevant. Actions are everything.

Lead by example. Help out on the crappiest jobs. Stay later. Come in earlier. Not every time, but definitely some of the time. Employees will never care as much as you do — and, really, they probably shouldn’t — but they will care a lot more when they know you do whatever it takes.

Solving the Health Care Cost Challenge: Leveraging RAND Expertise @Medici_Manager @RANDCorporation

In its second term, the Obama Administration and the 113th Congress must address the relentless growth of health care spending, a major contributor to America’s long-term fiscal imbalance.

Growing health care spending is fueling the federal budget deficit, crowding out other priorities in state budgets, hindering the competitiveness of American businesses, restraining job growth, and jeopardizing the finances of American families. Victor Fuchs, considered by many to be the father of health economics,summarized the enormous payoff of confronting this issue: “If we solve our health care spending, practically all of our fiscal problems go away.”

However, while there is no lack of ideas for how to slow spending, action is hindered by a lack of consensus.

In a series of research briefs dedicated to flattening the trajectory of health care spending, RAND Health outlines four broad strategies for constraining spending growth in our market-oriented health care system:

There Is No Magic Pill For Great Leadership @Medici_Manager @fastcompany


I’ve been interviewing a number of executives for my new book, The Magnetic Workplace(Nicholas Brealey, 2013) and so far my findings have been rather interesting. There is no magic pill for great leadership. Yet many organizations believe they can solve problems by handing someone a book (even if it’s authored by me) or sending them to a one-day management training program at the local Holiday Inn. The results by themselves are usually disappointing.

Here’s how great leadership is created:

Really getting to know your people. You have to be willing to put in the time to really get to know your people so that you can work with them to build on their strengths. Put down your smartphone, walk around your desk, and invite one of your people to lunch. While dining, sit there and really listen to what your employee is saying. Ask them to describe their dreams and aspirations. Then go back to your office and come up with a plan to help this person and others achieve what is important to them.

This is what great leaders do. They are always thinking what they can do to support those who work for them. In turn, these leaders have loyal employees who know that they’d be hard pressed to find a leader who has that much of a personal interest in them as the one they have.

Spending the money required to get the results you hope to achieve. I asked one of the executives that I interviewed what was the biggest myth surrounding the attraction and retention of top talent. He replied by saying that executives think they can do this without spending a lot of money or in some cases, any money. This simply isn’t true.

The organization that this executive works for is constantly spending money to boost the performance of their people and it shows. They are leaders in their field. You wouldn’t expect the top baseball team in the nation to be at the top of their game without the help of outside experts would you? Coaches are provided for these players who are already the best in the nation. And you know what? Most get better.

Spend the money and help your people achieve their full potential. Or if you prefer, spend nothing and use this money on returning products to unhappy customers or hiring new people to replace the ones who keep leaving.

Don’t tell outside experts how to do their jobs. You wouldn’t go into your car dealer and tell him to change out the engine because you heard rumblings under the hood, would you? No, you’d ask the mechanic to take a look under the hood and diagnose the problem. You’d then ask what your options were. I get calls weekly from companies asking me to come in and do training. I always ask why. Sometimes the person calling really doesn’t know why this is necessary and other times the solution they are provided me as the expert isn’t the best or least expensive way to resolve their challenge.

An outside adviser can usually see things more clearly than those who are immersed in the organization. However, they can’t do so if you insist on telling them how to do their job.

Creating great leadership in your organization requires a commitment from top to bottom. There is no pill for great leadership. If someone tries to sell you one as a prescription for what ails your organization, get a second opinion.

–Roberta Chinsky Matuson is the president of Matuson Consulting and author of the forthcoming book The Magnetic Workplace (Nicholas Brealey, 2013) and the highly acclaimed book Suddenly in Charge: Managing Up, Managing Down, Succeeding All Around, a Washington Post Top-5 Leadership pick. Sign up to receive a complimentary subscription to Roberta’s monthly newsletter, Talent Maximizer.

7 best qualities of healthcare’s lean leaders @HarvardSPH_ECPE @drsilenzi

Proponents of lean management argue that whether or not healthcare providers realize it yet, there is a major demand within their organizations for the model because, they will tell you, lean improves patient safety and reimbursement rates, and creates new standards around transparency. But getting healthcare organizations on the lean bandwagon takes leadership.

Healthcare Finance News talked to Ted Stiles, director of Stiles Associates, a lean-focused executive search firm, about lean management and leadership.

“In the manufacturing world, lean needs a ‘burning platform’ to motivate leadership in the middle of organizations to do something significant… and significantly different,” said Stiles. And healthcare is more than a burning platform – it’s a raging inferno.

Because of the value it returns to the patient, lean is experiencing a huge demand within the healthcare industry, Stiles said.

“One large organization I worked with, in five years, has seen financial results with lean leadership that were roughly worth over $100 million. The numbers are real. And the amount of opportunity is really kind of boundless at this point,” Stiles said.

But many healthcare organizations have departments that are not functioning at the level they need to. The fastest way to get a lean program highly operational is to bring in someone who’s been through multiple cycles of transformation before, Stiles said. Unlike quality initiatives where a person can receive a certificate saying they’ve passed some test now making them a qualified leader, lean is very experiential, he explained. The most effective classroom is in the environment itself, trying the work hands-on and accumulating scars because of it.

1. Experience
You need people leading this kind of work who’ve actually done it before. “You can’t be an effective lean leader by simply staying one chapter ahead of class. This mode has failed in other industries. Lean looks very basic and simple – but the magic is in the execution,” said Stiles. A qualified leader knows where pitfalls are and can help an organization navigate away from them. Transformational experience is critical.

2. Process-oriented thinking
The classic American industrial management theory is based on result-oriented thinking. Lean is the opposite. A good lean leader needs to be almost obsessive about processes – dismantling the techniques a healthcare organization uses to figure out if they’re the cleanest methods to deliver the highest level of value. If organizations can have faith in this style of thinking, results do happen over time.

3. Ability to slow down
Hospitals have much more red tape to go through than manufacturing companies, and sometimes they lack clarity and alignment, Stiles noted. “So people who are transferring from a different type of lean to healthcare lean need to realize that moving things forward can take much more time. There’s more listening and learning involved. Seeking to understand the complexity of the healthcare industry is integral before jumping in and changing the world,” Stiles said.

4. Brutal honesty
Lean work is hard. At its most basic level, deploying a successful lean program means people need to talk honestly about what they do well and what they don’t. Organizations need to be open about their shortcomings, too. In a lot of management cultures, the key to success is hiding or deflecting that. A good lean leader is going to push the organization to be more transparent. Once problems are visible then, and only then, can you dig in and fix whatever needs fixing.

5. Exceptional relationship-building skills
If you have someone that’s built a career in manufacturing on results, those skills won’t necessarily translate well into the healthcare space. “Candidates in healthcare won’t lead with results, they’ll lead with relationship- and trust-building, which is really the only way to get physicians or high-ranking clinical leaders – even nurses on the frontline – to talk to you about what their hopes and fears are, or where they believe the biggest amount of improvement needs to be done,” said Stiles.

6. Motivational
Lean is about change. It’s about pushing people out of their comfort zones. Lean leaders ask aggressive questions that challenge why things are done the way they are within an organization, especially when the topic of transparency arises. Lean leaders need to motivate people to be able to take that step out of their box. “If you can get someone who can tap into various different levels within organizations to find out what the hope is, what the optimism can be, that’s very powerful stuff,” Stiles said.

7. Operational management experience 
There needs to be some level of operational management thinking. That operations leadership piece is where you get into good sustainable, repeatable management systems, Stiles said. Setting up some kind of tracking board helps measure the right signals within key performance indicators (KPI), and once you develop that – you have those visual controls within a lean organization – you can begin the practice of daily “huddles” where leadership and other frontline supervisors can look at these boards to see whether the things that needed to happen happened. And if they didn’t, they can begin to spot any abnormalities developing where a process redesign is needed so that it can be attacked and rooted out with good cause analysis, nipping problems in the bud before it’s too late.

Steff Deschenes
New Media Producer for Healthcare Finance News

Lean management improves employee satisfaction @Qualityworld @drsilenzi

In the first independent comparative study of 13 Lean projects, staff at all levels reported higher employee satisfaction at every institution, citing better front-line staff involvement in problem-solving and employee collaboration, according to the Agency for Healthcare Research and Quality.

However, some staff didn’t fully embrace Lean initiatives–the management approach rooted in quality efficiency–at their institutions, according to a column in Hospitals & Health Networks. Some employees noted they were frustrated that committing time to Lean and working with other departments took away from their regular duties.

Physicians can be reticent to implement Six Sigma because the methodology has been incorrectly associated with huge resource output, their time specifically,” Marti Beltz, Six Sigma instructor for American Society for Quality and healthcare quality consultant, told FierceHealthcare in a previous interview.

But as Charles Hagood, president and founder of Healthcare Performance Partners, explained to FierceHealthcare, “If Lean Six Sigma is deployed correctly, [physicians] will see the value and will want to become a part of the equation.” He suggested carefully presenting the Lean Six Sigma approach rather than cramming it down, and physicians will come around in the long term and see its value.

Although healthcare leaders committed to Lean management as a way to boost quality and efficiency, none paid much attention to the implementation costs after adoption, Steven Garfinkel, managing director of the American Institutes for Research in Chapel Hill, N.C., wrote in the H&HN column.

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Sign up for our FREE newsletter for more news like this sent to your inbox!“We cannot be sure that Lean is more effective than other process improvement techniques,” he said.

Nevertheless, healthcare organizations can adapt the model successfully. For instance, one hospital conducted rapid process improvements to assess door -to-balloon time, a quality measure for treating heart attack patients. After emergency department staff and the catheterization lab met to find out why delays occurred, they concluded one reason was that a technician had to travel from home to set up the cath lab during night shifts. Instead, ED nurses and technicians then set up right after confirming a patient have ST segment elevation myocardial infarction. The result: Door-to-balloon time dropped from 89 minutes to 77.

For more information:
– read the H&HN column

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Read more: Lean management improves employee satisfaction – FierceHealthcare