Is your benchmarking missing the mark?
Is your benchmarking missing the mark?
Experts give advice for successful change
Mary V. Gelinas and Roger G. James are no strangers to the difficult task of successfully implementing change. With 40 years of combined experience, these two founders and principals of the Oakland, CA-based Gelinas James Inc. consulting firm have shepherded a long list of clients through the change process, including Kaiser Permanente, Levi Strauss & Co., Intel, Coca- Cola Co., Vanderbilt University Medical Center, Carondelet Healthcare, and Duke University Medical Center. They have worked with their health care clients on such issues as creating a more efficient system for patient flow and throughput, creating a stronger patient and customer focus, and reducing costs and bureaucracy.
Gelinas and James are the authors of a recently published book called Collaborative Change: Improving Organizational Performance.1 In it, they offer answers to some pressing benchmarking questions, such as those below:
Q: Everyone talks about quality improvement in health care. Why is it so hard to actually achieve successful change?
A: Unlike most industries, health care has a number of equally important "customers" (e.g., patients/families, payers, physicians), each with different needs and requirements. It is extremely difficult to satisfy all of them, yet it must be done. Also, those receiving the services are not the ones who pay. As one of our clients said, "Everybody wants our services, but nobody wants to pay."
The level and pace of change in health care is overwhelming and continuing to increase. In order to survive, virtually all organizations are constantly focused on mergers and acquisitions, new alliances, drastically cutting costs, etc. It is extremely difficult to know which change initiatives to undertake, and it’s difficult to actually pursue those initiatives in such a tumultuous environment.
Health care is under extreme pressure to cut costs while maintaining quality. For most industries, this has been the way of life for a very long time, but it is a relatively new demand in health care. Leaders do not often have the experience to respond effectively to the inherent challenges.
In most health care organizations, there is very little effective cross-functional collaboration. Individual departments or entities either do not see the need for or do not have the skills to work together to create a strategic vision for the enterprise and successfully sponsor the change initiatives required to achieve that vision.
Q: In a benchmarking effort, how can you make sure the data you’ve collected don’t sit on a shelf but are used to implement change?
A: The most critical element is involvement of key leaders (particularly physician leaders) throughout the benchmarking effort. They need to see themselves as active sponsors of the initiative. This means they have to set the goals for the effort, build a compelling case for change, participate in the effort, and ensure implementation of changes.
In a benchmarking effort at an academic medical center we worked with, one of the key surgeons, who was a very influential thought-leader in the physician community and a skeptic about the need to change, was convinced to participate in a field visit to a major hotel company’s flagship property. When he experienced firsthand the knowledge about the business and the dedication to customer satisfaction exhibited by employees at all levels, he became a powerful advocate for efforts aimed at developing world-class customer service in the medical center.
Q: What are a couple of the most common mistakes you’ve seen people make at the beginning of the change process?
A: The biggest and most common mistake is not building agreement early on among the senior leaders (administrators and physicians) on the key elements of the change initiative: vision/goals, case for change, change process, and role of leaders in sponsoring the effort.
A second, corollary mistake is underestimating the time and attention leaders need to spend on shepherding the change process. Many leaders act as if they believe they can simply hand off sponsorship of major change efforts to underlings or staff leaders (e.g., HR, strategic planning). In doing so, they send the message that the effort is not worthy of their attention and is, therefore, not of critical importance. So why would others in the organization focus their energies on the initiative?
Q: What are the best steps to avoid those mistakes?
A: One step that we have taken a number of times is to advocate that leaders not go ahead with a change effort if they do not have in place rock-solid agreement about the key elements listed above (goals, etc.). In one regional health care system, after a series of interviews with key leaders and an off-site session to plan for the initiative, it became painfully apparent that the leadership team would not be able to reach foundational agreements about the effort. We strongly advocated for abandoning the effort and outlined the predictable negative impacts of their going ahead. Fortunately, they took our advice.
It is critically important to involve ALL key stakeholders throughout the initiative, particularly at the beginning. For example, in one health care system, the leadership team considered a comprehensive change initiative so important that they formed a fully-dedicated "change team" of 10 senior people to work on the project. In addition to administrators and nurses, the team included three physicians, one of whom was the team leader. Without those physicians advocating with their peers about the importance of the initiative and involving them throughout the effort, the results would never have been as far-reaching and positive.
Q: How do you get staff to focus on what you’re trying to achieve?
A: Educate them about the project: the goals, its importance, the process, how they can be involved.
Involve them in meaningful ways at all stages of the process. (Meaningful involvement means they have the opportunity to influence the outcomes.) This avoids having to "sell" the solutions at implementation.
Use focused ways to involve people (e.g., large group conferences, focus groups on business process analysis, project updates in small groups on all shifts).
[For more information, contact Gelinas James Inc. at 6114 LaSalle Ave., Suite 442, Oakland, CA 94611. Telephone: (510) 339-4322. Fax: (510) 339-4324. Internet address: www.gelinasjames.com.]
Reference
1. Gelinas M, James R. Collaborative Change: Improving Organizational Performance. San Francisco: Jossey-Bass/ Pfeiffer; 1998.
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