ASQ - Team and Workplace Excellence Forum

January 1998


Have Faith In Your Future
Popcorn Discusses Consumer Trends, Effects on Business

Success Comes From Breaking New Ground - Not Plowing The Old

Taking It To The Public
Business Community Works With School Leaders to Turn a District Around

A Marriage Of Convenience
Unions, Management Team Up to Counter Takeover, Redesign Organization

The Baldrige Award: Winning Isn't Everything, Improving Is

Cutting Off Your Nose To Spite Your Face


Caring About Place
by Peter Block

People Powered Organizations
by Cathy Kramer


Brief Cases
Business News Briefs

Views for a Change

Book Review

Views For A Change

H. James Harrington Responds

"Leadership is as simple as 1-2-3.
1. Share clear visions of the future.
2. Ask the right questions.
3. Present many good examples (war stories).
All the rest of the activities are secondary."

Healthcare professionals are well educated, intelligent individuals. In order to get them to accept change, you need to provide them with tangible justification. This means you must develop a powerful business case that is reinforced with case studies from other healthcare centers. My experience with healthcare professionals is that most of them are extremely dedicated individuals who give fully of themselves. Often, these individuals interpret that the introduction of continuous improvement projects implies that they are not already performing at their best possible level. The real key in turning around this attitude is to focus not on individual performance, but rather on improving the systems that the individuals utilize in performing their assigned tasks. It is important to understand that change is a process and as such, can be and should be controlled just like any other process. It is a process of moving from a current state where the professional is in control through a transitional period that can best be described as disruptive, to a future state that is hopefully better than the current state. The professional may not be happy with the present state, but at least he or she understands it and has developed personal traits which allow him or her to handle situations as they arise. The transitional state truly is a stressful state because change can best be defined as when the individual's expectations are disrupted. During this state, the four C's come into play;

o Competency is questioned because the individual will have to learn how to per form in the future state.
o Comfort levels decrease because the individual cannot depend on previously used approaches when situations develop.
o Confidence is lowered because the individual is unsure of his or her ability to perform in the future state.
o Control is gone because the individual migrates from the present state to the future state and is not regained until he or she becomes experienced in the future state.

Frequently, the transformation from the present state to the future state has a number of negative impacts on individuals in the organization. As stability is lowered, stress levels become much higher, productivity decreases, individual anxiety heightens and this combination of negative feelings greatly increases conflicts within the organization.

Truly, no one is going to change unless the pain related to the as-is situation is greater than the pain the individual will undergo during the transformation period and the future-state situation. This means that management must provide everyone with a clear vision of the future-state situation.

There is a six-step process to effectively implementing a continuous improvement program.

Step 1 - Develop clear vision statements of the future state.
Step 2 - Provide ample data and case studies.
Step 3 - Identify improvement opportunities.
Step 4 - Develop measurements and goals.
Step 5 - Improve the processes and systems.
Step 6 - Reinforce desired behaviors by rewarding the individuals whom alter their behavioral patterns in the desired manner.

Let's focus on the most important one- Step 1 - Visioning. In order to provide individuals with a clear picture of the future state, you need to develop a series of environmental vision statements that define how the healthcare organization needs to change over the next five years. These vision statements should define key behavioral drivers, such as leadership styles, continuing education, patient interface, measurement systems, etc. It is important that these vision statements define the working environment from the standpoint of the nurse at the bedside, the surgeon in the operating room, the radiology technician and the remainder of the staff. A set of preliminary vision statements should be developed by a select group made up of administrators, physicians, nurses and technical staff that we will call the Continuous Improvement Team (CIT). The CIT will define what environmental factors impact organizational behavioral patterns and performance. The team will then prepare preliminary vision statements for each of these environmental factors. Typically, vision statements are prepared for eight to 10 environmental factors.

Next, the CIT will review the preliminary statements with employee focus groups. Following a series of focus group meetings, the CIT should reconvene to consider the inputs it received during these meetings, and then it can create the final vision statements.

It is absolutely essential that the CIT actively communicate these visions and the reasoning behind them to all of the organization's employees. Communication needs to go up, down, top to bottom, bottom to top, sideways, around corners and around the clock. Paperwork does not typically work with physicians. Much more effective communication methods are short luncheon meetings or five-minute meetings in the hallway. The CIT should prepare what we call "elevator talks which will allow team members to communicate during a short ride between floors. The CIT members should also identify informal leaders among the physicians, nurses and support staff and be sure they clearly understand and support the vision statements.

Now, flood the healthcare center with case studies about other healthcare units that have significant continuous improvements in their performance. If you do a good job of getting buy-in to the visions and provide examples of how other healthcare units are using continuous improvement tools to improve the organization's performance, you will be well on the road to gaining their support and commitment to the continuous improvement initiative.

John Runyan Responds

January '98 News for a Change | Email Editor

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