January 1998
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Articles Have Faith In Your Future Success Comes From Breaking New Ground - Not Plowing The Old Taking It To The Public A
Marriage Of Convenience The Baldrige Award: Winning Isn't Everything, Improving Is Cutting Off Your Nose To Spite Your
Face Columns Caring About Place People Powered
Organizations Features Brief Cases Pageturners |
Question: John Runyan Responds This is an excellent question. And I am particularly glad you are asking it, a physician leader with passion and commitment for making continuous quality improvements in your work. Too often, I hear other health care professionals and staff asking how in the world they can get their physicians to even consider trying the most basic tools of quality improvement, much less leading in that effort. Despite some trends toward balancing and equalizing status in the healthcare world, physicians still have the vast majority of power and influence in shaping the actual standards for and delivery of care. Because of this reality, I believe that you are in the strongest position of anyone in your organization to initiate the cooperative efforts necessary to pursue quality improvement measures. You frame your question in terms of "instilling in your colleagues and staff that same belief" in QI that you have. As a long-time observer of human nature, I believe that real change occurs only when people are invited and then actively choose to change their mind-sets and work behaviors - and subsequently choose again and again to sustain these shifts in their actions. Most people will not simply change their beliefs and instinctive behaviors because a leader or manager pleads, cajoles or coerces them from a position of higher authority. What I have seen to be most effective
in leading people is to combine a simple,
well-articulated vision with actions that consistently
match the intent and words of the vision, with clear
steps for others to follow. When this approach is paired
with a genuine invitation for others to join in quality
improvement efforts, I have seen outstanding results.
While leadership in this arena can involve many different
kinds of activity, I think that your motivating work is
in these three areas. o Describe what you want to
achieve. Throughout these steps, I encourage you to involve people from all of your constituencies in the exploratory discussions, crafting and review of what you are developing. Specifically, I suggest you include all the different kinds of health care providers that surround you, your administrative/business counterparts and a selected set of your current patients in this process. Once you and your chosen colleagues and staff have articulated your vision of the improvements for your work, you can turn to action. The single greatest lever you have to inspire and motivate others is yourself. If you begin to act boldly and decisively on the agenda spelled out in your vision work, you will inevitably draw others into your joint work. As the physician leader, you have the hierarchical position and professional standing to call for collaboration from others. When you use that standing to model the behaviors you seek from others, the odds are heavily in your favor. Equally, if you ask for new approaches, but do not model that behavior yourself, you virtually ensure the failure of your call to action. Finally, as a leader you need to find ways to engage others in this quality improvement work on terms they can reasonably meet and that will fit into their working lives. Over the years I have seen many QI efforts fail because they began with such a wide scope, used so many technical terms and tools, and were so purely quantitatively and statistically-oriented that they alienated or overwhelmed the average staff member who tried to take them on. I am convinced the best quality improvement efforts start with small, life-size steps that can be planned and achieved within days or weeks. Begin with brief orientations, just-in-time training with only a few, necessary QI tools and short decision-to-action cycle times to give people a chance to have early successes. Avoid launching a sweeping Quality Improvement Program with many bells and whistles. Help your staff focus on the processes that immediately affect you and them and targeted groups of patients. Join them in some of the projects that they initiate. Ask them to join you in projects that challenge and stimulate you. Show them your best thinking and expect the same from them. Weave together the most effective analytical/problem-solving approaches from the QI world with the most participative, respectful and caring processes from the organization development world. Celebrate your positive steps and
successes. Learn from your missteps and failures.
Demonstrate the mix of pride and humility that are
necessary to making progress in the complex world of real
healthcare improvement. If you truly bring yourself to
this work, they will follow. |
