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

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.
First, I suggest that you sketch out an image of what you are seeking to accomplish with your colleagues and staff. While this vision may begin with a statement of your philosophy and values, you need to quickly take this visioning to the very practical and concrete level:

o Describe what you want to achieve.
o If you have certain levels and measures of service in mind, spell them out.
o If you seek specific health outcomes for your patients, detail them.
o If you have the development of certain treatment processes and protocols as goals,
map them out.
o If you see a flow to the inter-locking parts of this vision, sketch out this agenda
for action.

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.
Moving ahead on this combination of visioning, acting and helping others to take their own steps will clearly call for significant amounts of your time and energy. However, I share the belief - made explicit in your question - that this effort will yield far better results for you as a physician leader, for your colleagues, staff and for your patients.

H.James Harrington Responds

January '98 News for a Change | Email Editor

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