Culture permeates all your organization produces. Whatever your culture prioritizes (or neglects) inevitably shows up in clinical, financial and satisfaction outcomes.
All organizations have a culture, of course, but is it a good one? We’ve recently covered the people aspect of building a strong culture (see part 1). In this follow-up post, we’ll focus on the next foundational steps: the structure and processes that enable consistently strong clinical outcomes.
Before we go further, it’s worth recapping why culture matters so much. “Culture’s all that invisible stuff that glues organizations together,” writes Nilofer Merchant, a Stanford lecturer, for the Harvard Business Review. “It includes things like norms of purpose, values, approach… It’s the stuff that determines how we get things done,” she explains. And how we get things done determines the results we get.
Neglecting culture isn’t just foolish or costly. In healthcare, it’s also dangerous.
Raising children, winning an Olympic medal, navigating traffic, and achieving great clinical outcomes all require clear boundaries, shared expectations, accountability, and the right tools to get there. Today we’ll zoom into the framework that enables a culture of continuous improvement.
We’ll break that into three parts:
Before you can hit performance goals consistently, people across your organization must be aligned and committed to your vision. An effective clinical improvement infrastructure makes that possible.
At a glance, that framework should include the following components with credit due to David Burton, M.D.:
| Effective Clinical Improvement Infrastructure | ||
| Clinical Management | Information Management | |
| Measurement System | Implementation Support | |
| Physicians, clinical administrative staff and operations leaders needed to best practices. | Support staff and systems required to measure clinical, financial and satisfaction outcomes for key clinical processes. | Staff and systems necessary to develop, disseminate, support and maintain the clinical knowledge base for implementing best practices. |
Let’s unpack that:
When introducing an initiative into your organization, successful adoption requires buy-in from three key constituencies: physicians, clinical administrative staff, and operations leaders.
If physicians aren’t on board, they won’t push it, won’t order it, and the initiative will go nowhere. If nurses aren’t on board, they’ll push back with concerns about their workload or patient safety. If operations leaders don’t buy into the vision, they’ll tell you there’s no budget for it.
There must be a way to measure clinical, financial and satisfaction outcomes for key clinical processes. Those metrics, in turn, should guide decision-making and improvements. Reasonably, leaders across your organization need easy access to metrics that are relevant, current and actionable.
One way to sustain the changes you want to see is through intentional, continuous education. In a healthcare organization, that includes creating educational materials to help frontline caregivers follow processes, examining data insights, and keeping up with field literature and developments. An effective IT platform is the conduit for that knowledge to flow and grow.
Putting it all together, a clinical improvement infrastructure helps ensure all stakeholders are in sync and equipped with the right knowledge and tools to move objectives forward.
In developing this infrastructure, we recommend:
Missed Part 1?Go back and read it now. |
You can help ensure patients get no more or less care and tests than they need by establishing an effective baseline care process. The idea is to define an evidence-based protocol to facilitate decision-making, while recognizing that variances will occur.
We recommend six steps to building an effective baseline care process with credit due to Brent James, M.D.:
Let’s acknowledge the elephant in the room: Some physicians shun protocols, reasoning that each patient is unique and demands a unique approach. They do have a point: From my experience, I estimate that two out of ten patients shouldn’t follow a guideline. The baseline care process isn’t designed to replace that individual approach, however.
Rather, it’s designed to facilitate decisions, so clinicians don’t have to remember all recommended tests and treatments. Instead, they can look at recommendations, then focus on: “Is there anything about my patient that says I should do this differently?”
The offshoot is that patients get what they need, and clinicians don’t waste time and resources on unnecessary care and tests.
Change can be tough, and some resistance is expected. You can anticipate and minimize it, however.
Strong leaders build buy-in and excitement around a shared vision by…
Beckhard’s Change Model argues that you can make a compelling case for change when three elements exist: (1) dissatisfaction with the current state; (2) a compelling vision; and (3) agreement on first steps.
Altogether, if the pain of staying the same exceeds the pain of change and people in your organization agree on what needs to happen next, you can overcome resistance.
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Don’t hesitate to contact us for clarification or further guidance on what you’ve read above. We’re happy to discuss how your peers have tackled similar challenges and help you identify next steps.
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