Journal of Healthcare Management - March/April 2014 - (Page 151)

w Hy H ospital i Mprove Ment e fforts f ail : a v iew f roM organizations frequently set unrealistic deadlines. Ambitious schedules can be established, but they must be tempered with the reality that implementation planned for an unduly short time frame can short-circuit the change process and cause leaders to "jump from having an idea or plan for improvement directly to implementation," with negative outcomes. One team captured the essence of this discussion as "bad planning plus unrealistic deadlines = failure." Leadership lesson: There is no substitute for taking the time to properly plan for the implementation of any desired change or improvement initiative. Without proper implementation, critical resources can be wasted without producing a tangible positive outcome. Key Factor 2: Failing to Create Buy-in for/Ownership of the Initiative Participants provided myriad examples in their focus groups describing how change and improvement efforts failed because of a clear lack of, in their words, frontline "buy-in," "empowerment," "engagement," "participation," and "ownership." A strong sense emerged from the discussions that hospital frontline personnel were frequently not included in important discussions and decisions surrounding how change initiatives might be rolled out to the organization. It was made clear that this lack of effort to "create buy-in" and "ownership from frontline personnel" demotivated, disenfranchised, and disenchanted the very people who were most necessary for effective implementation of any change or improvement initiative. Regardless of the nature of change, participants stated that without such tH e f ront l ine buy-in and ownership, frontline personnel are less likely to be committed to the change and take the steps necessary to ensure that the change will be implemented properly to achieve desired outcomes. Participants added that this lack of buy-in is frequently driven by the fact that senior leaders have failed to make a strong case or provide a solid explanation for the necessity of the upcoming change. This "case for change" is critical, as frontline personnel need to know exactly why changes are being required and what the desired expectations and outcomes are. Leadership lesson: Without input, buy-in, and ownership from the people responsible for making the change work, the likelihood of maximum performance diminishes significantly. Key Factor 3: Ineffective Leadership and Lack of Trust in Upper Management It is a well-worn axiom of organizational life that without effective leadership at all levels of the organization, real change or improvement is difficult at best to achieve. Participants frequently supported this position as they made it clear that, more than 60% of the time, ineffective leadership was a primary cause of an inadequate effort involving change in performance improvement. When people do not trust their leaders, whether the issue is character or competency, people are unlikely to provide maximum effort. When ineffective leaders attempt to implement change, their lack of credibility and trustworthiness provides their employees with a readymade reason to not fully engage in these efforts. 151

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014