Journal of Healthcare Management - March/April 2014 - (Page 154)

J o u r n al of H ealt H care M anage Ment 59:2 M arcH /a pril 2014 and cooperation are not natural byproducts of hospital work life; they need the foundation of effective leadership and specific efforts aimed at "breaking down walls," "eliminating silos," "reducing self-interest," and "building cross-functionality." For improvement initiatives to be successful and to take hold rapidly, diverse groups must come together with a shared sense of purpose and vision to develop a plan or process that encourages and even motivates people to work together. It is becoming increasingly difficult to solve a problem or improve a process in one part of a hospital without the new process affecting another part of the system-a phenomenon known as the law of unintended consequences. Leaders must take into account that activity in one area, viewed as improvement, might hinder the performance of another unit. Thus, it is important that they approach improvement with the team-based, problem-solving mind-set and introduce systems thinking into their efforts. Leadership lesson: Teamwork and cooperation are critically important to an organization's ability to increase the likelihood of successful change and accelerate the change improvement process. Key Factor 8: Failing to Provide Ongoing Measurement, Feedback, and Accountability Any successful change effort is characterized by ongoing measurement feedback and accountability for action. Because of the magnitude and volume of changes taking place in hospitals, it is not uncommon to see leaders responsible for handling multiple change initiatives at any one time. A natural by-product of this flurry of activity is a lack of time available to establish and provide appropriate levels of ongoing measurement, feedback, accountability, and follow-up. The focus groups discussed and made light of the fact that they were regularly engaged in change activities that frequently "disappeared," "fell through the cracks," "just went away," "died a slow death," or "were simply forgotten." All of these descriptions made it clear that those in charge of the change initiatives were not serious about delivering a real and tangible performance improvement or outcome. These practices were quick to elicit and breed "cynicism," "distrust," "skepticism," and "suspicion" on the part of the organization's members, who had been conditioned to not take these improvement efforts seriously. One team's description was apt: "Change efforts fail when leaders don't track progress or coach people daily." Ongoing measurement allows people to know that performance is observed, and that observation serves as a motivator. Ongoing feedback lets people know how well they are performing and what they need to do differently to improve. Finally, without enforcing accountability and providing follow-up, leaders send the message to their employees that the changes they have been asked to make are not important. Leadership lesson: For a change effort to achieve a desired outcome, individuals and teams must receive ongoing measurement and feedback on their performance and be made accountable for progress. 154

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