Transferring Best Practices

September 18, 2009

It is not finding best practices – it is transferring them.

Recently I attended a think tank meeting in Washington, D.C. At the meeting a well-known political leader, who was very engaging, said that if hospitals learned from non-healthcare companies how to improve process, healthcare would be much better.

He passed out a whitepaper with regards to funding a study which combined 5 top healthcare systems with top academia experts in areas such as process improvement. The paper went on to show how implementing the processes used in academia would help improve healthcare. They show how a physician, in streamlining processes, improved clinical care and reduced cost. It is a paper that is hard to disagree with in its intent.

I have great respect for this person and agree that there is solid room for improvement in both quality and cost regarding healthcare performance. I just don’t think we need another study on what to do to improve or create high performing organizations. We see high performance firsthand and read about it all the time.

As we seek to improve quality and access and reduce cost nationwide, to me the real question is not finding new best practices. The critical issue is how to transfer already existing best practices.

Why has this been so hard to accomplish in healthcare? There are areas in which high performance is transferred quickly. This is particularly true on the supply side. When a technology or pharmaceutical vendor has new software, equipment or medication they are quick to push the product into the healthcare arena. The challenge is not in purchasing such items, for the vendor will show the return on investment, the challenge is maximizing the value of this product in the organization. So the supply side of healthcare pushes what they feel are improvements into organizations and spends millions of dollars to make organizations aware of items and the value of each.

Often, the best practices related to demand, efficiency and effectiveness may actually require less expenditure, not more. They likely don’t have millions of dollars in advertising or sales tied to them. In reading an example of a physician best practice outlined in the white paper, if all physicians implemented, some on the supply side would do worse financially. So for some best practices there may not be an avenue to promote them by private companies. I am sure suppliers are looking to improve healthcare, and I do not fault them for doing what they feel is right, which is to have the organization purchase their solutions. My point is many improvements in healthcare are around people, systems, processes and execution; these most always require behavioral change. It’s not in the use of a new tool or medication. Substituting one medication for another is not a new behavior. It’s not a new generation of technology or software but many basic behaviors that need to change.

In order to implement the changes that we identify a need for through TQM, CQI, Six Sigma and Lean, it will come down to the organization’s leaders’ ability to align behavior, drive or entice actions and to hold people accountable. There is not a shortage of sound examples in healthcare. It is the inability of an organization to transfer these examples within their own organization, or even harder, to transfer from other organizations to their own.

For the past 6 months we have conducted a survey with many healthcare organizations. One of the questions we ask leaders is to rate their ability to transfer best practices within their own organization. On a 1 to 10 scale, with 1 being the lowest and 10 the highest, less than 10 percent of the senior leaders rate their organization’s ability to transfer best practices a 9 or 10. The average rating is a 5.

In my new book, Straight A Leadership: Alignment, Action and Accountability, which will be out shortly, I address the challenging issue of moving best practices. There are some obvious points and some below the surface issues.

Here are a few we have learned:

Issues below the surface:

  1. Leaders want their autonomy. By implementing some other way of doing something the leader will give up a bit of their autonomy.
  2. Leaders fear that if someone shows a particular method to work and they fail to successfully implement it, that this will be a bad reflection on their leadership. We can learn a great deal from physicians here. They are quick to duplicate others processes if they feel it will improve patient outcomes.
  3. Some feel they are different or suffer from the disease of being terminally unique. We are so much more alike in healthcare than different. This can also come across as rationalization.
  4. Ego. By the time some people get to the C-suite they are better leaders than followers, thus to copy or duplicate another leader or organization is hard.
  5. Too much change. There is so much change in so little time that the new way is not mastered and this feels like the practice did not live up to expectations or, because the execution was not crisp, it led to desired results not being achieved.

Other issues:

  1. Leaders who have best results and best practices are reluctant to promote them. The majority of leaders in healthcare are humble individuals who will say they are just doing their job and do not see what they are doing as special. So they do not promote them. Due to little money budgeted for a vendor the leader does not have a public relations and research arm with a sales force to take their practices elsewhere. Thus, best practices can be missed in an organization.
  2. Some may feel it is the leader and not the process. Often, leaders who discover, create and or implement best practices are high performers in an organization so the focus is on their skill and not the practice. This is many times part of the equation so the actual practice is missed or underestimated.
  3. The leader downplays what they are accomplishing. In healthcare I find that leaders are reluctant to take the spotlight and will downplay what they are doing. I have example after example of this. When I go to an organization I review data. I then visit a leader with outstanding results. When I ask them what they are doing, the first response is “nothing different from anyone else.” I then dig deeper with more specific questions and then I hear, "Well, we are doing this . . . " This then starts to identify processes, tools and techniques contributing to the high performance.
  4. The leader is reluctant to teach others. When the high performing leader is asked to present what they are doing to others in the organization, they are reluctant. They often say they don’t want their peers to feel they are saying they are better or they don’t want others to feel bad. If they do present they tend to hold back and even give reasons why they can do it but it may be hard for others to do. They feel uncomfortable separating themselves from others. In fact, they will do a better job explaining what they are doing to people from another organization versus their own.
  5. The leader fears they cannot sustain the success if word gets out.

Tips:

  1. When a leader’s results starts to separate into better or high performance take time to view and diagnose what is being done. This needs to encompass any change in process, tools or techniques. Just as important, diagnose any change in the leader’s behavior.
  2. Take time to document the findings in Tip 1.
  3. Create on paper a best practice transfer system that outlines outcomes, process and answers to any push back that will come from others. This is why best practices in one organization are so important. This takes away geographic and demographic excuses or items like staffing, pay, benefits, physicians and corporate. If this leader can do it here so can others.
  4. Assess needed skills to implement best practices: The person who created or implemented the best practice first has some skills that others may not. Assess what skills a leader must have in order to implement the practice successfully. They do not likely have an early adopter personality so skills that are there with the early adoptor are not there and must be acquired. If the leader does not have these skills, you may have to change the leader.
  5. Accountability: The best practice is meant to improve performance.  Are the desired outcomes included in the leader evaluation that monitors and evaluates performance? If not then the best practice becomes an option and will likely not be optimized.
  6. Are behaviors spelled out and sequenced for success? This will avoid making changes too much and too fast which leads to transfer failure.
  7. Put in validation systems. Tools that validate implementation are critical to measure implementation. Trust but verify.
  8. Spotlight with recognition those areas that are doing well in implementation. Ninety-two percent of people will move to what is being recognized. Use meetings, emails, letters and other avenues to spotlight those areas that are implemented well as milestones are reached. If you wait until you achieve the ultimate goal before acknowledging, you may never reach it. Those areas being recognized feel good and others who are not will notice and most likely move to the desired behavior.
  9. Identify the why and keep in front of the organization. In healthcare, when changes are being made, there are valid reasons and plenty of why. Make sure the why is communicated often; such as improved care to save more lives, better access to help more people, lower expenses that provide better organizations and staff security. In healthcare the “why” drives the “what.”
  10. Have a firm plan in place for those who do not have the will, the skill or both. If a leader has the skill to implement a best practice then the question is does the leader have the will. If they have the will, the question is do they have the skill. If they have both will and skill, success will be there. If they have one and not the other, ask yourself whether they can acquire the other, how fast and at what cost. Decide if the time and cost are worth the investment. If you feel it is not, then move quickly to remove the leader from this position. Over the years many best practices have taken a bad rap for lack of leadership.
  11. Standardize the steps and learn from your organization’s experience. Make sure you have in place the best technique to transfer best practices generated within your own organization and also those you learn from others.
  12. Relate, don’t compare. There is not a shortage of better ways to do things in healthcare, nor is there a lack of desire to share. A great characteristic in healthcare is the willingness for organizations to teach and learn from each other. While there will always be differences, the similarities will outweigh them. Relate on how to transfer.

Healthcare can spend lots of money to study non-healthcare organizations (who by the way are also not doing that well), to bring outside learning into healthcare (already done), or they can solve the real issue: how to transfer high performing leadership characteristics, tools, processes and techniques that increase access, achieve high clinical outcomes and lower cost throughout all healthcare organizations. There is not a magic pill or process. It is an organization’s ability to standardize high performance into their daily operations.

Sincerely,

Quint Studer

Quint Studer, CEO
Studer Group
http://www.studergroup.com/

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2 Responses to “Transferring Best Practices”

  1. ibrown Says:

    I agree with the author of your referenced whitepaper. Too often hospitals isolate and disconnect from the researched concepts that surface as opportunities to effectively improve the simultaneously simplistic in concept and complex upon implementation issues in our healthcare market today. Clearly, often times healthcare leaders (administrative and physicians alike) are not engaged in the strategic planning process. This is the first step to offer more than globalized reference to these researched concepts. This is how and where I think the transfer of best practices (whether within or from external resources) begins to fail. I believe that leadership should not only seek success from within at the micro operational level, at the dept level, at the clinical and administrative level, but each organization should seek this intent in a strategic, sustainable format. This requires on-purpose strategic collaboration among all parties with a true vested interested in success of healthcare at the local, regional, and global levels.

  2. Ellie Smith Says:

    3. Create on paper a best practice transfer system that outlines outcomes, process and answers to any push back that will come from others. This is why best practices in one organization are so important. This takes away geographic and demographic excuses or items like staffing, pay, benefits, physicians and corporate. If this leader can do it here so can others.

    While reading the third tip in Quint’s blog, I was reminded of the best practice known as service mapping. This is a process which is particularly effective when patient satisfaction scores are low in a particular area, yet the organization cannot seem to “fix” the situation.

    Service mapping is defined as the sequence of service process steps focusing on the customer’s experience, from the customer’s point of view. It gives staff an opportunity to understand expectations and empathize with the fears and anxieties of a patient as “seen” through that person’s eyes.

    For example, perhaps a patient care unit is experiencing a dip in scores; several strategic tactics have been tried, none of which has helped. So a cohesive multidisciplinary team is brought together, consisting of staff nurses, physi¬cians and other care givers. They identify – on paper – critical transaction points in the service experience as perceived by the customer; this in turn will help them make improvements at those junctures. Each step in the patient care continuum is considered as team members ask themselves, “What is the patient experiencing at this point in time, what are that person’s emotions?” Then, “What are we doing currently and how can we improve?”

    Once the service mapping process isolates the various touch points, strategies can be developed to effect the necessary changes. How better to transform the healthcare experience than gleaning the customer’s viewpoint and reacting positively to what that person is going through?

    The beauty of service mapping is that it will work anywhere in the organization, in any department experiencing service related problems. And because the touch points are identified on paper, one leader can easily transfer the best practice to another leader of a like department or unit. This cuts down on duplication of effort.


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