Driven by the pressures of rising costs and the need to provide a better patient experience, health care organizations of all types and sizes are increasingly focused on designing and implementing health care improvement efforts. However, a new study from the Institute for Healthcare Improvement reminds organizations that simply improving care isn’t enough on its own.
It’s also necessary to have a strategy in place for ensuring that any improvements made will be sustainable over the long term. Without such a strategy, there’s a real danger that early progress will disappear as attention shifts to other concerns and people fall back into old habits and entrenched systems.
So, what can organizations do to ensure the longevity of improvement efforts? The IHI study looked at a number of leading health care organizations that had not only achieved, but maintained, impressive improvements. It found one key attribute that all of them shared: a strong focus on ensuring that frontline managers and point-of-care staff are deeply engaged and that their work is standardized.
As outlined in a recent Harvard Business Review article, here are four steps that can help organizations effectively engage point-of-care staff and standardize their work as a way to promote sustainable systemic improvements.
Choose a pilot unit to test-drive new methods.
Choosing one clinical unit to serve as a “model cell” where testing, experimentation, and learning can happen on a small scale is a valuable first step in standardizing work for managers. For maximum effectiveness, it’s important to choose the unit judiciously. Key characteristics of a good pilot unit include:
A stable environment. Low staff turnover will make it easier to train teams and ensure that new knowledge will be retained. Stable units can also offer valuable insights in the form of ideas and testimonials from long-term staff.
An understanding of the context in which change will be made. Unit managers need to understand not only how their work is going to change, but why. When managers have a sense of the bigger picture and can see how changes will help sustain quality, they typically have a stronger commitment to helping implement and maintain those changes.
Good management practices. A pilot unit won’t be very effective at showing how broader-scale changes could look unless it already has good management practices established, including accurate budgeting and a consistent staff schedule. If a manager has enough on his or her plate dealing with a disordered environment, he or she won’t be able to focus effectively on the changes needed for improvement.
Start with the immediate supervisor.
According to the organizations profiled in the IHI study, the true frontline clinical leader is not the administrative manager, the director of patient care, or even the supervisor for the unit. Rather, it is the day-to-day operations manager, typically the charge nurse responsible for supervising patients’ nursing care.
Because leaders such as charge nurses and nurse managers have a highly-active, hands-on role in managing processes before, during, and after shifts, they are the people that will be most directly impacted by work standardization initiatives. They are also the ones who can best ensure that these changes are carried out successfully.
As such, these individuals should be at the heart of any improvement efforts. Otherwise, it’s very easy for systems to return to former processes and behaviors. This can in turn lead to administrative supervisors becoming counterproductively involved in micromanaging the daily routine of the clinical unit.
Build impetus from early successes.
It’s important to set the chosen pilot unit up for success by focusing on simple goals that the unit can achieve right away. For example, leaders in charge of improvement efforts – such as the charge nurse as described above – might choose to start a daily meeting as a way of monitoring and assessing the progress of improvement initiatives, perhaps using tools like visual management boards and simple tracking metrics.
Processes like these can be implemented and tested relatively quickly, making them ideal as “starter” goals. The idea is then to use these early successes to boost staff motivation and give teams the confidence to move on to other, more complex goals.
Focus on problems that frontline managers care about most.
Regimenting the work of managers, however clearly defined roles and responsibilities are, will not be successful if the managers themselves aren’t invested in the effort. To help them do so, leading health organizations have made it a priority to take their cues from the managers, focusing on implementing changes that address significant, manager-identified problems.
If managers can see that changes are specifically being developed in order to make their jobs easier – and their ability to care for their patients more effective – their motivation and buy-in for those changes will be that much stronger. By removing day-to-day hassles, simplifying workflows, and transforming chaotic environments into methodical ones, managers can have greater freedom to build change momentum and tackle other problems.