Through good intentions, leaders often support too many improvement projects, producing lackluster results.

pg43_column-jim-reinertsenOne health system CEO recently visited a team working on readmissions and learned that, within her own system, there were six other readmission working groups, task forces, and project teams—in addition to the one she was visiting. The team complained that the different groups were duplicating efforts, competing for resources, inhibiting coordinated implementation, and even using different metrics. Not surprisingly, no one team was having much impact on readmission rates. One team member called it the Tower of Babel.

Too Much of a Good Thing

How did this health system wind up with seven different groups working on readmissions? As it often does, the answer in this case came back to leaders’ inability to say “No” to enthusiastic proposals and good ideas. One team was formed after a faculty member received a grant to research ways to reduce readmissions. Another team arose because of the desire of an ambitious nursing leader to develop a nursing-led program. Still a third (the one the CEO happened to visit) was part of a national collaborative. Yet another was a two-year old chronic disease management initiative that sprang out of a medical home endeavor. 

When the CEO looked back at her own role in this mess, she realized that, during the past two years, she had personally signed letters of support for grant applications or other endorsements for four of the seven programs. As Pogo would say, “We have met the enemy, and he is us.”

I see this too much of a good thing problem in many organizations, and not just for readmissions. There are often multiple different groups, both official and informal, working on hospital-acquired conditions, flow management, coordination of chronic disease care, and other important problems. Most workgroups arise because good people want to have an impact on these problems; then they hear about a grant, a national collaborative, or an internal quality priority, and apply for permission, letters of endorsement, or support from their leaders. But if leaders uncritically say “Yes” to each of these initiatives, it can lead to the Tower of Babel situation described earlier: wasted staff time, stretched data and project support resources, fragmented attention of managers, dispirited teams, and stagnant results. 

The Few, the Fruitful

Health system leaders are under intense pressure to produce better results in safety, care outcomes, customer service, and costs. In other words, we already have very busy improvement agendas. We don’t need to add any more complexity. So before you say “Yes” to the next enthusiastically proposed initiative, you might want to ask some hard questions such as:

  • Is this initiative on the critical path toward our key quality, service, and cost goals?
  • Who in the organization is already working on this issue? How will we “make sense” of these efforts, and align all the work?
  • Do we have the analytic and data resources to give this initiative proper support?
  • Do we have enough managerial time and attention to implement and spread good ideas that arise from this initiative?

If you aren’t happy with the answers you hear to these questions, perhaps you would be better off turning down the request. It’s better to focus on a few things and to get results than it is to waste staff and organizational resources on dozens of poorly coordinated, fruitless projects. Sometimes the best thing a leader can do is to just say “No.”

James L. Reinertsen, MD, is CEO, The Reinertsen Group ( 

Publication Date: Friday, March 01, 2013