• How Strong Willed Is Your Health System?

    Mar 01, 2012

    By James L. Reinertsen  

    Organizational will is not a matter of luck. It can be strengthened through the regular practices and habits of organizational leaders.

    pg43_column-jim-reinertsenIf it hasn't already, your organization will soon face a test of its will, or backbone: the force that makes sure that important improvements are carried out, even against significant resistance. For example, what if a prominent physician ignores important safety practices, putting both your patients and your measured public performance at risk? Everyone will know the right thing to do, but might hesitate because the physician is known to be litigious or a big revenue source. Doing the right thing might put your organization's financial performance at risk, at least in the short term. This is a test of your organization's will to improve safety. Will you pass, or fail?

    Here are three examples of will-building practices that healthcare leaders can adopt, drawn from the experience of high-performing health systems such as WellStar in Atlanta; Legacy in Portland; Seton in Austin, Texas; and McLeod in Florence, S.C.

    Start Every Meeting with a Patient Story

    Choose a recent example of a safety incident, preventable readmission, or some other event that is relevant to data that will be discussed at the meeting. In simple terms, tell a three-minute version of the story, emphasizing the impact on the patient and family. Don't discuss details, don't solve the problem, just let the patient's experience infuse the room. It will change the conversation. (If you want to kick it up a notch, play a videotape of the patient or family members, or even bring them to the meeting. That will take longer than three minutes, however.)

    Focus on the Numerator

    Whenever possible, display your data about performance so that it's clear how many patients were affected. For much of your quality data, this will mean ignoring the denominator, and focusing on the numerator. How many of your patients received defective care last month? How many patients got a preventable infection last month? How many patients were readmitted unnecessarily last month? This is especially important for lay board members. When trustees see the number of people impacted, rather than abstractions, such as "risk-adjusted rates of infection per 1,000 device-days," they start to ask some very tough questions. And they expect improved results.

    Go Naked

    Strong-willed organizations publicize both their goals and their measured performance, far beyond the regulatory reporting requirements. When your community knows that you are aiming to reduce preventable readmissions, surgical harm, or serious safety events-and you regularly send out reports on your progress-it's highly likely that you will take the necessary steps to get results. This sort of transparency takes courage (particularly from your general counsel), but it is a key habit of organizations that have the backbone to pass their tests of will.

    Will is the primary factor that separates organizations that simply try hard, from those that get real results. In the era of accountable care, you will soon face some tough tests of will. Will your health system pass?  

    James L. Reinertsen, MD, is CEO, The Reinertsen Group, and a senior fellow, Institute for Healthcare Improvement (jim@reinertsengroup.com).