Why tactical tools are not enough, and what to do about it.

As hospitals struggle to financially recover in the post-COVID landscape and pressures grow to slash costs, healthcare leaders are racing to implement tactical changes shown to produce massive savings at other organizations, in hopes of mirroring those successes. In practice, those changes are never as straightforward as they seem on paper. 

Rather, what seems like a slam-dunk solution in theory can (and often does) get derailed, creating unforeseen costs, conflict, and adverse consequences. What is often missing in these situations is thoughtful attention to the cultural foundation essential for the successful deployment of disruptive change. Executive coaches can help bridge this gap, accelerating speed to execution, cultivating stakeholder commitment to increase the probability of success, and protecting the organization against costly lapses and blind spots.

In this post, we explore why tactical tools fall short, critical steps to driving commitment to shared goals, and how to boost your probability and speed of success.

Minimum standards or optimum performance?

In our work with healthcare clients we frequently see organizations seeking breakthrough improvement in one or more performance indicators by implementing tactical programs that have proven successful elsewhere. Examples of such programs cover a broad spectrum including adoption of evidence-based clinical standards, span of control ratios, patient experience initiatives, deployment of high reliability and process improvement programs, and efforts to redefine an organization’s market image and brand position.

In one example, imagine a team of consultants came into your hospital, examined the way physicians manage patients with congestive heart failure, and shared “evidence based” best practice protocols to optimize patient care and save money by avoiding unnecessary days in the hospital, diagnostic tests, and therapeutic interventions. On the surface, it makes sense. The problem is that the building blocks for deploying the theoretical “best practice” may not be in place.

The most obvious source of variation is in patient specific conditions which call for adaptation of the best practice. But variation in the other factors like training of the nursing staff, physical layout of the nursing units, availability of diagnostic test results, or a myriad other elements which are part of the patient care process may call for adaptation which blind “compliance” with the protocol would ignore. Not surprisingly, doctors who are mindful of patient variation and other important process elements  are likely to struggle to comply and see the protocol as something which represents what they fear most: loss of autonomy and compromise of their primary responsibility to the patient.

In such scenarios, the organization often doubles down on monitoring “compliance” to ensure clinicians and staff are following the mandated change. Not surprisingly, dissent festers as physicians and staff challenge the merit of those mandated changes. It’s no wonder, then, that initiatives implemented with that compliance mentality show nominal improvement, at best.

So what is the alternative? How do you create an approach which energizes people and cultivates a sense of ownership and commitment to changes designed to improve performance, instead of imposing changes that provoke resentment and resistance?

When deployment derails the path to progress

We believe one root cause for failed transformations is faulty deployment — sowing tactical “seeds” without first creating a fertile culture for those seeds to take root. The result is that employees and physicians who view new protocols as unwelcome disruptions settle for dispassionate compliance with minimum standards rather than the passionate pursuit of the purpose for which the program was created.

Leaders have a responsibility to create a culture that fosters a deep, personal commitment rooted in the desire to do work that makes a difference. Based on our experience, it’s why many healthcare leaders seek out executive coaching as an investment in the outcomes they’re seeking, and a layer of protection against execution blunders and misfires.

After all, the transformation you’re looking to set in motion won’t go as planned unless you get the heart and culture components aligned with the intended substance of the change. Managing the transition to emotional acceptance of change is key to the change achieving its desired impact.

You can give your organization the best chance of success in moving workers from compliance to commitment by following the seven critical steps outlined below.

  1. Focus on the “why.”

If you are to capture the commitment of your staff and inspire them to invest their thoughts, ideas and passion in the effort, it is essential to connect the work of their hands to a sense of higher purpose.

Much has been discussed recently, most prominently by Simon Sinek, about the importance of starting with “why.” That body of work captures the fundamental emotional (and, as it turns out, biological) reality that our feelings drive our decisions far more than rational facts.

Connecting your team to the impact that their work has on the people you serve can inspire them to do more than comply, using best practice tools and tactics to their full effect.

  1. Look first at leadership and the environment.

What leaders say is far less important than what they do. For organizations seeking to create a culture of commitment to transformation, the change begins in the C suite. We often see leaders who are asking for radical change from others but make no changes in the way they spend their time, effort and financial resources.

Leaders, whether they want to believe it or not, define and set the culture, and it is essential for the leadership team to re-examine every aspect of their work to ensure it aligns with the transformation they are seeking. Careful attention must be paid as well to symbols, language, stories, celebrations and recognition of “heroes” whose efforts give form and expression to the desired cultural shift.

  1. Build a “covenant” around the “why.”

Another mistake often made by leaders is the deployment of tactical programs that place the primary responsibility for breakthrough improvement on the shoulders of staff without a commensurate commitment to support them in their efforts. For example, it is not enough to define service standards and scripted conversations for employees to transform the patient experience if the organization does not have a parallel commitment to fix the systemic problems that stand in the way of their efforts to provide extraordinary care.

Think of it as a covenant between the organization and its people in which each person is asked to do their best to drive performance while the organization commits to creating conditions that make it easier for them to do so. Without this balance and support, employees can quickly become cynical about the organization’s call for transformation.

  1. Engage and equip people to take ownership and influence the change process.

The key to building ownership is engagement, giving voice to those whose support is key to achieving success so that their legitimate needs and requirements are addressed in the design of the change.  Engaging staff to drive improvement can be powerful, but it is important to equip them with the information, training and support required for them to do so effectively. Without that, rather than feeling empowered, staff can feel threatened, knowing that something is expected of them but not knowing how to deliver the desired result.

  1. Lead through the transition.

Change — even change with significant potential for positive impact — can be threatening for those who have to let go of the known to venture into uncertainty.

Leaders play a vital role during transitions: engaging those affected by the change to assist in the design process, honoring and bringing forward positive elements from the past, providing assistance and support through the awkwardness of adjusting to the new reality, and listening and responding to what is learned as the change is deployed.

  1. Communicate, communicate, communicate.

A critical part of leading through a transition is extensive, multi-channel, two-way communication. It is vital to share the impetus for the change, a compelling vision of the desired future state, a pathway to the future, and regular updates on the status of the effort. It is equally critical to listen and gather feedback to assess progress and adjust based on what is learned as the journey progresses. 

One of the harder things leaders must do is distinguish between negative feedback reflecting the unavoidable awkwardness of change from negative feedback about legitimate issues and concerns for which adjustments are required. Leaders must provide support and encouragement to push through the awkward period long enough to see the impact of the change at maturity. But leaders must be careful not to turn a deaf ear to legitimate concerns which, if left unaddressed, could jeopardize a successful outcome.

  1. Measure and report in a spirit of improvement.

Measurement is an important indicator of progress and source of learning, and any effort at transformation should define and closely track critical measures of success. Combined with a spirit of learning and improvement, data is a powerful tool. Misused as an instrument of blame, however, data becomes a threat against which your team will seek to protect itself.  This difference is subtle but powerful. 

Think about it in the realm of clinical improvement. Frequently, healthcare organizations seeking to eliminate unjustified clinical variation develop “compliance” reports on how often physicians adhere to evidence-based, best practice protocols. Typically that “compliance” approach provokes resistance as physicians recoil against loss of autonomy and the notion of “cookbook” medicine.

Contrast that with hospitals who use evidence-based standards as a tool for learning through variance analysis in the belief that practitioners desire and will use information that equips them to perform at their best. In those institutions, reception among physicians of the information that flows from the very same tools is typically far more positive.

Putting it all together

Successful transformation of organizational performance starts with the transformation of culture. It is not enough to provide your team with tools and standards. Leaders must reach and inspire the soul of the organization.

It’s a tall order but one that’s fundamental, and that can be greatly facilitated and accelerated with executive coaching. Only then will tactical change, driven by personal passion, realize the promise of breakthrough improvement.

The healthcare environment is more turbulent than ever before, demanding nothing short of transformational change. To meet this challenge, organizations need exceptional leaders with skills to design and execute a blueprint for success amidst rapid and dramatic change.

Have you ever considered engaging an executive coach to help develop those individual and team skills? We at MEDI Leadership would love to talk with you about how we can help.

Drop us a note or give me a call at (904)-543-0235.

Robert Porter
About the author

Robert (Bob) Porter is an accomplished organizational leader with over 30 years’ experience in health system leadership.
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