Dysfunctional health care can harm everyone involved. Too many health care clinics are wrought with stress, scarcity of resources, outdated systems and thinking, bitter staff and angry, demoralized patients. This harms not only patients, but providers, staff, and whole communities.
Delivering efficient, caring, accessible health care is not just an ideal, but a moral necessity. Once a problem is recognized to negatively impact the lives of patients, providers and staff, it is unethical to turn away from solving it.
Identifying the problem is the first crucial step to solving the problem. Those courageous and diligent enough to do that in the beginning have a strong chance of solving the problem. They'll also have a reliable yardstick to measure the relevance and effectiveness of various options.
Standards must be defined, measurable and required. "Excellence," "High Quality" and "Accessible" are not standards. For real change, executives must set and commit to clearly defined standards, including clear criteria for how they will be measured, what constitutes acceptable performance, and what the consequences are for unacceptable performance.
Consequences must be expected and enforced. When there are no consequences for unacceptable performance, morale suffers at least as much as service effectiveness.
There must be unanimous support for the change. One negative staff person can undermine change initiatives no matter what management thinks or says. Those who can't support the change are no longer a fit for the organization.
Productive, profitable, service-driven health is a win-win-win solution for patients, providers and financial stakeholders.
Top down-management is essential for good leadership, clear vision, expediency and accountability. That said, every initiative should be managed at the very lowest and most local level possible.
Bottom-up problem-solving by those directly involved in the work is the best and most sustainable means of innovation. The basic building blocks of effective clinic performance are small cross-functional teams who work together daily, tasked with continuous monitoring and improvement of at least one aspect of clinic performance, and empowered to try custom approaches to solving problems.
The 80/20 rule applies to changing clinic performance: 80% improvement can be achieved by solving 20% of the problems. 80% of the innovation will be led by 20% of the staff. 20% of the training budget should be for delivering the training; 80% of it should be for ongoing supervision and monitoring to ensure new standards are met.
Use the right medium for the message. There is no substitute for face-to-face training, but video, animation and e-learning can be the most effective way to teach ideas and behaviors that are complicated, the same across many locations, or important for staff roles where there tends to be high turnover. 1) Animation can be best when you want to show a complex idea (like a software application or collaborative work flow). 2. Video can be best when you want to highlight charismatic individuals, or show processes or communications techniques. 3. E-learning can be best when you need to track how completed certain segments, or how they performed on evaluation.
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