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Collaborative Workout

During business school, I took a course on Organizational Change with Bill Joyce, one of the consultants who helped design the GE workout program to:

• realize tangible improvements within a short time
• reduce bureaucratic barriers that hinder decision making and implementation
• expose and overcome misalignment of incentives
• generate ideas at every level
• increase visibility
• improve accountability

I wondered why healthcare organizations did not take advantage of the concept and process until I read What Top-Performing Healthcare Organizations Know: 7 Proven Steps for Accelerating and Achieving Change ( Butler G, Caldwell C. 2009. Chicago: Health Administration Press), which reads like a survival guide for senior healthcare executives and middle managers, with a coherent rationale, data from 222 hospitals, multiple checklists, and three case studies.

The book’s  premise is that organizational success hinges on how transformational initiatives are organized for accountability and action.  Structure drives culture as much as culture drives structure, according to the authors.

The reasons that the GE Workout model is impractical in healthcare settings are that it:

• Required healthcare providers and senior and middle-level administrators to remove themselves from the work environment for 2-3 days at a time, too long to be away from a dynamically changing situation
• Expected testing and redesign to be complete within 2-3 days, too short a time considering the complexity we face in healthcare settings
• Focused on a set of projects rather than promoting an ongoing performance improvement process

Instead, the authors tailored a process for healthcare organizations called the 100-Day Quality Workout (p.29), which proved more reliable in organizing healthcare professionals for change and creating a culture of action and accountability.  I liked the way they debunked the concept that accountability conjures up notions of judgment and failure.  A strong accountability system can help leaders focus attention on results while creating regular opportunities for collaboration and information sharing across departmental silos. 

The advantages of dividing each year into 20-day planning and 100-day implementation cycles are that it:

• fosters a perpetual environment of improvement
• limits the tendency to plan at the expense of execution
• creates urgency for change
• focuses the entire organization on achieving improvements in major core processes
• eliminates unneccessary meetings and unproductive teams

A case study that I found compelling (p.113-116) involved a 300-bed community hospital that faced budget pressures as a result of Medicaid cuts.  It recognized that layoffs were not an ideal solution in this tight-knit community and embarked upon an operational performance improvement program that generated nearly $5,000,000 in cost recovery the first year but less that $1,000,000 the second year, despite considerable effort. 
Using the 100-Day Quality Workout , the hospital evaluated staffing patterns on an hourly basis.  Each manager developed a plan for transforming his or her staff.  They eliminated minimum staffing burdens, cross-trained healthcare professionals, implemented irregular shifts, and staggered 12-hour shifts to match staffing capacity more closely with demand.  During the first 100-day cycle, they saved approximately $2.1 million . 
An Internet-based monitoring system tracked progress, so that results were visible to everyone in the organization.  This system created healthy competition and opened managers’ eyes to what others were doing.

It would be impossible to summarize the lessons of this well-written book in one blog post.  I encourage readers to buy this book, set a stretch goal to read it over a weekend, and implement at least one of its excellent ideas within the next 120 days.

What do you think?

• Are 20 days of planning and 100 days for implementation sufficient to make significant changes in a core process
• Does a system like this owe its success to top-down (executive sponsorship) and bottom-up (managers define quality) measures
• Is a “perpetual system of improvement” self-energizing

 As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
© 2009, all rights reserved

Posted in Building on Success

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