Sustainability requires improved organizational performance and improved value to our customers—that was the point of my colleague, OPEN MINDS chief executive officer, Monica E. Oss in her recent article, Sustainability Management = Portfolio Management. But shifting organizational culture to one that is data driven and can use metrics-based management tools is a challenge (see Understand Your Data, Make Decisions Quickly & Fail Fast and Is Your Organization Data Reactive – Or Data Predictive?).
That why an article about a project in Scotland to engage staff in driving quality outcomes through process improvement activities caught my attention. The project was a joint effort by Raigmore Hospital and the Institute for Healthcare Improvement (see A Simple Way To Involve Frontline Clinicians In Managing Costs).
The project uses the data that’s accessible, educates and empowers staff to identify and implement solutions, and links the whole process to quality targets. I think that organizations get stuck on trying to create complex data systems, and motivating staff to understand “value.” This approach educates and empowers staff, capitalizing on key principles of John Kotter’s change paradigm-creating a sense of urgency, building a guiding coalition, enlisting an army, enabling action by removing barrier, and generating short-term wins.
The project has a few key components for using data to drive service improvement initiatives by educating and engaging direct service staff.
- A simple tool to pull together current data on a weekly basis. The tool (a “box score”) provides key measures that fall into the three functional areas of clinical outcomes, financial measures, and staff capacity (i.e. direct, indirect time). The key is to identify measures that staff can both understand, and have the capacity to act upon.
- A communication process to help staff to understand and analyze the data. Creating a communication process involves two things. First, linking the box score to a “Visual Management Board” that defines the performance measures, captures causes of problems that impact the performance measures, and links to related performance improvement projects. This serves the purpose of both educating staff, and pulling all related information into one, accessible document.
- A strategy for implementing process improvement activities. This process improvement approach creates teams that meet briefly on a daily and weekly basis to review the box score, visual management board, and improvement projects. They can adapt their service processes one week, and assess the impact when the view the updated data the next week.
When used by the Raigmore Hospital respiratory unit, this approach resulted in both an increase in quality results, and a 15% decrease in costs. By educating staff, giving them a data tool to work with, and empowering the teams to adapt services under the process improvement system, they were able to improve services by “tuning the dial” and seeing the results right away. Even though executive staff still monitored results in a dashboard, the process moved ownership of improving quality outcomes into the hands of direct staff.
My question: Would this work here in the U.S. and if so, how?
I think that this approach has great potential for those organizations that are serious about empowering their direct service staff to use data to make quality clinical decisions.
First, it engages staff in understanding the dimensions of creating a value-based service approach by tying together clinical, consumer, and financial data. By working with the data on a weekly basis, staff are able to gain insight into how the data is related to actions that they take.
Second, the approach uses data that is currently available and easily updated. This is important because it emphasizes functional, timely data. The key in choosing the performance indicators is to ensure that they are tied to the quality goals, and can be acted upon. And third, it links data and actions to a formal quality improvement process. Remember, rapid and innovative change is facilitated with an approach like “Plan, Do, Study, Act.” This system creates a tool for accomplishing the three goals of a data-driven approach: pull together data related to intended outcomes, analyze that data and identify potential actions, and put those actions to work to improve your outcomes.
So here is your five-point test about whether your organization is ready to engage your clinical team in metrics-based performance improvement:
- Have you developed key performance indicators and performance standards? Key performance indicators should be created for each level of the organization. They should be specific, actionable, and align with the strategic initiatives and tactics of the organization. Performance standards should also be set, with targets that drive the organization to improve services and operational outcomes.
- Do you have the right data? The data needed for decisionmaking changes over time. This requires a process for continually identifying what data is needed, and ensuring that the data is available through the different data systems (EHR, finance, payroll, marketing, etc.).
- Have you created cross-functional teams that can analyze data, identify issues and solutions, and work collaboratively to implement those solutions? Cross-functional teams strengthen the change process by bringing together comprehensive data and insights. These teams also enable staff to move beyond focus on their specific roles, and understand the entire service delivery and operational process.
- Have you developed a dashboard to make your data accessible to your cross-functional teams? Getting data into the hands of staff on a timely basis shortens the time needed to make service and operational changes. The dashboard doesn’t need to be complicated. It just needs to give staff the information they need to assess where they are on target, and where to spend time in improving performance.
- Is there a formal quality/performance improvement system in place? Key components of a performance improvement system include using data to identify where work needs to be done, a “root cause” approach to problem management (understanding the problem before rushing to a solution), and rapid approach to implementing solutions. Under this approach, teams should be empowered to try new solutions within established parameters, and be allowed to fail fast to move on to better solutions when identified.
For more about managing performance through superior data use, join me on February 15 at The 2015 OPEN MINDS Performance Management Institute for my session, Using KPI To Manage To Improve Performance & Manage To The Market.