When I ask healthcare leaders what initiatives they have for their organization, they are usually quick to share a fairly lengthy list. Usually it starts with areas they are already addressing, and then moves to plans that are in development. Leaders often share they have more initiatives they are working on than they can count.

An abundance of initiatives can be a great sign of a vital organization with leaders who are committed to improving healthcare delivery. Unfortunately, there’s also a shadow side. We’re seeing a problem when it comes to engaging the frontline employees who are responsible for implementing these initiatives and improvement plans: the growing number of initiatives is leading to widespread initiative fatigue.

The Law of Initiative Fatigue states: “When the number of initiatives increases while time, resources, and emotional energy are constant, then each new initiative—no matter how well conceived or well intentioned—will receive fewer minutes, dollars, and ounces of emotional energy than its predecessors.” (Douglas B. Reeves)

Increasing priorities detract from the efficiency and effectiveness of all initiatives. They also drain employee morale and can lead to reduced emotional investment in future initiatives. Let’s dive into the symptoms and talk more about the overall impact.

The Symptoms

  1. Too many #1 priorities
    It’s not uncommon for healthcare management teams to have 50 “top priorities” that they are balancing. However, without a true hierarchy of priority and ownership, no one can have that many priorities and be effective at addressing all of them. Plus, it’s impossible for the front line to know what to focus on today.
  2. Low morale
    Generally, morale goes down when employees are confused about what they’re supposed to be doing, and how they contribute to the success of the organization. Too much ambiguity around priorities makes it difficult for teams to feel they are a part of the solution.
  3. Lack of clarity on what drives results
    Most organizations have clear goals and strategies identified. Often, though, teams don’t know what they can do today to have the biggest impact on achieving those goals. Frontline employees feel disengaged and managers feel stuck.

Let’s looks at an example. The senior management team realizes that length of stay (LOS) is an issue. Therefore, they create a goal to lower LOS by half a day. This is usually a very good thing for hospitals to focus on. But if you leave it at that—the lowered LOS goal— it becomes meaningless to many employees. For example, the radiology techs don’t know how their job impacts the goal, so they tune it out.

The Cure

In order to improve healthcare organizations clinically, operationally, and financially, we have to identify what needs to change. But we also must spend enough time and effort on identifying what the key outcomes of those initiatives should be. The cure lies in four key areas:

  1. Prioritizing initiatives
  2. Identifying who is responsible
  3. Determining what the frontline drivers are
  4. Understanding the key performance indicators that will determine the success of the initiative

Healthcare leaders need to understand the big picture of all initiatives and how they are impacting goals. Frontline employees need to know how their role makes a difference.

If you’re a healthcare leader, can you say that you know every initiative or performance improvement project going on in currently your hospital? Or, do you have one place to go to find the answer?

Going back to our earlier example, the radiology tech might say, “What I do has no impact on LOS.” But what if they knew that the turnaround time for inpatient MRIs has a dramatic impact on length of stay? When a physician orders an MRI and it takes two days to get it scheduled and completed, you’ve added two days to that patient’s length of stay. With the knowlege that turnaround time impacts the LOS, the radiology techs can now focus on their contribution to the initiative—empowering them to feel connected and a part of achieving the goal.

A Strategic Integrated Work Plan

We help healthcare systems implement a Strategic Integrated Work Plan (SIWP). SIWP is a comprehensive operating system designed to organize, prioritize, and communicate organization-wide project plans to gain accountability and measure results.

The SIWP process starts with a straightforward diagnostic question: “Do we have the right structure and alignment to support the mission, vision, and values, as well as the necessary short- and long-term goals?”

Often, we find healthcare leaders have broad indicators that something is wrong: they aren’t meeting financial or productivity goals, or value-based purchasing scores aren’t where they need to be. However, pinpointing what specific actions to focus on can be challenging.

SIWP compiles all current and future organizational initiatives into a single work plan and prioritizes them based on the timing of desired clinical and financial outcomes. A detailed plan is also created for each initiative that identifies the key performance indicators (KPIs) and frontline drivers (FLDs) that drive each project’s success.

Each project is then assigned a sponsor from the C-suite and an owner. Baseline data are determined to track progress toward operational and clinical performance improvement goals. These plans identify how each initiative not only contributes to the organization’s bigger mission, but also clearly lays out how each individual’s contribution makes an impact.

Let’s take one last look at our radiology example. Once technicians have a clear goal and plan for improving turnaround time, they can begin tracking that metric and focusing on improvements that impact it. For physicians, we might find that ordering tests based off a standard is resulting in unnecessary tests and longer turnarounds. Day-of discharge testing is another area that we look at very carefully. When we can discern which behaviors in specific departments impact the end goal, we’re able to engage the front line in developing solutions.

At this point, leadership has gained alignment on the priority of all key initiatives. These priorities are backed by data, and KPIs and FLDs are identified and tracked. This now provides one overarching work plan for the organization.

Results and Benefits of a Strategic Integrated Work Plan

The essence of the SIWP is a coherent, disciplined operating system to manage an organization’s current and future initiatives. With the SIWP in place, the next time you roll out an initiative, you won’t further disengage your healthcare employees. Instead, you’ll energize the right people to focus on the aspects of their role that will help the organization reach its goals, ultimately addressing widespread initiative fatigue.

About Mark Reifsteck, MHA, FACHE

Mark Reifsteck, President and Managing Director, is an experienced healthcare executive with more than 30 years of consistent achievements in complex, values-based organizations. Mark has a track record of excellent working relations with senior administration, physicians, and other departmental leaders to realize ambitious operational and clinical quality improvements. Contact Mark or read more about him.

 

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