A Rapidly Adaptable Management System.

As healthcare organizations nationwide are compelled to move from volume-based payments to a value-based system, one thing has become painfully clear: Most of these organizations are not equipped for flexibility. We cannot change at the required rate. One CEO told me recently that we need a rapid adaptability system and we don't have one. One problem is that healthcare leaders are typically managing dozens, even hundreds, of initiatives. Few of these projects are delivering better value for patients and most rarely lead to sustainable change. A new unified management system is needed.After years of studying the transformation efforts of more than 160 healthcare organizations in 16 countries, I have found that a framework exists for a rapid adaptability system. This framework is a daily management system that requires fundamental change at both the frontline and leadership levels. This column will address the core elements of this management system.LEADER PREWORKBefore a new system is built, some personal prework is required. An organization's leaders must agree on the need for and purpose of the work. Moreover, they must focus their efforts. I have observed leaders deploying an inordinate number of key performance indicators (KPIs). KPIs should be the critical few measures, but I have seen cases in which 50 or more KPIs were at play, creating a muddle of expectations. Organizations need five to eight key metrics that eveiyone can understand and rally around. I call this true north. For example, at the Children's I Iospital of Eastern Ontario in Ottawa, Canada, leaders identified five metrics, one of which is the number of days children wait for tests and appointments. The current goal is to slash that number by 50,000 days over the next 2 years. It is a clear, immediate goal. Prework, then, is creating an organization's true north and then reducing the number of strategic initiatives.I recently observed a senior leadership team that had 248 strategic initiatives. Senior leaders created the initiatives, but the work was actually done by middle management. As a result, the manager's day was spent putting out fires and performing tasks related to senior executive strategy instead of helping frontline caregivers improve the patient experience. Winnowing initiatives down to the critical few is an essential role of senior management. I lowever, accomplishing this requires persistence because it is difficult to take things off the plate.Some of the most difficult prework is the personal side of change. If you pride yourself in coming to the rescue, being the hero, and setting people straight, your leadership style is going to need an overhaul. I describe the desired behavior as improvement leadership (Toussaint, 2013). This type of leadership requires leaders to approach their work and their colleagues with humility rather than autocracy. Leaders need to adopt the habits of observing the workplace with curiosity, seeking to understand the problems of frontline workers, and helping to create positive change. Instead of embracing an attitude of "the buck stops here," leaders need to become facilitators of improvement efforts. In most cases, leaders will require the expertise of a teacher who can help them see problems and learn new facilitation skills. Leaders must be open to changing the way they behave, what they prioritize, and how they speak with others. They also need to mentor and coach others to do the same. The new leadership behaviors are required to support the model cell.MODEL CELLThe model cell is the real transformative work. The model cell is not about making tweaks to current processes but about creating innovative work processes and applying Plan-Do-Study-Act (PDSA) rapid cycle improvements to address any problems that arise. The model cell is focused on an important business problem. It runs an inch wide and a mile deep, meaning the scope of the project must be limited, usually to one unit or clinic, while every aspect of the work processes is rebuilt to benefit the patient. …