Monday, July 25, 2011



Here is the first of three core beliefs for excellent hospital operations which are lived every day by the successful hospital executive. They appear common, but are not commonly practiced. It is in the details you will see a road map for success.

1. Continuous Improvement

Continuous Improvement programs have caused the early demise of many great ideas. But it isn't entirely their fault. There is no end to passive collection of data, no point where the case is airtight where there is no leadership. When the leader is not willing to say "we must move forward" how can a decision ever be reached? What progress can be expected?

How much data do you need? One patient who has not been served well is all the analysis you need, if their experience is rightly understood.

It is a great challenge for any leader to set a firm target, and make a job assignment to everyone to participate. It takes a lot of guts, faith in answers you don't have yet, and willingness to do some hard work collaboratively through the whole process.

It takes character to offer amnesty for past performance, praise for noble failures, open praise for success, and sanctions for inaction. It takes a leader to hold above everyone, every interest,  the mutual best interest of the targets for improvement. Targets deserve that spot if they are mission-driven. They will align all interests in time, if leaders publicly set them first, and privately adhere to them consistently.

That is no simple task. Open praise of a few makes criticism, even in private,  intolerable to the rest. And it is not uncommon that in many organizations open praise is also intolerable.

It is the effective executive who says "this is new. We will be making a few mistakes, but it is necessary, and I shoulder the responsibility with you. We will all learn together. The success of any one of you will really be the success of all of us, so long as we are always working to help each other deliver better care.

"You have responsibility, visibly, and so do I. I don't have the answer. I have absolute faith we will discover it through effort together. I ask you to join me in holding that faith in our future and in working with me to build it. Since I don't have the road map we will need to work together. And I will do whatever I can to help you help us all.

"Therefore, it is now a part of your daily job to help discover, design, test, refine and fully implement the solutions that will move us forward. Make it your routine. We must achieve this target this year for the sake of this community. That is my commitment and my responsibility to you as well. It's my job too. I'll be there when you try and fail. I'll be failing with you. And we'll be learning, not failing, together.

"Give me your best failures and we will never fail. We'll all grow together.

"The only real failure is inaction.

"If you want to criticize because you are willing to try something new, something better, I'm with you. If you criticize and have no answers and aren't putting in the time and effort to develop them, then instead of criticizing try something new and you may learn a better answer.

"The secret to good teamwork is to go along with things that you think are good, even if they aren't quite as good as your personal idea. Support them, own them as if you think they are perfect. Get behind good ideas and back them up, sell them, and put out effort to make them work. Every idea needs enthusiastic supporters and tireless builders, refining the answers all the time: Real Progress Engineers.

"The problem of bad teamwork is criticizing a good idea because it isn't perfect or it isn't yours. These are what I call the only real failures - lack of teamwork, lack of action, or action that is undermined.

"If you go along with it, it IS your idea and you can share in the success, and no one will care about who actually came up with it. Who gave that person the idea? Who knows? Everyone owns it.

"The rest of the things we used to call failures are now learning experiences. What did you learn? What are we going to try differently? Many good things that failed can work with a little tweeking. I don't want to lose those things just because they need a little grammar, a little English, a little polish and a little time.

"I'll be there when the smallest efforts succeed, to say "Thanks" and to let everyone know what you have done for the life of a patient, for the well-being of their family and the future of our hospital. Let's get started..."

Continuous Improvement is a commitment to a vision and a concrete set of targets made public first and foremost by the Leader; a commitment of continuous attention to operational excellence, quality and service by the top executive and all management every week, every day, every hour of every day.