Improving Healthcare Delivery: Effective Performance Improvement

How do you conduct effective performance improvement for your clinical laboratory when facing the complex challenges under the Affordable Care Act (ACA) 2010 and regulatory compliances? Producing healthy revenues and manageable costs are crucial components and challenging objectives for any organizations. Healthcare organizations have performed strategic renewals and redesigned their business operations by enlisting performance improvement plans. However, after all that hard work, many organizations still end up with large deficits to their operational budgets and non-compliances on their accreditation agencies’ regulatory requirements that may require drastic measures to rectify (such as employee lay-off or early retirements). Some organizations, even after performance improvement programs or formal business reengineering, will end up closing their doors. According to Harvard Business Review, among Fortune 1000 companies, success rates of business reengineering is lower than 50 percent and can be as low as 20 percent! What can be learned from this? How do you get employees on-board to performance improvement plans toward improving healthcare delivery?

Management should not expect that employees share their desire for change when the organizations are not performing well. Nor should management create teams and expect those teams to produce changes without providing the context for that change. Effective performance improvement does not start with solutions that are prescriptive and instructional; however, it should start with shared diagnosis and mutual engagement involving all employees that result in shared values and collaboration. These in turn help build the organization’s culture toward long term success and not just temporary fixes. High levels of employee commitment result in higher productivity, creativity, and collaboration. This, in turn, creates successful performance improvement programs.

According to Bert Spector, scholar and author in organizational change management and Director for Emerging Executives for the Federal Bureau of Investigation, these five elements create high commitment among employees when implementing performance improvement:

  1. Clarity of the organization goals by employees at all levels,
  2. Teamwork
  3. Shared Information
  4. Organic Controls
  5. Individual development opportunities

Employee communications play a significant role in the success or failure of any major performance improvement or change program. Management needs to get feedback from their employees, and employees need to have a safe environment in which to give that feedback. A good understanding of theories for effective performance improvement (especially those that deal with employee motivation) is a crucial step in improving healthcare delivery.

References:

Spector, B., (2013), Implementing Organizational Change: Theory into Practice, 3rd ed., Upper Saddle River, New Jersey: Pearson, pp. 51-98.

Barrett, D. J. (2002). Change communication: Using strategic employee communication to facilitate major change. Corporate Communications, 7(4), 219-231.

 

Information on policies or practices are solely from my personal experience ONLY and have NO relation to my affiliation with any regulatory or government agency.

satyadi

-Caroline Satyadi, MT(ASCP), SM, DLM, SLS, MBA, MS, CQA (ASQ) has been a laboratory management professional for over 25 years. She has worked with several different medical industries for CLIA/CMS, FDA/ICH/ISO, TJC/CAP/COLA/HFAP accreditation survey readiness.

 

Improving Patient Safety: Effective Communication for Performance Improvement

In 2014, the Joint Commission updated its National Patient Safety Goals (NPSGs) in order to address areas of concerns for patient safety to reduce harms to patients. These goals include standards for clinical alarms, transfusion errors related to patient misidentification, reducing likelihood of patient harm due to anticoagulation therapy, reducing the risk of healthcare-associated infections, implementing evidence-based practices to reduce healthcare associated infections due to multidrug resistant organisms, and prevention of central-line associated blood stream infections. A multidisciplinary team comprised of all clinical areas including nursing, laboratory, pharmacy, radiology, biomedical engineering, and environmental services are necessary to become compliant in all of the NPSGs.

How do you effectively communicate the NPSGs (or any other change initiative) to all personnel? Sometimes organizations will implement initiatives and performance improvement training with score cards, only to find that the initiatives did not produce the expected results. Prior to launching any new initiative for performance improvement toward NPSGs compliances, management needs to take the extra steps to communicate clearly to employees the background of the current situation within the organization, explain why there is a need for performance improvement, and emphasize what the stake are if the organization isn’t compliant.

The transformation process in change management involves changing employees’ behavior to enhance personnel capabilities. According to Kurt Lewin’s model in the traditional change management, there are three phases of change: (1) unfreezing, (2) change, and (3) refreezing that specifically focuses on employees’ behavior or involvement. In general, employees would not necessarily change their behavior just because the organization performs poorly or there are new standards to follow. Employees will keep their attitudes or behaviors when they feel comfortable or safe with the current behavior and there’s no sense of urgency to change their behavior or the work environment allows them to choose not to change. Lewin’s model identifies that in the unfreezing phase there should be open communication and motivation to employees to understand the situation fully. Allowing employees to question the status quo or feel discomfort with the current practices creates “buy-in.” Employees feel invested in the process and that in turn facilitates employees’ participation in the next phase: “change,” when the new improvement strategy is adopted. The last phase, “refreeze,” is implementing and sustaining the change.

Employees’ attitudes are structured along three dimensions labeled as cognitive attitudes (beliefs), emotional attitudes (individual feelings), and intentional attitudes (evaluations based on past or intentional behavior). Communication to explain and motivate employees will help overcome uncertainties and enhance employees’ control and well-being, which in turn promotes empowerment. McEwan studied the indicators of personal empowerment include improved perceptions of self-worth, empathy and perceived ability to help others, the ability to analyze problems, a belief in one’s ability to exert control over life circumstances, and a sense of coherence about one’s place in the world. McEwan pointed out that within the empowerment framework change begins at an individual level; as an individual becomes more empowered, their increased personal capacity makes a positive impact on an organization or group, and ultimately, the wider community. In general, people are not resistant to change; however, they mostly object on being told to change. By investing the extra time and efforts on open communication to motivate employees and create buy-in, the organizational change initiatives will have a much higher probability of success and sustainability.

 

References:

http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf

Lewin, K. (1947), “Frontiers in group dynamics”, Human Relations, 1(2), 143-53.

Pideret, S.K. (2000), “Rethinking resistance and recognizing ambivalence: a multidimensional view of attitudes toward an organizational change”, Academy of Management Review, 25(5), 783-94.

McEwan, Alexandra B,B.A. (Anthropology)(Hons), L.L.B.(H., Tsey, K.,PhD.(Social Sciences), McCalman, J., & Travers, Helen J,GradDip Primary Health Care. (2010). Empowerment and change management in aboriginal organizations: A case study. Australian Health Review, 34(3), 360-7.

 

Information on policies or practices are solely from my personal experience ONLY and have NO relation to my affiliation with any regulatory or government agency.

satyadi

-Caroline Satyadi, MT(ASCP), SM, DLM, SLS, MBA, MS, CQA (ASQ) has been a laboratory management professional for over 25 years. She has worked with several different medical industries for CLIA/CMS, FDA/ICH/ISO, TJC/CAP/COLA/HFAP accreditation survey readiness.