Quality improvement professionals know their efforts will be more successful when they gain the support of the hospital board of directors and top executive leaders. However, it can be difficult to obtain this backing. Organizing data and intentions properly, as well as transparency regarding current operations, are key.

The C-suite is critical to achieving quality and patient safety objectives at any hospital, according to Richard Becker, MD, senior managing director with ToneyKorf Partners, a management and advisory firm in New York City specializing in the healthcare industry.

Becker says leadership engagement tracks directly with accomplishing outstanding results. Hospital boards and top executives should help make the hospital or health system a high reliability organization (HRO), in which the organization achieves and continuously maintains excellence in quality and safety across all services.

Becker explains HRO performance is built around these three major areas:

• Leadership committed to the goal of zero harm;

• A culture of safety throughout the organization that allows and encourages all staff to report anything that would negatively affect the organization, its patients, and staff;

• An empowered workforce that employs specific tools to address improvement opportunities they find to drive significant and lasting change.

“Every member of the C-suite must be tirelessly and continuously engaged in developing this approach and culture,” Becker says. “Without leadership that both communicates and demonstrates these principles and behaviors, the hospital will never achieve the level of excellence it seeks.”

Dr. Leslie Solomon

It is critical to gain the support of the C-suite at the level of sponsorship, says Leslie Solomon, PhD, director of healthcare at human capital advisory firm FMG Leading. Many healthcare leaders do not understand what the role of sponsor is and need to be given guidance on how to sponsor without micromanaging.

“Clarifying the role of sponsorship as a co-planning and review role, while leaving the deployment and problem-solving to the improvement teams, will be critical,” she says. “It is also helpful for sponsors to understand how to review the improvement project using skillful inquiry to determine whether the process is robust without inserting bias.”

When approaching board members and senior executives, Solomon advises beginning with a vision of the desired state rather than the “problem.” Engage people with what is possible, and that will open their thinking and neural pathways to new thinking rather than beginning with the problem, which will tend to evoke negative emotions and less creativity. Follow leading indicators and metrics for process health so everyone knows which processes are performing and which are failing, Solomon says. Keep leaders and the board updated with dashboards of process performance.

Also, be willing to use nonlinear approaches to problem-solving, such as cognitive interviews and double-loop modeling. Police use cognitive interviews to help witnesses effectively recall details about a crime, using multiple retrieval techniques that acknowledge how memories are made up of a network of associations. Double-loop modeling involves teaching people to think more deeply about their own assumptions and beliefs.

These methods are more conducive to learning from improvements and are more suited to the complexity of healthcare systems, Solomon says. When presenting to board members and top executives, quality leaders should avoid framing process improvement as a fix of failure. That approach does not support a culture of learning.

“Many organizations lack the trust and safety required to report accurately on issues. All quality improvement needs to rest on a just culture framework,” she says. “This will provide the safety for employees to report accurately and will also help leaders separate environmental and work design issues from personnel issues.”

Even with all this in mind, it still can be intimidating to go before the hospital board seeking support for quality improvement initiatives. When that time comes, Solomon advises keeping some key points in mind.

“Begin with the desired state, explain why it’s important, clarify the desired impact in risk management, and cost savings. Delineate both hard costs, like investment dollars and savings, and soft costs, like work climate and safety,” Solomon says. “Clarify what you are looking for from them, such as their role as sponsors and how you will keep them engaged in progress. Provide best practice examples at the outset so they have a basis of comparison and a vision of success.”

To view the complete article on Hospital Peer Review, click here.

SOURCES

• Richard Becker, MD, Senior Managing Director, ToneyKorf Partners, New York City. Phone: (855) 857-1212, ex. 120. Email: rbecker@toneykorf.com.

• Leslie Solomon, PhD, Director, Healthcare, FMG Leading, San Diego. Phone: (714) 628-2900. Email: lsolomon@fmgleading.com.