Changing a hospital’s culture to increase organizational capacity

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Over the years there have been many quality improvement techniques that have made the rounds in health care – each promising to deliver results that have previously been difficult or even impossible to achieve. Although methodologies such as Six Sigma, Lean Thinking and CQI have all initially yielded impressive results, often the gains we make are not sustainable if not supported by a fundamental change in an organization’s culture.

Organizational culture is pervasive – it is the glue that holds an organization together and it is the key determinant in the long-term success of any improvement initiative. Three years ago our hospital launched a Capacity Building Journey to make our hospital a great place for people to work and receive quality care. We began our journey with an Open Space Conference to which we invited staff, physicians, volunteers and Board members to help create a plan that would remove barriers to change and improvement and replace them with new and innovative practices that would lead us to the success that we all desired.

Although our journey is far from over, York Central Hospital has experienced a dramatic shift in its organizational culture evidenced by steadily improving patient satisfaction scores and significantly increased staff and physician satisfaction. Recognition of our changing culture and readiness to support leading edge hospital management systems and practices can be seen in the recent announcement of York Central Hospital as a 2009 Best Practice Spotlight Organization and a $1 million grant from the Institute of Public Administration in Canada to continue our Capacity Building Journey.

The essence of our journey, and the resulting change in our organizational culture, can be summarized in the following key elements: engagement, strategic planning and implementation, accountability and communication.

Engagement – One of the first steps in initiating a culture change is taking stock of your organization’s current climate and the commitment level of its people to make things better, which we did through two Open Space Conferences. One of the key learnings of this engagement strategy was the need to create closer working relationships and greater strategic collaboration among our administrative, clinical and medical leaders. This finding lead to the formation of a 20-member Strategy Team that includes Senior Management, Directors and Clinical Chiefs. Our hospital’s Leadership Team was also redefined and expanded to 120 people to include both formal and informal leaders.

Strategy development and implementation – Canadian health-care providers have a reputation for great strategy development. Unfortunately, the skills and support mechanisms for successful strategy implementation in such a complex and fast moving environment are often not as well developed, ultimately reducing the effectiveness of our chosen strategies. Using the information gleaned through our Open Space Conferences, York Central Hospital involved its entire leadership team in the development of a new organizational strategy map. The Leadership Team identified four strategic themes for which it collectively developed desired outcomes, key objectives, leveraged actions, and strategic enablers for each theme to create the best possible foundation for achieving success. Once the Strategy Map was finalized, all leaders were then asked to work with the staff in their respective programs and services to develop service level plans for supporting the implementation of the new strategic themes. This key step ensured alignment and served to connect our strategic themes to the day-to-day activities of front-line staff.

Accountability – One of the major challenges of operating in a systems-driven environment is ensuring that there are well defined roles and accountabilities for every member of your health-care team beginning with the leadership team. To address this challenge, accountability agreements were developed for all administrative, clinical and physician leaders in the organization. These agreements identified key leveraged actions that aligned directly with our Strategy Map as well as specific role objectives to be achieved within the year. In addition, the agreements identified individual learning initiatives to support leadership competency development which was viewed as a key enabler for strategy execution. Supporting the implementation of accountability agreements with a pay-for-performance compensation program further reinforced accountability and provided a tangible incentive for achieving the desired results.

In addition to individual accountability, there must be well defined mechanisms for measuring and evaluating organizational performance. York Central Hospital has developed a Balanced Scorecard to measure leading indicators to help us evaluate our progress on a quarterly basis. A slightly less detailed version of the same scorecard was developed for use by our Board of Trustees to provide a common framework and language in the way the Executive Team and the Board measure and evaluate our success. Scorecard results are shared widely across the organization and used in the evaluation of individual leader accountability agreements.

Communication – Ongoing and multi-faceted communication of our progress as measured through the Balanced Scorecard is essential to keeping staff engaged and motivated. Our hospital introduced rounding of programs and departments by Senior Leaders to solicit feedback directly from staff and managers on their successes or obstacles in achieving our Strategy Map objectives. We also created Capacity Building Boards for all patient care areas and support departments to publicly display our progress against the performance targets contained in our Balanced Scorecard. Quarterly Staff Summit and Listening Post meetings provide opportunities for staff to provide suggestions on how to further improve both the patient and staff experience.

As we continue our journey initiatives such as our Diversity Council, Leadership Talent Management, 360 feedback assessments and our recently launched Code of Conduct have helped to further define and promote the learning and accountability culture that we believe will help us realize our vision and strategic goals.

Changing an organization’s culture is never easy; however, our experience and results would indicate that it is well worth the journey.