Getting ‘in line’: The journey
to organizational focus
In health care, we all know that change is constant and that our structures, decision processes and ways of leading are evolving. What worked 10 years ago, or sometimes even 10 months ago, does not work today. At Markham Stouffville Hospital, our transformational journey has taken us to every corner of our own organization and has partnered us with other organizations from across North America.
It all started with a commitment and a newMissionstatement – Excellence: Your Expectation, Our Inspiration.
To achieve our Mission we have undertaken a journey towards becoming a high performance organization. One of the first things we needed to do was to ensure that, from the board of directors to the front line, we were aligned in our goals and actions.
No small task when you consider our organization has over 1,800 staff, 350 physicians and 1,000 volunteers and treats over 300,000 patients each year.
Focusing our energy
We began our journey towards alignment through the Centre for Health Quality Improvement (CHQI) Leadership for Performance Excellence program. This 16 month program, built on the Institute for Healthcare Improvement (IHI) framework of seven leadership leverage points, was designed to strengthen the ability of senior executives to design and realize quality as a core business strategy. For MSH, this included a crystal clear focus on quality and safety as well as the implementation of a high performance organization structure and processes to support execution and sustainability. We were fortunate to be paired with Bellin Health, a health-care system in Wisconsin that is a recognized leader in designing and executing organizational structures and processes that align operations to strategy.
We created focus by implementing a structured 120 day high performance cycle and establishing true north or ‘big dot’ metrics, aligning all activity within the organization underneath. We wanted to ensure that our Mission and Beliefs were more than words on the wall and served to focus the collective energy of the organization, towards their achievement, ensuring that what we do is purposeful, meaningful, focused, aligned and resourced appropriately.
We have also added to this organizational process change the components of the Impacting Cost + Quality program from the IHI. This program provides the framework, skills and tools to simultaneously improve quality while reducing cost.
As our focus has shifted towards being a high performance organization so have many of our internal structures and processes. The number and focus of our committees have changed, and our talent management program is currently being redesigned to ensure that our leaders have the skills and the tools that will help them deliver on this new focus.
What can be accomplished in 120 days?
Creating an unrelenting focus with associated accountabilities changed our view of what can happen in four months. Our first step in this journey was to understand all of the projects currently “on the books” and the demands that these were placing on each department. When we began, MSH had over 50 corporate projects demanding time from multiple departments, some of whom had never agreed to be part of an initiative. This was in addition to the regular work of the departments and special projects within the departments. Today, we have 19 corporate projects that have been agreed to by all hospital leaders. In monitoring our journey we learned that staff members believe that the new structure with aligned goals enables them to feel more focused and allows them to accomplish more.
Today, any new corporate projects must be brought forward to the Leadership Team via a project charter which includes a clear and well defined rationale, timelines, accountabilities and a business case identifying resource requirements and/or cost avoidance. During our 120 day cycle meeting, the team leads present the new project, including impacts on other departments or programs. Once all the charters are reviewed, the group looks at the organizational energy required to carry out each project and completes an “energy grid.” This energy grid helps us to see where there may be bottle necks which will impede success. For example, in today’s world many projects require support from the information technology department. Each project may need only a “little” time however this “little” time, when multiplied by 19 becomes a substantial problem for the department. Once this work is done, the entire team reassesses which projects will go ahead, which require more planning before they can be considered and which will be put on hold until some organizational energy is freed up.
This process is repeated every 120 days. Our priority setting day begins with each of the project leaders reporting on their progress. There is excitement when a project is completed and team problem solving when a project is stalled. Some projects have been discontinued and we have learned from each of these.
A project charter that ‘pushed’ the organization
An example of a project that was included in our 120 day cycle and the Impacting Cost + Quality program was an aggressive plan to reduce the number of caesarean sections in our birthing unit. The project was initiated in response to a budgetary challenge; we needed to reduce and then maintain our current budget in our maternal child department but we wanted to do this without decreasing services for our growing community. Reducing our caesarean section rate also increases quality and reduces risk. The director, working with the medical chief of the program, conducted an analysis of the program and then sought the support of all staff, physicians and volunteers to take on the challenge to reduce caesarean section deliveries. Because this had impacts outside of the maternal child department, a charter was created and presented at the 120 day cycle. The project was selected as one that would proceed as it was consistent with our Mission of Excellence and supported several of our big dot metrics.
The project team developed a slogan for their work, “Pushing for the Best Choice” and worked closely with the physicians and clinical staff. The initiative required a shift in our practice for scheduling inductions as well as the criteria for caesarean sections and supporting vaginal birth after caesarean section (VBAC). Educating the general public, the mothers and fathers in our care and the referring physicians was a key change enabler and was very time intensive. We were pleased to see the results of the initiative very quickly, with our induction rate decreasing by two per cent, our VBAC rate almost doubling, and our caesarean section rate reducing by three per cent. These percentages reflect a significant shift for an organization that welcomes over 3,000 babies each year.
From the physicians, to the managers and directors to the front line staff – the entire team was engaged in this project and clearly knew the stakes involved. We can say with confidence that there was alignment between our corporate goals and our operations. We are also pleased to report that we have seen this type of project and success replicated throughout the organization on a number of other projects. We recognize that this is a journey, as opposed to a destination and are proud to say that the focus on quality and high performance is one that is owned by all at MSH – the board, the senior team, our physicians and our staff.