Good is the enemy of great
Brant Community Healthcare System (BCHS) has many things of which we can be proud, yet these are only a part of what it takes to make our organization a “great” place to receive care. This past year we hit the big dot targets in our three strategic directions – patient centred care, workplace excellence and financial sustainability. We are one of the safest hospitals in the nation as measured by The Canadian Institute for Health Information’s (CIHI) Hospital Standardized Mortality Ratio. For three years running we have been recognized as a top employer in our area with vacancy rates and sick days well below industry benchmarks. Consistently finishing each of the last seven years in the black is also a source of pride and proof of sound stewardship.
BCHS has been innovative on several fronts such as creating a video that has gone viral promoting hand hygiene. Being a Canadian pioneer of custom fitted knee replacements has produced lower lengths of stay, less blood loss, less equipment reprocessing and lower inventory costs – albeit raising wait times as demand for this innovation soars.
Our investment in organization development and LEADS-based framework builds capacity and provides personal/professional development opportunities for staff and those who consider joining BCHS. To find the right leaders we are also not afraid to look outside the health care industry.
We are asking our people to improve our quality practices, creatively address ongoing challenges and, while staying positive, prepare for a future coming faster than anyone can imagine.This means working in the “grey zone” of ambiguities, lack of autonomy and competing interests. Such a complex environment can often take the steam out of dedicated and motivated people.
Yet we also know our world will not get simpler. It becomes more complex given increasing demands for access, sustainability, safety, patient and stakeholder input and their high expectations.
Such ambiguities and polarities are natural and we choose to embrace, manage and influence rather than run from them. In fact we have been innovative and built them into our new strategic planning process which also incorporates our Quality Improvement Plan, accreditation preparedness and a comprehensive program of community engagement. We will struggle finding the appropriate balance between continuity and change; patient focused and provider focused; investment and cost containment; organizational autonomy and integration. I suspect my colleagues have similar struggles. These are no longer “either/or” propositions in healthcare.
It seems the more we consider these tensions in the system, the more complex and grey our world becomes. I would add that if decisions appear easy, we likely have not considered all details, points of view and/or consequences. The challenge can be paralysing but status quo cannot be an option.
To decide to move a “good” organization to be ready for the future, you have to define realities and promote a vision of something even better. Success at BCHS has given us the confidence to be able to share the good things we are doing, but also to call out areas where we come up short. I might also add that it is not difficult to find others willing and able to help with the calling out!
Unfortunately I get to see and experience my share of horror stories related to cumbersome processes, unrealistic expectations and communication breakdowns. Some we may cause and others are inflicted upon us.
BCHS has embarked on a journey of “performance excellence” based on creating a LEAN culture and a new way of viewing and managing our efforts ultimately to improve patient satisfaction and outcomes. My experiences in Saskatchewan with “quality as a business strategy” and personal credo “carpe diem” convinced me of the need to challenge BCHS to invest in and strive for greatness while looking for better ways.
We recruited professionals from non-health care industries and are developing people within our organization to utilize accepted tools and principles such as the Toyota Management Systems. This helps shake us from notions of complacency, mediocrity and the idea that “good” is good enough for now or the future. Successful organizations around the world have gone this route and demonstrated great success. We have no problem learning from others.
Many of the tools and concepts we have been introduced to are simple to grasp, yet difficult to put into play. Leader standard work, visual management, rapid improvement events (RIEs), and team huddles are now in use. However, not everyone “gets it”…yet. Implementing performance excellence into a health care organization has its critics. Fortunately, questions strengthen the case for change and develop a firm resolve to improve a system that can breed complacency and satisfaction with the status quo.
The BCHS is achieving some outstanding results.
• RIEs have become highly anticipated throughout the organization. One of our first RIEs reduced the number of times an MRI requisition form was handled from 18 to 6 – a 67 per cent reduction! The OR supply chain RIE created more nursing time for patients and reduced costly inventory.
• Huddles across the organization have improved daily communication regarding quality metrics and communication among staff. Huddles align to our big dot measures and introduce standardization using a uniform whiteboard and script.
• Training clinical leaders to a common standard of work has focused their daily schedule, eliminated unnecessary meetings and committees and established metrics to trend, address results and act on opportunities for improvement.
Our latest Board meeting began with a huddle standing around our wall of big dot indicators where I had to explain current trending – the good, bad and ugly. Talk about accountability!
Each morning clinical managers huddle in the cafeteria for all to see. It has become “the huddle” to attend as directors, support personnel and senior leaders hear the latest on emergency wait times, staff shortages, safety issues, delayed discharges or infection control matters.
It is clear we have a good thing going. It is also clear that Brant Community Healthcare System is a vital player in our province’s health care system and is committed to investing in and moving from good to great. Our “people” deserve nothing less!