Coach’s Playbook

Building an Organization of Problem Solvers

by Kay Kendall

How would you describe your staff members? Are they troublemakers? Clock watchers? Problem solvers? The first group may be difficult to lead. The second may be difficult to motivate. But the third group can elevate a good organization to one of excellence. What leadership skills make the difference?

Last week I had the privilege of talking with the CEOs of two highly regarded health care organizations, Brian Dieter of Mary Greeley Medical Center in Ames, Iowa (a 2019 Baldrige Award recipient in Health Care) and Dr. Fred Cerise of Parkland Memorial Hospital in Dallas, Texas (highly ranked by U.S. News and World Report in five adult specialties). I’d like to share their organizations’ similar approaches for engaging staff in problem solving.

WHO’S RESPONSIBLE FOR PROBLEM SOLVING?

In both organizations quality and reliability serve a centralized function. Both CEOs, however, view these departments as “centers of expertise” and “facilitators of improvement” … but not the solitary “owners” of problem-solving. In Parkland’s case, it’s the Performance Improvement group within the Quality function that promotes centrally driven projects. Mary Greeley Medical Center devises both strategic projects that align with overall (“Big Dot”) goals and “local” projects that are driven by functional owners within a department or unit.

Both organizations employ various improvement processes to work through challenges: Parkland uses Lean, as its High Value Care Team seeks to eliminate waste. Mary Greeley’s Performance Improvement group uses Rapid Improvement Events and Small Tests of Change before new or re-engineered processes are adopted as standard work.

Neither organization does extensive training for the sake of training. In many instances, improvement project teams are given just-in-time training, teaching whatever tools are best suited to address their specific circumstances.

THE GRASS IS GREENER “OVER THERE”

I’ve worked in some organizations where people are quick to point out problems in other departments while turning a blind eye to their own. I asked Brian and Fred how they prevent this. Mary Greeley requires that a team’s first 90-day opportunity for improvement be in its own department. Leaders encourage a fresh set of eyes from another department be brought in to question the “why” of current processes.

Brian Dieter, FACHE President and CEO Mary Greeley Medical Center Ames, Iowa

Brian Dieter has served as President and CEO of Mary Greeley Medical Center since July 2008 and prior to that, he served the medical center as Vice President and Chief Financial Officer for nine years. Before joining Mary Greeley, he spent 10 years in financial leadership at three affiliates of Ancilla Systems Inc. Dieter received his B.S. degree in Business from Indiana University and his M.S. degree in Administration from the University of Notre Dame. He is a Fellow in the American College of Healthcare Executives and active in several national, state, and local organizations.

Frederick P. Cerise, MD, MPH President and Chief Executive Officer Parkland Health & Hospital System Dallas, Texas

Frederick P. Cerise, MD, MPH, was named President and Chief Executive Officer of Parkland Health & Hospital System in March 2014. Prior to joining Parkland, Dr. Cerise served as Vice President for Health Affairs and Medical Education of the Louisiana State University System. From 2004 to 2007, he served as Secretary of the Louisiana Department of Health and Hospitals. Dr. Cerise began his career at the Earl K. Long Medical Center, Baton Rouge, Louisiana between 1991 and 2004 as an LSU Clinical Faculty member in Internal Medicine.

He holds a Bachelor of Science degree from the University of Notre Dame and earned his Medical Degree at Louisiana State University in New Orleans. He completed a residency in Internal Medicine at the University of Alabama in Birmingham. In 2011, he earned a Master of Public Health degree from Harvard University School of Public Health. From 2010 to 2016 he served on the Kaiser Commission on Medicaid and the Uninsured and currently serves on the Medicaid and CHIP Payment and Access Commission.

Parkland simply puts the problem on the table; whichever cross-functional team is affected by the issue becomes the single owner of its improvement process. Fred stresses that having a culture of humility helps!

THE SECRET SAUCE

Both leaders emphasize the need to help people see how their role fits in with their organization’s bigger picture and ensure that everyone connects personally with the organization’s purpose.

At Parkland, this means setting the tone during the hiring process. From the beginning it is stressed that Parkland’s culture is one of innovation and improvement, that they seek people who will go beyond a set of job expectations. At Mary Greeley, Brian reminds people at every opportunity that they have two responsibilities – do their job and improve their job. This helps every employee continually recognize their value and ensures that their work remains relevant. In turn they, themselves, become increasingly valuable to the organization.

BIG DOT GOALS

Mary Greeley’s Brian Dieter describes a time when the hospital tried to connect staff members with its overall goals using an old-fashioned red/ yellow/green scorecard with 43 metrics. He says, “Almost no one outside of the executive team understood what the metrics meant or how their job contributed to the results.”

So Mary Greeley adapted best practices from IHI philosophies and fellow Baldrige Award recipients to develop “Big Dot Goals” which create for every staff member a sense of organizational focus, alignment, and connection.

With four overarching objectives that encompass all supporting tactics, everyone in the organization can identify at least one Big Dot Goal that their work directly supports. • Reduce preventable harm. • Increase employee engagement. • Increase inpatient engagement. • Achieve operating margin.

Every department has its own Big Dot Goal huddle board showing how its workers support the organization’s Big Dot Goals. The huddle boards help teams tracking their progress on related project processes and improvements. Each employee carries a Big Dot Goal card (Figure 1) behind their identification badge. On it is handwritten their personal commitment to at least one of these goals.

Brian and Fred each emphasize the importance of removing organizational barriers to problem solving as people test new ideas and evaluate potential improvements. Both leaders are active listeners and help their problem solving “idea generators” attain the needed data for making informed decisions about a potentially intelligent risk.

Fred Cerise stresses the importance of not expecting every change to have an immediate ROI; one of his investments includes building a data analytics group with the anticipation that it will have a future positive impact on hospital readmissions.

Brian Dieter blocks out four hours each week on his calendar to personally facilitate work systems mapping and problem solving with front line staff. He says, “It’s rewarding and fulfilling to me. I feel like I give more value to the organization and learn more about what’s really happening than [when simply using those hours for] meetings.”

Big Dot GOALS

REDUCE PREVENTABLE HARM

Goal: 95 (or less)

IMPROVE INPATIENT ENGAGEMENT

Goal: 85th Percentile

INCREASE EMPLOYEE ENGAGEMENT

Goal: 77th Percentile

ACHIEVE OPERATING MARGIN

Goal: 3.0%

IS YOUR HOSPITAL FILLED WITH PROBLEM SOLVERS?

I hope that your answer is a resounding, “yes,” but if it isn’t, here’s a quick checklist to help you turn that situation around. 1. Do you recruit, hire, and onboard people with a bigger job in mind for them? 2. Do you encourage improvement and innovation beginning in new employee orientation? 3. Do you ensure that your employees have the right tools to identify problems, analyze, and solve them? 4. Do you recognize problem solving as a desirable trait for your employees to have? 5. Do you connect every employee with the purpose of your organization? Do they know, in a very tangible way, how they contribute? 6. Do you look for and personally see to it that barriers to improvement are removed? Name:

Doing what's right.

My commitment to:

Reduce Preventable Harm

Increase Employee Engagement

Increase Inpatient Engagement

Achieve Operating Margin

The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement. As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework. Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook. Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com.

Figure 1. Mary Greeley Medical Center produces this graphic as a fold-over card each employee can fill out and keep in their badge sleeve.