Ah, the power of vision. As we have learned from recent events, the lack of vision can bring down large multi-national corporations as well as lofty political campaigns. On the other hand, organizations that drive a compelling vision across their enterprise have become "game changers" in their respective fields or markets (see "Sisyphus or the Flywheel" for more on that). With any business we expect our leaders to share a vision and communicate it effectively. Otherwise, how can we decide whether to follow them?
This week, Nick Toscano suggests that hospitals and health systems need to develop a shared and compelling vision for implementing supply chain improvements. We're pretty good at figuring out how to make our operations better, but we continue to struggle at making some of the cultural adjustments needed to "hold the gains" or sustain the improvements. These are the qualitative elements of creating cultures of savings, and Nick believes they're just as important to drive sustainability as those things we traditionally measure.
Nick shared his thoughts on the Clinically Integrated Supply Chain last week. This is the second of his two-parts in MediClick's Culture of Savings series.
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The supply chain has a natural quantitative bent to it. We prefer thinking in terms of numbers whether it's the algorithms of a logistics calculation or the debits and credits of an accounting statement. It's part of our nature, and that's a good thing. Our jobs require a certain analytical rigor, and there's no better way to demonstrate success (or lack thereof) than hard numbers.
But as with everything, our quantitative side must be balanced by a healthy respect for more qualitative variables. These are often dismissed as the "touchy-feely" parts of our job. Perhaps there's some truth to that, but when it comes to instilling cultures of savings in our hospitals, these attributes become imperatives.
Here's a formula I refer to frequently: "Q x A = E". (By the way, it's not lost on me that there's some irony that I'm using an equation while making the case for using non-quantitative elements. I guess you can't stray too far from your natural tendencies!)
What does it mean?
Starting at the end, "E" stands for effectiveness. It's the business result you're pursuing. For example, your goal may be to build a supply chain that is both patient-centered and keeps supply expenses below 15 percent of net patient revenue. Now, how do you get there?
"Q" is quality of solution or the technical aspects of making a change. It's the systems and processes we use to reach our desired outcome. It's the easiest part to define, so we tend to be most comfortable with "Q" variables because we can measure the impact we get from hiring good people, installing excellent processes, investing in the right information systems, etc. Consequently, we spend most of our time working on the "Q".
"A" is the acceptance of the change by the people who will make it happen (or prevent change from occurring), and it's much more difficult to measure. We spend a small percentage of our time working on the "A". Invariably, I spend much of my time talking with health systems about their need to focus more of the work on these elements of "A":
- Creating a shared need. What is your reason for making a change? Once you determine it, whether it's driven by threat or opportunity, you must work hard to communicate the message and instill it within the organization.
- Shaping a vision. Let your team, your executives, and your clinical departments understand the desired outcome of your proposed changes. Make sure it is clear, legitimate, and widely embraced.
- Mobilizing commitment. Who do you need to get onboard and how will you do it? Make sure all participants in the change are committed to making it work, and come up with a plan for countering resistance when it emerges.
I often ask health systems to use a scale of 1-10 to rank themselves on how well they do with "Q" versus "A." It's not too surprising that I see a lot of 8s and 9s associated with Qs. It's a comfort zone for us. But when I question their ability to accept meaningful change, they have far less confidence in their "A" success. I get many 2s, 3s, and 4s there, drastically reducing the overall effectiveness score ("E") of change initiatives.
Health systems are highly complex entities comprised of many people, some of whom share similar agendas but many of whom don't. As supply chain leaders, we've been trained with a structured, quantitative mindset that likes well-defined processes and systems. They help us organize the chaos inherent to the hospital setting.
But as we're creating cultures of savings, we will find our initiatives cut across multi-disciplinary departments, forcing us to pay strict attention to how people (our colleagues) impact the success or failure of our work. This is where we must be leaders, creating a sense of shared need, building a common vision, and ensuring we have the commitment of all the right people to achieve our goals.
We will be much more effective as change champions as we improve our ability to drive acceptance in our hospitals. This will require us to change our own leadership imperatives to truly spend more of our time working on the "A".
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