TOP 10 PERFORMANCE IMPROVEMENT MISTAKES
Part 4. Boil the Ocean

In previous issues of this series, we explored performance improvement training, the link between quality and finance, and leadership engagement. If you have those things in place, it means you’ve done a lot of hard work to get where you are. At this point, it is common to try to dive in and solve some of the organization’s toughest problems. But, hold on! An attempt to tackle problems that are too large or too complex is a common mistake - especially for newer Lean Six Sigma deployments. “Boil the ocean” projects are kicked off with much fanfare, but usually die a quiet death. Here are some ways to get to the important problems while avoiding large and costly disappointments.

Solve One Problem at a Time

Performance improvement projects are intended to produce incremental changes in perpetuity. Some of these changes do produce huge leaps in performance that can truly be considered breakthrough. Other changes produce good results that, although not considered “breakthrough,” move the organization forward towards achieving its strategy. Regardless of how large the impact is, good projects have this one thing in common - they set out to solve one problem at a time.

Attempting to solve multiple problems simultaneously causes a lack of focus, increased project span time, unneeded complexity, confusion, and difficulties with sustainability. For example, your emergency department may be suffering from long wait times and poor patient satisfaction. However, these are different problems. Yes... satisfaction is driven by wait time, but there are many other drivers of satisfaction. Additionally, wait time in the ED can be a very complicated problem to address, and the team shouldn’t be distracted by the need to actively dive into causes for low satisfaction scores. Instead, charter the project with wait time as the primary metric. Then include patient satisfaction as a secondary metric, indicating that changes cannot negatively impact satisfaction. A separate team can explore the satisfaction issue once the changes from the wait time project have been stabilized.

So, define a project that impacts one primary metric. Decide on which methodology can be best used to solve that specific problem. Next, get the right team and resources on board and get the results - quickly! Then you can move on to the next problem and continue to build on your success.

Break it Down

There is definitely a need to go out and work on your organization's most difficult problems. Some of these challenges are so new as a result of the latest regulations and changes in the healthcare industry that they have yet to be solved by any organization. Many of these problems span across multiple parts of the organization and require subject matter expertise that very few people have. Medication reconciliation comes to mind, as well as the Recovery Audit Contractor (RAC) Program from CMS.

These new challenges simply cannot be solved by attempting one large project. There’s too much to do, extreme amounts of change, and so many chances to lose momentum. Rather, it is much more advantageous to break these initiatives into smaller, more manageable pieces. Outpatient appointment scheduling, for example, could be broken down into three separate efforts including, master calendar creation, slot creation, and appointment change management.

Find the Right Pace

There is a certain amount of change that an organization can absorb at any given time. An organization that is in the midst of a merger, for instance, may already be suffering from change overload. Healthcare is undergoing an enormous transformation right now and leaders must understand how quickly the organization can assimilate the changes by pushing forward at times and then pulling back when there seems to be too much instability. A change readiness assessment can help measure how well the organization is prepared for change.

In regards to performance improvement, these factors all play into how much can be taken on at once. If too many projects are in progress at one time, similar problems to those that occur with boil the ocean type projects might arise - added complexity, confusion, and difficulty with sustainability. Sometimes the projects have a significant amount of scope overlap and the teams end up bumping into each other.

So, it’s effective to break down projects into more manageable pieces, but then also determine the right pace at which those individual efforts can proceed.

Don’t Forget the Low-Hanging Fruit

Lastly, there are so many opportunities for improvement out there. Some of them are easy to achieve with the right improvement methods in place. There is no need to tackle only the toughest problems all the time. Does the organization really have the endurance and the resolve to keep fighting the toughest fights without a little room for quick wins and celebration? There is low hanging fruit out there that is easy to reach and can rapidly produce a positive impact on important metrics for your organization.

Remember, one problem at a time, break it down, pace yourself, and generate some quick wins. And, make sure to tune in next time for Performance Improvement Mistakes, Part 5: The Theory of Evolution.

Past Issues

Part 1: Create an Inventory of Experts

Part 2: It's All About Quality

Part 3: Get Leadership Buy-In