Published by: Anna Roth on 10/22/2010 1:37:52 PM
With increasing demand, those working to preserve and enhance the safety net will need new levels of leadership skill, improvement knowledge, and systems-thinking to face the significant challenges that lay ahead.
Frequent changes in leadership and direction - as well as inaction when change is clearly needed - have resulted in a culture of mistrust in health care and hierarchical control rather than shared decision making and participative improvement. Too often, when thinking of the safety net, a “last resort” image prevails rather than a place of excellence, hope and recovery and as a place where no one is left out. To add to the challenge, there appears to be a lack of emphasis on the acquisition of continuous quality improvement skills among the safety net workforce.
On the positive side, studies have identified organizations performing at extremely high levels of excellence and achievement. These organizations seem to possess a set of attributes and skills that have allowed them to overcome common challenges many organizations face.
Attributes found in high performing health systems, as well as in complex adaptive systems in other industries, can be summarized and applied to our safety net system as follows:
• Establish a shared set of improvement aims.
A clear and explicit set of aims and portfolios of work for the safety net would support the identification and dissemination of ideas and promote synergy among stakeholders, whose efforts sometimes collide or interfere with each other.
• Set standards and persist in the expectation that patients and families will be actively involved in design and improvement at every level of our system.
Involving patients and families in defining quality, setting aims, assessing performance, and designing and redesigning systems of care in their communities, will result in a more meaningful and valuable output.
• Focus on measurement, results and transparency.
Agree on a small set of high-level systemic aims for improvement, with shared definitions of quality in the safety net system.
• Assess, mend and rebuild trust between the frontline workers and managers at every level.
Mechanisms to support dialogue, shared vision, and cooperative experiences will help build trust.
• Develop a culture of learning, innovation and accountability.
As learning and technology improve, structural changes such as regulatory mandates and aims are not only appropriate, but unavoidable. Additionally, safety net leaders should lead with confidence, showing a high tolerance for risk-taking, learning, and cooperation. Support for safety net leaders to look to the patients, families and the communities we serve for signals about their priorities and ideas for improvement, will accelerate improvement, build local cooperation, increase quality and decrease waste.
Barriers to breakthrough performance improvement persist in our nation’s safety net health system, but can be overcome. There is need for a shared framework for improvement at the national level, and we must involve patients and families in meaningful improvement activities and designs on a much larger scale in order to establish a clear and shared definition of “quality.”
I am confident that the nation’s safety net has the potential to be a model for the new American system of health care that patients, families and communities need, want and deserve. We know that great leaders must meet the needs of today while they pursue a longer-term vision. We face ongoing political realities with local, state and national fiscal crisis. We must support each other as we set shared aims - practical, achievable, feasible aims - that are meaningful to those we serve. A sky filled with clouds of change offers the perfect opportunity. It truly is a “perfect storm” and should not go to waste. We should not run for shelter, nor should we baton down the hatches to protect the status quo. We should look to our legacy and our long history of innovation and instead we should dance in the rain.
Anna Roth, RN, MS, MPH
Chief Executive Officer
Contra Costa Regional Medical Center