For 30+ years healthcare in the US has been attempting change and improve. The areas of focus usually included quality of care, patient satisfaction, care provider satisfaction, safety and, of course, cost reduction. Program after program has been attempted, including Deming, Baldrige, TQM, Six Sigma, Lean and Lean Sigma. There are others. Add to this a plethora of leadership (soft skills) training and healthcare should have resolved its problems many times over. But it hasn’t. In fact, for the vast majority of healthcare organizations, things have gotten worse instead of better. Today, 30 years and $billions later, healthcare has the exact same issues with no end in sight.
Imagine for a moment that virtually everything healthcare attempted to do to improve was doomed from the start, not because the programs were bad, but because these “programs” are not programs at all. They are, for the most part, systems-based management and leadership models. Leaders in healthcare tried to stuff these systems-based models into the legacy top/down leadership and management models we see in healthcare. Talk about a round peg in a square hole.
If we are ever to see genuine transformation in healthcare, there are a number of things that must change. One of the most important is that systems-improvement work must be implemented bottom/up, where care is actually delivered. This means that those on the frontlines will initiate and own the work. Think of nurses working with an enlightened physician and possibly a champion for change from Admin. I call this group of three the Golden Triad and it only takes one of each, regardless of title or position, to begin the transformative process for an entire organization. In my experience, it is nurses who generally drive the transformative process forward. I try to never get in the way of a nurse on a mission.
