Richard J. Banchs - The Quality Improvement Challenge

You may be approached by a senior leader with a request for an improvement project. Most likely this leader will become your Primary Sponsor. If you have the opportunity to choose your Primary Sponsor, there are a number of requirements you should keep in mind. While all Primary Sponsors are senior leaders, not all senior leaders should be the Primary Sponsor. Ideally, the leader you have chosen to be your project’s Primary Sponsor has the following characteristics:

is well respected by both the team and key stakeholders,

is considered a credible leader,

has the authority and appropriate leadership level to be able to resolve cross‐functional issues when they arise,

has experience in leading projects and change management initiatives, and

has the willingness and ability to actively participate in the crucial phases of the project.

Many healthcare organizations have a matrix reporting structure that complicates the selection of the Primary Sponsor. You may need to select a Primary Sponsor and ask for the assistance of a second senior leader. In these situations, clear communication with all leaders involved is necessary. While not ideal, you may need to choose two sponsors for your project.

1 What is a Primary Sponsor?A person that will support your QI projectA high‐level leader that can ensure the success of your projectA leader that establishes the priorities of the QI projectA leader that is actively engaged in the change initiativeAll of the above

2 One of the greatest contributors to project success is the active and visible participation of a Primary Sponsor.TrueFalse

3 A Primary Sponsor is generally a senior leader (executive, high level manager, physician leader) in the organization who can “open doors” for the QI team.TrueFalse

4 An effective Primary Sponsor must have the appropriate leadership level to be able to resolve cross‐functional issues.TrueFalse

5 One of the greatest obstacles to the success of change initiatives is ineffective change management support by the Primary Sponsor.TrueFalse

6 To be an effective Primary Sponsor of a QI project, you need to be visible, engaged, and active throughout the life‐cycle of the project.TrueFalse

7 Which of the following is NOT a typical role of the Primary Sponsor?Provide resources for the improvement teamEstablish priorities for competing initiativesResolve cross‐functional issuesAnalyze baseline data and create a graphic summary of the findingsEngage key stakeholders to support the change and manage any resistance

8 To effectively support an improvement team, a Primary Sponsor mustbe a leader with authority,have the appropriate leadership level in the organization,be respected,be able to be actively engaged in the QI project, orall of the above

Key: 1e, 2a, 3a, 4a, 5a, 6a, 7d, 8e

1 1. Heifetz R. (2002). Leadership on the Line. Harvard Business Review Press.

2 2. Prosci®. (2016). Best‐Practices in Change Management. Best‐Practices Report. Edition.

There are projects that are simple, straightforward, and quick that an individual can do without a team. These are the “quick‐win” projects. In general, however, QI projects are better done as a team. Teams are integral parts of healthcare organizations, both operationally and clinically. Typically, teams are built in order to solve problems or complete work that exceeds an individual’s capacity or requires the expertise of a diverse group of individuals. In general improvement is a “team sport.” Teams outperform individuals acting alone especially when performance requires multiple skills, judgments, and experiences.

There are two significant benefits to working as a team:

1 Higher quality of solutions. Diversity of opinions creates better solutions. People in teams share their competencies and experiences, and combine their unique talents to fuel creative and innovative problem solving and optimal solution generation.

2 Increased productivity and motivation. Alignment of team members toward a common purpose focuses their efforts and accountability toward an agreed‐on target; timelines facilitate successful project completion.

The formation of a high‐functioning team dedicated to improvement tasks is difficult in healthcare. QI teams face three main challenges:

Time. Teams in healthcare often struggle with getting off quickly to a productive start and finding the time to carry on their project activities. Patient care is always the priority for clinicians; QI activities are often seen as less important. Resource constraints related to staffing and scheduling requirements limit the availability of key stakeholders to participate regularly on QI project teams. As a result, teams are composed in an indiscriminate way with an underrepresentation of front line clinicians because they cannot be relieved from their patient care responsibilities.

Silos. The culture of the healthcare environment also makes improvement work difficult. Healthcare silos (doing what is best for me or my department/unit/function instead of what is best for the patient, team, or organization) foster group mentality and functionality rather than team performance. Competing priorities create confusion and adherence to dysfunctional loyalties, making the task of improving difficult.

Pushback. QI teams in healthcare often struggle with the lack of buy‐in from the front lines; under these conditions, it is difficult to have a successful handoff of their recommendations to the people who “do the work.”

These three challenges require separate, specific approaches:

The challenge of time. A team needs to focus their team on productive activities. A QI team needsA leader willing to get the right people on the team, provide the needed resources, and “open doors” when problems arise.A leader that is willing to deal with the cross‐functional issues and political barriers as they arise.A leader that provides clarity regarding the team’s purpose and goals, so that QI teams get off to a quick, productive start. Clarity on the team’s purpose is always made easier with a clear, well written, and agreed‐upon Project Charter.

The challenge of silos. A QI team needs to work together to develop clarity in the team’s purpose, goals, and work strategy. This will enable team members to develop common commitment and trust; commitment and trust can overcome silo mentality and the disconnect between the members of the team. Open and effective communication among team members must be present to achieve this critical affective component (see Chapter 27).

Pushback and lack of buy‐in. Support for the project depends onthe leaders and their active participation throughout the life cycle of the project;the QI team supporting, training, and coaching frontlines professionals;effective communication; andan early engagement of the front line in the co‐creation of the solutions (see Chapter 29).

Quotable quote: “There are two types of people – ones who do the work and ones who take the credit. Try to be in the first group. There is less competition there.” Indira Gandhi

“Who should be sitting at the table”? Make sure your QI team has the right professionals from the front lines. It is important to include the people that “do the work” from all levels of the value stream. Improvement teams often have too many supervisors, managers, and directors, but not enough front line stakeholders who have the “know‐how” of the process that needs to be improved. Without first‐hand knowledge of the process, improvement ideas are usually inadequate, too broad, or too restrictive. These ideas are seen as out‐of‐touch with the reality of the daily work because they have been developed by a QI team lacking the technical expertise or process knowledge of the intimate details of how work is actually done. Without first‐hand knowledge of the process, improvement suggestions are usually not supported by the people who actually “do the work.” How do you feel when regulatory agencies and administrators tell you how to “improve” your clinical practice?