Although each chapter in Getting It Done was written to stand by itself, certain characteristics of each chapter’s heroic journey toward getting it done share common elements, as described below. I will quote examples for each point and encourage readers to let me know what I missed. Thanks in advance for your active reading.
I. The status quo was unacceptable:
- The anesthesiology department was bankrupt. The chairman was on sabbatical, and one-third of the anesthesiology faculty had resigned…. Overall, operating room morale was at an all-time low. The wagons of surgery, anesthesia, and surgical services were tightly circled for self-preservation (Chapter 12. “Building a Functional Operating Room Culture,” p. 158)
- We finally agreed to a stipend of $4,300 per day, 365 days per year- a pretty large ransom, but one we felt we had to pay. I thought we had this put to bed until I received a call the very next day from the senior physician. He wanted to thank me for all of the work that we had done to put in a ‘fair’ rate for general ortho call and felt we should waste no time starting to discuss the rate for spine call. He thought that $4,300 was a good starting point (Chapter 8. “Collaborative Approaches to ED Call,” p. 110.)
II. They admitted uncertainty and invited insights from outside their field:
- Frustrated by the pace of change, one of the authors hypothesized that the missing piece was a stronger organizational culture focused on patient safety… he partnered with Performance Improvement International because of its reputation for safety improvement in the nuclear power and airline industries (Chapter 4. “Building and Sustaining a Culture of Safety,” p.50.”)
- Innovation is one of the most sought-after competencies…. Shouldn’t all hospitals … turn to this new skill set to … be more successful?…. Drawing on the experiences of more than 40 of America’s most innovative companies and working closely with leading innovation experts, Memorial has begun the journey of ensuring that ‘innovation everywhere’ is a cultural shift that benefits the entire community (Chapter 5. “Launching an Innovation Revolution in Healthcare,” p.63.)
III. They recognized that improvement is a non-linear iterative journey:
- After two more years of collecting data, we noted that our annual mortality rates were creeping up to 27 percent. When we looked at our process measures, we noticed that we were not performing as well as we had initially. Some of the reason might have been protocol fatigue. When a protocol is new, enthusiastic practitioners put forth effort to make it work, but as time goes on, enthusiasm and effort wane (Chapter 1. “Saving Lives by Improving Processes of Care,” p.8.)
- Over time, a lack of implementation of the communication guidelines, coupled with a lack of unit direction to sustain the momentum and hold CT team members accountable, allowed old behaviors to reemerge and the project teams to break down (Chapter 14. “Coaching Healthcare Teams to Improved Performance,” p.199-200).
Both groups used the setback to convene their champions and brainstorm how to move forward. To learn more how each group handled initial setbacks, please check the sepsis and coaching teams blog posts, or read the two chapters.