Friday, March 21, 2008

The secret to successful teams

I recently came across this nugget of wisdom, contained in one of the numerous newsletters and websites that come into our consultancy daily.

In the United States an annual top leadership team competition is hosted by HealthLeaders Media, aimed at idenitfying the most effective management teams in the health sector. Jim Molpus, from HealthLeader Media was asked, what are the secrets of top management teams?

Guess what his answer was. There are no secrets. Well buggar me, that's two of us in the world who understand that there hasn't been anything new in management techniques or strategies since the days of Aristotle. Despite the best efforts of publishers, the media and the ever-growing corps of self-styled, management gurus - the truth is out, there are no secrets. There is just common sense applied to tried and true processes of communication. For those that doubt me on this, try reading (or rereading) management books by Peter Drucker and Charles Handy. I know you will find them far more relevant and useful than anything else that has been published in the past twenty years.

There are however consistencies that appear in effective management teams and the people at HealthMedia have picked up on these over the years, and I am happy to share them with you here.

  • Consistency--Many of the winning Top Leadership Teams have had their core of senior leaders together for a period of several years, as many of the worthwhile goals in healthcare take as long to achieve.
  • No tolerance for silos--Winning Top Leadership Teams have found ways to break down traditional silos and barriers that can block healthcare organizations from achieving their goals.
  • Strong at the top, but not dominant--Winning leadership teams have highly-effective CEOs. But we have found that almost every winner over the first four years has had a CEO who delegated key strategic responsibilities to top team members, held them accountable for achieving these goals, but ultimately stayed out of the way.
  • Transparent--Winning teams in healthcare have to be transparent about what they are doing, who is doing it, and how success or failure is measured.
  • Be a quality organization--Top Leadership Teams create high quality organisations
How well does your organisation rate? The following are some of the things the competition judges look for when reviewing entries into the competition -

  • Teamwork exhibited among an organization's senior leaders to achieve stated operational goals/objectives
  • How a senior leadership team works together to effectively overcome any challenges/barriers encountered along the way to reaching its goals/objectives
  • The success of senior leadership in meeting the team's goals/objectives
I am interested to hear from anyone reading this blog entry. How does your organisation rate on the above criteria. Rate your organisation from 1 - 7 with 1 suggesting your organisation is about to do a 'warley' and disappear into the ranks of health providers that are no more and 7 meaning your CEO has just been invited to speak to an international conference on hospital management.

I would hope you would email me your ratings and criteria. I will keep the information to myself, or if I did use it I would seek permission first to do so.

Here are the criteria again -

  1. How well does your management team achieve stated goals and outcomes? 1 - 7
  2. How well does your management team work together to overcome barriers on its way to achieving the goals and outcomes? 1 - 7
  3. How well does your management team actually work as a team? 1 - 7
  4. How well does your team retain its core members over a prolonged period? 1 - 7
  5. How good is your management team at dismantling 'silo's and creating cross-functional collaboration? 1 -7
  6. How well does your CEO delegate tasks to key executives and hold them accountable for the outcomes? 1 -
  7. How well does your management team maintain transparency by monitoring outcomes and communicating successes and failures throughout the organisation? 1 - 7
  8. A quality organisation is one where all the above occur, where innovation and continuous improvement is encouraged and celebrated, where employees at all levels would recommend their friends work there and where ethical standards are met at all levels. How well would you rate your organisaton as a quality organisation? 1 - 7
I look forward to hearing from you.

Tuesday, March 4, 2008

GP Waiting Lists

The Australian Federal Government has announced it plans to publish details of waiting lists. This is one piece of information consumers would like to see. The single biggest complaint about the health system is how long it takes a patient to recieve treatment. It is preferable to provide information on waiting times than on the numbers of people waiting for treatment.

I wonder how this information will be presented? Will it be presented in a manner that makes it useful for consumers? How will the hospital sector use this information? Will it reduce the actual waiting lists? Will health funding be tied into reducing waiting lists? Why should a hospital be funded to provide a service and then retain that funding when it fails to deliver? Will the waiting list information distinguish between in-patients and out-patients?

Logically the information should be broken down by State and then by hospital. There are difficulties in doing this however. Not all hospitals provide all services and in breaking down to the individual hospital inequities and anomolies might be created. It would be helpful to have the waiting list broken down by surgical procedure. The issue with aggregating State information is that it becomes difficult to hold individual hospital administrations to account.

Perhaps the Federal Government should also look at publishing details of the waiting list for those with private health insurance and seeking care in the public system and those without private health insurance. In this way it might be possible to identify the level of queue jumping that is percieved to take place. Likewise information on the number of surgical procedures that were 'rescheduled' and the reason for that would help also to induce a sense of accountability within hospitals. If rescheduled surgery information was provided, would the waiting times be accumulated for each patient or would only the shortest, most recent period of time be recorded?

Ten years ago, in 1997, in NSW, it was reported that there were often two waiting lists. One held by GP's and one maintained by surgeons. Perhaps the Government could collect data showing the differences between the information provided to GP's and what actually takes place.

Reducing waiting lists is important to consumers. There are records of people actually dying or suffering greater illness while waiting to recieve treatment. At the same time consumers have few options as to which hospital they might go to and recieve treatment. Yet that is not sufficient reason not to collect and publish data. Consumers pay for hospitals, they have a right to information on performance. Hospital adminstrators have an obligation to spend public money in an effective manner.

What might the Federal Government do with this information? There is little evidence to suggest that spending increased amounts on infrastructure and or additional specialists will actually reduce waiting lists. There is a straightforward reason for this. Specialists will act to protect their own interests. The answer may lie in removing the final decision from the specialists. Hospital waiting lists are also a necessary evil. Considerable investment is made in infrastructure, staffing and equipment. These resources cannot be allowed to remain idle. The aim should not be to eliminate waiting lists, rather to minimise the time an outpatient spends waiting for treatment. While decisions will always need to be made on a individual case basis, there is evidence that minimum waiting times can be introduced and maintained.

The case for minimising waiting lists is not a one way street. Consumers also have to take responsibility for their behaviour. When a patient doesnt turn up, as scheduled, for an appointment or procedure, they have effectively wasted an opportunity, not only for themselves, but they may also have contributed to someone else's misfortune. If hospital administrators are to be penalised for poor performance then it is reasonable to suggest consumers should also be penalised for poor performance.

GP's themselves may have to take greater accountability for their actions. GP's cannot treat every health issue, therefore they refer patients to specialists. How may times is this done for convenience sake? The Federal Government has clearly set out its priority and focus upon primary health care. Is it possible GP's might collaborate more with the primary care sector and perhaps consider referring patients in this direction, for preventative action, rather than automatically referring to a specialist? This might have a double benefit in that it may contribute to reduced waiting lists while also helping patients take greater responsibility for their own health outcomes.

Maybe it is time for greater collaboration between hospitals within States and between various State health sectors. Collaboration may lead to improved utilisation of resources within hospitals. Not every hospital in the country is fully utilised at the same time. While this would mean some consumers having to recieve treatment away from their home region - at least consider giving them the option. For some consumers the option of treatment now in another state would be preferable to waiting on a list for an unknown period of time.

Saturday, March 1, 2008

Performance monitoring in hospitals

The Australian Federal Government has reached agreement with State Governments to implement reciprocal performance reporting of public hospitals. This is a step in the right direction. It is not possible to improve performance without first collecting data for analysis. The reality is, of course, that hospitals already collect vast amounts of information about themselves. It might be that collecting the data is not the issue, the real issue might be that they chose not to act upon the information they collect.

Talk is cheap. In the past the State Government's have not been keen to be placed under scrutiny through performance monitoring. The New South Wales State Government has been particularly opposed to the idea. Only time will tell as to what the performance measurements will be, and how well the State Governments support the process.

In theory all hospitals should be the same. This suggests measurement parameters would provide comparable information. In theory consumers should be able utilise the information provided through monitoring to help them choose where they would like to go for care. The reality is different to the theory. Often consumers have little option where they go for hospital care. Even for those with private health insurance, freedom of choice, long touted by private insurers, is limited by the availability and location of services. Politically it may not be in any Governments best interests for its health service to come under close public scrutiny.

Consumers want certain information. For example, they want to know that hospital waiting lists are becoming shorter. They want to know about the safety record within hospitals. They want to know which hospitals experience outbreaks of infection within the hospital. They want to know which hospitals experience high levels of deaths by accident.

Hospital administrators also need information. They need to know what their patients think of their service. They need to know the level of staff turnover, the average length of hospital stay, the time taken for triage, the number of day procedures, financial data, the level of in-hospital infection, bed availability, number of surgical procedures. Much of this information is already collected within hospitals.

Hospitals have expressed reservations about the validity of 'league tables' comparing one hospital against another. Such reservations are often well founded, except, that is when the hospitals use the shortcomings of league tables to avoid overall scrutiny. There does not appear a lot of evidence to support the theory that creating league tables leads to improved productivity. League tables imply all hospitals are equal. They may well have been created equal but they do not operate in equitable environments. League tables do not take into consideration additional, regional, factors that individual hospitals may have no control over. It is unlikely league tables will provide consumers with usable information.

Consumers may not want ‘league’ tables. Tables can make for interesting, and sometimes controversial fodder for the media, however consumers have neither the time nor the inclination to analyse such tables. It is not even a given that consumers want raw data. It is possible all they require is reassurance the processes designed to minimise the impact and maximise the benefit to them are in place.