Improving organisational performance in health care

Doctors and hospitals have put significant efforts into delivering optimal patient outcomes. The same focus and dedication is needed for the sector's operation and performance.

Healthcare professionals need to pause, reflect and make integrated decisions about redirecting energy from crisis mode to creating a health system that is both strategic and outcome-focused.

Our healthcare systems have operated under enormous pressure over the past two years — where we have expected systems to function at a peak level for too long. They have delivered outstanding care to patients but have damaged their own organisational health in the process.

Now is the time to take stock. Leaders in the health system need to find the time and space, collectively and individually, to make their departments healthy again. What makes a healthy department? It is one where there is a clear vision, it is grounded in behaviours and actions for everyone, with a clear strategy or pathway to deliver it. There must be alignment between vision, strategy, measures and individual motivations. Leadership is the pivotal force joining all of these.

Reflection and alignment require both art and science. Science is the evidence and data: looking at employee surveys, financial bottom lines, patient data and efficiencies with clear hypotheses and an analytical precision. Bringing this together against the vision and strategy, to make new decisions. Art is the judgment and wisdom that leaders bring to the room. Data mustn’t drive decisions. It can only inform. The lived experience of leaders and their teams allows for meaning, prediction and ultimately compassion.

So where to start? Use science to consider the best clinical service model design. Consider how this needs to be reconfigured for the future, incorporating recent learnings. For example, ensure that the advances made in digital health become embedded in business as usual.

Get all your data together. Don’t go fishing — you may catch something that throws you off course. Develop hypotheses to frame data analytics, such as hypotheses formed from human experience (your team, the patients, community). Look for fresh insights. If the analytics are only reconfirming what you already know, then perhaps you are not asking the right questions of the data.

Consider questions such as:

• Have the frequency and nature of interactions between people and teams shifted? This may give evidence that staff need to solve operational problems and patient outcomes differently.
• What data is sitting under the success or lack of success of established measures and targets (in addition to the obvious impacts of COVID-19)?
• What factors co-exist to drive both positive outcomes for patient experience and staff experience?
   

Straight away we can see that the art of thinking well is critical to the use of science. Science alone can take us on the wrong path, if not given careful consideration.

The art of thinking, sensing and understanding people is critical to re-establishing organisational health in the healthcare sector. But where to start? Start at both ends of the hierarchy. Leaders need to start by forcing a practice of reflection. This involves stepping back and looking through the lens of our people to understand how we can best develop future leaders, as well as listen and actively respond to the needs of front-line staff. This alone will ensure the long-term health of our health systems and the people who work within them.

But take care not to fall into the mind trap of ‘rightness’. In the words of Jennifer Garvey Berger, rightness occurs when our instinct to believe that we are right closes us off to the ways that we are wrong. Health care is filled with examples of leaders believing in the certainty of their own views even as complexity grows.

Stepping back to step forward

To manage operational pressures effectively and sustainably in the long term, leaders and executive teams must create the space to step back and re-evaluate their system as a whole. While easier said than done, we have seen great progress from executive teams who take time out and are willing to refocus on strategy, as well as shape clear, medium- and long-term plans for recovery and transformation.

The first step to this is ensuring their organisation has a powerful ‘organisational vision’ to work towards, followed up by a clear, measurable delivery plan that provides staff and patients with the clarity to move forward.

COVID-19 brought healthcare leaders together around the single, sometimes bloody-minded purpose of tackling the pandemic that drove change at a pace we rarely enjoy. We saw the building of field-testing centres, creation of telephone-first triage systems to limit the spread in hospitals and the rapid deployment of mass vaccination programs.

Beyond the current crisis, it is now vital for leaders and staff to harness the same clarity of purpose and planning as efforts shift to the recovery and redesign of our clinical services.

Creating capacity and capability

During the pandemic, we witnessed health and social care leaders, both young and old, ‘run towards the fire’ to deliver the world-class performance we needed to care for our populations.

Now it’s time to capture all these learnings and better ways of doing, and use this to invest in our leaders so that they have the skills and networks needed to lead change. The opportunity is now to transform, re-create and realign our healthcare systems and capabilities for tomorrow.

Currently, health services are experiencing a wave of retirements, workers exhausted and exasperated by the pandemic. Now is the time to capture that loss of organisational memory and reflect on the internal networks which are so often relied upon to get things done.

Managers have started to lead in different ways. They harnessed the need, naturally co-designed with their teams and provided exceptional care. Their approach demonstrated the art of looking forward by bringing these experiences into consciousness — to reflect and learn. There was a natural ‘hot housing’ of innovation in nearly all frontline teams to make a difference. There was trust within a framework.

Yet we have observed the resurgence of anger and frustration in many hospitals, as business-as-usual creeps back in. Legacy systems and practices close back in to restrict leaders, and untapped potential is left to fade.

Some of our most recent work has involved bringing together cohorts of frontline leaders — including those who have run towards the fire and are ready for their next mission, and those reaching the end of their careers and investing in their co-development.

We hope to equip leaders with the skills they need to be the next generation of health system leaders, but also create networks which they can rely upon and mentors they can learn from. Investing in ‘pre-retirement groups’ can not only provide these mentors, but may also create opportunities to retain these experts in our services for another few months. This will have a significant impact on recovery efforts and retention of their institutional knowledge.

Using an approach that combines the art and science of organisational health has the potential to transform the healthcare sector beyond just effective operational management. There is a real opportunity to redesign our systems to be sustainable, efficient and fit for the demands of future healthcare services.

Now is our moment to change for the better.

*Lyndal Hughes leads the health sector practice in Australia for Q5, with over 25 years’ experience in implementing effective transformation and leadership strategies for blue-chip companies and government departments in Australia, New Zealand, the UK and the USA. As a former London-based Accenture executive, Lyndal offers rigour and insight to all the projects she works on. She has been the Head of Culture and Change for Woolworths Food Group and founder of the highly regarded change consultancy Treacle. This consultancy was rolled into Q5 in 2021, bringing with it deep expertise in working with leaders to shape and implement integrated change programs that align with strategy. Lyndal delivers measurable differences in workplace behaviours, wellbeing, organisational culture and leadership impact.
 

**Charlie Penny was Q5’s first ‘boots on the ground’ when our work to support the building of the Dragon’s Heart Hospital (DHH) commenced. The DHH was a surge hospital with 2000 beds for COVID patients, built in 30 days in the Principality Stadium — the home of Welsh Rugby. Building the DHH formed the foundation for the past two years for Charlie, who has subsequently led a series of projects in the NHS. His recent work has included supporting executives to refocus on their strategy and longer-term transformation plans following the intensely operational, fire-fighting period experienced during the pandemic. He has also supported a number of service improvement programs, including accelerating efforts to vaccinate the Welsh Population.

Image credit: ©stock.adobe.com/au/sdecoret