how to achieve and sustain excellence

Why can some organizations achieve and sustain excellence while others cannot? What makes the difference is one of the most important things the Studer Group has learned

Here's what we have found: Most organizations have a strong strategic plan in place to achieve excellence. Where they struggle is in the execution. We find that organizations get the outcomes they seek only when they successfully hardwire excellence across all operational areas.

Most organizations have pockets of excellence. Typically, the majority of operations are goodand sometimes great. There are usually a few areas of concern. Yet more than half of initiatives will fail despite good intentions and adequate funding. An example: High failure rates of total quality management/continuous quality improvement programs-60 percent to 67 percent, in factaccordingto a 2,006 literature review (Organizational Improvement Techniques-Success Rates ofTQM/CQI and an Overview of Six Sigma and Lean Thinking) by Studer Group's Alliance for Health Care Research. These failures occurred not because of basic flaws in the principles of TQM/CQI, but mainly because of ineffective implementation systems.

Why? These organizations lack an approach for systematic execution across the organization. We would never put new IT in place or construct a new building without a clearly thought out, sequenced plan for execution. But when it comes to leadership execution, organizations often lack the approach, detail, or sequencing it takes to hardwire excellence across the organization.

7 Ways to Hardwire Excellent Outcomes

Here are seven ways to avoid the most common pitfalls that derail organizations from attaining some of their most important goals, including high employee satisfaction, high-quality service to patients, excellent clinical outcomes, growth, and strong financial results.

Incentivize alignment. Organizations need to achieve a critical mass of leaders and employees to reach the tipping point that moves organizational performance. To do that, an organization must hardwire the use of tools and practices that reward strong performers and motivate chronic low performers to improve or leave the organization. When the organizational performance curve is too high in the middle-not enough high performers consistently executing-the organization reaches the "wobble point" and stays there.

Use objective leader evaluations. With a subjective leader evaluation system, leader evaluations are based on subjective measures and/or competencies. These do not include enough objective measures to align leaders' focus to the highpriority goals the organization needs to attain excellence.

Does your organization do this? Find out with a simple exercise. Look at the most recent evaluations of leaders who have not attained their department goals. see what their evaluation says. In our pre-work with organizations at the beginning of a coaching engagement, we routinely find that 95 percent of leaders have received evaluations assessing them as "fully effective" or "excellent," even though the organization has not achieved the desired results. This is the major disconnect that prevents excellence organizationwide.

Build skills to meet goals. In health care, we are often quick to promote, but slow to train in the new competencies leaders need to succeed. (These competencies range from first-level developmental needs, such as effective communication and managing resources, to senior-level developmental needs, such as visionary leadership and building business partnerships.)

Plus, working in health care can be like walking up a down escalator. If you stop or remain still, you move backward. With changes in the external regulatory and payment environment, we must always work smarter just to do as well as we did last year. To perform better, each leader has to commit to continuous improvement of his or her skills, processes, and techniques. Yet most organizations still fail to provide the intense leadership development that success will require.

Sequence change. Because so many initiatives have come and gone in health care, the latest buzzword program rolls out to an ever more skeptical group. It's easy to overwhelm leaders with new expectations they don't accept. Leaders today have full plates. That is why it's so important to introduce new tools, behaviors, and processes in a sequenced approach, one change at a time. As they see real results, middle and high performers will increasingly engage in the process.

Transfer best practices quickly. Organizations do not move best practices throughout the organization quickly enough. Sometimes leaders visit other hospitals to benchmark best practices, but miss the opportunity to seek pockets of excellence in their own organizations. Mentoring by high-performing leaders within the organization is an effective and inexpensive way to transfer learning to other units and departments. However, leaders should be prepared to take action with individuals who believe their own desire for autonomy is more important than a standardized approach that delivers organizational outcomes.

Do not tolerate subpar performance. If subpar performance and those who tolerate it are not coached to meet expectations, and do not face consequences for failing to do so, solid performers get tired and discouraged. Every individual deserves performance feedback, coaching when goals are not being achieved, and a clear understanding of what will happen next if performance does not improve.

An organization can meet its goals only when leaders are committed to enforcing an "up or out" approach with poor performers. Also, leaders who tolerate subpar performance place the safely of patients, the health of the organization, and the opportunity to realize the organization's mission at great risk. (Remember, no one ever wishes they had waited longer to fire a poor performer.)

Connect often to purpose, worthwhile work, and making a difference. In a recent poll we conducted, most employees said that in the past six months they had not read a patient letter or heard a positive story about the impact they or their organizations have had in the lives of patients, physicians, coworkers, or the community. These stories abound where you work. You will hear more of them when you share your enthusiasm for doing so. Harvest stories actively, and share them widely at meetings, by e-mail, on units, and in departments.

Almost everyone, regardless of their job title, chose to enter health care because of their desire to have purpose, do worthwhile work, and make a difference. Even the most self-motivated people can get discouraged if they are not reminded and shown that the work they do is valued.

What to Do Next

If you would like to move results at your organization more quickly, take a minute to give yourself and your organization a quick self-test in the seven areas above. Then commit to real change in just one area and take action.