Becker's Hospital Review

53 Executive Briefing: Organizational Improvement confirms the procedure steps before the first incision is made. The entire team participates in a quality de-brief before the pa- tient leaves the operating room. This includes a "lessons learned" document that identifies even the smallest opportunity to improve efficiency, standardization or safety. It's a consistent process that reveals deviations from best prac- tices. These deviations reveal stories — stories staff can relate to, stories that change behaviors. These events drive the team's educational and training plan. Initially, nearly 50 percent of cases give rise to learning events. Over time, process improvements drop this to five percent of cases. In addition to safety, the ap- proach improves operational efficiency. Surgical volume increas- es while labor hours per case decline. You can start to see the path to "value" — improved patient safety and reduced costs. 2. Relationships. This laser focus on process improvement re- quires an extraordinary level of teamwork and collaboration among a diverse surgical team of technicians, anesthesiologists, sur- geons, support personnel, surgical assistants, nurses and nurse anesthetists. Team dynamics and culture are critical. It requires an interactive and complex leadership style and an "every patient, ev- ery time, mentality" that permeates the entire team. There is height- ened culture of accountability. Peer-to-peer performance observa- tion checklists are valuable and accepted. Behavioral expectations are built into the employee performance management system. Everyone on the team holds everyone on the team accountable, and is accountable to the organization with regard to the behaviors required for success. Yes, this includes the anesthesiologists and surgeons. No, this is not the traditional operational room culture. 3. Care experience. We speak often about the patient "care ex- perience," but what about staff? The experience of the operating room team impacts not only their degree of job satisfaction, but their job performance, the organization's performance and patient outcomes. Staff struggle to adopt mandated approaches when they question the organization's commitment to patient safety. Even in strong organizations, operating room culture can be prob- lematic. Employee engagement surveys often reveal that staff don't see a positive safety climate, hospital administrative support or overall positive department morale. On top of this, they don't feel valued or see physicians (the purported leader in the room) actively creating a positive workplace environment. Is it any sur- prise that merely mandating a checklist, failed to create meaning- ful change? Culture, behaviors and talent strategies Checklists can work, but mandates are insufficient. They work when a cohesive team actively participates in the implementation and when the efforts contribute to achievement of individual team member goals. Using a checklist, correctly, every time is a behav- ioral choice, predicated on a shared purpose and understanding. There appear to be a few "cultural prerequisites" to the success- ful implementation of processes like an operating room checklist: • Hospital and staff need to accept "value" as their shared pur- pose • The behaviors that contribute to "value" need to be built into the approach to talent • Physicians need to be receptive to these concepts • A willingness and ability to develop the "human" resource • Organizations struggle with the concept of developing a par- ticular culture. This is most often because "culture" remains a vague and elusive concept. In the operating room example discussed here, the necessary culture grew out of specific processes and behavioral reinforcement. If we think about culture as nothing more than the collective behaviors of the workforce, we can begin to "operationalize"culture. These behaviors are what matter and what drive outcomes. How do these cultural prerequisites relate to the approach to talent? 1. Identifying value as the shared purpose is the lean "true north" your talent strategies must support the organization's move toward value. 2. Define with specificity, the behaviors that support that goal. In the case of the operating room checklist, for instance, a flexible leadership style, high levels of accountability, a sense of ownership and the ability to collaborate are critical. 3. Build talent strategies around these behaviors. What are you doing, everyday to ensure that the people you bring on to the team have the behavioral competency to perform? Build these same competencies into your performance management approach and hold people accountable for these behaviors. 4. Needless to say, a similar approach needs to be taken with physicians. What it means to be a successful physician has changed and we need to provide physicians with the tools to understand, and develop, behavioral skills. Conclusion Healthcare, more than any other industry, is about people. The service being provided impacts patients in intimate and profound ways. The service is provided by staff and professionals who are deeply invested in their jobs. The initial failure, and subsequent success of, surgical checklists, is the perfect example of what Mike Hoseus spoke of: Process is only half of the equation and will fail to yield the desired results if you don't put people before products. n Since its founding in 1993, Select International has been dedicated to developing assessment solutions that help companies identify, select and develop top talent throughout their organization. Select's Healthcare Solutions Group specializes in developing assessment technology to help healthcare orga- nizations improve the return on their most important investment – their people.

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