Why Do Some Hospitals Tolerate Poor Performance?
By Cary Gutbezahl, MD, President, Compass Clinical Consulting:
When we are asked to help a hospital that has major financial or quality problems, we almost always find that these problems didn’t begin overnight. In fact, there was evidence of problems for many years. In retrospect, it is easy to point fingers at those individuals and boards that “missed the problem.” The more important issue is whether the problem should have been recognized at an earlier time, when the problem could have been corrected without significant damage to the organization.
Our experience says that while hospitals sometimes overlook indications of problems, more often, CEOs and boards tolerate a series of ineffective attempts at fixing the problem.
Why would that be?
One reason we have found is that there exists a limited understanding of the real nature of the problem. Many organizations don’t think through what is driving poor performance issues. The best way to gain an understand of the problem is to mix knowledge with novelty. We recommend bringing knowledgeable insiders together with “uncontaminated,” but capable participants. The insiders provide factual information about what is going on, while people who are uninvolved can ask questions to surface issues that might be overlooked by people involved in the issue every day.
Another cause of poor performance is an unwillingness or inability to figure out how to deal with the drivers creating the problem. For example, sometimes people are afraid of asking the medical staff to change. In reality, this should not be difficult if hospital leaders develop a good solution that meets everyone’s needs.
Again, this is a situation in which unbiased participants can spur innovative solutions. Non-participants can ask questions or challenge assumptions that prevent creative solutions. As an interim CMO, I have often approached problem physicians and achieved positive outcomes. I don’t think this was because we were both physicians since other physician leaders had made failed prior attempts. The source of my success was that as a newbie, I wasn’t afraid of approaching the physician, I showed respect and that I brought a fair and unbiased perspective.
Often, failed problem-solving begins when the wrong people are invited to solve the problem. Many hospital managers when faced with a problem of poor performance have a tendency to “round up the usual suspects” (apologies to the movie, Casablanca). Frequently, this means the very people who have been unable to solve the issue before are still asked to come up with a new answer. The people who are involved in long-standing or slowly simmering problems had plenty of time to fix the issue but have been unable to arrive at a durable solution. This is a case of what you don’t know can hurt you – and it calls for a new set of eyes to bring about sustainable improvement in performance.
To create solutions to persistent problems, leaders and managers need to think differently. That usually requires gathering new perspectives from people who haven’t been part of the problem.
Read more about how hospital leaders can impact hospital performance.
Filed Under: Featured Articles • Hospital Leadership
Case studies to learn more about ways in which Compass Clinical has worked to create better American hospitals.