What once seemed like a burden became a gift. It doesn’t take long, after becoming a physician leader for a hospital or healthcare system, when you will be approached about starting up a program. My experience working for a large integrated delivery network was no different. When I was a member of a team that was working on a new program it seemed simple. When I became a leader who was charged with developing a new program, I quickly realized I should have been taking notes on program development when I was just a member of the team. It was a struggle at first, but, in time, I learned. I started taking mental notes of what features were associated with successful programs and what were not. In particular, I wanted to know what distinguished successful programs from unsuccessful programs. The result of that endeavor was the gift, or what I refer to as the Seven Pillars.
The Seven Pillars are fundamental elements that all successful programs build into their structure. While their presence does not always guarantee success, their absence is highly associated with a greater likelihood of failure. To remember the Seven Pillars, think of the mnemonic “SPECIAL PI”. This stands for, Seven pillars, Purpose, Engagement, Communication, Infrastructure, Accountability, Leadership and Performance Improvement. The following is a summary of each of the Seven Pillars.
- PURPOSE: It begins with having a purpose. Every member of your team must understand and articulate the “why”. In summary, it is because a formal organized approach to any hospital based program produces better outcomes at a lower cost compared to not having a program.
- ENGAGEMENT: Engagement has become a buzz word in the healthcare industry. More specifically hospital administrators and physician leaders want “physician engagement”. For many it has become a quest for the Holy Grail. The unstated belief is, “If we only had physician engagement, then we could solve all of our problems in healthcare.” There is no doubt that physician engagement is important for change management in healthcare. Before we get to this place though, we need to set up our program to become engaging. In summary, the first step in this process is to stop doing those behaviors that disengage people and move on to those behaviors that create an engaging program.
- COMMUNICATION: Programs must communicate to their stakeholders. It is impossible to educate and inform people without a consistent process for communicating to them. Communication must be a two-way process. A program must not only communicate to its stakeholders but its stakeholders must have a mechanism to communicate to the program’s leadership. In summary, effective communication increases stakeholder support. If you want to be successful, then you must communicate effectively.
- INFRASTRUCTURE: All programs must have a well developed infrastructure. A program’s infrastructure is the foundation on which the program will develop and sustain itself. This is often considered the boring work of building a program and therefore nonessential. Unfortunately, many organizations overlook this important element. In summary, it is all the people, process and technology that increases the likelihood of a highly functioning program.
- ACCOUNTABILITY: Without accountability all programs eventually fail. Programs perform best when the accountability is integrated into the structure and governance of the program. In summary, someone or some group must be accountable for the following.
- Implementing the program
- Managing the program
- Establishing goals for the program
- Creating action plans to achieve goals
- Reporting results to Medical and Administrative leadership
- LEADERSHIP: In order to successfully navigate the complexity of our modern healthcare system, there must be an individual or dyad at the helm of the program. People want and expect good leadership as a part of any program. We’ve found that a dyad leadership structure is particularly effective. This is typically made up of a physician leader and a nursing leader in the hospital setting. In summary, all stakeholders will have varying expectations of you as a leader. Understanding what each stakeholder will expect from you will improve your ability to lead.
- PERFORMANCE IMPROVEMENT: Performance improvement answers the question of how we are going to improve value for patients and the people who provide their care. In addition, it is very difficult, if not impossible, for a program to improve without data. Data is the backbone of performance improvement. Whenever possible, the data should focus on quality, utilization, cost and patient/provider experience. While some data may not be accessible to a program, this should not prevent any program from developing a data source. Performance improvement has been done with pencil and paper long before computers, databases and statistical software. While this may seem primitive, based on modern capabilities within most healthcare systems, it is important to note that data comes in many forms, and data analysis is only limited by our imagination and willingness to be creative about how we collect and interpret data. In summary, you manage what you measure. If you want to improve, then you will always want to know, compared to what?