Leadership Engagement is Critical to the Success of Improvement Efforts

November 15, 2013
By Cindy Hutter

There’s no easy way around it: change is hard, and resistance to change comes in many forms. Oftentimes, proposed changes aren’t viewed as doable or as a priority. Regardless of the type of opposition, teams working on everything from breastfeeding support to sickle cell disease are finding ways to ensure leadership commitment to help overcome organizational resistance.

Find the Best Path to the Top
One fundamental way to create leadership buy-in is to tie proposed changes to the organizational mission. Successful quality improvement teams say that understanding the multiple priorities of an organization and its various departments helps them create an appropriate message to get support for a project.

Patrice Gutierrez, RN, IBCLC, the team leader at United Regional Health Care System in Wichita Falls, Texas, used the hospital’s mission of providing excellence in healthcare in local communities to garner support for participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative. The collaborative is a project by NICHQ, the Texas Department of State Health Services, and the Texas Woman, Infants and Children Program to improve service delivery and create settings where a woman’s choice to breastfeed can be best supported, with the goal of increasing exclusive breastfeeding.

“Our CEO is focused on the idea of providing excellence. Excellence can only be done by using evidence-based practices,” says Gutierrez. “Putting the project in the lens of striving for excellence made such a difference in the discussion.”

Another tactic to help get leaders committed is to communicate the financial impact of proposed changes. Teams have received positive responses when they share how changes can save an organization money, improve patient satisfaction scores, or tie to a crucial accreditation requirement.

Even after articulating an argument tied to an organization’s strategic plan or priorities, going straight for the top isn’t always the best place to start. A second strategy to obtaining leadership support is figuring out how to approach leadership and who the best messenger would be. It’s helpful to look at a team’s sphere of influence and see if there are informal organizational leaders, like a physician, that can be brought on board and serve as a stepping stone to getting an executive’s support. This tactic is especially helpful if a project is being led by a lesser-known staff member.

For difficult-to-access executive leadership, teams have found success in using proxies to make sure information is shared up the chain of command. A Florida team participating in Best Fed Beginnings, a national quality improvement project run by the Centers for Disease Control and Prevention and NICHQ that aims to help hospitals improve maternity care, used this tactic to reach a busy new CEO.

“The new CEO is focused on positioning our organization to succeed in an uncertain financial environment. I have not had the opportunity to speak with him directly about Best Fed Beginnings, so I’ve focused on filtering the information up through our VP, who is familiar and supportive of the project,” says Karen Fugate BSN, RNC-NIC, a quality specialist at Tampa General Hospital. And that, she says, has helped keep leadership backing her team’s efforts to make changes in day-to-day protocols to better support breastfeeding.

Communicate, Communicate, Communicate
Once leaders are onboard with a project, it’s important to frequently share information to help transition them from supportive to engaged. One powerful way to share the importance of the change effort is to share qualitative data in addition to quantitative data.

“There is no more effective messenger for improvement work than the consumer,” says Tiffiny Diers, MD, principal investigator for the Ohio Valley Sickle Cell Network, a member of the Working to Improve Sickle Cell Healthcare (WISCH) project, an effort seeking better care for patients with the blood disorder. “Find ways to make sure that senior leaders also hear the patient voice. You need both data and stories about how practices are affecting lives to tell a compelling story.”

Gutierrez says she has shared press releases and e-newsletters about the project, an article from a local newsletter about being selected for the project, and data on how successfully implementing the program would raise patient satisfaction scores.

“We have multiple touch points of opportunity for team members at all levels to come and share information about what’s going on with the project from their perspective, including monthly and quarterly meetings” says Diers. “That has been helpful in keeping leadership within the pediatric center engaged in our work.”

Amy Diane Short, MHSA, the Ohio Valley Sickle Cell Network project director, adds, “We do a lot of management just by walking around. I make a point of going to the cafeteria or other places on campus where I can run into people and give them an update on our work.”

The Value of Engaged Leadership
Having leadership advocacy for a project can prove invaluable for addressing naysayers and overcoming barriers. The Best Fed Beginnings quality improvement team at Carolinas Medical Center involved physicians from the beginning of the project to increase support. Instead of just being on the receiving end of instructions on how they need to change their practices, physicians felt more responsible for and invested in the changes. However, the team found a few practitioners still resisted, and that is when leadership backing came in handy.

“We talk to our senior leaders and then they speak with the physicians and reinforce that the change effort is what the hospital is doing and they need to participate. The evidence of it being best for the patient is the biggest bullet,” explains Leah Ledford, MSN, clinical nurse leader at Carolinas Medical Center. “I can’t overemphasize the importance of having leadership support. When you get resistance from people you need to have leadership support you to build engagement with the stakeholders for successful implementation."

Adds Fugate, “When you reach a barrier that you don’t seem to be able to solve, don’t continue to spin your wheels and waste resources and energy. Pull in your senior administrative leader and see if she has a recommendation to overcome a barrier. They may be aware of resources and ways to tackle a problem that people on the front line don’t think of.”