A new CEO arrived at an organization that had a strong vision & mission to contribute to improving the quality of healthcare

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A new CEO arrived at an organization that had a strong vision & mission to contribute to improving the quality of healthcare. The quality improvement business of the organization seemed reasonably strong and well regarded. However, within days of assuming the new responsibilities, the CEO realized that there were symptoms of a less than desirable culture, the product was becoming less relevant to clients and it was evident that external stakeholder relationships required strengthening.

The Problem

The culture of the organization was such that staff were afraid to speak up, that they would ‘get in trouble’ or ‘lose their job’ if they offered suggestions for improvement. Teams were not working well together. Communication was poor. Meetings were not well organized, for example, there was no set agenda and no minutes were taken. The Board and board members were not effectively utilized. The primary quality improvement product was becoming ‘out of touch’ with reality and client needs. Some clients were questioning the value of using the product. External stakeholder relationships were adequate, but not strong, and there were non-existent linkages with some obvious potential partners in the quality sphere of healthcare. For example, a representative of the organization was not invited to important meetings. They were not deliberately excluded, they were just not thought about.

The Consequences

Internally, staff turnover was high (in the region of 20-25%). Teams were not working well together. Senior management was not committed to attending senior management meetings – they attended if they wanted to or often missed the meetings. There were senior meetings where there was no agenda and no minutes taken. While the Board met at the defined quarterly intervals, the expertise of the Board was poorly utilized.

Externally, while the organization was well regarded by its clients, key stakeholders and others were minimally engaged. The organization was excluded from external discussions on key healthcare issues where, if involved, it could have provided valuable input. Clearly action was necessary to :

1) Develop a strong internal culture of quality, one within which staff knew they were valued and respected;

2) Improve the relevance of the product; 3) Strengthen external stakeholder relationships.

Barriers / Obstacles

The main barrier was that the culture was entrenched. Many coordinated steps had to be taken to begin to turn the culture around. Several senior staff who contributed to the negative culture were still within the organization. Addressing their behaviours and approach was a sensitive issue and challenging.

Actions

Internally (staff):

· Actions were taken to prove to staff they were valued – we were all partners.

· The staff developed new values for the organization – these were presented to the Board for input & acceptance.

· The values were converted into ‘expected behaviours’ – an exercise undertaken by the staff – and then assessed twice/year.

· All-staff sessions were held at minimum every few weeks – with an agenda and time for open dialogue within which anything could be raised.

· The CEO had informal sessions with staff on a monthly basis. There was no set agenda and any issue could be raised.

· A fitness room was installed.

· A policy was developed such that all staff members, from clerical through to senior staff, must be ‘on the road’ with the product at least once every 3 years.

Product:

· Extensive steps were taken to upgrade the product over a period of several years.

· Short term / immediate changes (easy wins) were made while the medium to long term changes were underway.

· The name of the organization was changed in order to better reflect its mandate.

· Feedback mechanisms were strengthened to obtain product feedback from all stakeholder groups on a regular basis.

Board:

· A strong partnership between the CEO and board was cultivated.

· Location of Board meetings began to be held across the country – to facilitate engagement with key stakeholders.

· The Board members were consulted and involved between meetings and attended conferences and other meetings with stakeholders.

External stakeholders:

· Deliberate steps were taken to meet with existing external partners – mutually identifying where the partnership could be strengthened.

· New partners were identified and relationships initiated.

· External communication was strengthened.

· All staff and stakeholders were involved with appropriate initiatives. Partnerships and collaboration were key.

 

 

What Worked?

All actions worked, however it took time. The inter-relationship between the internal culture, productivity, relationships with the Board, quality of the work, product changes and external relationships wove an integrated picture. It took at least 2 years to truly shift the internal culture and measure the impact.

The external relationships were significantly stronger, such that we were invited to meetings and conferences with such frequency that it was difficult to keep up with the requests. It took about 3 years to effectively shift those external relationships to the extent that the input of our organization became a ‘given’ and valued.

Outcome

The internal culture turned around markedly. Staff turnover dropped significantly, to about 2% rather than in the region of 20-25%. Staff engagement surveys improved.

The Board was better engaged and convening the Board meetings in other cities and liaising with stakeholders of that region was an extremely positive change with positive feedback.

Positive feedback on the improvements to the product was obtained, with regular feedback mechanisms in place. There were ‘bumps on the road’, however the areas of concern were respected and resulted in modifications as necessary.

External relationships improved substantially, one measure of which was that we were invited to meetings and conferences with great frequency as noted previously.

The organization went from being seen as a leader of the quality improvement business to a leader in healthcare, with valuable input to provide on key healthcare issue discussions & debates.

Lessons Learnt

The main lessons learnt were as follows :

· Care for your staff and they will care for the clients.

· As CEO, be present and accessible to the team.

· Building relationships requires the leader to take deliberate steps to meet with

stakeholders and to meet regularly, even if there is not a problem to solve or a topic at

hand.

· Don’t be afraid to bring groups together.

· Remember to evaluate and measure everything you are doing. It is crucial to identify if

progress is being made, or where course correction is required.

· Listen to the clients, truly listen to both the good and the bad. Don’t be afraid to adjust

course if there is unreasonable resistance. A degree of flexibility is important, while also

adhering to your values and direction.

· Don’t sit back once a goal appears to have been achieved. You must continue to nurture

the progress and continue to evolve and improve. If the leader takes his/her eye off the ball, the organization will slip back into old habits or not evolve. The culture, the product, the Board and the external relationships must continually be nurtured and addressed.

Questions

1. When a leader/CEO faces challenges internally and externally, how does he/she prioritize and identify where to begin addressing those challenges? What steps should be taken and how would you plan to address this situation? (minimum 150 words)

2. What leadership style and approach would be most effective in this circumstance? (minimum 150 words)

3. What measures / indicators should be identified and tracked to note progress or further deterioration (internal, product, Board, external stakeholders, etc)? How would you measure success? What would be the ultimate measures of progress? (minimum 150 words)

4. What should a leader do to ensure an organization does not ‘backslide’ after achievement of some marked improvements? (minimum 150 words)