Explore Our Case Studies
Designing and Delivering Coordinated Care
Flagship hospital in Southwest’s largest hospital system
Patient revenues more than $1 billion
366 acute care beds; 1,300 physicians; 1,600 employees
The CEO and executive team were committed to maintaining their leading market position, despite challenges such as competitors expanding services, physicians splitting time between multiple hospitals, and the growth of ambulatory surgical centers in their service area. These senior leaders decided to create three service lines simultaneously to deliver seamless coordinated care to patients and their families. They also committed to actively engage key physicians in governing the service lines.
Conducted a session with the executive team – CEO, COO, and CNO – to define desired outcomes, build a culture for growth, and lead the overall process.
- Led a cross-functional team in the rapid-cycle implementation of high-impact levers to enhance the patient experience across the organization.
- Led a cross-functional team of senior leaders to design and implement three service lines, while learning and practicing high-performance ways of operating.
- Engaged frontline leaders in “Making The Matrix Work” sessions where they created implementation roadmaps and agreed to make decisions based on what is best for the patient and the organization, versus what might be best for their function or unit.
- Coached the executive team on how to communicate the vision so that it was meaningful to staff members and moved them into action.
- Developed capability of the top 70 leaders to make decisions based on what is best for the patient and each other’s mutual success
- Focused top 70 leaders on breaking historic patterns of finger pointing, working in siloes and trying to “fix” the behavior of others.
- Partnered with the Organization Excellence team, utilizing their staff’s expertise and LEAN principles in implementing and measuring key projects to deliver seamless coordinate care.
- Provided structured feedback from selected directors to executive team on their collective leadership strengths and development areas; coached leaders in their role in ensuring the delivery of seamless coordinated care.
- Coached hospital leaders to successfully recruit influential physicians to serve as co-directors, along with an administration partner, for each of the three service lines.
- Instituted a dyad leadership model for the service lines in which a physician and administrator worked together, based on clearly defined roles and responsibilities.
Within the first year, the hospital
- Resolved major surgical scheduling challenges.
- Increased on-time operating room first-case starts by 32%.
- Increased neuroscience surgeries by 78%.
- Equipped staff to collaborate across traditional boundaries for the benefit of patients and the organization.
- Executive team was aligned on the vision, strategy, and structure for the service lines and on how to deliver seamless coordinated care.
- Staff engagement was significantly improved by the involvement and commitment that was created among the top 70 leaders.
- Senior leadership team capability increased through coaching members of the team to facilitate off-sites, co-design agendas, and build ownership for the direction.
- “We are all looking at how to be 100% responsible in providing safe seamless coordinated care every day! We never thought that would happen.”
- We had some real breakdowns between Nuclear Medicine and EP Lab. There were big fights. We brought the groups together and talked about the shared commitment to our patients and helped our staff be 100% responsible. “
- “The staff went from saying ‘it’s not my job’ to helping each other out – making beds where necessary, not criticizing each other, and working together. Our patients noticed and gave the staff huge accolades which made them feel great.”
- “We had an instrumentation issue with a physician. We are engaging the nurses, physician and even the sales rep in solving it. There is no blame or finger pointing. We are focused on what we are committed to doing and providing the physician what he needs.”
- “One of our neurosurgeons has been a lot more engaged and is excited about the new service line. She is stepping up as a leader and bringing more cases to us. She likes what she is seeing and has more confidence we will meet her needs.”
Transforming A Business Through Leadership
The Western Business Unit in the US of an international oil and gas company
This business unit realized that they needed to build the leadership capability, as they learned to operate more like an independent vs. a large corporation.
The first step was to have the organization aligned in pursuit of a meaningful twelve-month goal, to be profitable in a $1.20 per MCF environment. The Western BU VP did an excellent job of having the leaders within the organization understand why this was critical, for the BU’s long term viability. During a one-day leadership offsite, the top 40 leaders:
Identified the key results their teams needed to achieve to succeed
Defined the interdependencies between the various teams
Discussed how they would engage their teams in achieving the $1.20 per MCF goal
We then designed and implemented a leadership development process for Team Leaders. This unique process built sustainable leadership skills by combining formal classroom discussion with implementation of a “Leadership Challenge”, a project that required participants to utilize their leadership skills to complete, by engaging their teams and others. The process was completed over a 90-day period. Participants met once a month for 4-6 hours, where they were exposed to key leadership capabilities and then utilized those capabilities to implement their Leadership Challenge. Each monthly classroom session built on what was learned the previous month.
Our consultant held monthly, one to one coaching sessions with each of the participants to challenge them to raise their perception of what is possible and assist them in successfully engaging their teams to succeed.
The BU was operating at $1.17 MCF within only ten months
The BU became self-funding for the first time in over five years
Cross-training between Facility and Production Engineering, Maintenance and Operations, and Mechanics and I&E Technicians resulted in greater efficiency and increased run time
We have become the premier BU in the U.S.
"We defied physics by flattening the decline curve of a dying gas field; you just don’t do that"
"My team is working for each other’s success; we have knocked down the siloes that existed"
" This has helped me achieve results within my team that I did not think possible"
400-bed community hospital in Midwest
1,800 employees and 500 physicians
High-volume emergency department
Major safety net provider in the region
Hospital leadership realized that they had a problem and needed to intervene. Patient satisfaction scores and community perception were at an all-time low. Initiative overload and a history of little follow-through on change initiatives were impeding efforts to turn the hospital around — traditional approaches were not working. The workforce was demoralized; the leadership team was unsure how to proceed and there was significant employee attrition. A fundamentally different approach was needed to disrupt historical patterns and create a common sense of purpose to make the hospital great once again.
We focused on co-designing a pilot on an in-patient floor for creating an extraordinary patient experience. This would give us the quick win that was needed to build staff confidence that they could make a change that benefited their patients. Specifically, we did the following:
- Actively engaged community leaders, physicians, and hospital leadership to define a meaningful vision and build commitment to what’s possible.
- Trained Charge Nurses in effective coaching techniques.
- Designed and implemented stroke care pathways.
- Trained staff in techniques to create a wonderful experience for their patients and families.
- Conducted multiple retreats with large cross-functional groups of staff members, to build collaboration and a common vision of the patient experience.
- Built an understanding among staff of how their behavior affects each other’s success and the patient’s welfare.
- Took the design team and executive team to a Planetree hospital to broaden their perspective of what was possible.
- Brought the Rapid Cycle Implementation methodology, which became known as Dynamic Lean, to energize the hospital’s continuous improvement process.
- Trained internal staff to replicate practices on additional units.
Within 10-12 months, the hospital had realized the following results and was on a path to win many awards in the coming years and be ranked in the top 10% nationally for medical excellence in stroke care and patient safety related to major cardiac surgery.
- 66% decrease in fall index.
- 26% decrease in stroke patient average length of stay.
- 70% increase in teamwork scores.
- 51% increase in ESAT scores.
Increase in top box excellent scores six months following implementation
- Recommend and return – 30% increase.
- Doctors, nurses and staff working together – 23% increase.
- Staff responsiveness – 39% increase.
- Nurses’ ability to communicate – 32% increase.
- “In 25 years of nursing I have never seen anything like this.”
- “I’ve been here before, and I didn’t want to come back. But this time everything has been different. I don’t wait for someone to answer my call light. It’s immediate. My care has been wonderful. And I am 87 years old.”
- “I’ve always felt like an outsider. Now I am an insider. They share information with me.”
- "The most enjoyable and rewarding aspect of my job is helping patients and their families. Now I can spend time with patients and assist with their needs.”
- “I can be out here with my patients. I can anticipate their needs before they get to their call lights.”
- “It’s nice to know who will be taking care of me and who I can call when I need help.”
Perioperative unit in a Magnet Hospital
$25M perioperative services expansion in past year
Designated as a “Baby-Friendly” Hospital by WHO and UNICEF
Affiliate of large faith-based, nonprofit system
The perioperative team’s effectiveness was critical for delivering both positive PSAT scores and the hospital’s financial commitments. The opening of four new operating rooms made this the perfect time to repair historically dysfunctional ways of working and co-create how the team could work together to help the hospital become the destination of choice for physicians and their patients.
The department was known for negativity, resistance to change, and cynicism. Long-term employees had no interest in “playing nice with others.” Employees acknowledged they were not honest with each other, blamed others, got defensive, and were not aligned.
The hospital brought in new leadership to turn the department around, but the leaders were getting threatening phone calls and other dysfunctional responses from the legacy staff. The question became: How do you get this team to play a leadership role in culture change and to produce excellent results for the hospital?
The most critical factor for high performance is the ability to create and sustain leadership and organization alignment. Our task was to generate leadership alignment and commitment to a shared vision and direction for the struggling division.
- Performed a departmental assessment to identify the strengths of the leadership team and find ways to improve its performance. Focused on the positive and why people care.
- Defined ambitious performance goals and aligned the top leadership team around the goals and what they would mean for the department.
- Engaged informal leaders within the various departments in perioperative services to tap into what they cared about and what they could see as possible for the department.
- Facilitated monthly workshops and provided one-on-one coaching for members of the leadership team to work through the challenging dynamics.
- The number of surgical patients coming through the recovery unit increased by 20 percent.
- The OR is operating more efficiently and procedures are starting on time; the percentage of first case on-time starts doubled within 6 months.
- Perioperative leaders now share accountability for meeting overall goals, are communicating effectively across departments, and actively support each other.
- Team is working at a level of maturity that allowed elimination of two manager positions; supervisors confidently take ownership for outcomes.
- The senior leadership team is demonstrating heightened creativity, a greater sense of teamwork, and more enjoyment in their work.
In summary, the leadership team and departments that make up perioperative services are now working together as “one perioperative” and setting an example for delivering seamless coordinated care within the hospital.
- “We were working in silos, focused on our own areas, not communicating and pointing fingers. Now, we are working for each other’s success as a leadership team and building ‘One Perioperative.’”
- “We have techs from Endoscopy wrapping instruments in CSU, physicians working with us to consolidate and streamline instrument trays, OR staff taking patients to the restroom in Day Surgery. That has never happened before.”