Setting Goals for Redesign in Seven Steps
A Simple Method for Effective Leadership
Health care managers are often reluctant to set meaningful goals, fearing accountability and failure. Here are seven simple ways for leaders to be more effective.
“THINK “DESTINATION.” Don’t think “Goal.” Think bigger than goal. A “goal” is not the point. The point is to decide where you want to end up. What’s your “destination? If you’re going on vacation you are thinking, “Wow, we’ll take the family to Disney World, stay at a fun place, go on all the rides, see all the sights and have a great time.”
You’re NOT thinking, “We will travel in a car at an average speed of 70 miles per hour for a distance of 750 miles heading in a southeasterly direction until we reach our pre-determined destination.” You may have to do this, but the reason you are willing to do the mileage is for the benefits of the destination. So, you’ve got to know where you’ll end up before you’re willing to go on the journey.
And your destination should be immensely meaningful to those who will join you on the journey. If it’s not, then you need a better destination. The meaningful “destination” gets people to say, “It’s worth the inconvenience, the effort, the pain.” And, the tougher it is to get to the “destination,” the more “fun” the destination better be.
NOW THINK “GOAL”. Now that you know where you’re traveling to—your destination—translate your “Destination” into a goal. “One goal?” Well, the fewer the goals the better, but have no fewer than one! In fact, one “unifying” goal is much better than a whole bunch of goals. A “unifying goal” is so clever that if you achieve it you “cure a lot of ills.” It’s big.
I’ll give you a good example. Every redesign team we work with must have a performance goal and it’s always pretty much the same: “90% of all patient visits must be completed in 45 (or 40, or 35, or 30) minutes.” That means that 10% of the time the goal doesn’t have to be met. There are circumstances you’re all familiar with that prevent anyone from reaching this goal—appropriately—100% of the time.
The minutes refer to the total time the patient is under your roof. The only way you can reach this goal is by changing the way you care for patients, the way you work together, the forms you fill out, the way you stock the rooms…in other words, everything. You throw out anything that gets in your way. So, when we achieve the goal successfully we have streamlined everything and we have great teamwork and the patient is our entire focus.
The interesting thing is that when you achieve this “cycle time goal” all kinds of other good things also result. For example, when cycle time is reduced consistently to 45 minutes, productivity goes up without anyone really even talking about productivity. You can’t help but see productivity rise when systems are simplified and streamlined and staff work very closely as a team. You also see quality increase because interruptions are radically reduced so staff members are more focused as they go about their work. And when that happens, staff become more satisfied with their jobs. And the patients are happier because patients largely complain about only two things: One: “I can’t get in to be seen.” And, two: “Once I’m in, I can’t seem to get out.” The shorter cycle times eliminates a lot of frustration.
So, the goal “Reduce patient visit cycle time to 45 minutes for 90% of all visits” does as good a job—as a goal—as if you had a whole bunch of goals that included “Increase patient satisfaction,” “Increase staff satisfaction,” “Increase productivity,” “Lower visit unit costs,” and “Increase the quality of care.” Better one goal, than five goals, if one goal will give you a bountiful harvest when achieved. This is the toughest part of this whole process. Be clever about creating a unifying goal.
One other thing: the goal needs to be measurable. If you can’t measure it, you can’t tell how you’re doing. More on this later. Final point: the goal should be BIG. In other words, it should be powerful. When achieved it should make everyone sit up and take notice. A goal should be so BIG that you can’t reach it doing business as usual. So we want a goal that makes us stretch beyond our normal efforts. Trust me, it’s more fun that way. As Michael Hammer, our reengineering guru says, “Above all, goals must be challenging enough that, if achieved, they have a MAJOR impact on OVERALL organizational performance.”
THINK “MEASUREMENT.” Now, don’t think “collecting numbers.” That drains the life out of the whole concept. “Measurement” is the information we give ourselves and others so we know whether we are getting closer to our destination and goal.
That’s why when traveling by car on unfamiliar roads through unfamiliar geography, we frequently look at the map. We continually ask ourselves: Are we lost or on the right track? How far have we gone? (In comparison to where we’ve been.) How far do we have to go? (In comparison to our destination goal.) Looking at the map is a form of measurement. Watching those mile markers is a form of measurement. If we are on a personal weight reduction program, counting calories is a form of measurement. Getting on the scale is a form of measurement.
This is why any good goal is not only MEASURABLE but is also EASILY measured. When it is EASILY measured, you can measure it FREQUENTLY. And it’s like anything else: When you find you are closing in on your goal you feel great, and when you’re not, you start questioning whether you’re using the right tactics to reach your goal. More on that later.
“THINK DEADLINE.” A goal without a deadline is not a “goal,” it is a “hope”…as in “I hope this happens some day.” A deadline forces everyone on the journey to remain focused on achieving the goal. It creates momentum and teamwork for getting the job done. Think about your Joint Commission accreditation. I think the single most important benefit of accreditation is that it teaches an organization how to achieve a BIG goal. It’s everybody everyday for a limited amount of time. Intense, but time limited. That’s the strategy for success. Setting a deadline for any goal is an art, not a science. That’s another way of saying it’s a guess. The deadline should be tight, but not impossible. But, as a rule of thumb, shorter timelines are more effective than longer timelines.
THINK “FAILURE.” Yes, that’s right. To reach your destination, to achieve your goal, you’re going to have to try a lot of new things (at least they are new to a lot of folks at your site). These “things” are called “tactics.” And, frankly, you’re not going to know ahead of time which may work and which may fail abysmally. So you are best off trying as many ideas as you can. Every week you should deliberately try something new. It’s like a new lever. And now you pull on that lever. Either something happens, so you keep the lever. Or nothing happens (or something bad happens) and you dump it. It’s as simple as that.
In using this method, however, the stuff you dump didn’t work. If it didn’t work it was a “failure.” It’s OK to think of it this way. The CEO of a very prestigious design firm in Palo Alto, California (IDEO) tells his people “Fail often so you can succeed sooner.” Reportedly, it took Edison close to 1000 experiments to develop the first successful light bulb. 999 “failures” and one huge success. Failure is a part of success.
So don’t be afraid to fail. Identify and try different “routes” (tactics) to get to your destination in the fastest time. If you measure your results frequently (See Step Three again), then you will know which of your tactics work and which do not. Once again, drop the tactics that don’t work and stick with the ones that do.
THINK SHARE, SHARE, SHARE. If you reach your destination alone when you really meant to bring the “family,” then you really haven’t achieved your goal. And others can’t join you on the journey unless they are full partners in all aspects of what we’ve talked about so far.
Everyone at your site should share your enthusiasm and passion for the “destination.” If not, you need a more compelling vision of where you will be at the end of the journey. If the unifying goal isn’t convincingly compelling to those you want and need to join you on this journey, then you need to listen to them and redesign the goal (or, goals). And if you’re able to do these two things successfully, you need then to share ALL measurements with your “journey partners” continually since measurements are the mile markers that tell us whether we are closing in on our destination. This will allow everyone to take credit where credit is due and let everyone participate in figuring out which tactics work and which do not.
THINK “CELEBRATION.” Celebrate victories all along the way, not just the achievement of the BIG GOAL. (“Hey kids, look we’re crossing the state line!”) That tells staff that great effort and teamwork is valued, appreciated, and rewarded and that it is NOT taken for granted.
By Roger Coleman,