Meet a Real Management Team
The Management CompStat Team
Patient Visit Redesign™ veterans are familiar with two types of teams: Redesign Teams and Patient Care Teams. The former is the five-member team responsible for redesigning patient flow. Its job is to design a new patient visit process and test it until a proven redesign can be implemented throughout the clinical site. Typically, the team is a mix of line staff and managers, with the emphasis on the former.
Patient Care Teams (PCTs) are “medical homes” for patients. Typically, a PCT will have a clinician teamed with one or two medical assistants, a front desk utility player, and a nurse (who often is a member of another PCT simultaneously). Team members work consistently together in providing care to a panel of patients. Because patients develop familiarity with all team members, a PCT provides great continuity of care.
This year Coleman Associates has been prototyping a third type of team comprised only of managers: The CompStat Team. An exemplary CompStat team has emerged at Community Health Centers, Inc. of Salt Lake City.
This article examines how this team has achieved notable success within two short months. This is not your typical management “team”. “Teams that work most effectively are those whose members work together, figure each other out, and are on the same page,” said CompStat Team Member, Jennifer Thomas.
What is CompStat?
CompStat refers to the problem-solving and resource redeployment scheme pioneered by William Bratton while he was the New York City police chief under former Mayor Rudolf Giuliani. CompStat represented a wholesale change in how a police department judged its effectiveness. Until CompStat, effectiveness was measured by how fast police officers responded to 911 (emergency) calls. But even with a timely response, often the crime was committed and the perpetrator gone by the time the police arrived.
CompStat was a methodology with an explicit premise: Police effectiveness was inversely correlated to the crime rate. If your city had a low crime rate, the police were effective. Period. No excuses.
After CompStat was implemented in New York City, the crime rate plummeted. The result is that on a per-capita basis, New York City now has one of the lowest crime rates in the country. FBI data, based on the crime rate per capita, shows that among the 25 largest American cities, New York ranks 23rd, with only San Diego and San Jose having lower rates. New York is safer than many smaller cities, too: among the 182 U.S. cities with populations of more than 100,000 (NYC has 8 million residents), New York City comes in at 136th—about the same as Boise, Idaho.
And CompStat has spread to other major urban police departments, almost always with similar results. The methodology is conceptually simple but very hard to do in practice (much like Patient Visit Redesign™). Let’s say you’re on a CompStat Team. Here’s what you do:
- You determine the few indicators that will make the most sense to track, and you watch them like a hawk. It is important that the indicators be few in number.
- You meet regularly, usually weekly, to review the indicators and determine if there are any adverse trends. These meetings last about 30-45 minutes.
- If there is an adverse trend, you act immediately. You never, ever say: “Let’s see what happens next week.” A rapid response is key to success.
- You act by redeploying resources with great urgency to determine the source of the problem and to resolve the problem. In short, you intervene aggressively and you continue to intervene until you get different results.
- Then you review the statistical trend again at your weekly CompStat meeting to make sure your intervention is producing results. If not, you re-examine your tactics and strategies and try another intervention.
So, the people who meet weekly to review the indicators comprise the CompStat Team. The weekly “meetings” are really CompStat Sessions. They are strictly tactical. No one spends time talking about the typical agenda fodder of most management meetings. And, speed is of the essence. Finally, there are no excuses for not producing results, which is why there are almost always results.
Salt Lake City CHC CompStat Team
There are four clinics in the Community Health Centers, Inc. system in Salt Lake City. Each clinic has a clinic manager. None of the managers have been formally trained in operations management. But they have worked together for years, they are all women, and they have great chemistry. Meet Linda Stearns, Michelle O’Malley, Jennifer Thomas, and Roxanna Redford. They are humble and modest. They are skillful. And they are great team players.
Before CompStat, each manager was accountable for the results at her own clinic. As a group, they would discuss their challenges and seek advice from each other. “If I had a problem at my clinic I’d pick up the phone and call one of the other directors,” said O’Malley, “and she’d give me suggestions and other input.”
But the managers had been working within a lousy process—the typical management “team” process. You know it well. You meet. You complain. And, you suffer—alone. Comradeship is restricted to the meeting room. Once you leave that safe harbor, you are out on the turbulent sea by yourself. Good luck!
But with a CompStat methodology, these managers are a real team. They meet weekly, review data, openly discuss their challenges and problems, and then “determine where to strike next” to improve their performance results. Once they make that decision, and they make that kind of decision every week, they schedule their “swarm”. The “swarm” is when they pounce, as a team, on the suspected source of poor results in one of the clinics. Now that’s firepower!
CompStat member Michelle O’Malley told her colleagues that she was unhappy with the average patient visit cycle time in her clinic—around 68 minutes. She said only a couple of Patient Care Teams were diluting the results of the whole clinic. If the CompStat Team could move these teams to higher performance levels, the clinic’s cycle time average would improve significantly. “My cycle times were out of control,” said O’Malley. (Cycle time is the total time a patient spends under the clinic roof to complete a patient-clinician encounter, from the time the patient enters the facility until the patient exits the facility.)
The CompStat Team scheduled a swarm to take place within the next few days. “I was a little nervous because I knew everyone on the CompStat Team would see the mess I had,” said O’Malley. “But I was very excited to get help.”
At the appointed time, the four clinic directors (along with Deputy Director Dexter Pearce, their boss) appeared at O’Malley’s clinic. They knew they didn’t have to arrive at the clinic with answers in hand. CompStat is all about exploring problems and imagining solutions. Let the process do the work.
The Team fanned out to track patient visits (using the patient visit tracking methodology of Coleman Associates). The tracking exercise revealed the flaws in the visit process and the Patient Care Teams.
After the trackings, the managers huddled and put their heads together. “It was just amazing to get an outside perspective from people who aren’t part of this clinic,” said O’Malley. The managers isolated which Patient Care Teams were having performance problems and why.
The CompStat Team then huddled with these Patient Care Teams to review the performance problems they were seeing during the clinic session. “We started as a group, and then we split up to talk to people,” said O’Malley. Often Patient Care Team members thought they were working together well, but the direct observations of the CompStat Team told them otherwise. The managers pushed the Patient Care Teams to devise tactics for increasing their effectiveness.
In the four weeks since the CompStat Team intervention, the clinic’s average cycle time has dropped steadily from 68 minutes to 48 minutes. And, productivity (i.e., patients per hour per clinician) has increased from 2.8 to 3.4 patients per hour.
Let’s review. A true team of managers reviews two indicators weekly—cycle time and productivity. One of the managers says: “I don’t like my results, so I want your help.” The CompStat Team determines that this is worth a “swarm”, that the bang is worth the buck. They schedule a four-hour swarm for the targeted clinic. Once onsite, the Team quickly identifies the source of the performance problem and then intervenes aggressively (but tactfully) to correct the problem. The CompStat Team watches the post- intervention data like a hawk and determines whether additional intervention is needed.
What Makes a Team Truly Successful?
Real teams are complicated. They go beyond “groups” and “cooperation”. A real team is intimate. It’s committed. It’s dedicated. Above all, it’s honest. A real team is based on the promise that each team member will do everything in her power to solve a common problem. “It’s not about our ego,” said Thomas. “We really want things to be better for our patients and for our staff. And we are idealistic so we believe we can do it.”
“We were a close team to start with, which is probably why we could even do CompStat in the first place,” said Stearns. But it’s one thing to complain about the problems you’re facing and another to ask for help in solving them. The strong foundation of trust and openness shared by these team members is the prerequisite for CompStat success.
“We are able to be open with each other and share ideas and concerns,” said Redford. No one person dominates the discussion or tries to control the team. It’s a true team of peers. “And, if someone’s sitting back not participating, we will call each other on it,” said O’Malley. “We know it affects all of us, so we expect each team member to pull her own weight.”
A team’s ability to be effective slowly erodes when important issues are not addressed, and frustration and resentment ultimately triumph. Since the CompStat methodology makes issues and problems transparent, team chemistry is strengthened.
This management team is not full of bluster and ego. These managers really listen to each other, even when the subject is difficult. Because they aren’t trying to prove anything to each other, they are open and honest. “Let yourself be vulnerable. Let people hold you accountable. And trust that people are going to give you good advice,” said O’Malley. “Once I was open to that, it made a big difference.”
The Salt Lake City CompStat Management Team seems to have it all figured out. They’ve come to understand that no one of them could have all the answers, and they’ve been able to turn traditional management practice on its head. “That team of managers is really running the show at Community Health Centers,” said Dexter Pearce, Deputy Director of Community Health Centers, Inc., “and the rest of us are trying to keep up or just stay out of the way.”
by Roger Coleman and Molly Weisse-Bernstein, Coleman Associates