I was recently asked what was the most important thing I’ve done to bring positive change to the Children’s Hospital where I’m a leader. I was surprised by the question because we’re early in the journey, what we’ve accomplished so far certainly isn’t just my doing, and it isn’t just from one thing.   I replied, “Relentless alignment, disciplined improvement, and empowering accountability.”  But I quickly realized it didn’t answer the question: “What’s the One Thing?”

Is it Relentless Alignment?  This does take the most effort and time. Alignment is important and one must be relentless in pursuing it. I started with the creation of a vision and plan, followed by formulating specific metrics and milestones.  And then came the constant consistent communication, which included clarity around priorities and transparency regarding results.  Alignment is about inspiring a shared vision and creating a renewed culture of excellence.

Is it Disciplined Improvement?  Constancy of purpose around continuously improving quality is important, but without discipline, it doesn’t happen. Consistent use of standard methods at all levels, and especially by the senior leaders, coupled with a culture of open communication, experimentation, and learning are required. It’s about the 20-mile march. We are using Lean and the science of quality improvement to provide the needed discipline.  We manage our projects using a disciplined approach.  And we prioritize our projects using decision support tools when possible.  Lean and CQI work well when used consistently with an unwavering discipline.  Standard work is a powerful tool.  Quality improvement is about optimizing outcomes while minimizing waste engaging everyone in the process using standard work to do so.

Is it Empowering Accountability?  I call this Management by Leadership.  When things don’t happen as expected or performance is less than desired, its often a systems issue, a communication problem, a structural misalignment, a talent and/or resource issue. And often one of the root causes is a lack of staff engagement. Front-line management often isn’t equipped or empowered to address these higher level issues. We’ve been emphasizing leadership more than management and systems more then individuals when it comes to what needs to work better.  I will admit, however, that I’m a management fanatic underneath.  I have checklists for everything.  However, I consider myself a management disciple of W. Edwards Deming.  I follow his theory of profound knowledge:  appreciation of systems, theory of knowledge, the psychology of change, and understanding of variation.

In health care, superb leadership is a must-have.  Yes, management excellence is also needed, but its best when born from excellent leadership.  The Leadership Challenge articulated by Kouzes and Posner has been a useful frame for me.  Leaders 1) inspire a shared vision, 2) model the way, 3) challenge the process, 4) enable others to act, and 5) encourage the heart. I see these 5 things as enabling a leader to achieve relentless alignment, disciplined improvement, and empowering accountability.

So, to answer the question “what is the most important thing?” I would have to say leadership is the most important thing that has made a difference at our children’s hospital.