Define and champion what success looks like, and why it matters

‘You need to develop that sense of shared consciousness…so we all know what the picture is, what we’re striving collectively to do and we’ve got permission to get on and do it.’

Joe Jenkins, Director of Fundraising and Supporter Engagement, The Children’s Society and formerly Friends of the Earth

Help people see beyond the limits of their own job

When Dr David Feinberg became CEO of the UCLA Health System, the organisation was facing a tough challenge. Though it had a very strong track record for the quality of the surgery people received, too many patients were unhappy with their experience of the hospital. In fact, two out of three patients said they would not recommend the hospital to others, and the hospital languished at very low rankings in the various other measures of patient satisfaction.

Dr Feinberg wanted to find out what was going on, so one of his first moves was to ask the patients how they felt about their experience at the hospital. He and his colleagues did this in as many ways as possible. They interviewed one lady who had had a very traumatic experience at the hospital, including receiving surgery for a part of her body which was in fact healthy and should not have been touched. To cap it all, when the time came to go home, she realised she would need a taxi.

She discovered she was short on cash, but when she asked for a voucher from the receptionist to cover the taxi she needed to get home, she was told that according to the hospital rules, she did not qualify for the taxi voucher scheme.  As a result, she took a taxi as far as the change in her purse would allow and then painfully struggled the remaining miles to her home on foot. 

This upsetting example brought home to Dr Feinberg what was going wrong. Most staff were doing just what they viewed as their bit of the job. Though the receptionist’s behaviour is inhumane from the reader’s point of view, as the receptionist dealt with the many elements of her busy job, she probably reasoned that all she could do was her job. That, concluded Dr Feinberg, was the problem: far too many people were just doing their jobs. Everyone was so focussed on what they thought their roles were that they did not realise that every time they interacted with a patient, they were in fact the ‘keeper of the flame’ for the entire hospital.

The UCLA health care system is a vast organisation, including over 50,000 doctors and nurses, let alone numerous other roles, and is split across several sites. The vast majority were good people, working very hard in a complex environment in spite of numerous challenges. 

How did the leaders help everyone feel they had to do things differently? 

They created opportunities for the staff to meet patients like the woman we mentioned earlier and hear what had gone wrong and what impact that had had. In so doing, they helped everyone to not only understand the mistakes, but also to own and learn from them. The result was that everyone started to feel that they had messed up if a patient was not taken care of in any part of the system. 

Another challenge was that with so many different, specialist roles in the massive workforce, Feinberg and his team needed a way to help people work out what they should do, no matter the situation. The solution was the motto ‘how would I treat this patient if they were my own mother?’. Furthermore, Dr Feinberg repeatedly stated that this meant that if in doubt, you should ‘make the decision. Do what’s right.’ So when certain doctors came up with excuses, the nurses would now be fully supported if they challenged them: ‘I can see this is a difficult situation, but as it stands my mother wouldn’t appreciate the solution you propose’.

Within a few years, the culture in terms of the patient’s experience at UCLA Health Care System changed completely, and this shift made a demonstrable difference in their measurable results. For example, the average waiting time in the Emergencies department was slashed from over three hours to just 18 minutes; and in terms of patient satisfaction the Centre has become one of the highest-performing hospitals in the US.

As outlined in Prescription for Excellence, the platform which made this extraordinary change possible was initially built from two building blocks: firstly, ensuring that everyone truly felt the need for the change, by focussing on their reasons why; and secondly making it simple and clear what success would look like. ‘How would I treat this person if they were my mother?’; ‘If in doubt, make the decision. Do what’s right.’