Consistently high-performing health systems and hospitals share a common trait. Their leadership teams are exceptionally humble. Regardless of the organization's many accomplishments, including local, state and national awards, their board members, senior executives and physician leaders realize excellence is an ongoing journey, not a destination.
The leaders of Children's Hospital Colorado in Aurora, Duke University Hospital in Durham, N.C., Nationwide Children's Hospital in Columbus, Ohio, and Schneck Medical Center in Seymour, Ind., all expressed similar sentiments when discussing how they became the winner, finalist and citation of merit award recipients, respectively, of the American Hospital Association–McKesson Quest for Quality Prize. Their remarks were conveyed during a pre-meeting workshop of the Health Forum and AHA Leadership Summit in July in San Francisco.
Although feeling honored and humbled to be recognized and being proud of their staff, they emphasized that their organizations could not and would not be any less zealous in working harder to improve patient safety, efficiency, effectiveness, timeliness, patient/family-centered care and equity. The leaders' strong message was, "Yes, we have accomplished much, but we can still be better."
Humility has a profound influence on an institution's culture. Legitimate progress and achievements should be enthusiastically celebrated; but everyone knows that patient harm, for example, can only be avoided by constant vigilance and adherence to well-developed policies and procedures. Invariably, every health care facility has eloquent vision, mission and value statements; but they are meaningless if there is a disconnect between their content and the reality as evidenced by the provision of high-quality patient care on a daily basis.
Other Common Traits
High-performing organizations share some additional characteristics:
Active leader engagement at every level of quality and safety. Leaders must emulate the behavior they expect of others, holding themselves to the same standards they want the staff to meet. In creating and sustaining a culture of performance excellence, there is no substitute for active role modeling by leaders.
Insistence on aspirational goals. Whether the objective is zero harm to patients or eliminating racial disparities in health outcomes, strong leaders understand that audacious targets have great motivational value and convey a powerful message to multiple stakeholders.
Commitment to transparency. Disclosing inconvenient truths and sharing negative as well as good news on a consistent basis builds both leadership credibility and trust within the organization.
Adoption of best practices used by other institutions. There is no acceptable excuse or rationalization for not capitalizing on lessons available from other organizations inside and outside the health care field.
Dedication to expanding and improving user-friendly data analytics. The time, cost and effort associated with making real-time data accessible for improved decision-making are admittedly high; excellent leaders realize that the consequences of not having a reliable and effective system are much higher.
Maintenance of a nonpunitive, just culture to facilitate reporting of errors and near misses. Well-designed anonymous employee and physician surveys should indicate if the existence of such a culture is genuine and authentic or an illusion based on empty platitudes.
Employment of job candidates with a good organizational fit. Increasingly, top employers devote more time to screening applicants and using questionnaires to confirm compatibility of values and expectations.
Devotion to educating and promoting staff with leadership ability. Recruiting and retaining exceptional staff are much easier if these individuals are confident that their skills will be enhanced and rewarded.
Recognition of the need to sustain a safe environment for staff members as well as for patients. Best-performing institutions know that employees and physicians can be subjected to preventable harm, including exposure to violent patients, family members and other visitors; and these institutions implement proper measures to minimize the potential harm.
Use of powerful individual stories to dramatize failures and successes. Regardless of an organization's size or reputation, AHA–McKesson Quest for Quality Prize recipients noted how a compelling story involving a specific patient often had much more impact than impersonal statistics in influencing significant behavioral change.
Participation of former patients and/or family members on board, quality improvement and other committees. While risk managers and attorneys predictably express concern about issues of patient confidentiality and potential litigation, award winners provided persuasive testimony of how the advice and perceptions of patients and family members have been invaluable. These organizations are focusing well beyond just improving customer satisfaction and scores from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey. These organizations are seeking to create partnerships with those who seek their care.
Development of creative partnerships with such community bodies as schools and religious institutions, as well as governmental agencies to improve population health. Historically, hospitals have been the center of the nation's disease care nonsystem; now our most progressive leaders are collaborating with a wide range of partners to address the social determinants of health status, including education, poverty and racial/ethnic disparities.
Personal Humility Also Required
False modesty is quickly recognized. Leadership's behavior and decisions must be authentically aligned with the organization's moral fabric as reflected by its value statements and code of conduct. Disingenuous or misleading statements, improper conduct and duplicity will undermine credibility and respect quickly. These two attributes are essential components of personal humility, but they are also extremely fragile. Once lost, they are hard to recover.
Egocentric or arrogant leaders may be productive in the short run, but it will be difficult for them to maintain progress over time. Accelerating institutional excellence, when much success has already has been achieved, depends on leaders who are exceptional role models, relentless in pursuing even greater benefits for their patients, staff and communities.
Paul B. Hofmann, Dr.P.H., FACHE, is president of the Hofmann Healthcare Group and a member of the AHA-–McKesson Quest for Quality Prize Committee. Gary R. Yates, M.D., is president of the Sentara Quality Care Network and chairman of the AHA–McKesson Quest for Quality Prize Committee.