Engaging Physicians in Changing Organizations: A Baldrige Fellow's Systems Approach

As a U.S. health care executive, Eric Moll has observed firsthand what he describes as the “massive shifts in health care delivery and payment” occurring throughout the nation in recent years. When Moll became a Baldrige Executive Fellow in 2015, he had already gained insights on organizational change through use of process improvement methods.

“Physicians are obviously key stakeholders and decision makers within the delivery of health care,” said Moll, chief executive officer of Mason General Hospital & Family of Clinics in Shelton, Washington. “From our Lean journey, we learned that engaging people who are doing the work is critical to improvement.” “It was important,” he added, “that we develop a new approach to provider governance (leadership) and strategy so that providers were directly part of our transformation efforts.”

Moll soon applied some of his learning from the yearlong Baldrige Fellows program to help create such an approach. He made the aim of his capstone project to establish “a systems approach to engage physicians in helping Mason General Hospital & Family of Clinics achieve our mission and vision,” he explained.

I recently asked Moll to share more information about this physician engagement initiative for the benefit of other health care leaders and organizations facing similar challenges. Following are his responses to my questions.
 

• What were some milestones of your project, and how did learning with and from other Baldrige Fellows enhance your project?

For provider governance, major milestones were (1) gaining consensus on developing a medical staff governance model that included both the hospital and ambulatory clinic-based providers and (2) launching a dyad management model in which a physician leader is paired with a service-line director, ideally to make consensus-based decisions regarding the operations of a service line. For strategy, we completely revamped our strategic planning process, borrowing heavily from past Baldrige Award recipients such as Ritz-Carlton [Hotel Company, LLC], Lockheed Martin [Missiles and Fire Control], Hill Country Memorial, and Advocate Good Samaritan [Hospital].

Previously, we had what I would describe as an episodic approach to strategic planning, meaning we would create a process to develop a strategic plan every few years. The Baldrige Fellows experience showed me a better approach that was a continuous process, ensuring that our strategy would be agile and flexible. This addressed a major concern I had about our past approach to strategy—relevancy.

Also, the new approach to strategy created two-way engagement with our provider stakeholders during the strategic planning process. Physician leaders became part of the team to develop our goals, strategic objectives, and measures of success. Borrowing an idea from Advocate Good Samaritan, we have developed a Strategic A3 process that creates a deliberate emphasis on planning before developing the action plans for strategic initiatives. We go through a lot of pencils and erasers because we know if we do it right, we will rewrite the reason for action in box 1 at least four or five times as we spend time working through the root cause in box 4. This process has been extremely valuable in helping us focus our action plans.

Honestly, before I started the Baldrige Fellows program I didn’t really know what an A3 was. I kept hearing other Baldrige Fellows referencing A3s during some of our open discussions, and they became really excited when Pattie Skriba [vice president, business excellence] of Advocate Good Samaritan presented to our group. That enthusiasm got my attention, and I tried to learn as much as I could from Pattie. Baldrige Fellows from other industries were doing some pretty innovative stuff around customer and employee engagement. They were very open with me in sharing their companies’ best practices, which I incorporated into how we measure results and use those results for strategic planning and performance evaluations.

• How will changes you’ve led improve your organization for the long term? Could you please describe any results or impacts so far of your project?

The biggest impact so far is improved focus and execution. In the first year of using the new strategic planning process, we committed to 14 strategic initiatives. By the end of that year, we had achieved our measures of success for less than a third of our goals. The next year we had nine strategic initiatives and improved our success rate to nearly two-thirds of our measures of success. This year, we have seven strategic initiatives and feel even more confident in our ability to execute on the most important things. We are learning through experience something that I think is obvious to most people: you can achieve more when you focus on less. The problem in health care is that it is incredibly difficult to focus when everything seems important.

• What were your key learnings from the Baldrige Executive Fellows Program?

The mantra throughout the program was “learn by doing.” The faculty pushed us to get beyond theory and concept. Personally, I loved this focus on action, even though at times it was uncomfortable when I had not attained mastery of the concepts. Action should not be confused with activity. Part of the action was tied to developing a clear approach. I learned that deeply understanding the reason for an action to solve a problem was an iterative process through which the more time spent on the front end, the higher the likelihood of success. As my [organization’s leadership] team spent more time thinking through the reason for [problem-solving] action, we were surprised how often our initial understanding of the issue became materially modified. This was initially fairly humbling and even frustrating for some of my senior leaders, but it made us more effective in our planning and execution.   

• Would you please share a few insights you gained from delving into the Baldrige Excellence Framework (health Care version) during the Baldrige Fellows sessions that you have been able to use for the benefit of your organization? 

I gained a better appreciation for the critical role that leadership plays in organizations in order to achieve breakthrough performance. It’s easy to focus on the charismatic leader, but the Baldrige Executive Fellows Program provided many examples of how a systematic approach to leadership is most effective. Intuitively we may know this, but understanding how to do this had been a barrier for me.

The Baldrige Fellows program linked the framework provided in the leadership category to examples from Baldrige Award recipient organizations. This allowed me to incorporate those examples into my own organization. For example, leveraging processes from Lockheed Martin, we developed a process linking leadership focus on action with measures of success that we track and review on a monthly basis within our leadership team. We then communicate progress and results to our key stakeholders. This has improved our focus, accountability, and communication.  

• Would you please describe the value of the Baldrige Excellence Framework to health care organizations today?

Health care is a very complex industry. The Baldrige Excellence Framework is a great way to gain a better understanding of an organization’s strengths and opportunities for improvement. Because of the complexity in health care, we have many important processes or approaches that are unwritten or informal, creating a likelihood for variability or confusion. 

The Baldrige Excellence Framework helps organize and formalize these processes around areas such as work systems, strategy, and knowledge management to better engage the leadership and key stakeholders. At its essence, the Baldrige Excellence Framework is a series of related questions that drive an organization to the heart of success. Every question is relevant and straightforward. 

For me—and I know I’m not alone—it was an eye opener to discover how many questions in the Baldrige Excellence Framework I could not answer clearly, let alone have confidence that everyone in my organization would have the same response. The Baldrige Excellence Framework can show the way toward true excellence, but each organization will still have to do the heavy lifting of determining the answers to the questions.

I love that the Baldrige Excellence Framework does not provide the answers because quite frankly each health care community and culture is unique. You need to find the answers that work for your organization. In a way, Baldrige is the solution because it gives you a systems approach for asking the most relevant questions.