Ever been to a Brazilian steakhouse? The ones I've frequented are full of waiters each carrying around a spit of different kinds of meat. It's hard to choose which one to eat as the meat is offered to the tables: They all look so good. If you give the signal for "more", a waiter will come over and slice some more meat for you... and everyone else. Who could say no, even if they were full? In this situation you leave the restaurant stuffed, wondering how you ended up eating so much, and leaving a lot of good food on your plate as you walked away.
This is a lot like what happens in health care, but the Brazilian steakhouse version actually has a much happier ending. Similar to restaurant patrons, health care leaders have many stakeholders inside and outside their organization, all approaching the leadership table with seemingly very important things to change or accomplish. Leadership pleases the stakeholders by readily accepting the various initiatives and assignments. In effect, they give the "more" signal again and again.
But, while health care and Brazilian steak houses have some things in common, there are some not so subtle differences in these examples that I think are worth noting.
For example, the "waiters" in health care are not necessarily invited to approach the table: Many stakeholders have inserted themselves into this quagmire such as government regulators, employers and insurers worried about healthcare outcomes and costs. Analysts and experts also show up debating and complaining about how our system is in dire need of an overhaul. And, while the waiters at the restaurant won't approach your table until someone at the table signals they are ready, health care system stakeholders approach without noticing or caring about what's already on your plate. Finally, the health care leaders at the table rarely have to digest the work given them: The responsibility for new initiatives is typically handed off to other people in the organization.
The result of all of this activity (invited and uninvited) is overburden. Overburden is a phenomenon where equipment or people are pushed to run at a harder pace and with more effort than is appropriate. In manufacturing settings, it's equivalent to running machines faster and longer than they were designed to do. As a result, the equipment breaks down.
In health care, we staff the facilities to take care of the patient load. Then we add on more work in the form of all the initiatives rolling downhill from leadership, overworking our human capital. This process creates confusion in the organization because the new priorities aren't integrated into existing capacity and the staffs have no understanding of "why" and how new initiatives relate to existing efforts. And, we seem to use supersized plates, as all work is additive. While people are still digesting the last set of initiatives, we simply pile new ones on top. Finally, overtime increases as these initiatives compete for resources focused on patient care, putting outcomes (or improved outcomes) at risk.
I recently worked with a large mid-western physician practice where the COO had handed off many initiatives to the clinic managers over an 18-month period. When these managers were asked to collectively report out the status of these initiatives, the COO was not aware of how many projects were handed off (there were 26 all together) or the status of the efforts. Many projects had not started at all, while others were designated as "complete" with unclear documentation and deliverables. Some projects had begun and then been abandoned as other projects were given to the managers who were frustrated by the requests that kept them from attending to their primary performance and management objectives.
And all of this was before the Patient Protection and Affordable Care Act (PPACA) became a reality!
I believe that this overburden phenomenon is becoming the silent killer of health care transformation. In my opinion, it's not the health care changes that are killing us: Change happens in every industry and in our personal lives every day. What will kill the transformation to a more efficient, patient-focused system is not having the time for the smart, passionate, capable people in healthcare to work through these changes and adapt their organizations to new realities.
Addressing the silent killer
With the constant volley of new, competing, and sometimes conflicting initiatives swirling around the industry, the universal reaction seems to be that each initiative is as important as the next. This reaction is fully owned by the healthcare leadership in each organization, as they are ultimately responsible for aligning initiatives to strategic goals and then finding the human resource capacity to complete these initiatives.
It's not hard to imagine the health care leaders being as overwhelmed as the rest of the organization. The difference is that they are the only ones who can LEAD the organization on a path that reduces the overburden.
So, if you find yourself at the overburden table, here are some healthy choices that might help:
Short-term thinking: Step away from the buffet table and pick some food off the plate
Take inventory of the current situation from the people with plates full of initiatives. What's the status of these efforts and what is the staff's understanding of their accumulating goals and priorities? How much human capacity is being consumed, and what's the impact on the organization's ability to create and provide improved patient care? Once you've grasped the situation, challenge this inventory:
• Reflect on the true purpose of each initiative: how will each effort actually help you align with the future?
• What are the few things that you NEED to get done to meet the 3 -5 most critical goals this year?
• What can be combined, dropped or delayed?
• How can you level this work across the organization?
• What is the impact to the organization if you limit the initiatives to an important few?
Long term thinking: limit yourself to a few courses on the menu every year
Being deliberate about what you put on your plate each year allows your human capacity to focus on the 3 - 5 strategic outcomes most important to your survival and success. But, that may not be enough to keep the waiters at bay, so consider carving out specific capacity to address future initiatives as opposed to "adding it to the plates" of your organization. And, as these initiatives are served up by your stakeholders, compare the request against what you've already committed to. Send those that don't match up back to the kitchen.
Now that you know what's on and off your plate, pass it along to those responsible for implementing the initiatives in a way that ensures that the purpose, goals, and priorities are clear. And keep on top of what's going on! Your organization has some great people who can help move the organization forward if they just have the time!
Like all silent killers, overburden sneaks up on you and your organization. Learn to sense it, see it, analyze it, and deal with it to help your organization not only survive, but thrive.