Too Many Demands Can Frustrate Frontline Workers

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When I joined Indiana University Health in 2015, the organization faced a growing problem: quality metrics had multiplied so much that frontline employees were starting to express frustration or even cynicism.

Our hospitals counted 199 internal metrics they needed to track and answer to – everything from infection rates to medication errors and beyond. Way beyond, it turned out.

All those good-intentioned efforts to track and ensure quality in healthcare had put overwhelming demands on doctors, nurses and other caregivers. They were hard-pressed to keep up with mandates from government, insurance companies, certification organizations and others. Worse, the metrics changed constantly and were sometimes contradictory.

We worried that if employees felt helpless or inadequate trying to meet inconsistent, ever-changing quality goals it would add to the risk of burnout.

An attempt to simplify things by creating one broad index to reflect hundreds of underlying metrics didn’t help. I remember one meeting where a committed physician leader stood up and said, “I have absolutely no understanding what that index means, how it was calculated and what I can do to make it better."

We knew some serious work was needed to raise employees’ confidence in quality measures.
What to do?

Since the business of healthcare is inextricably linked with meeting or exceeding quality mandates, our decision was to simplify – in a smarter way. So nursing, physician and quality professional leaders were asked to accept ownership and be part of the solution by selecting the key quality metrics they’d consider most critical if they were caring for their own family members. The result: Those 199 metrics were boiled down to 10.

The 10 “bucket” metrics became the ones our frontline caregivers use to guide their actions. They include key measurables, such as infection rates and preventable harm events. As far as all those other detailed metrics? We still diligently track them – but not by distracting our frontline personnel from the 10 most important metrics.

It’s like a delivery service asking drivers to keep tabs on essentials such as work hours, gas mileage and customer addresses while letting the back-office folks handle the more granular business details like tire tread wear, coolant levels and billing.

To carry out the changes in metrics, teams of physicians, nurses and other key employees were created in each of our state regions. IU Health’s Chief Nurse Executive Michelle Janney and I modeled the physician-nurse “dyad” leadership for each of the teams. The teams personalized the regional approaches to stress quality issues that were more important for their patients. It took a while for the teams to realize their input really mattered and decide how they’d resolve differences of opinion. Once that happened, the teams threw themselves into the work.

The outcomes have been gratifying.

Letting frontline caregivers concentrate on just the quality metrics that are most useful and vital has improved patient care. Since quality metrics were winnowed down in mid-2015, total harm events and three key infection rates across the 15-hospital system have all significantly dropped. The metrics are regularly reported to frontline employees so they can see the results of their work – and alter their approaches if needed.

I’m convinced IU Health has created a stronger culture around quality of patient care by realizing some basic workplace truths:
     • Goals around quality should be meaningful, realistic and attainable -- and not overly complex.
     • Employees should be engaged in the process and connected through peer learning.
     • Work outcomes should be transparent.
     • Accountability should be built into the process.

I now see less employee frustration over quality metrics. More-focused quality goals and the elimination of peripheral demands have helped reawaken employees’ sense of calling and passion for work while favorably moving the dial on quality itself.

And that frustrated physician leader? He’s fully engaged with our new approach to metrics and liking what he sees. 

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