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Building a culture of excellence

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Nilaya Varma, Partner and Leader, Markets Enablement, KPMG in India, shares tips on how healthcare organisations can build and sustain continuous improvement by following certain core values

It should not come as a surprise to anyone working in the healthcare space, that the way staff feel and care about their workplace, has a direct bearing on the quality of patient care, as well as on the go efficiency and performance of an organisation. Healthcare providers internationally, today are faced with numerous challenges which include increasing staff engagement, difficulty in driving improvement, ongoing cost containment and communicating their organisational objectives.

So what is the need of the hour?
The answer to this is continuous improvement, which is imperative to address the mentioned obstacles by fostering a systematic and sustainable approach to enhanced quality of care and in turn better outcome for patients. An organisation’s wide approach to continuous improvement principles engages a frontline staff and embeds a scalable methodology for coordinating improvement activities. The challenge here is to understand how to lead the implementation of continuous improvement tenets sustainably and successfully across large scale and complex healthcare organisations, to deliver the benefits it can provide. This can be even more challenging in a country like India, where in the past few years have authorities intensified efforts to focus on health programmes to provide good healthcare to every citizen of India. The recently launched programme to achieve the target of universal health coverage, is a step in the right direction. In India specifically, just improving access to healthcare may not ensure better outcomes. The aim for healthcare organisations here, must be to ensure sustainable continuous improvement, with the objective of improving access, quality of care and achieving operational excellence.

So how have healthcare organisations globally achieved this improvement?
KPMG International’s report-Creating a Culture of Excellence, lists out some foundational truths that are essential for those looking to take their healthcare organisations on an improvement journey and seeking to sustain and scale it.

Let’s dive deep into some of these truths.
Globally healthcare organisations are creating end to end management systems which are not just limited to being a process improvement team. They use status sheet exchanges, structured problem solving, unit leadership teams etc. to aid in bringing improvements, so they can go a long way in having a tangible and positive financial impact. If you get the quality right, then the money follows.

Secondly they are working towards getting senior leader’s commitment to change themselves, not just others, meaning having a sense of purpose, scientific thinking, ensuring quality at source and transparency through visual management. This essentially means, they are working towards reducing waiting times for patients by a long mile which is key Thirdly they look at continuous improvement from three aspects – balance, planning and doing it over a multi-year journey, which is resulting in improved quality and good clinical engagement with successful communication.

Fourthly, healthcare organisations abroad are constantly committed to finding new ways of working. Though this can become difficult, unsettling, and even threatening for some, the importance of anticipating these potential obstacles and engaging with staff is important. When this is done, the staff become champions to drive implementation forward; when it is done poorly, the resulting lack of staff engagement could cause the programme to falter, without even delivering the desired patient, staff and organisational benefits.

Fifth and in my opinion most important is healthcare organisations abroad are today aligning their organisation to deliver their ‘True North’ – which means ensuring that improvement work on the shop floor reflects the overall strategy. The handful of metrics which represent the goals an organisation is targeting are often referred to as the‘True North’: the true direction in which the organisation should be travelling. Achieving this even to a certain extent, has seen many of these organisations achieve success by offering patients’ good quality care and safety, which means zero harm, family centered care and hundred person engagement.

So what can Indian healthcare organisations learn from such successes?
India has an elaborative health care delivery system but the system is not able to deliver quality. This is true for organisations both public and private in the country. Some of the successes highlighted, showcases great potential for continuous improvement approaches in healthcare in India.

Healthcare organisations in India should look at inculcating a complete and long term commitment within the organisation so as to ensure sustainability and end the vicious cycle of short-term gains followed by a relapse into old ways.

What is required in a country like India is placing emphasis on making improvement a mandatory part of everyone’s daily work as opposed to focusing on a set of specific projects. Healthcare organisations and their leaders should look at supporting staff with on-the-job coaching so as to provide them with the skills and confidence to challenge the status quo.

Continuous improvement could result in the traditional ‘cost versus quality’ argument redundant as effective clinical efficiency and quality of patient care, both public and private institutions can reduce costs.Lastly achieving operational excellence through the implementation of a culture of continuous improvement is both a challenge and an opportunity for healthcare leaders today. Therefore, the journey should be viewed as an enabler to channelise the ideas of healthcare professionals into practical solutions that meet the 21st century challenge to permanently raise quality and reduce costs over decades.

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