By Patrick Cawley, MD
MUSC Excellence, a leadership transformation initiative undertaken by our hospital, takes a bottom-up approach to training clinical leaders. The program is simple: It starts with aligning goals and moves to aligning care-giving behaviors across our clinical staff.
We first saw the need for this approach when we noticed a disconnect between our organization’s performance on employee and patient satisfaction surveys scores and the goals set by leaders on an annual basis. The satisfaction numbers were not good, but leaders were scoring well on goals. How could that be? If leaders were scoring well on goals, why weren’t patients or employees more satisfied? This became the basis of our case for change. In March, MUSC participated in the AAMC HCAHPS webinar, during which we shared our system and practices with other schools and clinicians across the country.
The most important elements of the MUSC Excellence program are its tactics. We have found that accountability must be closely partnered with the right tactics for improvement. You can’t hold people accountable if they don’t know what to do.
It’s just like teaching. If you don’t show your student the correct way, he’s not going to do what you want if he doesn’t know how to do it. You have to show people how to do something before they can do it correctly. One of the most powerful tactics we use is called, “High, Solid, Low.” Every leader in the organization is expected to have the “High, Solid, Low” conversation with their direct reports, annually at a minimum, more often if possible.
With high performers, we usually tell them to keep up the good work and ask how we can help them continue to do a good job. We tell solid performers, “You are doing a good job and you should keep up the good work. But if you do X, you will do a better job.” We provide incentives to middle and high performers with specific goals that are attached to annual performance pay. Depending how they do on those goals, they are eligible for more performance pay. Retaining high and solid performers is the most important aspect of this system.
Clearly delineating how to deal with the low performers is also vital to this system. We put the low performers on notice — not a formal probation, but a very clear, forthright conversation that outlines what they need to do to perform better and in what timeline. Many people improve with this system.
Next, it was important to understand – and demonstrate – how and which employee behaviors contributed to increased patient satisfaction, and to show employees how to improve those behaviors. We developed patient satisfaction scorecards with clear goals, then looked at individual leader performance in light of those goals. If the leaders’ patient satisfaction scores weren’t improving, it was evident that one part of the hospital wasn’t working.
About 6 years have passed since we first began implementing the program. Patient satisfaction scores have improved, but MUSC Excellence is really about leadership. It’s about changing leadership, making sure leaders understand their goals and that they are all aligned. The CEO of the hospital has goals for me, and I have goals for the people below me, and so forth; so we are completely aligned throughout the organization.
—Patrick Cawley, MD, is the Executive Medical Director & Chief Medical Officer and the Medical University Hospital Associate Professor of Medicine at the Medical University of South Carolina (MUSC). He can be reached at email@example.com.