How to Capitalize on One COO’s Key Challenge and Lesson Learned

Becker's Hospital Review featured a Q&A with Johnese Spisso (Chief Health System Officer of UW Medicine) earlier this week about the challenges and lessons she's learned while running an academic medical center.

When asked about challenges, her answer boiled down to this: staying financially viable while doing more with less (achieving better outcomes with fewer resources).

What about her lesson learned? She mentioned the importance of having the leadership team embrace their strategic goals and be accountable for achieving them.

Both the challenge and the lesson are, I'm sure, familiar. And they're intertwined. The only way to do more with less is to focus everyone--from the leadership team to the front-line staff--on achieving the same strategic goals, and to hold each person accountable for his/her share of the results.

How? Incorporating strategic goals into the incentive plans of your senior leaders is a good start, but it’s not enough. Most leadership teams do this, and still I don’t see stellar results across the board.

Here are two elements that are far too rarely embraced, but which can help any COO achieve Johnese’s vision:

1. Adopt a new kind of business performance review 
   • Leaders should sequence or prioritize which strategic goals will be discussed (most typical reviews cover far too many topics).
   • All the right people must be in the room to address a specific focus area (otherwise, this is a missed opportunity to think and manage cross-functionally, which is required for almost every high-level issue in a health system--or any other type of business, for that matter).
   • Have access to all necessary information during the review (having only surface-level data available in the reviews means that probing questions often can't be answered).
   • Ask the right questions (as mentioned above, most review discussions do not lead to verified root causes of underperformance--partly because underlying levels of information aren't accessible and partly because leaders fail to ask enough of the right probing questions).
2. Prioritize resources 
   • Success is not only determined by what you WILL do, but also what you WON’T do. Leaders must make the tough calls on which less-strategic projects won't get resources--at least not now.
   • If you don't already have one, you need to put a system in place that lets you see all of the work that's currently going on in the hospital.
   • You need to have a structure and process in place that enables you to make resource decisions based on rational criteria (including degree of alignment to the prioritized goals).
   • COO reviews must include decisions on sequencing and prioritization for improvement projects and other initiatives.
   • If you don't already have one, you need a system in place that lets you monitor if resources actually get allocated and deployed as suggested, who is responsible for the work, and if the related improvement work has the desired effect on outcomes.