Select the Next NIATx Project

What project is next? The Executive Sponsor strategically steers the organization project by project.

After completing one project, most of us are convinced that process improvement is well suited to our organizations. It has been proven to be a powerful tool that really can change our organizations. So, how do we spread what we have learned so far? How can we use our experience to strategically steer the organization? How do we spread and sustain the knowledge and skills we have acquired in the first project(s) to more of our organization, both its processes and its people?

How can the Executive Sponsor and Change Leader steer the organization? The Executive Sponsor spreads the knowledge and skills of process improvement by:

• Strategically selecting projects
• Strategically assigning people to those projects.

The Change Leader spreads process improvement by:

• Developing and coaching new team leaders
• Helping people new to process improvement get caught up with others

Strategically Select Projects

Note the definition of project: one aim + one target population + one level of care + one location. Change any one of these, then it is a new, and different, “project”. A project is defined by these four factors, not by the team assigned to work on it. One team can work on more than one project at the same time.

You have learned a lot about your organization doing the first project(s)—both the things you do that get in the way of making changes, and things you do to facilitate changes. You can use that knowledge as you move on to the next projects.

The Executive Sponsor strategically selects the next projects. This is a surprisingly straightforward and effective way for the Executive Sponsor to steer the organization. For example, the Executive Sponsor may want to increase the size of one level of care while decreasing another; he/she may want to change payer mix by increasing admissions from one payer while holding constant on another; he/she may want to improve continuation to the next level of care within the organization in order to increase billable events. All of these are examples of projects available within NIATx.

Strategically Assign Team Members

The Executive Sponsor assigns team members to a change project. This assignment is a temporary, additional job for the team members. Here are four rules of thumb—no evidence, just expert judgment—for assigning people to projects that enhance spread:

1. Each project should be able to be completed in less than 6 months.

This assumes the team meets at least every other week, for at least one and one-half hours, and does work between meetings in preparation for the next meeting.

If you have not completed the first project you started within 6 months (using the definition = one aim + one target population + one level of care + one location), it is time to wrap it up. Do not let it drag on.

2. Each project should have at most seven people assigned to complete it.

When the project is completed, these people become “free agents” available for assignment to another project.

3. One person should not be assigned to more than two projects at any one time.

People can be expected to do their regular work in addition to the project work. While this may appear daunting at first, it is surprising how the project work becomes more fun, more important, and more satisfying than whatever it was people were doing without the project work. (Only exception: counselors are needed for many of the projects, and they still need to see clients, i.e., bill hours. They may need backup.)

Sustained process improvements have a way of making people’s regular work more fulfilling. Most people see this possibility early on and are willing to give the short term extra effort for a better, more satisfying job. We often hear, “Finally, they are listening to me, and making the changes I have told them to make for years.”

4. One full-time person can lead at most eight projects.

Therefore, if the change leader is third-time, he/she can lead at most two to three projects. This means the change leader has to start “scouting” for potential team leaders and develop them if more than three projects are to be completed at one time.

Develop Change Team Members

Change Leaders should lead the initial teams to show others how it is done, (and gain expertise in process improvement).

Team members who look like promising team leaders should be asked to lead one of the rapid PDSA cycles to completion, including adjustments to the initial change, (the Change Leader should lead a cycle to show how it is done).

When the change leader and Executive Sponsor have confidence in a person to lead a project, the Executive Sponsor should assign the person to lead the next project. Do not change team leaders in mid-stream unless the team leader is not working out – in which case the process for selecting team leaders should be improved.

Orient New Team Members

Members of a new team who have not gone through an orientation process need to “catch up”. Orientation should not occur until the person has been assigned to a project. There is nothing more frustrating than being ready to use new knowledge and skills, and having no where to try them out. Real learning comes from on-the-job activities and team participation. This experience is so valuable that experienced team members have to be limited to 2 teams at any one time or their regular jobs suffer.

Change leaders transition from leading teams to coaching team leaders, including periodic meetings with all team leaders to share successes and frustrations.

Summary

The Executive Sponsor spreads the knowledge and skills of process improvement by:

1. Strategically selecting projects
2. Strategically assigning people to those projects

The Change Leader spreads process improvement by:

1. Developing and coaching new team leaders
2. Helping people new to process improvement get caught up with others