As I reflect on my previous employer, a small clinic in rural Kansas, the three words I would use to describe the organization would be: self-focused, under-managed, and under-paid

QUESTION

Need Discussion Response:

As I reflect on my previous employer, a small clinic in rural Kansas, the three words I would use to describe the organization would be: self-focused, under-managed, and under-paid.  These words were reflective of the virtual bubble that the organization existed in. While the organization was near to a major city, the community functioned as though it existed without the support of the larger community.  The hospital foundation had the funds, from wealthy community members, that provided equipment and covered providers so that the community could have “big city stuff” in a small community.   The three descriptive words did not, and do not, promote quality performance.

By self-focused, I mean the managing partner and the management style that he led with.  The idea of improvement projects and the team approach to improvement was opposite to how he led.  He resisted all changes that did not benefit himself and the other partners.

Under-managed and under-paid are words that go hand in hand to reflect on the clinic’s ability to hire and grow employees in their current roles.  During my time at this clinic, as the coding and billing supervisor, I would often go weeks without communicating with the managing partner. Not ideal when I was doing the bulk of the coding and billing.   There was an office manager, but not a true practice manager, all those decisions went through the practice managing partner.  As employees left for better and higher paid jobs, little was done to improve the offerings to their replacements.

Each of these words does not have a direct and obvious tie into quality improvement, each one points to why quality improvement was not occurring.  These words remind us for quality improvement to be successful there are key structural needs within the organization.  “Strong leadership is essential to a well-functioning improvement project.” (Spath, P., 2018, p.187) This organization lacked strong leadership, leadership focused on the greater good of the organization and of the patients.  For growth in a medical organization to occur, “everyone in the organization is continually learning, adjusting, and redesigning systems for safety and managing behavioral choices.” (Boysen, 2013) Investments in meetings, training and staff salary ensure that we are hiring, training up and keeping the quality staff that we have.  We cannot be looking inward, we must remain focused on the good of the many, the best for our patients and our teams.  Quality improvement should be ingrained in all that we do.

ANSWER

Response

Your reflection on your previous employer highlights some significant challenges that can hinder quality improvement efforts within an organization. The words “self-focused, under-managed, and under-paid” paint a picture of an organization that lacks a culture of collaboration, effective management, and investment in its employees. These factors can indeed impede the success of quality improvement initiatives.

The self-focused nature of the managing partner and his resistance to change indicate a lack of leadership commitment to improvement. Quality improvement requires strong leadership that is willing to embrace change, engage employees, and foster a culture of continuous learning and improvement. Without a leader who prioritizes the greater good of the organization and its patients, it becomes difficult to drive meaningful quality improvement initiatives.

The under-management and under-payment issues you experienced highlight the importance of investing in employees and providing them with the necessary resources and support to excel in their roles. Effective management involves clear communication, regular feedback, and a structure that empowers employees to perform their duties effectively. Additionally, offering competitive compensation is crucial for attracting and retaining talented staff members. When employees feel valued and adequately compensated, they are more likely to be motivated and engaged in their work, which positively impacts the quality of care provided.

Your observation that these factors may not have a direct and obvious tie to quality improvement is insightful. However, they serve as important indicators of underlying issues that hinder quality improvement efforts. To achieve successful quality improvement, organizations must address structural needs, such as strong leadership, effective management practices, and a supportive and fair work environment.

Investing in leadership development programs and providing ongoing training opportunities can help cultivate leaders who embrace change and prioritize quality improvement. These leaders can guide teams in implementing evidence-based practices and driving improvement initiatives that benefit both the organization and its patients.

Furthermore, organizations must prioritize the recruitment and retention of high-quality staff members by offering competitive salaries, opportunities for professional growth, and a positive work environment. Quality improvement should be ingrained in the organization’s culture and integrated into daily operations. This requires ongoing training, regular performance evaluations, and the allocation of resources to support improvement efforts.

In conclusion, your reflection sheds light on the challenges faced by your previous employer in creating a culture of quality improvement. The self-focused leadership, lack of effective management, and inadequate compensation are factors that hindered quality improvement efforts. To overcome these challenges, organizations must invest in strong leadership, effective management practices, and a supportive work environment. By prioritizing continuous learning, employee engagement, and a focus on the greater good, organizations can foster a culture of quality improvement that benefits both the organization and the patients it serves.