In Praise of Specificity

Jay Moore, for HealthLeaders Media, December 11, 2008

See if you recognize any of the following phrases:

  • "The initiative required physician buy-in.?"
  • "We have a commitment to innovation."
  • "Support has to be top-down."
  • "To make [insert concept here] work, it must become part of the organization's culture."
  • "Communication is critical."

I'll stop there. But there are others.

Any of those sound familiar? They should. We all hear and read these kinds of phrases a lot. Constantly, in fact. Maybe it's not in the exact form I listed above, but it's usually pretty close. It might be a hospital's renewed effort to enforce hand washing requirements. Maybe it's a push to post a health system's quality data for all to see. Or a program to reduce bullying among caregivers. Or any number of other admirable goals. It doesn't seem to matter—one way or the other, one or more of these kinds of phrases are offered as key elements of success.

Big, broad concepts. Many of them in connection with some pretty important undertakings. Communicate, collaborate, innovate.

I just have to say one thing: Enough, already.

Now, before you fire off a scathing e-mail in defense of such concepts, please understand: Yes, I believe endeavoring to make a program part of an organization's workplace culture demonstrates a commitment that, say, an isolated directive given to a lone manager does not. Yes, leadership support is crucial. Yes, communication is a good thing. I can't imagine an initiative that would be made more effective by less communication.

But when it comes to making meaningful strides in the realm of quality and patient safety, big-picture generalities can only go so far. Saying communication or leadership support is important to the success of a healthcare quality initiative is like saying tasty food is important to the success of a restaurant. Yes, I know you want to emphasize infection control as part of your organizational culture. How? What are you really doing differently now than you were two years ago, when infection control wasn't part of your "culture?"

As a healthcare journalist, I get to talk to some brilliant minds—people who know significantly more about the industry than I do. But curiously, one of the most consistent challenges journalists face is getting senior leaders to look past the platitudes and offer specific examples of creative actions their organizations have taken. So I can't help but wonder: How does the average healthcare worker look upon the themes emanating from above? If a senior leader speaks of changing the organization's culture, do staff members nod in agreement or just nod off?

Not long ago I read about a study presented at the American Society of Anesthesiologists' annual conference that concluded that some of the best ways to reduce medication errors are some of the smallest steps you can think of—standardizing medication labels, for instance. Steps rooted not in abstract management theory but in everyday operational reality. Things that plenty of organizations have been doing for years, but things that are also easy to overlook in the search for grander solutions.

So the secret to quality improvement isn't better communication, but color coding medication bottles? Uh... no. Actually, heck if I know what the secret is. But asking ourselves what substance lies beneath all of that leadership buy-in and cultural shifting might be a good start in finding it. I heard some interesting discussion in Nashville this week at the Institute for Healthcare Improvement's National Forum on Quality Improvement in Healthcare about some efforts to uncover some of that substance. IHI President and CEO Donald Berwick, MD, talked yesterday about the IHI's follow-up initiative to the 100,000 Lives and 5 Million Lives Campaigns: the "Improvement Map," or what Berwick called "a master, overarching agenda of processes" that must be improved to achieve the highest level of patient care. The Improvement Map, Berwick said, is meant to reach beyond the focus on reducing needless deaths and injuries to address the entire spectrum of hospital care by analyzing the myriad processes that go into the running of a hospital.

Berwick's address wasn't the only intriguing session at the conference. I heard an engaging description of the IHI's partnership with the National Health Service in Scotland to improve quality and patient safety in the acute-care sector in that country; I also listened to some detailed descriptions from Gary Kaplan, MD, CEO at Virginia Mason Medical Center in Seattle, and Jim Anderson, president and CEO at Cincinnati Children's Hospital Medical Center, of the changes in their respective organizations. I'll delve more deeply into the IHI's latest efforts in next week's column.

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at

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