Successfully Rolling Out Healthcare Improvement Initiatives with Key Influencers

Henry Wadsworth Longfellow wrote, “Listen my children and you shall hear. Of the midnight ride of Paul Revere…” Why, you might ask, would I start off a post about achieving enterprise-wide deployment of data-driven best practices with a line from a poem about a prominent figure in the American Revolution?

Because the story of Paul Revere’s ride is a powerful illustration of how to use key influencers to both spread news and prompt action. Get ready for a brief—and hopefully interesting—history refresher showing how picking the right influencers can make a big difference in the success of your hospital’s data-driven improvement initiatives.

Deploying Analytics Systematically

When it comes to using data to drive quality and cost improvement, one of the biggest challenges that organizations face taking small, successful initiatives and implementing them across the entire organization – while still achieving the same or similar results. You may, for example, decrease the rate of elective deliveries before 39 weeks in one flagship hospital in your system. But then you find that implementing the same best practices and achieving results across the entire health system is a much more difficult prospect.

Achieving buy-in of new best practices and processes across an organization is imperative to success, but it is no easy task. The key to doing it well lies in establishing a deployment system. An effective deployment system standardizes organizational work. It involves implementing team structures that will enable consistent, enterprise-wide deployment of best practices.

The question, then, is this: How do you pick the right people for these teams? The importance of picking the right people is what the story of Paul Revere illustrates.

Paul Revere’s Ride: The Importance of the Right Influencers

Because Henry Wadsworth Longfellow’s poem made Paul Revere so famous, people sometimes forget that Revere wasn’t the only rider out that night warning the populace that the British army was marching from Boston toward Concord. Another man, William Dawes, also undertook the dangerous ride. On the night of April 18, 1775, Revere and Dawes rode through the Massachusetts countryside, knocking on doors to raise the alarm and call out the militia. This resulted in the first clash between colonial minutemen and British soldiers at Lexington and Concord—and the beginning of the American Revolution.

Healthcare Improvement Map courtesy of The Paul Revere House

Dawes actually covered more territory than Revere, but Revere was far more effective not only in spreading the word, but also in driving action among the populace. Both Malcolm Gladwell, in his book The Tipping Point: How Little Things Can Make a Big Difference, and Everett M. Rogers, in his book The Diffusion of Innovations, explain the difference between Revere and Dawes.

In Gladwell’s words, Revere was “the man with the biggest Rolodex in colonial Boston.” He was an activist for colonial rights and knew everyone in Boston involved in the movement—from the craftsmen in the taverns to the doctors, lawyers and businessmen who spearheaded the protests against the British. Most importantly, he knew the revolutionary leaders in each of the towns that he rode through. He had ridden thousands of miles across the colonies as a courier and had also made the trip to Lexington and Concord several times to relay news. Dawes, on the other hand, was just a brave guy willing to help spread the word.

Rogers explains the difference this made for the effectiveness of the two men’s contributions on that midnight ride as follows:

  • “Revere knew exactly which doors to pound on during his ride …. As a result, he awakened key individuals, who then rallied their neighbors to take up arms against the British.”
  • “In comparison, Dawes did not know the territory as well as Revere. As he rode through rural Massachusetts on the night of April 18, he simply knocked on random doors. The occupants in most cases simply turned over and went back to sleep.”

In short, Revere cultivated influencers and used them strategically. He knew the people in each town who could rouse their neighbors, get them out of bed and get them ready to face the British.

Choosing Key Influencers to Drive Effective Analytics Deployment

The last thing anyone who is implementing a quality improvement initiative wants is for people to ignore the call for data-driven change. That’s why it is essential to staff deployment teams with key influencers who will rouse their peers, get them committed to change, and, most importantly, get them to act.

In his book, Rogers provides what has become a very familiar Bell curve of five major groups involved in the diffusion of any new idea throughout an organization:

  • Innovators
  • Early adopters
  • Early majority
  • Late majority
  • Laggards

drive effective analytics deploymentThe important influencers, for our purposes, in this graph are the innovators and the early adopters. Innovators would be the real forward thinkers like Paul Revere. Early adopters would be those people who can best influence the majority and promote adoption.

How Key Influences Fit into Team Structures

These innovators and adopters need to fit into three key team structures for health systems to drive successful change:

  • Guidance Team: The guidance team provides governance over all the workgroups under a clinical program. For example, a guidance team for the Women and Children’s clinical program might oversee three separate workgroups focusing on gynecology, pregnancy, or normal newborn. The guidance team takes into account resources, readiness, and political climate to determine which workgroups receive priority.
  • Workgroup: The workgroup is a small, representative sampling of clinical staff that actively delivers care around a given work process (such as gynecology, pregnancy, or normal newborn) within a clinical program. The group typically consists of a physician lead, an RN, and an operations manager. Based on the data and their own knowledge of clinical workflow, the workgroup makes initial decisions about where to focus improvement efforts. For example, it may decide that the greatest opportunity lies in targeting variations in length of stay following a cesarean section. This group is also tasked with determining how to implement best practices that would drive the desired improvement.
  • Clinical Implementation Team: This group consists of representatives of all the practicing clinicians who will participate in a data-driven improvement initiative. It hears the workgroup’s findings and makes recommendations back about which ideas to prioritize and how to roll out a best practice. This kind of participation and feedback cements each participant’s investment in quality-improvement decisions and ensures that all participants understand the implications of any initiative on their clinical workflow.

Here’s how the idea of key influences would apply in a clinical setting to the three types of deployment teams I mentioned above—workgroups, clinical implementation teams, and governance teams:

  • Workgroups must consist of innovators. These are the people who are going to determine how to redesign care delivery. Based on data and their own experience, they will decide which best practices to implement to achieve improvement goals.
  • Effective clinical implementation teams must be staffed by early adopters. These are the broader teams that represent each of the units, clinics or facilities where the improvement initiative needs to be rolled out. They are the people who can rally support and influence their peers to adopt the best practice.
  • Governance teams should consist of both early adopters and innovators.

Now, how do you identify the right innovators and influencers? The best approach is simply to ask.

  • To choose effective innovators, you could ask people in the targeted department, “Who are the top three MDs in our group who are likely to invent a better way to deliver care?”
  • To choose effective early adopters, ask, “When you have a tough case, who are the top three MDs you trust the most and would go to for a consult?”

It is very important that you get fingerprinting and buy-in from the groups as you pick those individuals who will be leading the effort. That is one reason why simply asking can be so effective.

Have you been able to use key influencers effectively to drive change management? How did you choose these influencers? What questions would you ask identify the right influencers?

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