Clinical Excellence and Process Discipline

We have discussed value-based intent to be clinically excellent (culture), adherence to professional standards and evidence-based practices, tools which fit, and metrics to objectively drive competency, adoption, execution and outcomes.  But how does excellence actually result from good intentions, tool investment and measurement?

We must now address questions of workflow or process and the necessity of operating discipline (management). Rigorous process definitions must be designed which positively assure clinical performance, safety, and sound outcomes; reliably and routinely delivered to every patient, every day.

Process design starts with a careful understanding of clinical work products and delivery standards that define excellence. Clinical excellence is no longer “in the eye of the beholder” or defined by collective agreement. Work products should be derived from current professional standards published by acknowledged, credible organizations like the American Hospital Association, American Medical Association, Joint Commission, New England Journal of Medicine, Centers of Medicare and Medicaid Services (CMS), and other recognized authorities.

Process performance standards should result from analysis and discovery of truly optimal (not possible, historic or competitive) expectations. Especially, Swift performance, zero do overs, no mistakes or waste, consistency of performance, elimination of safety risk and poor execution should be the goal every time, all the time, by everyone, without excuse.

These goals require processes supported by tools, metrics and training optimized for throughput, minimized handoffs, verification and layered validation at each step.
  • Engineer language, orders and clinical data capture to assure clarity and precision of communication and information
  • Incorporate sufficient redundancy and verification of practice to positively assure sound execution
  • Specifically, Provision software tools possessing functionality and configurations which support clinically sound processes, standards and goals
  • Especially, Measurement should be a highly credible byproduct of performance within a tool-enabled set of processes.

Alright! We have publicly committed to a culture of clinical excellence. We have defined operational outcomes and work products which manifest clinical excellence by adopting current best practices from highly respected authority organizations. Processes, training and metric support have been provided to our dedicated clinical teams which unambiguously communicate expectations of performance. Tools have been configured to enable and support sound clinical content, presentation formats, process execution and performance metrics.

Now the last hurdle must be cleared: management commitment and discipline.  There must be clear, public commitment from all levels of management throughout the organization to drive individual and collective adoption of changed standards, processes, and performance expectations. Habits are hard to break and reestablish. Change is hard, even frightening and risky. There is an old change model that starts with a frozen cube, becomes an unstructured puddle, before successfully refreezing as a pyramid. This model clearly speaks to the very real period of operational risk. Especially, from launch of new practices to clearly demonstrated, institutional mastery.

Smart leaders openly acknowledge this period, providing temporary support to assure safety and success:
  • Active support at points of care;
  • Attention to key indicators, hyper examination and collection of feedback;
  • Also, Intensive communication of status, support actions, barriers and problems.

The objective is to minimize missteps, avoid misinformation, swiftly resolve issues that do occur and assure a successful transition.

Immediate expectations of robust adoption and compliance may be pragmatically modest. However, it must be clearly understood by all that there is no “going back” and everyone will get with the new program. Often a few will passively (or actively!) resist efforts to “raise the bar” on performance and quality. Everyone is watching management closely when holdouts become unmistakable. However, If allowances and accommodations are made, general adoption will suffer. While every effort should be made to help everyone make a successful transition, those who refuse or lack necessary capability must be respectfully dealt with.

True excellence is really tough. Especially, It is not a destination, as professional standards, evidence based practices and medical science are advancing constantly. Mastery of the art of clinical practice change, fostering expectations and partnerships with medical staff and clinical employees that regular change is a healthy and necessary expectation, and alert focus on the highest external professional standards are keys to building, then maintaining, excellence in clinical care.

Gary Seay is Principal of BrightWork Advisory, LLC., a practice focused on enabling innovative healthcare solution success.  Mr. Seay is an author, speaker and advisor possessing extensive executive experience with major healthcare provider systems, managed care organizations, venture capital firms, and academic programs.  He can be reached at