Clarifying your vision and objectives

Physician Executive, July-August, 2005 by Edward J. O'Connor, C. Marlena Fiol

In the long run, men hit mostly what they aim at.
--Henry David Thoreau (1)

If you don't know where you're going, you might not get there.
--Yogi Berra (2)

As noted in our last column (The Physician Executive, Vol. 31(3), May/June 2005), when your people don't understand where you want to go, they have a hard time signing up for the trip. Without knowing where the organization is going, behaviors make little sense to the people carrying them out. As a result, morale sags, performance deteriorates and change is blocked.

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Real clarity, and the energy that flows with it, occur when targets are so well specified that you can measure where you are, where you want to be and your progress along the way during the journey. Evidence indicates that organizations that clearly defined who they are (values and purpose) and where they are going (vision and goals) outperformed the general stock market by 15 to 1 over a 50-year period of time. (3)

In addition, goal-setting research has long demonstrated that trying to "do your best" isn't likely to achieve your best. Instead, specific, hard, measurable goals produce the highest level of effort and performance. (4,5)

Giving your staff the opportunity and knowledge to see the big picture can make a dramatic difference. It makes them feel more like they are a part of things, thus increasing involvement and participation, and leading to increased production and overall satisfaction.

When this important information is not provided, departments become stagnant and separated. You hear a lot of "that's not my job," and animosity is created. Needless to say, change under these conditions becomes extremely difficult, if not impossible.

Measuring momentum

In the process of forging agreements around what will be measured, how it will be measured, and when it will be measured, as well as what those measures will look like when you are successful, people begin to arrive at a common understanding of the change implementation trip that lies before them.

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After all, how long would you continue bowling if there were no pins at the end of the alley? (Possibly until the refreshments ran out?) How long would you play golf if there were no cups in the greens? How long would you watch a basketball game if there were no hoops? Hoops, cups, and pins create targets that let you know how well you are doing and what corrections need to be made in order to improve your outcomes.

Measurable clinical, financial, and human outcomes similarly create targets for people in health care organizations. Both short-term and long-term targets are important in getting and keeping people in the game. If you wish them to participate with enthusiasm and to self-correct when they are off course, you must give them targets to aim at and feedback about how well they are doing.

Naturally, it is important that your people find these targets meaningful. Fortunately, health care change projects are likely to impact a wide variety of outcomes. Since some people find clinical outcomes most meaningful, these should be included in order to fully engage their best efforts.

For example, will current change projects in your organization result in decreased mortality, reduced infection rates or a lower number of treatment errors? Will there be fewer unscheduled readmissions, lower complication rates, improved return to work times or decreased reports of pain?

Making your targets clear and allowing people to provide themselves with feedback flowing from measurable results increases the likelihood of engaging their support for your change.

Since other people find financial and/or human outcomes more interesting, these should also be included among your measurable targets. For example, will current change efforts reduce costs, expand revenues, improve cash flow, expand market share or increase profitability? These need to be specified if you wish to engage the support of financially minded stakeholders.

For others, human outcomes such as improved patient, physician or staff satisfaction, reduced complaints, enhanced communications/cooperation or reduced absenteeism/turnover are judged to be important outcomes worthy of their best efforts. If you wish to engage this latter group, identifying these targets and measuring progress toward them is essential.

Researchers and practitioners have documented the importance of clearly identifying your vision and objectives. An overview of these findings is presented in Figure 1.

Focusing people forward toward specific, measurable stretch goals maximizes performance and improves the likelihood of change implementation success. However, clarifying where you want to go may not be sufficient to energize support for your change.

In our next column we will describe additional tools that help people understand why it is in their best interest to move into and through transitions.

Edward J. O'Connor, PhD, is principal with the Implementation Institute, a professor of management and health administration at the University of Colorado at Denver and Health Sciences Center and a member of the faculty of the American College of Physician Executives. He can be reached by calling (303) 573-1273 or by e-mail at edward.oconnor@cudenver.edu.