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Working the Vital Few

I see this in many organizations in other economic sectors, too. Organizations have to have a process to select and work the Vital Few. Kim Barnas says this well:

Great article by Kim Barnas, CEO of Catalysis


I’ve visited a number of organizations and one of the recurring problems I’ve seen is lack of an effective prioritization process. I think this is paramount. In this world of competing priorities and regulation, we must have a way to focus on the “vital few,” demonstrate and stabilize the improvement, and move on to the next “vital few.” We will accomplish more sustainable solutions with added focus. 

There are three things you need to have:

  • A process to filter multiple priorities

  • Recognition that we cannot solve 250 metric problems at one time

  • Executive leadership that supports a more focused approach to problem solving

Each healthcare organization has its own unique set of cultures and circumstances that need to be addressed, so when you go into some cultures, the whole idea of prioritization is a difficult one. They do not have a system to measure results or a way to review these through a performance review process. Furthermore, they do not have an adequate process in place to deploy metrics and understand if they have the resources to actually functionally improve them, meaning they do not have a way to prioritize.

Many healthcare organizations today are measuring in excess of 250 different metrics. Many focus on service, quality, finance, or public reporting. I cannot imagine the amount of resources really needed to improve and sustain the improvement of so many metrics. Fortunately, not all of them need improvement, but we must focus our efforts and resources. Many of these metrics are not critical to our success or improvement of the patient experience. We must keep an eye on all of these metrics (watch indicators), but we also have to acknowledge that we cannot improve all of them at once. There must be a process for prioritization that says, we are going to work this problem first, this problem second, and this problem third—because we do not have enough resources to work on all of them at once. I would suggest that to start this process you need to develop the first filter—True North metrics.

With True North metrics, we as a board, system, and community identify what’s important in determining the health of the organization. For many organizations the most important things are:

  • Safety

  • Quality

  • Customers

  • Our People

  • Financial Stewardship

When you are having a discussion about prioritization and there is disagreement, you can use this filter by asking—how does this affect Safety, Quality, Customers, People, and Financial Stewardship?  All the projects you have on your plate that don’t align to your True North metrics, you will need to consider where they fit in your scheme of prioritization. When you have enough resources, do you work on them or do you say we are not going to work them this year because other things are more important?

Having both strategic and operational improvements aligned through a True North filter defined process generates focus and an understanding of the resources required to achieve innovation and improvement goals. This is the first step in the strategic deployment process, and is a critical step for an organization to begin to identify what they can actually deploy to the front line. True North metrics simply provide an aligned screen through which to filter so that organizations are focusing their resources on the vital few. If we are going to transform healthcare and improve our organizations we must find a way to focus. How can you begin to see the vital few? A good place to start is with the development of True North metrics.

Kim Barnas, CEO Catalysis

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