Building in Strategic Communication as Key to Leadership in Improvement

• 3/24/2010
• Author: Steven Berman
• Category: The Journal Blog
• 14302 Views
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This week, Julie Kliger, lead author of “Empowering Frontline Nurses: A Structured Intervention Enables Nurses to Improve Medication Administration Accuracy,” which appeared in the December 2009 issue, guests on the Journal blog. As you will recall, the article reported how a 36-month demonstration program led to a 87.7% reduction in medication administration errors—increasing medication administration accuracy to 98% at six Bay Area hospitals. An expanded cohort of 56 units in 9 hospitals showed similar results during the course of 13 months, from September 2008 to October 2009. Ms. Kliger follows up on the article to discuss the critical role of strategic communication in the medication administration project and to preview the current project on sepsis. We welcome your comments.

Change management and leadership are hot topics throughout the health care sector, as they have been for some time. At the University of California, San Francisco Center for the Health Professions, the Integrated Nurse Leadership Program (INLP) has demonstrated the importance of empowering capable frontline clinical staff—who have the creativity, insight, and expertise to drive sustainable change from the bottom up.

The demonstration program described in the article used the INLP model of quality improvement (QI)—a holistic leadership training program that, as we reported, “leads clinicians through an entire process of QI, during which participants learn to innovate, test innovations, diffuse innovations throughout the hospital, and embed innovations in hospital policies and daily practice.” The critical term here is holistic. Effective leadership requires a broad skill set that is beyond most frontline clinicians—for example, conflict resolution, lateral-level management, coalition building, and delegation. Nurses attended seminars, received one-on-one coaching, and implemented inter-session “homework” assignments at their institutions.

Nurses need the skills and authority to redesign processes, test potential solutions, and measure results, all of which were part of the INLP program. But that is not enough—our program also included training in a strategic communications component because change management, to be effective and sustainable, requires institutional buy-in.

We found that communication was essential to moving the program forward. Nurses were often challenged to communicate the purpose and importance of the program to peers, as well as potential allies and detractors in other departments. Keeping the program going required institutional buy-in and culture change, neither of which was possible without developing a compelling message and then delivering it effectively throughout the institution.

It is important to distinguish “strategic communications” from tactical initiatives (for example, SBAR [Situation-Background-Assessment-Recommendation]). Most tactical programs narrowly seek to improve technical skill relative to specific clinical tasks. However, task-based communication is very different from the kind of strategic message delivery practiced by professional communicators. The strategic communication portion of the curriculum included new skills, such as developing targeted messages, building programmatic outreach strategies, and creating an identity (a brand and tag line) for the change initiative. For example, nurse teams at several hospitals developed comprehensive branding programs, including a logo, slogan, posters, and t-shirts. These branding efforts allowed for clear, consistent message delivery and helped build institutional momentum behind their initiatives. One hospital used an informal event strategy—a “trolley” with program literature and refreshments—that they wheeled out once a month, visiting a different floor each month.

Most important, nurse teams were trained to identify key audiences and their core personal and professional concerns so that they could develop targeted messages that were relevant and meaningful and reflected respect for each individual’s point of view. Such customization of the program message to address individual concerns was critical to overcoming objections and gaining participation. 

I believe that this focus on strategic communication was instrumental in the success of our leadership program. It made our teams more effective in achieving targets, sustaining change, and spreading redesigned best practices throughout the hospitals. We are applying the same holistic leadership approach, including the strategic communications component, to early goal-directed therapy (EGDT) in the treatment of severe sepsis. The sepsis program is targeting a 15% reduction in sepsis mortality in approximately 60 units, at the same nine hospitals in the Bay Area. However, whereas medication administration was an “event-based” challenge, sepsis is a diagnostic- and treatment-based challenge. The  sepsis program, which centers on a regimented EGDT protocol, requires higher institutional commitment and more systematic coordination across multiple departments, making effective communication an even greater challenge—and an even more important potential solution.