Module 2: Landscape & Leadership
Action Plan
Background
Our aim for this module is to explore the local context of diagnostic excellence at our site, identify and understand our stakeholders and to develop our team structure for the DxEx program." and instead "This module explores the local context of diagnostic excellence at our sites, identifies and understands our stakeholders and develops our team structure for the DxEx program.
- To begin to understand your organization, you should seek the organizational chart for your Division, quality department and executive leadership.
- These organizational charts are visual representations of the structure of teams and often create clarity around relationships and responsibilities.
- Your goal should be to build things that integrate into existing structures, avoid redundancy, and build reporting structures that facilitate accountability, support, and resource allocation.
- A stakeholder map is a plot of people who may influence your work or be impacted by it.
- The way you engage stakeholders should be determined by both where they are on the power:interest grid and what their preferences may be.
- Power mapping—a good rule of thumb is that those in a ‘high power’ category are likely a named individuals or roles (not a group of individuals). While physician groups may seem powerful/influential, their Chief or Quality Chair are the power people, not the group.
- Interest mapping—you may not know how interested in your efforts an individual may be until you pursue your Voice of the Customer so this mapping is subject to change. A major danger is to underestimate a high-power person’s interest such that you do not keep them adequately informed. High-power individuals may not recognize their interest until later. This results in them sliding into the high:high quadrant—you should adjust your engagement accordingly.
- Determining degree of engagement.
- High power/low interest: Keep Satisfied. They need regular updates—in particular, this group can be helpful in elevating your successes and potentially removing larger system barriers. Their feedback is also important but may not be required for all decision-making.
- High power/high interest: Manage Closely. These are key stakeholders. You should meet with these individuals on a regular cadence. Their feedback and perspective should be integrated into decision-making and they should be fairly intimately familiar with your work. Generally, this group will be identifiable individuals, not necessarily large categories of people. Ideally your executive sponsors are in this category—in order to promote your work and to be invested enough to remove barriers, they need to know what’s happening. If there are important updates or issues they need to know before it goes public.
- Low power/high interest: Keep informed. These are usually larger groups of individuals and often represent a customer base of sorts (this may be the residents, the hospitalists). Most often these are people you are asking to adopt a behavioral change. As such, this group needs a lot of communication about the change (the sense of urgency, logistics, etc.) and should be a focus of your celebration. While their perspective is important to decision-making, they are usually not directly engaged in making decisions.
- Low power/low interest: Monitor. These individuals just need major project updates. You may consider a quarterly (or biannual depending on pace of program) update.
- This is a way for you to gain an understanding of your key stakeholders and their thoughts on diagnostic safety—what are their relevant motivations, needs, perspectives.
- Your Voice of the Customer exploration may be through conversations or review of leadership presentations or strategic priorities. Often the goal of a first meeting with more senior leaders is to pique interest enough to get a second meeting. It is usually at the second (or third) meeting that you begin to address resource and support needs.
- You may also use surveys as a modality. Surveys are a good way to learn what people think/want, but it’s also a way to engage and communicate with them. Even if you ‘know’ what people are thinking, it’s good to be able to reflect that back to them with data. This also plays a crucial role in identifying people interested in helping you, signaling that change is coming, and that you want their support.
- Your guiding coalition is a team of typically 6-10 people who are committed to advancing and leading your diagnostic excellence program. This may not be synonymous with your ADEPT case review team.
- You should think of this group as the team that manages your program, not case review. Case review is part of your program, like research and education that are all managed by this group.
- It should be comprised of individuals with varying expertise, experience, and perspective.
- To gain trust, expertise, and insight, you may consider interprofessional team members, patients and others outside of your hospitalist program.
- Remember to include the ‘cool kids.’ These are the influencers, the people others look to for their cue of how to react. These people usually do not have formal titles. They play a crucial role in helping you create and lead the effort.
- To gain resources, you do want some team members with power (various levels of organization, your boss).
- These team members should all be in the high interest category of your stakeholder map. They are rarely individuals with extremely high power such as the c-suite. These individuals rarely have the time to serve in this capacity. But, you should manage the relationship per the grid as you will likely be going to them for support and resources.
- Your team should have a sense of the vision, mission, tactics, and their role/expectations within your team.
- There is ample data that diversity on teams stimulates more diverse perspective, fosters creativity, enhances fact recollection, improves information digestion, challenges groupthink, leads to stronger long-term decisions. In the business world, a diverse management team has been shown to result in higher financial returns.
- It is important to consider the race, ethnicity, gender identity of your team and valuable to assess the diversity of experience (years of experience, non-medicine experience, outside institution) and the diversity of interests (quality, safety, education).
Pro Tips
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