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Ideas are the fuel of innovation, but many senior housing communities and long-term care operators struggle to engage their front-line employees in idea generation. This is both unfortunate and short-sighted. As Alan Robinson and Dean Schroeder note in their book, The Idea-Driven Organization, a steady stream of ideas can lead to competitive advantage, better service and higher quality—three things that aging services providers, now more than ever, must maximize. For nursing homes, an idea-driven culture is a crucial component to any successful QAPI program. For other providers, rapid growth and development is squeezing margins and increasing calls for enhanced regulation around quality and service.

Generating Ideas

Generating ideas isn’t hard and it doesn’t have to cost a lot money. In fact, more employees will offer them for free. Why? Humans love to make things easier—it’s hardwired into our biology. In a typical workplace, however, rules, bureaucracy, and hierarchies all work to hamper employee engagement and reduce the flow of new ideas. An employee with too many ideas is often ostracized or, worse, accused of being trouble and offered the door. Other employees learn that it’s better to be quiet and keep ideas to themselves.

To break this cycle, build a culture where ideas are welcomed. Reward employees for sharing ideas. Create safe spaces when employees’ voices aren’t overshadowed by louder colleagues or discounted by management. (The nominal group technique can help with this!) Make it easy by ensuring that management spends time with front-line staff in their own work areas. When there, leaders should probe employees, ask questions and encourage contrarian views. Include idea generation and testing in job descriptions and performance evaluations to reinforce its value and importance.

Some organizations try suggestion boxes to solicit ideas. These rarely work; ideas becomes disconnected from their source, and are pre-judged to be undoable, or forgotten about in an ever-growing mountain of executive to-dos. Instead of closed (or locked!) boxes, try open boards, instead, where ideas and follow-ups are shared openly. Open boards are also useful for aligning ideas with strategic priorities and organizational goals; list specific topics with known barriers or challenges on the board to help harness the wisdom of staff. Technology tools can be useful, too, such as idea management software and enterprise social networking tools.

Managing Ideas

Generating an idea is only the first step. Once an organization starts to truly encourage an idea culture, it’s important to have a system to manage them. Countless idea programs fall into quick disuse as employees learn that the systems are of little value in enacting change.

Idea management takes energy and resources, but it shouldn’t be complicated or hidden from view. Track ideas openly, and allow for feedback, evolution and improvement. Many organizations limit the flow of ideas due to a lack of perceived bandwidth to accomplish goals. Instead of parking ideas or telling staff that there isn’t time to work on something, look for ways to enable and empower staff members themselves. While prioritization of ideas is important, of course, but don’t get trapped into creating so formal a system as to require every action be approved by three levels of management. Decentralization is key to an idea-driven culture. The vast majority of ideas should be tried and tested by front-line staff and supervisors, who are then supported in sharing both successes and failures.

There are many examples of organizations that have successfully done this, such as Ritz Carlton permitting any employee to spend up to $2,000 to make a guest happy. (Compare this to some nursing homes where staff struggle to have enough pens and thermometers.) Brasilata, described in The Idea-Driven Organization, authorizes front-line supervisors to spend up to 100 reals and managers up to 5,000 reals implementing an idea.

However the system is designed, the most crucial point is to not let ideas linger. Static action plans, known issue lists, and problem trackers that are not acted upon serve to stifle innovation and reassure staff members that the organization cares little about their ideas.

Here again, managing ideas through a visual board or an open, collaborative software system enables open lines of communication, frank discussions of challenges and impediments and innovative problem solving approaches.

Ideas Lead to Success

Lean organizations thrive on a constant, substantial flow of ideas. By building a culture that not only allows, but actively supports, idea generation, and then managing the flow in an efficient and transparent manner, companies can accelerate their improvement practices and develop a more robust and agile organization. When combined with a fervent improvement mindset, these organizations can far outshine their competitors.

Have more time? Listen to a wonderful podcost with Dr. Dean Shroeder & Dr. Alan G Robinson, authors of the Ideas Driven Organization, and visit their website, Idea Driven.

Are you struggling to accomplish your desired strategy? Thwarted by constant operational challenges? Your measurement systems might be able to help more– or they might even be part of the problem.

Many healthcare organizations track enormous amounts of data to guide their action and strategy. Sometimes, however, the pursuit of measures and metrics interfere with the implementation of strategy, and organizations struggle to move past the day-to-day business challenges to accomplish their long-term goals. Balanced scorecards and KPIs are two tool sets that, when used properly, can be used to facilitate both managing operations and preparing for future work.

Balanced Scorecards

The concept of a balanced scorecard was developed in the mid-90s by Robert Kaplan and David Norton (with help from Art Schneiderman, et al.) as a response to the over-dependence on financial measures to guide organizational action. The purpose was to translate strategy into measures that could inform action by balancing financial measures with measures around the perspectives of customers, internal business processes and innovation/ learning. Over time, additional features were added, such as strategy maps to help visualize direction, and destination statements to provide more definition around goals.

A key challenge to implementing balanced scorecards is they take a significant investment of senior leadership’s time to develop. While financial measures are easy to translate across organizations (census, payer mix, days in AR and financial ratios would be common in long-term care), as well as some internal business measures (quality indicators, survey and cert. results), the customer and innovation quadrants needs to be more locally refined. Some organizations, for instance, serve specific populations, and the measures of success need to be closely aligned with those missions. Similarly, learning and innovation is important in every organization, but the actualization can vary from an interest in employee development to implementing evidence-based practices to technological adoption.

Sometimes, the challenge is having vague ideas about strategy but no clue about how to get there. I’ve worked for and with several organizations that have wanted to “be the best place to live and work” and “a teaching and learning organization.” They struggled year after year with making progress, however, because they didn’t hone in on specific measures to drive that strategy, nor did they have clear ideas about what exactly those lofty goals meant.

The Capital Care Group in Canada implemented a balanced scorecard, and there are some great lessons learned from research on that process:

“The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient resources must be assigned. However, success will ultimately depend on the culture of the organization being appropriate and receptive.”

Key Performance Indicators (KPIs)

KPIs were developed to focus attention on accomplishing organizational strategy by measuring discrete data points. Again, financial measures have been used successfully for quite some time, but KPIs expand the reach to things like productivity, marketing success, turnover, meaningful quality measures (ones that either impact action or reflect operational results) and the like.

When adopting KPIs, it’s important to choose a limited number so that staff don’t become overwhelmed with the measurement of data for its own sake. It’s also important to understand the tendency for measured indicators to pervert performance by allowing managers to manipulate action in promotion of measured activities even at the expense of organizational success. I frequently see this when organizations measure turnover without regard to other performance metrics. This tends to incentivize managers to keep staff regardless of performance or actions– even at the detriment of team morale and operational effectiveness. High turnover is a costly problem in long-term care, for sure, but not all turnover is bad.

Using Organizational Metrics Effectively

Whatever system of measurement you use, it’s important to understand the systems themselves don’t determine strategy. Measurement systems are oftentimes compared to an automobile’s dashboard or an airplane’s cockpit: but remember, you can’t tell where you’re going, or, even moreso, what you’re supposed to do when you get there, by looking at a dashboard; nor can you tell whether you should go through an intersection by staring at your dash. Instead, the dashboard helps keep you on track and can highlight problems that might interfere with your trip. Balanced scorecards and KPIs function in a very similar way: they guide action and help implement strategy– but you still need to know where you are going and what you want to do when you get there, and you must keep in mind that they are only a piece of the overall operational puzzle.

eSSee Consulting has extensive experience developing and implementing measuring and metric systems in long-term care organizations. If you’re unhappy with your current system, or don’t have effective dashboards at all, we would love to help simplify your life by focusing on measures that truly impact performance and push you towards your desired goals.

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Building a Culture of Continuous Improvement with an Idea-Driven Approach