Would You Attempt to Run a Marathon Without Preparing?

Getting Ready

If you were forced to get up from your desk right now and start running a marathon, what would happen? Maybe 26.2 miles is unthinkable. What about a half-marathon (13.1 miles)? Unless you’re a dedicated runner, Kenyan, or otherwise unusually genetically gifted, it is going to be a bona fide disaster. In fact, one source says to those who try, “Prepare for a long and painful recovery if you didn’t train properly... Running a marathon without training can send you to the hospital and cause muscle strains, stress fractures, and long-term joint damage. So hear this: Attempting to implement improvements in operations at any scale, without preparing, will likely lead to a failure and, “...a long and painful recovery…” 

Once a nursing education organization (NEO) sees the connection between operations and ever-improving delivery on mission, it will naturally develop an appetite for improving operations. When that appetite is established, the difference between those who get nourished and those who go hungry will come down to careful planning and preparation. I’m not sure if Benjamin Franklin ever ran a marathon, but if he had, he would have undoubtedly said, “Failing to plan is planning to fail.”

What does preparation and planning look like? Following are three fundamentals steps your NEO should take before embarking on its journey to leverage operations for the excellence, effectiveness, and efficiency we all are keen to see in our workplaces. Depending on the scale, complexity, and culture of your NEO, you may find that more key elements are needed, but not less. To get prepared, the NEO must dedicate leadership time, alter organizational DNA, and ensure early success.

Dedicate Leadership Time

As an administrator, it may be easy to think that improving operations can simply be informally added to the role of one of your current NEO leaders (or worse yet, a committee). You might reason that side-stepping the effort it takes to change a job-description or create a new position is energy saved which can be allocated to improvement. Not so fast… If a NEO is serious about improving operations, like all other mission critical functions, it will need dedicated FTE. That is, someone, somewhere, needs to be formally and publicly tasked with the work of improving operations. 

Who should that someone be? Consider attempting to meet two criteria when making that decision. First, the individual must be a recognized leader with both positional and influencer power. The nature of change-work in a NEO is complex at best and bruising at worst. As discussed in an earlier post in this series, NEO’s are not naturally bent toward frequent and rapid change and in some cases they may be outright oppositional. To get the best value out of your investment, select someone who is not easily ignored (positional power) and has won the respect and regard of their peers (influencer power). Anything less will almost ensure that the effort will be relegated to the “latest-big-idea-the-boss-has-come-up-with” pile and go quickly to the euphemistic “parking lot”.

Second, the individual needs to be committed to the improvement mindset and at least familiar with  some of the methodology. There is no use in designating someone as a champion for operational improvement when they are not interested in giving champion-level effort. If you have to choose between passion and prior experience, choose passion every time. While an improvement skill set can be quickly acquired, a passion for improvement and operations is a much more difficult quality to instill. If know-how is lacking, consider partnering the leader with an improvement professional, at least until they become moderately experienced. If you are “all-in” and looking for the titanium-level approach, permanently pair an executive leader with an improvement professional and stand back. You’ll see great things happen.

A couple of cautions to note when identifying someone to lead in operations improvement. Most nurses, especially those with DNPs, receive formal education in improvement methodologies. They practice in clinical settings that are swimming in improvement work. Strangely, these experiences and skills are rarely translated into academic settings.  Don’t assume that because someone has the jargon of Lean or Six Sigma or Agile, that they are prepared to lead in improvement work in your NEO. Trust, but verify. While improvement work is, at the end of the day, improvement work, context matters a lot. Lastly, there is no surer way of telling the organization you are not serious about improving operations than assigning the work to a committee and giving them a year to develop a plan.

Alter Organizational DNA

If improvement work is made the responsibility of a few, your NEO has no hope of substantial and sustained change. If you’ve ever attended any major sporting event, you know what this is like. It's that handful of five or six people who are trying to start the wave. It’s just not enough. You have to get to a critical mass for the flywheel to turn, for the wave to roll across the whole stadium. The same is true for improvement work. In fact, improvement work is just as much about an organizational mindset and culture as it is about strategies and methods. When it comes to preparing for the systematic improvement of operations in your organization, you can’t begin with a project management mentality, it's too limited. You must set out to fundamentally alter how the organization sees itself and how it sees change.

If you had a version of CRISPR that was designed to alter organizational DNA, there are three techniques you would use to begin transforming your NEO into a continually self-improving entity. The first is persistent organization-wide communication. Every chance you get, you put top-level leadership in front of faculty and staff to let them know that your NEO is getting serious about effective and efficient improvement and the transparent goal is to get every member of the organization actively involved. This is done through emails, blogs, large meetings, small meetings, video messages, individual exchanges and every other communication channel, formal or informal, that you can put your hands on. The NEO must be clear that the leadership is fully on board and is dedicating executive energy to supporting success. 

The second technique is “just-in-time” and “just-enough” training. As improvement projects are identified, project owners will need on-demand training that gives them enough gas in the tank to get going. This can be a co-mingling of jargon, concepts, and techniques. The more standardized, the better. If culture change is the ultimate goal (which it is!), you want to create a common or shared body of knowledge and know-how that allows people to actively participate in a new lingua franca. “Just enough,” because of what follows in the third technique, on-the-job assimilation. Improvement work is a lot like the Rocky Mountains to a lifelong flatlander - you can’t believe it until you see it. Drowning people in multiple hours, or even days, of training is going to be time and energy wasted. Give them just enough to be dangerous and then use real-time coaching to help them find their way through their first project. In improvement work, education can be wasted on the young! Once someone begins to taste and see the value that improvement work can create, the appetite is whetted and some real experience is in place which provides context for their new learning to fit into. That is the time to enroll them in higher-level training.

Ensure Early Success

Lastly, preparing your NEO for improving operations will require careful consideration of where to begin the improvement work. You only get one chance to make a first impression - so you want to begin in places that are likely to yield success. This means among the hotspots that you have identified, a lot of reflection and research needs to take place. Two questions can help you rank order the possibilities. First, ask yourself, “Is this low-hanging fruit?” Sure, that means there is an element of “easy” to the project, but it’s more than that. Once completed, will the improvement be easy to see (high visibility), easy to feel (high impact), and easy to hear (high explainability)? You may feel that no “low-hanging fruit” project could actually meet those criteria. Here are a few hints about where you might start: 5S a busy workroom or lunch room, create standard work for a single element of your hiring process, or create a transparent visual management system for tracking the status of projects senior leaders are working on. 

Second, ask yourself, “How can this be connected to established organizational priorities?” If your NEO is having conversations about improving operations, then that is a good sign that your organization is hungry for more strategic effectiveness. There is no time better than the present to begin honoring the strategic plan in your organization. By taking time to signal to your NEO that the improvement work is intentionally aligned with the stated priorities of the organization, you simultaneously elevate the importance of both the priorities and the improvement work. This is exactly how high-performing organizations operate. Every significant expenditure of energy is aligned. A secondary benefit is the gripe-proofing of the improvement work. In a healthy organization, when the justification for a new initiative is grounded in the strategic plan, it goes a long way in silencing the complaints up and down the chain of command.

Marathons consume far too many resources to risk failure. If you set out to run one, you want to be sure that your chances of success are very high. A good plan and tenacity in execution, all immersed in healthy doses of emotional and social intelligence, can get you there. Similarly, improving operations, if planned and prepared for with great care, can be a low-risk and high-reward investment for any NEO. 

Next up: How to execute improvements in operations.