Processes, People and Teams: Part 1

by | Jul 7, 2020 | Consulting

There’s an old expression my mom would repeat when we were growing up to talk about a hard time, or someone who was going through a challenging time.  Maybe you’ve heard it: “through the mill.” From the 1800’s, it alludes to being ground down like grain in a mill, and connotates hardship, rough treatment (  I’ve been thinking of this often when I think of what the healthcare industry has gone through.  A ton of stressors: critically sick people, rapidly changing conditions, huge changes in operations, overtaxed staff and severe financial losses.  There have been unbelievable miracles such as the daily fight to save lives, generosity of time and talent, and the sheer grit and ingenuity in doing things that have never been done before: transforming space, turning BiPAP into ventilators, and collaborating with competitors.

As we advance reopening into Phase 3 this week in New York City, there is no reverting back to whatever normal was.  The only way forward is to look forward and build the new normal. There are many articles, webinars, and podcasts about how to restore lost revenue, how to reimagine operations, and what bringing people back to work might look like. All very complex. Some people I’ve talked with have expressed confusion about where to even start; overwhelmed at what to do first. Understandably so.  It’s hard to put back together what was pulled apart in a hurry.

I’ve been advising clients to get back to the basics: processes, people and teams.  I’ll start with processes.

In times of normal operations, if staff is not clear about basic processes, this confusion will only be magnified in a crisis. Clients have said to me, “We knew we had this problem; but COVID only shined a spotlight on it.” A classic example: if staff don’t understand how to get an IV pump serviced and returned to the unit in a timely manner in normal circumstances, they’re only going to struggle more in a crisis. The best thing leaders can do now is to take an honest look at what went wrong, what isn’t working and fix it.  There is no shame in admitting a process is broken.  There are no bad people, only bad processes.  Get your staff in the room. They are the ones who will have the best solutions, as they are the end user of the process day in and day out.  Flow out your broken process. Grab a big piece of paper, some post-its, markers and go at it. Celebrate when you find the bugs and discover the waste. Awareness is the first step to do something different. You’ll be on path to stronger staff morale, faster productivity and higher quality service to your patients. 

If a step in your process says, “John gives it to Jane, Jane fills out the form,” you have a people dependent processes destined for failure. Sound processes are not people dependent.  Anyone should be able to step into John or Jane’s roles and do what she does.

Take the time to document your new processes and make them available to all stakeholders in the process.  It doesn’t have to be fancy and doesn’t have to be mapped out using the latest software.  You can draw it on a piece of paper. Send the process out to your staff and involved teams.  Post them in work areas where people can refer to them. Each staff member should be able to explain the entire process at a high level, even if they only own one step.  Schedule periodic reviews of the new process to be sure metrics are being met, to head off molehills before they become mountains and to prevent old process steps from creeping in.

When the next pandemic or crisis comes to town (and it will), a crash redesign of processes will be much easier if you understand what you do now, and if what you do now works!  If it doesn’t work, fix it now!

Stay tuned for Part 2, where I’ll talk about the next topic: People…

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Nancy Jacoby,

Nancy is a registered nurse, recovering hospital administrator and ICF certified coach and consultant. She leads individuals, teams and organizations in growth, development and process improvement to yield sustained change and desired outcomes. 

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Nancy Jacoby, RN, MBA, MHSA, FACHE, ACC  |  212.779.2049  |  Connect on LinkedIn

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