Shared responsibility: the key to true pay-for-performance and great customer service

In an earlier post, I discussed how companies — and specifically healthcare organizations — who want to fix a dysfunctional process often end up trying their hand at something that does not quite yield the hoped for results. This is because, again and again, people fail to take a broad enough perspective of customer service, do not really understand the connection between shared responsibility and pay-for-performance, and generally approach a problem from a variety of well-meaning but too narrow viewpoints.

Continuum of care

In my earlier example, I talked about how the narrow focus of the staff in improving wait times and throughput in the ER was doomed to be sub-optimal if the bigger picture was not considered. This would have meant not only understanding in an intellectual sense but also accepting in a practical sense — and thus modifying behaviors — that the ER is not an island unto itself, and that there is a continuum of treatment for the patient that may involve post-ER transfer to another facility, discharge home, or admission to the hospital. Unfortunately, due to a variety of reasons, staff who are managed with a silo mentality — and rewarded or penalized according to narrow criteria where jobs are considered to have fixed scope set by departmental boundaries — will behave in silo fashion as well.

Why impermanence defeats ownership and shared responsibility

The typical approach to ‘breaking down barriers’ is to set up cross-functional project teams. This rarely works, because people dislike anything that they feel takes them away from their narrow focus of specialty, and too many projects are staffed by people who don’t really know what’s going on, project metrics of performance are often undefined or clash with departmental ones, project managers may not have the requisite authority or skill to to ‘herd cats’, and so on.

In my opinion, the best answer lies in truly understanding the concept of continuum mentioned above, and in having performance metrics that really address the service given to a patient (or, in other contexts, to a retail or business customer), in soup-to-nuts fashion. People talk ‘one team’ but it rarely goes beyond lip service, whether because of workplace rivalries or simply due to difficulty coordinating complex efforts in the midst of competing priorities.  I believe interdisciplinary teams need to be established that are permanent — unlike project teams that come and go, thus creating little bond among participants, with the project being a distraction from the departmental or function-centered activities.  If at all possible — and I take this from personal experience standing up several teams —  members should be physically co-located and should interact in person continuously rather than via email sporadically, and so on. Brief progress huddles should be held twice a day, and whiteboards or similar devices should be used to enhance visibility of progress and issues — these are all ‘communication enablers.’  Note that this streamlining of communication goes directly to the project bottom line in terms of greatly sped up schedule, which means no costly overruns.  Time-boxed development also helps in achieving incremental deliveries to the customer, and thus in keeping them in the loop and up to date. This creates synergy.

Solutions vs. tasks

Because a solution is something that goes from requirements to implementation and beyond, these teams need to be mini-centers of excellence, with resources that are capable of providing a solution, not just complete a task and then hand the result over to someone else in another department, at which point ‘my job is done.’  No one’s job is done until everyone’s job is done, and done well, and the customer is satisfied.  Therefore, organizing solution teams along lines of service rather than solely by function or department makes sense.

Pay-for-performance and shared responsibility

Furthermore, performance evaluation of the staff needs to be tied to customer satisfaction for everyone, not just those team members that interact directly with clients, be they patients or retail buyers.  By prioritizing department performance (local, narrow) over true customer service and outcomes  (global, all-encompassing), a conflict is created that breaks the connection between well deserved pay for oneself and optimal results for others.  As obvious as this may sound, permanent teams working in the described fashion are certainly not common practice.

And yet, by personal experience, permanent, solutions-focused teams are the best way that I know of creating true collaboration among specialists in different areas, of everyone knowing what the end goal is and keeping it in sight from beginning to conclusion, of developing a sense of involvement, bonding, and shared responsibility towards the customer that goes beyond good intentions, and of compensation having the potential to be truly reflective of staff performance and outcomes for the customer.





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