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"What we can or cannot do, what we consider possible or impossible, is rarely a function of our true capability. It is more likely a function of our beliefs about who we are."


Performance-improvement sustainment is an ongoing state whereby a healthcare organization is continuously improving its processes with minimal external support. This path to self-sufficiency requires organizational commitment over an extended period of time. At the highest level, a performance-improvement deployment is approaching sustainability when the program is contributing more to the organization than the resources it uses. In addition to quantifying deployment efficacy and ensuring that project results are being realized and replicated whenever possible through the use of sound deployment metrics—addressed in Chapter 5—leadership must be proactive in the development of organic capability.

Organic Capability

While it is a fairly common practice to use external consulting support as a temporary measure until organic capability is developed, leadership must pursue internal capability aggressively. Organic capability means a cadre of performance-improvement practitioners throughout the organization taking actions to close performance gaps.

Program Oversight

The next level addresses how those performance-improvement resources are managed. The program management office concept was discussed in Chapter 6. While a healthcare organization may have invested in the training and development of a decentralized cadre of practitioners, the program management office—under the guidance of the deployment champion—must ensure that their efforts are supportive of organizational strategies and that methodologic rigor is maintained. In many instances, the deployment champion has not progressed to the advanced practitioner level necessary to provide the requisite technical support and oversight. Champions are neither required nor expected to be advanced practitioners. This drives a requirement to have at least one advanced practitioner assigned to the program management office.

Other roles of the mature program management office include management of the project portfolio as well as scheduling training and development for new and existing practitioners. Succession planning for current practitioners is also needed to ensure continued performance-improvement capability despite turnover.

The practitioners dispersed throughout the organization generally focus their efforts locally. All action, even if globally aligned, is local. Centralized full-time resources—assigned to the program management office—also lead more complex cross-functional or enterprise-level projects. While there is an obvious requirement for at least one centralized advanced practitioner, depending on the size of the healthcare organization, additional resources may be required. The centralized practitioners are advanced practitioners capable of running multiple projects, mentoring others, advising leaders throughout the organization, and in many instances delivering training. Another critical component of the program management office is to maintain the deployment metrics and advise the executive leadership team on performance improvement.

Program Assessment

As the deployment progresses, it is essential that it be evaluated for overall efficacy. The primary evaluation ...

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