December 4, 2023 A proposal for a new framework of “Healthcare Leader Standard Work”

Tim Darling

What it is

The term Leader Standard Work has its roots in Lean principles. Leader Standard Work is the documentation of the intentional value-added processes that high-performing leaders consistently execute. 

Regardless of whether an organization has gone through a Lean journey, there is unique value in clarifying the work of frontline leaders for both them and their executives. Leaders who build on these processes and do them consistently obtain efficient impact across the outcomes they are responsible for.

While there isn’t a single detailed approach that can be applied across all organizations, there are fundamental shared elements of standard work that consistently lead to outcomes (e.g., employee retention, patient experience, and quality and safety) regardless of local context. And there are shared stories, ideas, and experiences that help leaders inspire each other.

Frontline leaders need frameworks to help them prioritize actions that lead to outcomes, especially when faced with exceptional constraints

To support leaders in the current health system environment of resource and financial constraints, we need to reinvigorate and reimagine leader standard work in a way that emphasizes a scientific approach to quality, safety, and retention. 

Frontline leaders have tremendous power and potential across all outcomes, but they are also overwhelmed with administrative work, conflicting priorities, and constant firefighting. The way forward is by (a) defining evidence-based Leader Standard Work and (b) providing managers with tools and support to execute on it.

Leaders often report feeling overwhelmed and find it difficult to determine where to focus to achieve the desired team and departmental outcomes or performance. The proposed “Healthcare Leader Standard Work” provides a framework of common processes for leadership roles to help achieve operational success and efficiency. Incorporating Leader Standard Work into practice helps to improve the leader's impact by adjusting the way they think and manage, thus allowing for sustained improvement and performance consistency. 

Building efficiencies into their work enables leaders to spend more time on activities that build a greater understanding of the challenges and opportunities faced by their team members, patients, and peers.

The overview presented is intended to provide a strategic and inspirational perspective on both the types of work and the outcomes of the work. The framework should not be interpreted as lowest common denominator items that are consistently practiced by all managers. For most managers, there is work to be done to maximize the items here. All managers undoubtedly would welcome any support by their executives in being provided with tools and support (e.g., reduction in administrative work) to allow them to dedicate more time to them.

A proposed framework for “Healthcare Leader Standard Work”

The framework was developed over the course of dozens of conversations with both frontline managers (clinical and non-clinical) and executives in health systems. Some brought the reflection of an entire career, while others brought the pragmatic challenges of current daily life.

This framework intentionally does not include details into the different tactics and processes; additional resources will be added in future articles to address the techniques, tools, and skills that support each area.

What I'm managing and leading …

My leadership 

• Creating and communicating a vision with my team
• Reflecting, evaluating, and reprioritizing my team/department's performance and my own leadership, professional development, and well-being
• Improving how I communicate with my leaders

My Team: The individuals on my team

• Recruiting and hiring with diversity; onboarding   
• Recognizing purposefully and inclusively 
• Setting expectations with feedback and accountability
• Completing education, training, and certifications  
• Coaching, developing, and supporting

My Team: My team as a collective 

• Communicating transparently to the team
• Collecting and acting on feedback with the team

My Department: Unit-level structures and processes

• Staffing, scheduling, and workforce planning 
• Creating processes to collaborate on unit decision-making, processes, and work environment 

My Department: Financial and operational performance 

• Reviewing unit productivity  
• Budgeting and budget reconciliation  
• Ordering supplies and equipment  
• Submitting payroll

My Department: Quality of care 

• Creating a culture of safe, high-quality care with process improvement and following up on safety events  
• Reviewing outcomes and developing action plans
• Ensuring compliance with regulatory / accreditation  

My Patients: Patient experience

• Creating a culture of compassion
• Gaining insights into patients’ experiences
• Following up with real-time service recovery and implementing specific improvement interventions

What I'm contributing to…

Interdepartmental structures and processes

• Building relationships across the organization
• Collaborating on interdepartmental processes and responding to requests from other departments
• Coordinating on patient flow and capacity management