"All change begins with one small test."

Anna Roth, CEO of Contra Costa Regional Medical Center, wrote me the other day with a summary that is revealing about what we are all trying to do.  It is all the more powerful because CCRMC is a safety net hospital, short on resources but strong on mission.  The context was her description of a “Change Agent Fellowship" program, modeled after her own IHI fellowship, which couples mentoring and experiential learning with traditional learning such as didactic sessions.

The fellows were chosen by an executive leader who assumed the role of their sponsor and general support throughout the fellowship year.  Fellows were also assigned mentors. These were strong leaders from within and outside our system who could work with fellows and comfortably provide feedback to executive sponsors. I recruited an accomplished executive who had recently retired to run the program.

Each executive makes a promise to the fellow that they will look for learning opportunities and experiences. We have weekly seminars where fellows and their sponsors meet and have speakers join. They discuss projects individually and in a group setting. Though the fellows work on extremely diverse things such as; getting patients and families engaged on all improvement teams; eliminating infections in the hospital;  creating a social impact bond to bring diverse stakeholders together to eliminate suffering in Richmond neighborhoods near the refineries; embedding primary care and respite services within our homeless shelters…it goes on. These discussions often lead to identification of barriers.

Often even though the projects are quite different, the barriers are common across projects. Frequently one barrier is lack of leadership engagement or support to overcome local conflicts of interest or simple things that an executive sponsor can do to help such as authorize a purchase or extra staffing to conduct a test to learn.

What happens?  What is learned?

In terms of the leaders, they will tell you the experience of taking the journey with the frontline staff is both humbling and transformational. Most of us leaders don’t know about improvement or how to lead change. We are promoted because we are masters of the current system. It isn’t easy to stop, listen and let others guide/lead us. This can also be seen by some as weakness. Health care is notorious for charismatic heroes. Faster and more is often seen as better.

The truth is the most important decision made in my organization is not made by me in a board or conference room, but by one staff member at a time, one patient at a time, far away from the board room and far from me. My job is to help create circumstances that will allow our team to easily do what is right. Our mission is what guides us and that is why people come to work. They don’t come to work to cause harm which we hear so much about and is happening far too frequently. They come to help people.  I’m not trying to boast or ring our bell. We have a great deal of work to do. We have only scratched the surface. There isn’t a day that goes by I don’t think about how much more we need to do.  

All change begins with one small test. For us, the fellowship is one strategy designed to systematically deliver an experience that enables leaders and the front line to offer and accept help and to begin doing this on a regular basis with one person. We have seen leaders begin connecting with employees, patients and family members in a very different way after sponsoring a fellow and the fellows go deep into the operation or to the front-line and influence and amplify the voice and ideas of those around them.