Contributed by Richard Stone

There’s a familiar saying that gets bantered about these days when things don’t change – Question: What’s the definition of insanity? Answer: Doing the same thing over and over again and expecting different results. Hospitals, like so many of us, suffer from this form of myopia. Little has changed in the past hundred years when it comes to role definitions. Managers continue to manage with other priorities being top of mind instead of how their actions contribute or detract from the safety and satisfaction of patients. It’s no wonder—there are so many things to keep track of. Staffing requirements, compliance with a whole host of ever changing regulations, pressures on nurses and other caregivers to handle the care of more and more patients, not to speak of the intermittent crises that emerge almost daily when the care continuum breaks down. In many healthcare facilities, the ship is sinking under the weight of these demands, yet managers continue to hold steady to their familiar course, hoping that with time they can weather the storm, saying to themselves, “If we can just bail a little faster, we’ll make it to tomorrow!”

I suggest that first we need to reexamine one of the most important new roles that has emerged in healthcare settings in the last 20 years—that of the quality improvement manager. Step one is to eliminate the position of “quality improvement manager”. That may seem harsh, but I contend that the organization does not need one person attempting to engender improvement from the top. Lasting improvement like all social change of any consequence comes from the bottom, emerging from the rank and file.

Step two, give everyone of your team leaders and managers an additional title—Quality Improvement Manager. Put it in their job descriptions. Incorporate it as a top priority in performance reviews. Compensate them for results. Hold them accountable if they can’t achieve results. Define the skills they need to succeed and provide them the tools and resources to continually improve. Hire people who fit this job profile and expect results starting on day one.

You will have now sent a message to every member of your management team that doing the same old things and expecting different results will no longer cut it. Be as bold in your expectations as your patients are of your institution. Leadership is a verb, not a noun. In doing the above, you’ll find that innovation and ownership will take immediate hold with a lasting and sustainable impact.