Chapter 2. Leadership
Effective leadership skills are essential for developing and maintaining something as large and complex as a regional coalition. Strong leadership not only visualizes what can be achieved but also creates a supportive organizational structure that fosters the environment necessary to make the vision a reality.
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Vision, Mission, and Values
An important first step in establishing a coalition is to define its vision, mission, and strategic values. A vision statement clearly and broadly captures what the coalition aspires to become, and the mission is an enduring statement of purpose that describes the coalition's reason for being. Both the vision and the mission statements reflect the coalition's values, which guide how it operates and succinctly present its underlying philosophy.
Each element helps provide the coalition with a shared sense of purpose and direction. Clearly stating the coalition's guiding purpose and overarching vision provides the often disparate members of a regional coalition with a common goal to aim their energy and resources. It also can help to maintain the coalition's focus during difficult times and keep staff motivated with an inspiring objective, such as contributing to the greater good by improving health care.
The following example from Massachusetts Health Quality Partners illustrates how one Better Quality Information (BQI) site presents its vision, mission, and statement.
Massachusetts Health Quality Partners' mission is to improve the quality of health care services delivered to the residents of Massachusetts through broad-based collaboration among health care stakeholders.
Massachusetts Health Quality Partners' vision is to be the premier health care quality collaborative in Massachusetts, including the most trusted and influential source for comparative health care quality performance information.
We believe in the power of collaboration.
We believe our work should have a measurable impact and be evidence based.
We believe that eliminating unnecessary duplication and improving efficiency are key components to quality improvement.
We believe that credible performance information supports improvement.
We believe that educating the public about health care quality, including appropriate public release of performance information, supports quality improvement and enhances public accountability.
We believe that engaging health care providers and consumers in an open dialogue about performance information is a critical part of the quality improvement process.
The Massachusetts Health Quality Partners board of directors has identified the following five strategic focus areas in support its mission:
- Take a leadership role in building collaboration and consensus around a common quality agenda.
- Aggregate and disseminate comparable performance data.
- Increase coordination and reduce inefficiencies to improve the quality of care delivery.
- Develop and disseminate guidelines and quality improvement tools.
- Educate providers and consumers in the use of information to support quality improvement.
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The Need for Visionary Leadership
Forming a regional coalition requires dynamic, dedicated, and visionary leadership that can bring together a diverse group of stakeholders. The need for visionary leadership was a recurring theme among the BQI sites, particularly during each site's startup phase.
What is "visionary leadership?" A visionary leader has a sharp understanding of a current reality that needs improvement and offers a vision for how to improve it. Visionary leaders also inspire, influence, and guide others in helping work toward making this vision a reality.
In creating a shared vision, leaders answer such basic questions as, "Where are we going" "What are we trying to do" and "Why."
The BQI sites typically identified individuals who possessed visionary qualities. These leaders recognized the need for change early on and played an essential role in envisioning and establishing the coalition. Leaders of BQI sites typically:
- Have a highly respected reputation among influential stakeholders in the local health care community and are capable of getting buy-in.
- Possess the ability to articulate the vision of the coalition persuasively and enthusiastically to a variety of constituencies and are able to motivate action.
- Are tirelessly persistent in promoting the need for a regional coalition, its activities, and its objectives.
Examples of Effective, Visionary Leaders
Massachusetts Health Quality Partners. Massachusetts Health Quality Partners began in 1994 with the visionary leadership of the late H. Richard Nesson, M.D., then-board chair of the Massachusetts Hospital Association Board. After the Boston Globe printed data that gave the wrong impression about mortality rates in Massachusetts hospitals, Dr. Nesson used the opportunity to build support among a variety of constituencies for creating a coalition to measure themselves and be accountable to the public by publicly reporting performance results.
Minnesota Community Measurement. Minnesota Community Measurement was created as a result of visionary, can-do leadership seizing the opportunity to proactively bring groups together to improve health care in the region. In 2001, three medical directors of the largest health plans in Minnesota informally met while attending the Institute for Healthcare Improvement's annual conference in Florida. Over coffee, they discussed how the health plans could more effectively use Healthcare Effectiveness Data and Information Set (HEDIS) data to improve health care in Minnesota.
Gail Amundson, M.D., a medical director from one of these large health plans, had the vision of aggregating health plan quality of care performance data and reporting it at the medical group practice level. The trio of medical directors met throughout the following year to develop a pilot proposal to report the HealthPartners HEDIS-Plus Optimal Diabetes Care measure by medical group practice. Dr. Amundson led the Medical Director Team and Data Planning Team, both of which contributed many hours and much talent to making the pilot successful. That pilot eventually grew into Minnesota Community Measurement.
Wisconsin Collaborative for Healthcare Quality. Two sparks ignited the formation of the Wisconsin Collaborative for Healthcare Quality. One was the publication of Wisconsin's first comparative performance report by The Alliance, a Madison-based business health care coalition. Using a public-use dataset of administrative claims, this report focused on hospitals and was a clear indication of the business community's desire for access to comparative performance information. At the same time, the State of Wisconsin was preparing to implement a law mandating the collection of administrative claims data from medical groups.
Astutely discerning the implications of these two events, John Toussaint, M.D., president and chief executive officer of ThedaCare, an integrated delivery system in Appleton, called his peers at several other systems in Wisconsin, including the Marshfield Clinic, Gundersen-Lutheran in LaCrosse, the Medical College of Wisconsin in Milwaukee, and Dean Health System in Madison, and shared his vision of a voluntary collaborative effort that brings together physician groups, hospitals, and purchasers to design and report accurate and actionable comparative performance information. This vision served as the genesis of the Wisconsin Collaborative for Healthcare Quality.
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Go Slowly at First
Setting the right tone in the relationships you initiate as a coalition leader will go a long way in establishing your reliability and trustworthiness. As part of your leadership style, BQI leaders recommend forming the coalition at a pace that is conducive to building relationships and instilling trust and credibility as honest brokers in the coalition.
In addition to promoting the coalition's vision, take the time to define clearly what the expectations will be for potential participants while cultivating the common ground among various groups. Massachusetts Health Quality Partners was "in business" for 5 years before it became incorporated as a nonprofit organization. The coalition focused on developing small, achievable projects to secure early successes.
The Wisconsin Collaborative for Healthcare Quality started with nine health care organizations located in separate geographic markets. The leaders of these organizations agreed to limit participation during the first year (2002) to determine the feasibility of collaborating on a performance measurement. As word began to spread about the meetings among the nine organizations and their business partners, there was considerable pressure from other health care organizations that wanted to become involved. The founders held firm until the group's first public report was issued and then decided to become a membership organization. Although the decision was difficult, it did not preclude the Wisconsin collaborative from growing rapidly once others were invited to join.
Assess Participant Core Competencies
Leaders should identify skill sets of participating members. Just as having a technically skilled staff enhances trust among stakeholders, identifying who among your stakeholders has the well-developed technical and collaborative skills necessary to complete tasks efficiently and effectively can strengthen the coalition's integrity.
Be Prepared to Address Stakeholder Concerns
As a leader, your ability to successfully address and resolve participant concerns is crucial for maintaining the coalition's credibility. Before engaging potential stakeholders, be prepared to welcome concerns and criticisms from participants and have transparent processes in place to resolve issues quickly. This approach will establish the coalition's collaborative image among participants and may win over critics. Coalition leaders in Minnesota found that their willingness to openly engage on and learn from the concerns critics raised actually moved many initial critics from resistance to full engagement in the coalition.
Develop Processes for Addressing Mistakes
Strong leadership depends on anticipating mistakes and addressing them while minimizing damage to the coalition's credibility. Developing processes early that openly and quickly correct mistakes is vitally important. Leaders in the California coalition, for example, encourage developing a policy of acknowledging to stakeholder groups when mistakes occur as soon as they happen. After notifying participants of a mistake, the team quickly works to correct it and communicates the resolution immediately to stakeholders.
For example, when the California Cooperative Healthcare Reporting Initiative's copying service experienced equipment problems, the coalition was unable to return charts to participants on time. Although this glitch caused anxiety among participants, staff members helped allay the stress by honestly acknowledging the situation to the participants and sending frequent updates on how the problem was being resolved.
When the Massachusetts Health Quality Partners' Web site crashed on the day it was to publicly release data, the coalition received numerous calls from angry people who found the site down. Staff members phoned and E-mailed each caller to apologize and explain what had happened. Many callers were pleasantly surprised by this personal contact and were left with a positive impression of the coalition, thereby helping to maintain trust.
Tip: Actively solicit direct, honest feedback from stakeholders by maintaining an open, ongoing dialogue with them.
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Proceed to Chapter 3