1. It’s better to set realistic expectations for teams and hold them accountable than it is to set unrealistic expectations that hold them hostage.
Everyone in healthcare is busy. Frequently, organizations drop new initiatives onto already full plates. Well-meaning employees hungry to make a difference will also volunteer to do more than they can realistically accomplish. When we begin a project, we ask each member of the team what percentage of their capacity is allocated toward it. If the percentages are low or team members can’t answer, the project is at risk before it even begins. When team members aren’t given a realistic chance to succeed themselves, they can’t be held accountable for the success of an initiative.
Requirement: A dedicated team accountable for success.

2. Your project needs two leaders—one focused on politics and one focused on pragmatism.
Projects require discipline in addition to vision. The person or persons who provide structure must manage the timeline and see that the inputs from team members are integrated into the flow of the project. These people must have the ability to make meaningful decisions, and a process for escalation and redress when a project is at risk. Leadership on projects takes more than one form. Typically there is a champion who is getting political buy-in and moving blockers in addition to the person dealing with all of the details and moving things along. The most successful projects have these two people working in lockstep.
Requirement: Empowered project leadership.

3. Know and show how all the dots connect to each other.
On clinical floors, each member of a care team has to understand exactly how his or her role fits into the bigger picture. This is equally true in successful completion of a project. Team members need to understand both what discrete tasks they must complete and their macro-level role in the effort. This should be discussed openly, agreed upon explicitly and documented thoroughly.
Requirements: Clearly delineated responsibility.

4. Bend reality to your vision. Not the other way around.
Changing horses in the middle of a raging river is inviting disaster. Changing destinations is just short of outright sabotage. Projects that start without a clearly defined vision end up in flux. For legitimate reasons, healthcare is an industry filled with structures that stifle change. Without a clear vision, the shape of an initiative will bend itself to fit the current status quo. We set parameters in stone at the beginning of projects by forcing team members to sign off on a list of rules that cannot be changed without a complete reboot. We also believe in tangibly marking important decisions that are made throughout a project as a trail of breadcrumbs back to the initial vision. This applies even to fact-finding projects that set the vision for future improvement or innovation efforts. Even research projects require explicit goals.
Requirement: Consistency and clarity of vision.

5. It’s less about big reveals than it is steady change.
Leave the big reveals for home improvement shows. We believe in the power of chunking. It’s how we analyze information and it’s how we manage change. Large, complicated implementations must be broken into smaller achievable goals. Each incremental advancement should be studied so learnings can be incorporated into the next phase. Incremental rollout also has the benefit of incremental buy-in. People are more willing to accept change if they think they have been involved in the process to getting there — even if it’s just the occasional status update meetings.
Requirement: Incremental rollout.

6. Collecting data is hard. Collecting useful data is harder.
Any innovation project in healthcare requires an upfront assessment of what metrics will be used to determine its success or failure, and a plan for how that data will be collected. If that plan requires additional work on the part of clinical team members, it is high risk. We are adamant that clients not only have a data management plan but a realistic one at the beginning of every implementation. It’s better to collect less data rigorously than it is to collect a lot of it intermittently. Data analysis is not an upfront and end-of-project task; it should inform teams on a daily basis.
Requirement: A data plan and ongoing collection of data.

7. Innovation without clinical buy-in is just theory.
Everything in healthcare comes back to the provider and the patient. There are many capable people playing crucial roles behind the scenes to enable this interaction, but every project in healthcare is a clinical project. There is almost nothing in a complicated system you can touch that will not trickle down to clinical care. Providers are trained to put their patients first, second and everything else last; if the voice of the clinician is not involved in a project from its earliest stages, there’s a good chance it will make itself heard later and louder.
Requirements: Clinical involvement and analysis.