What makes a hospital great?

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Becker's Hospital Review publishes a list of 100 great hospitals every year, using rankings from a variety of sources. Most of those listed are urban medical centers, and many are the flagships of large health systems. These are the hospitals with the deepest pockets, able to take advantage of big technology budgets and sophisticated expertise, so it's not surprising that they have risen to the top.

But what sets them apart isn't just the depth of resources. While deep resources help, greatness starts with something more fundamental. It takes a vision, persistence and a willingness to keep getting better. A supportive community helps, too.

While some of these hospitals started as academic medical centers, many were established long ago as small community hospitals with just a few beds. But somewhere along their timeline, a group of people with a vision saw a bigger future and invested in excellence. The early effects tend to influence the behavior and attitude of the existing staff, but this also extends out and attracts likeminded individuals. It is that willingness to invest time, effort and money in excellence that matters. Because once you have a vision, and once you invest in excellence, you change the nature of the organization.

Visionaries attract other visionaries and excellence attracts more excellence. We see the same thing online — social influence impacts individuals' behavior and even health. If your online circle of friends are healthy, their influence will shift you toward healthy behavior (the reverse is also true).  And even those who aren't initially obsessed with excellence are affected by the culture, which changes their frame of reference. If you set a high standard, if you make that standard a part of the everyday routine of a hospital, everyone – not just clinical staff, but everyone associated with the hospital – is touched by the culture of excellence. It becomes part of their cognitive reference. People who would, in another culture, cut a few corners or accept a mediocre result, rise to the challenge of excellence.

But setting high standards isn't enough, either. Most truly great hospitals are pioneers, places that took risks and gave opportunities to innovative thinkers. Instead of accepting the status quo, these organizations constantly ask, about tasks large and small, "Is there a better way?"

But openness to change and risk-taking isn't enough, either. Not every risk is worth the gamble, and we've all seen re-organizations that just shuffled the deck chairs, wasting time and opportunity. The great organizations are open to change, but also careful about what and when they make changes. They are clear-eyed when it comes to data, able to look dispassionately and objectively at facts, even when the facts torpedo what seemed like a good idea. In the oft-cited guiding principle — they move fast and fail fast, accepting failure as a learning opportunity and moving quickly to stop unsuccessful projects or ideas and move on to the next idea. They don't let themselves be steered by the force of a leader's personality. While personality may be a factor in some of these organizations, the organizations have good governance structures that provide checks and balances that dampen the effects of individual desires and hidden agendas.

So that's another point: governance structure matters. It's a boring truth, especially in contrast to the exciting visions of greatness, but without effective governance, a great organization can run off the rails. Like the balance between a vision of greatness and the clear understanding of the realities of real life, good governance creates an environment that allows the good ideas to be vetted, quickly finding the relevant and possible among all the options available. It also provides a framework for boundaries and respect and fosters collaboration, not just control. In some interesting work out of Harvard, Charles A. O'Reilly III and Michael L. Tushman identified key characteristics of successful innovative organizations, describing these organizations as "ambidextrous." They have governance that separates the running and optimization of day-to-day operations from groups focused on re-thinking the way to do business and deliver care.

The teams in these ambidextrous organizations remain tightly connected at the senior leadership level, where sufficient coordination and direction can occur, but the bleed of influence between these two very different management styles is kept to a minimum. This allows successful operations to proceed efficiently without stifling the innovative spark that needs freedom from traditional thinking and processes.

In the age of technology, a hospital's ability to quickly adopt and use advances can be important, too. Many of the great hospitals on Becker's list are also on the Most Wired list. But it's not just the quality of the technology, it's the thoughtful use of technology that really matters, the way it is integrated into workflows and supports the work of the hospital. You don't have to be cutting edge all the time, you just need to recognize the relevance (or lack thereof) of any technology and involve the front-line users in the adoption of technology.

So deep pockets and access to superior resources can help make a good hospital truly great, but it's not the key element. Even a small critical-access hospital can achieve greatness on its own terms, if it has people with a vision, a willingness to think and learn, and an ability to persist in the face of barriers. Even a task as seemingly mundane as cleaning a hospital room can be an opportunity for greatness, if the person who does it is thoughtful and willing to go the extra mile. You don't have to be a great surgeon or a visionary leader to achieve excellence within healthcare. You just have to hold yourself accountable, respect the work you do, and keep thinking, listening and learning.

Ultimately, great organizations grow from the collective power of thoughtful individuals who never accept less from themselves than they are capable of. 

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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