24 Sep Bench Depth: Ensuring Quality Continues After “They” Leave
This first part addresses the identification of potential succession issues. Part two – to be posted in couple of weeks – will discuss the solutions.
Not too long ago, I emerged from a short period of exile, aka: ‘voluntary inactivation,’ following the departure of one of our Primary Physicians. As our team waded through the hundreds of pages of UNOS forms, credentialing and commitment letters, CV’s and case-logs, we found ourselves a single case shy of currency.
If it is true that one definition of insanity is doing the same thing over and over and expecting different results, then a sad discovery in this process was that I was certifiable. Not all of my previous lapses have been so serious that they contributed to the inactivation of a program, but it was sobering to realize how entirely preventable this had been. Even worse, as I knew from my own consulting experiences at programs of all sizes that faced a variety of outcome or compliance issues, many program crises had been foreshadowed as they were deeply tied to departures or role changes where there was little or no “depth on the bench.”
“Preventable” is the key word. In this scenario, there was no active, ongoing succession planning. Succession planning is the concept of developing internal people with the potential to fill strategic roles, particularly leadership positions, in an organization. Transplant is not alone in this struggle. A 2016 National Center for Healthcare Leadership (NCHL) study published results on the systematic failures of healthcare organizations. The finding indicated that not nearly enough attention is currently being paid to succession planning or talent management activities.
In transplantation we are quick to think of succession planning in terms of programs served by single physicians or surgeons; but in reality, it’s pervasive throughout our centers. Talented physicians, administrators, business, clinical and quality managers, and even data, financial and office managers are often just “one-deep’ with cross-coverage limited to only a few aspects of the role.
Vulnerability Check: Are you running a “One Deep” Program?
Take a moment and jot down four or five people who….
- You lean on
- Make your center perform well
- That are strong leaders
- Perform a critical function at your center
- Have been instrumental in gains/growth.
Think about the primary physician and surgeons in each of your program(s).
- Have you confirmed that an OPTN-qualified backup is present and active in the program?
- Does that person(s) meet required training and experience requirements?
- Has someone collected and validated their case logs against OPTN required information?
Consider the people you first thought about when you went through those two exercises: your “second-in-commands.” If they HAD to step into a key role for an extended period starting tomorrow, what key areas of their performance you would be most worried about?
- Political skills/savvy?
- Regulatory or operational knowledge?
- Personnel Management Skills?
I suspect that the answers to all three exercises exposed some areas of vulnerability for your center. And, if you’re reading this, you work in the field of transplant – so, it’s likely you don’t need to be told that catastrophes happen. Any one of us could readily find ourselves with a surgeon unexpectedly in a prolonged recovery from their own surgery, a medical doctor on extended leave to care for family, an administrator lured away to greener pastures, a clinical manager whose spouse is forced to geographically relocate, or a looming retirement that is now just around the corner.
In the next article in this series (to be published a couple of weeks from now) will provide some suggested solutions to these succession vulnerabilities.