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by Yaneer Bar-Yam
Step II: Empower Workgroup Competition

Workgroups must be of the right size and function to be able to improve based on the measures evaluated. Some efforts have attempted to produce competition between entire hospital systems, but these units are too large and unwieldy. They focus responsibility on the hospital system management. Since these efforts do not directly measure workgroup performance, they do not enable practitioners to take responsibility for their outcomes or work together to improve their performance. Having provider workgroups rather than management assume the responsibility for healthcare performance in a competitive environment is key.

Once workgroups are created, the metrics of competition must be designed. Healthcare administrators should determine workgroup-performance measures that cover health outcomes, costs, lengths of hospital stays and patient satisfaction. Remember—what is measured is what will be improved: performance metrics must be designed carefully, and should be revisited periodically for updates and improvements.

Finally, workgroups’ performance on each of the measures should be publicized to all the groups on a regular basis—say, monthly. The workgroups would compare their results with those of other workgroups providing similar types of care, like other surgical teams or other nursing stations, and then be responsible for their own improvement.

Care must also be taken to set an appropriate tone for the competition. Just as with sports, rules must be established which will encourage good sportsmanship. Also, as teams improve their performance, swapping team members among them causes better strategies to be shared and improve the performance of all teams.

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