Hospital Leaders Ask, Experts Answer: The Real Reasons Productivity Stalls — and What Works
Don't miss the next session — register your interest in future High Performing Hospital webinars by completing the form at the bottom of this page.
1. To what extent is process improvement necessary to hospitals achieving operational excellence?
It is absolutely fundamental, and I've validated this with 300–400 doctors this year. Strong processes, those which connect the moments of craft between clinicians and patients, are vital to operational excellence. Without them, errors are inevitable and safety is compromised.
The data tells us that noise levels can sit at 30 to 70 percent. If you can halve that, you take a massive step towards improving all of the quintuple aims. And everybody wins when you target noise: patients, staff, and those responsible for the bottom line.
2. What is the cost of running improvement programs on an incomplete picture?
Many hospitals are doing this, and it's not their fault. They're often improving in the gaps. Frontline leaders are closest to the problems but lack the visibility to see how their work fits the bigger picture, so fixes tend to be localised rather than addressing the stickier system-level opportunities. Central improvement teams have the mandate for system-level change but are separated from the frontline. Without the structured method and data, they struggle to unearth the real issues or replicate success.
And critically, improvement with an incomplete picture will fail to bring along the people who actually have to adopt the changes. Without that, any benefits, regardless of solution quality, are unlikely to stick.
3. How do you shift process in an entrenched ‘disengaged’ culture?
Three levers.
The first is genuine engagement. Entrenched cultures will not respond well to change being pushed on them. What works is getting people to collaborate in diagnosing the problem themselves, and then asking what they think should change. Not every change needs to be tied to a KPI; some of the most powerful early wins are goodwill gestures that show leadership cares about what matters to the people doing the work. And then, non-negotiable, you follow through. Nothing kills momentum faster than staff flagging issues and nothing changing.
The second is measurement. Alongside KPIs, we use Behavioural Change Indicators (BCIs), which monitor how well change is actually being adopted on the ground. These drive regular, data-led conversations about how the process is shifting, not just whether outcome metrics moved. What gets measured gets done, and over time, culture follows.
The third is leadership, that balances collaboration and direction. Leaders must visibly demonstrate that the change matters to them and actively manage their teams through the transition. In stagnant environments, you often need to push something small through at first. It gets things moving and demonstrates to the wider team that change is possible. Sometimes people just need to see it to believe it.
4. How do you create capacity to do the improvement work with heavily burdened teams?
There's an undeniable truth in operational improvement: all change requires effort and ownership. That tension is felt most acutely in service departments that don't control their own demand.
Where you have capacity, the most effective lever is a dedicated person or team to drive the improvement work alongside clinicians and nurses, minimising specialist’s time off-tools. That person owns the capturing of noise, the analysis, and the doing of change.
Where you can’t do that, sequence your improvements to build capacity before you spend it. Start with lower-effort changes that free up time first, measure adoption rigorously to prove when the capacity is real, and only then move to bigger ideas.
There's also a more human lever: a social contract with your team. Be transparent. This will require a temporarily heavier load, but on the other side there will be a genuine period of relief before that freed capacity is redeployed. That honesty, and following through on it, is often what makes the difference between teams that engage and teams that don't.
5. Were nursing and interdisciplinary leaders included as stakeholders?
Yes, and it is essential. Leadership representation from all impacted departments allows you to cascade messages, surface real failure points, and build solutions that work for everyone, not just the team initiating the change.
Nurses in particular require careful consultation, because they represent one of the highest-risk points for unintended knock-on consequences.
Stakeholder management must be disciplined. The best change leaders are clear about who needs a seat at the governance table, who needs to be consulted at the right moments, and who simply needs to be kept informed. Exclude the wrong people and you miss critical issues; involve too many and decision-making stalls.
6. How do you improve admin efficiency?
Trying to improve administrative processes in isolation can be frustrating and, at times, fruitless. Admin areas are often deeply embedded in the care pathway, even when that isn't visible.
The starting point is the same as anywhere else: gather the data on the end-to-end system the admin team inhabits. Only then do you have a true picture of the value they generate, and where they may not. That data is also what puts you in a stronger position on technology investment. Without it, hospitals risk introducing tools that digitise the wrong things or add complexity where they intended to reduce it. The data ensures any investment is targeted, high-value, and additive. Not an expensive fix to a problem you haven't fully diagnosed.