Figure 2 • The four necessary elements
to achieve operational excellence.
excellence will follow. The necessary elements for an organization to achieve operational excellence have been adapted from
the Baldrige Health Care Criteria for Performance Excellence and are defined below
(see also Figure 2). 1
• Vision refers to the desired future state of
the organization. The vision describes
where the organization is headed, what it
intends to be, or how it wishes to be perceived in the future.
• People refers to all people actively
engaged in accomplishing the work of
the organization, including paid employees (eg, permanent, part-time, as well
as employed physicians), independent
practitioners not paid by the organization, volunteers and health care students,
• Processes are linked activities with the
purpose of producing a healthcare service for patients and stakeholders within
or outside the organization. Generally,
processes involve a combination of people, machines, tools, techniques, materials, and improvements in a defined series
of steps or actions. Three popular
processes that have become widely
accepted in the healthcare industry to
advance operational excellence include
Lean, Six Sigma, and the Baldrige Health
Care Criteria for Performance Excellence.
• Technology is the enabler that allows
people to accomplish systematic pro-
cesses efficiently and effectively. Technology
can include everything from an MRI to
the computer workstation to the time
In the book, Execution: The Discipline of
Getting Things Done, execution is described
as “the missing link between aspirations
and results.” 2 Successful execution is a competitive differentiator that sets healthcare
organizations apart from their cross town
rivals. The authors suggest the first building
block to execution are a leader’s seven
essential behaviors, which include2:
1. Know your people and your business.
2. Insist on realism.
3. Set clear goals and priorities.
4. Follow through.
5. Reward the doers.
6. Expand people’s capabilities.
7. Know yourself.
An employee (eg, technologist, scheduler)
plays a critical role in helping the organization achieve operational excellence.
However, many employees in our organizations today do not fulfill the expectations identified by the manager/supervisor
and thus represent a significant lost
opportunity in employee engagement,
dollars (in terms of salaries and wasted
time), and patient satisfaction. It is suggested in the book, Now, Discover Your
Strengths, that each employee be provided
with a 12 question survey designed to
uncover a productive culture. The questions include3:
1. Do I know what is expected of me at
2. Do I have the materials and equipment
I need to do my work properly?
3. At work, do I have the opportunity to
do what I do best every day?
4. In the last 7 days have I received recognition or praise for good work?
5. Does my supervisor or someone at work
seem to care about me as a person?
6. Is there someone at work who encourages my development?
7. At work, do my opinions seem to
8. Does the mission of my company make
me feel like my work is important?
9. Are my coworkers committed to doing
10. Do I have a best friend at work?
11. In the last 6 months, have I talked with
someone about my progress?
12. This last year, have I had opportunities
to learn and grow?
Operational excellence supplements the
strategic vision for the organization. If
we define operational excellence as “the
delivery of ever-improving value to patients
and stakeholders, contributing to improved
healthcare quality and organizational stability,” then three different perspectives
contribute to successful achievement of
this objective. The organization, man-agers/supervisors, and employees all play
unique and important roles in providing
healthcare value to patients. When all three
of these roles are working in coordination
and fulfilling their requirements, the
healthcare organization is advantageously
positioned in their market.
1National Institute of Standards and Technology. 2009-2010 Health Care Criteria for Performance Excellence. Available at: http://www.
Accessed June 8, 2010.
2Bossidy L, Charan R, Burck C. Execution: The
Discipline of Getting Things Done. New York,
NY: The Crown Publishing Group; 2002.
3Buckingham M, Clifton DO. Now, Discover
Your Strengths. New York, NY: The Free
Jason C. Theadore, MHA, CRA, RT(R) is director of
diagnostic and therapeutic services at OhioHealth
in Columbus, OH. He can be contacted at
Craig Anderson, Jr. is senior manager at Charis
Healthcare in Hudson, OH. He can be contacted at