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CHAPTER 5 Don’t Go at It Alone : Find a Primary Sponsor

STORIES FROM THE FRONT LINES OF HEALTHCARE: TURN‐AROUND TIME FOR X‐RAYS IN THE ED

Dr. Ashley Nixon was an Emergency Department (ED) physician at Mercy Hospital. She and her colleagues staffed the surgical care track of the ED. She took pride in her work and her ability to provide high‐quality, efficient care to her patients but was becoming increasingly concerned about the long turn‐around time for X‐rays. The time to get an X‐ray result once the order was in had more than doubled in the last six months. This was affecting patient flow and her ability to provide timely care for her patients. Dr. Nixon decided to launch a QI project to improve the situation. After evaluating the current process, she decided to make some changes she thought would improve turn‐around time for X‐rays. She discussed these changes with Dr. Edward Mosley, a colleague. He agreed that she had a good plan and that the changes would help expedite the turn‐around time for results. Dr. Nixon emailed the revised process to the ED nurse managers and the radiology manager, indicating they would start the revised process the following week. On Monday morning, Dr. Nixon met significant resistance. Nurses and radiology techs said they didn’t know anything about the revised process and would need their managers’ approval before proceeding with “doing anything differently.” When asked for advice, Dr. Mosley suggested to Dr. Nixon that she talk directly to the nurse and radiology manager. Over the ensuing months, several meetings were scheduled, but without the active involvement of a senior leader, no progress was made. Delays continued with X‐rays in the ED.

What was the problem? How did Dr. Nixon approach it? What was the result? Why did this happen?

THE PRIMARY SPONSOR

What Is a Primary Sponsor?

All projects need a sponsor. A Primary Sponsor can be a physician leader, departmental chair, division chief, executive leader, director, or high‐level unit manager.

A Primary Sponsor is the senior leader who has access to the necessary resources and the authority to ensure the success of the improvement project or change initiative.

As a senior leader in the organization, the Primary Sponsor can “open doors” for the improvement team. The Primary Sponsor uses connections, influence, and a power base to increase buy‐in, resolve cross‐functional issues, and mitigate resistance from the frontline stakeholders.

The Critical Role of a Primary Sponsor

The role of the Primary Sponsor in the QI project is critical. The Primary Sponsor serves an essential function for the project team in helping move the project forward and achieve objectives. These are the most important functions of the Primary Sponsor:

 Establish priorities for competing initiatives.

 Resolve cross‐functional issues.

 Remove roadblocks; the Primary Sponsor serves as the point person to address barriers that interfere with the project’s progression.

 Help manage change by building a coalition of key stakeholders to support the change.

One of the most common causes of QI project failure is the absence or lack of meaningful involvement of the Primary Sponsor to provide the necessary leadership and support for the change initiative. The Primary Sponsor needs to be visible, engaged, and active throughout the lifecycle of the project.

The role of the Primary Sponsor is crucial in the team’s ability to manage change. Improvement teams often start a project without involving a senior leader and then struggle unnecessarily throughout the project. The Primary Sponsor is the project facilitator and the change leader. Ronald Heifetz, professor of leadership at the John F. Kennedy School of Government at Harvard University, defines the change leader as “the person that provides the technical solution while preparing people for the adaptive change by understanding their loss, providing hope, and explaining the process” (Heifetz 2002).

To appropriately fulfill the role, the Primary Sponsor must spend time communicating directly with the front lines to help the QI Team gain buy‐in for the project. One of the greatest contributors to success in change initiatives is an active and visible Primary Sponsor. The greatest obstacle to success is ineffective change management sponsorship to support the QI project (Prosci 2016).

WHO SHOULD BE YOUR PRIMARY SPONSOR?

You may be approached by a senior leader with a request for an improvement project. Most likely this leader will become your Primary Sponsor. If you have the opportunity to choose your Primary Sponsor, there are a number of requirements you should keep in mind. While all Primary Sponsors are senior leaders, not all senior leaders should be the Primary Sponsor. Ideally, the leader you have chosen to be your project’s Primary Sponsor has the following characteristics:

 is well respected by both the team and key stakeholders,

 is considered a credible leader,

 has the authority and appropriate leadership level to be able to resolve cross‐functional issues when they arise,

 has experience in leading projects and change management initiatives, and

 has the willingness and ability to actively participate in the crucial phases of the project.

Many healthcare organizations have a matrix reporting structure that complicates the selection of the Primary Sponsor. You may need to select a Primary Sponsor and ask for the assistance of a second senior leader. In these situations, clear communication with all leaders involved is necessary. While not ideal, you may need to choose two sponsors for your project.

REVIEW QUIZ

1 What is a Primary Sponsor?A person that will support your QI projectA high‐level leader that can ensure the success of your projectA leader that establishes the priorities of the QI projectA leader that is actively engaged in the change initiativeAll of the above

2 One of the greatest contributors to project success is the active and visible participation of a Primary Sponsor.TrueFalse

3 A Primary Sponsor is generally a senior leader (executive, high level manager, physician leader) in the organization who can “open doors” for the QI team.TrueFalse

4 An effective Primary Sponsor must have the appropriate leadership level to be able to resolve cross‐functional issues.TrueFalse

5 One of the greatest obstacles to the success of change initiatives is ineffective change management support by the Primary Sponsor.TrueFalse

6 To be an effective Primary Sponsor of a QI project, you need to be visible, engaged, and active throughout the life‐cycle of the project.TrueFalse

7 Which of the following is NOT a typical role of the Primary Sponsor?Provide resources for the improvement teamEstablish priorities for competing initiativesResolve cross‐functional issuesAnalyze baseline data and create a graphic summary of the findingsEngage key stakeholders to support the change and manage any resistance

8 To effectively support an improvement team, a Primary Sponsor mustbe a leader with authority,have the appropriate leadership level in the organization,be respected,be able to be actively engaged in the QI project, orall of the above

Key: 1e, 2a, 3a, 4a, 5a, 6a, 7d, 8e

REFERENCES

1 1. Heifetz R. (2002). Leadership on the Line. Harvard Business Review Press.

2 2. Prosci®. (2016). Best‐Practices in Change Management. Best‐Practices Report. Edition.