Organizations often have a strategy and process improvement program in place, but eventually start seeing signs of waning momentum. The organizations experience a familiar realization that it is difficult to sustain improvements. Organizations including hospitals and health systems have encountered similar challenges. It is not easy to launch a major change initiative in healthcare, and it is even harder to make sure the initiative continues to move in the right direction with long-term results.

Part of the problem may be an abundance of improvement ideas all vying for attention and fishing from the same pool of resources. When program leaders are presented with multiple opportunities for strategy or process improvement, a common question often arises: What should the team focus on first?

Strategy or Project?

A project leader taking a poll of stakeholders across the organization regarding various proposed projects might discover convincing arguments that appear to be equally weighted. There might be an overflowing funnel of projects waiting to be launched – driven by suggestions from various departments, managers and clinicians. The fact that people are increasingly recognizing opportunities to improve is a positive sign that a program has made an impact. But it is also an indication that an organization may need to rethink their selection process. Everyone, it seems, believes their strategy or project should take precedence. Who is right and how should a project leader begin to prioritize?

Unless the organization has unlimited resources, some tough choices must be made regarding where to initially concentrate the efforts. Strategists in the organization tend to focus on refining strategy while process improvement methodology experts sway toward finding better projects or selecting the right project leaders.

Communicate the Strategy

Numerous Lean Six Sigma deployments have shown that for a program to succeed organizations must develop and communicate a clear and coherent strategy understood by everyone. They must also manage the correct key metrics to highlight particular areas of opportunity. Figure 1 illustrates this basic process of alignment – flowing from the high-level vision of the organization, to the more clearly delineated objectives, into more specific strategic initiatives and then finally translating these concepts into the identification of individual projects that can turn the vision into reality.

A carefully crafted communication plan is critical – especially in the early stages of any improvement initiative. An important driver behind the success of a program is ensuring the strategy is effectively and consistently communicated to all levels of the organization. When system wide communication occurs, a consistent framework and language around accountability begins within the organization. People know what the organization’s primary strategic goals are – from the front lines to the executive suite – and they understand their roles and responsibilities.

Select the Project and the Leader

If the overall strategy is developed first selecting the right projects to pursue should be clear. Identifying the right project leaders to carry the initiatives forward will help put the team on the fast track to sustainable success. Project leader selection is critical to ensure the time invested on identifying the right projects has been well spent. There are many criteria to consider in selecting successful project leaders, but a couple of the top traits are the ability to lead others and a demonstrated expertise in managing change.

Project Strategy
Project Strategy

Some may wonder if they will still achieve solid results if their focus is on having the right projects to lead first. Provided an organization has the right project leaders to guide the process and navigate through unforeseen issues, the end results will have a measurable impact. Do not expect the results to be as significant or sustainable, however, if the projects have not been thoughtfully aligned to the overall strategy and the organization’s leaders do not understand why they are being held accountable.


Major transformation in healthcare versus the quick fix requires a broader and more holistic view of the organization. It requires strong leadership and unambiguous linkage between strategy and execution. To keep Lean Six Sigma and other improvement initiatives from faltering, leaders must make sure that the individual projects people are managing always connect back to that original vision of the ideal future state.

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