It’s all about untapped potential. In more than 24 years at some of the top centers in North America and through extensive experience in academic society leadership, I have never seen a Heart Center that truly leveraged all the talent residing within. High performing programs - and those under pressure to improve outcomes - typically share a common set of opportunities to improve performance through release of untapped potential.

The avenues of opportunity for improvement reside within the bedrock concept of the Donabedian triad which focuses on the causal (linear) relationship between Structure > Process > Outcomes. In Heart Centers, a respectful modification of the Donabedian concept posits that Structure creates a set of possible Processes which actually define Culture - and Culture defines a set of possibilities for refinements in Structure. Consequently, the interplay of Structure, Process, and Culture is a CYCLE and the {Structure/Process/Culture cycle} ultimately determines Outcomes.

Upstream from the {Structure/Process/Culture cycle} is Mission. Without a razor sharp mission, all three parts of the cycle will be less than optimally efficient. For example, although the Mission may be publicly proclaimed to be focused on the provision of optimum care for patients, the structure in many Heart Centers is actually best suited to optimally preserve the established academic hierarchy rather than deliver state-of-the-art multi-disciplinary care. Processes may be subverted to focus on non-productive social issues between groups of caregivers rather than truly prioritizing the patient. Culture may be subverted to focus on preservation of clan power rather than fully inclusive decision making, optimal delivery of care, and productive team-based performance review.

Recognition of this conceptual approach (e.g. Mission > {Structure/Process/Culture cycle} > Outcomes) is important because Heart Centers seeking improvement often focus on one aspect of these concepts without recognizing the need to comprehensively evaluate all of them in a simultaneous manner. For example, an effort to ‘improve Culture’ to achieve better Outcomes without deep evaluation of Mission, Structure and Process and their complex interrelationships is doomed to fail. Mission, Structure, Process, and Culture must be evaluated simultaneously to achieve an improvement in Outcomes. This statement is equally applicable for a high performing Heart Center wishing to ‘up its game’, for an underperforming Heart Center under serious pressure to re-organize, or for a Heart Center seeking to gain market share through superior performance in a competitive market.

Releasing untapped potential to reach a peak level of excellence in a Heart Center, is best achieved with a partner to help on the journey. The partner should have ‘internal’ perspective (e.g. deep content expertise and ability to truly understand how a Heart Center works) AND be a trusted external colleague who can provide the dispassionate objective perspective necessary to identify untapped potential, work with the Heart Center Leadership to develop and implement a plan to move forward, and be available for support every step of the way.

Change is hard- but ALWAYS achievable with insight, commitment, patience, a sound plan, and the right team.