GSM Self-Audit
How Close to the Mark Is Our Organization?

GSM is a way for management teams to think through what they are doing and how they want to change their organization performance profile. Look both at Processes and Results.

• GSM Processes Achievement. These are some of the upstream drivers of downstream results. Without them there is little chance that results will be achieved. Look first to see whether the organization is doing the right things in management.
• GSM Results Achievement These represent the types of results associated with excellent managing. The levels at which their achievement must be met means that an organization has clearly emerged as an industry leader due to its high performance ability.

Below are criteria reviewed by a panel of 25 hospital CEOs and which serve to give a flavor of what GSM means in actual practice. Start by having your management team check off which elements are in process or achieved and see what the profile looks like currently.

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GSM Processes Achievement

Balanced Scorecard

• Balanced scorecards are found posted prominently in public and department areas
• Goals called for must be at levels similar to those required for Results, i.e. audaciousness for excellence (see below)
• Measures set must be valid and have credible databases, i.e. are not soft or equivocable.
• Dates for accomplishment are set for 12-24 months, no 5-10 year fuzziness.
• Substantial annual tactical work plans are rolled out under a commando change group to oversee their implementation, i.e. this is not left simply to the executive normally in charge. This criterion is looking for aggressiveness on task.

Leader Selection

• Leaders are selected less for technical skills, though these may be required, and more for interpersonal skills and achievement orientation.
• Leaders are selected for Edge, Execution, Energy, and Energizing capabilities. There is evidence of a clear orientation to achievement.

Leadership Education & Evaluation

• The management team completes an initial course of study of 80 hours (10 days), and a minimum of 40 hours (5 days) of management education annually thereafter.
• Failure to complete the annual course of study results in a removal of the leader for inadequate preparation.
• Instructors must be considered competent and qualified, are evaluated and recertified annually, and replaced as necessary.
• Managers will be evaluated by staff, peers, and executives in some form of 180 degree process.

Management System

• There is an established housewide system that details management values and philosophy and operating practices beyond what is normally found in personnel and accounting manuals. (See the MANSYS Management System as an example and beginning platform).
• A succession management plan and development mechanisms to implement it are present for all positions at department director level and above.

Time Management

• 90% of meetings are controlled with a prioritized agenda, start and stop times, are paced and then evaluated for effectiveness.
• Meetings or committees not producing results follow a sundown rule.
• 75% of middle management meetings with executives are used for upward communication on operating problems and needs, with announcements relegated to print or email.
• Managers utilize a Key Results Hour technique to focus on priorty problems or needs at least 4 days/week.
• Reduction of unnecessary paperwork, processes, and other trivial task reduction is aggressively pursued.

Work Planning & Organization

• Tasks and projects considered essential to business mission are identified in each area in sufficient quantity as to actually "move the numbers."
• The management team uses some form of work planning or management by objectives in which a written list of Key Results Area task are prioritized and agreed upon, with followup evaluation of progress by involved executives. This procedure is repeated on either a monthly or quarterly basis. An annual work list does not qualify.
• Tasks not contributory to key results are minimized, delegated if there is a positive development consequence to the person asked to do them, or are automated.
• Any policy or procedure or practice older than 5 years comes up for automatic revision, renewal or replacement in a process of scheduled reinvention.

Tools & Systems

• Productivity is enhanced by adequate tools, technology and systems. Provide evidence of a substantial shift away from hand labor and travel time to investment in labor and time saving tools. Computerization leads that parade but there are many other tool approaches.
• Flowcharting, travel time calculations, work simplification and process improvement efforts are substantially underway to turn work into a smooth and lean flow.
• Standards: The pursuit of perfection means that an organization never accepts second rate vendors, equipment, supplies. Do it right or don't do it all is the house operating philosophy and practice
• Standardization: Removal of variance and cost by standardizing how things are done.

Human Resources

• Selection follows the principles of best person, selected by multiple raters and with multiple interviews.
• Problem people who cannot be developed are removed.
• There is a high degree of recognition and reward.
• Small group process and participation is widespread.
• "Every employee a manager" is practiced; empowerment levels are high
• Open book management is practiced.
• Culture development and sustainability is treated as a high priority.

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GSM Results Achievement

High Customer Satisfaction:

• Organization must be rated by its customers at 90th percentile or above compared to norm group (database must include at least 50 organizations).
• Organization shows year over year internal improvement on customer satisfaction scores for each department

High Quality: This award is satisfied by any one of the following:

• 90th percentile on HCIA-Mercer quality indicators
• Top 100 Hospitals status—(Note: this criterion does not fit all hospitals).
• Leapfrog Group prime indicators met of computerized order entry, hospitalists, and meeting volume of surgeries requirement (Note: not all reviewers were sold on these indicators).

Low Cost: This award is met by any of the following:

• Freezing prices to market 3 years in a row
• 90th percentile on HCIA-Mercer cost indicators
• Adherence to budget, profitability and low cost indicators endorsed by HFMA.

Best People: All of the following must be met:

• 30 training hours/person. All forms of training and orientation can be exceeded. (This requirement is being debated and may be reset to 40 hours.)
• Overall morale scores must be at the 90th percentile for the questions "My overall rating of my job," and "I would recommend a good friend to work here."
• Ideation implementation equals or exceeds 2 ideas/person during the calendar year.
• Improved retention rate as measured by 3 year moving average.