This is a story of leadership faced with setbacks that typically derail redesign initiatives. This profile illustrates idealistic, strong, and focused leadership in a turbulent environment. "Boldness has genius, power and magic in it," claimed Goethe.

In February 2004, Jackson Health System's Sandy Sears, Senior Vice President for Ambulatory Services & Community Health, initiated a radical project. She hired Coleman Associates to conduct a Patient Visit Redesign™ Collaborative involving nine clinical sites. Five were hospital-based sites and four were free-standing primary care centers. Oh, yes, and this is a public hospital. And, a teaching hospital.

The total amount of time a patient spends in the clinic from start to finish is the "visit cycle time". Prior to the redesign project, the nine clinics had average visit cycle times that ranged between 120 to 223 minutes. In other words, to have a primary care encounter, patients could expect to spend two to four hours in the clinic.

Productivity is measured as the number of patients seen per hour per clinician (and "clinic hours" include those after-clinic hours spent by the clinician dictating progress notes). Prior to redesign, productivity ranged from 1.1 to 3.0 patients per hour.

Sears has a personal commitment to patients that is remarkable:

"My patient care experience motivated me to get into the field that I'm in today. I see myself as an advocate for many individuals in this community who can't speak for themselves. I take that role very seriously. So as their advocate, I'm outspoken. I know what I want. And, I'm ever mindful of what it's like to be a patient.

"I get in a line with patients to experience it myself, and I ask ‘What is your experience like?' If they don't tell me ‘Excellent' then I want to know what it takes to make it excellent."

She implemented a system-wide redesign effort aimed at radically transforming the patient experience even though the organization was experiencing financial difficulties. When asked what she would have done differently she said:

"I would have timed it at a point when there was much more stability in the larger organization. In the midst of our redesign initiative we found our health system had significant financial issues that we had to respond to immediately. We had to respond to them in the way of staff reductions and staff reassignments. That was very challenging for us."

When faced with similar challenges, many leaders would lose their focus on redesign. Not Sears. She said that whenever she's in doubt, she just puts herself in the patient's shoes. She knows then that she can't go wrong.

Eighteen RN positions have been converted to LPN and PCA positions in the in-hospital Ambulatory Care Centers, and they are working with 45 fewer staff than they were in the summer of 2004. Most of these staff members were reassigned to other departments in the system. Sandy Sears feels these losses acutely.

All health care systems go through upheavals and transitions. What's admirable about the work done in the Jackson Health System is that Sears never let the financial pressures divert her attention from transforming the patient experience. She never used the turmoil as a rationale for suspending the redesign project or lowering her performance goals.

Her commitment to redesign led her to implement a "Train the Trainers" system to ensure a cadre of staff that understands how to design (and redesign) work processes. New staff members are quickly brought up to speed to prevent the loss of momentum. "If management is not focused and vigilant, staff will quickly go back to their old ways of doing things. You've got to keep your eye on the ball. It's a long term process." said Sears.

Since the Patient Visit Redesign™ Collaborative concluded in August 2004, Jackson has spread redesign throughout all ambulatory sites. Nine sites were trained by Coleman Associates, and now twenty-four sites are doing patient visit redesign.

Sears and her management team (about seventy-five managers) meet regularly, with redesign still at the top of the agenda. And "redesign consciousness" is evident on the clinical units. Data banners, on which cycle time and productivity data are recorded weekly, are posted in every clinic. Sears also keeps a master banner on her office wall with data from all clinics. This high profile visibility tells her managers: "I'm still focused on redesign results."

Sears reflects: "We continue to make significant progress because as a management team we've made it clear to everyone that this is not an option, it is a mandate. And there is ongoing monitoring and reporting."

Sears and her managers have moved to tackle problems beyond their immediate control. They're coordinating with the emergency department to reduce inappropriate usage of the ED and enhance continuity of care. "We have set aside appointment slots in each of our clinics so that when patients arrive inappropriately in the ED, they can be referred to our clinics and be seen that day."

The management group also has increased collaboration around problem solving. Managers whose clinics haven't been doing well collaborate with managers whose clinics have better outcomes. Sears said, "We are learning from each other."

Not only is Sears a champion for patients, she's also believes passionately in her staff. "They know that I will speak on their behalf and will advocate and fight for them. But they also know I have a no-nonsense attitude."

Sears took a bold risk in redesigning the patient visit process when the health of Jackson Health Systems was uncertain. She's been recognized for her courage and tenacity. And it was reflected in her annual performance evaluation. "I was commended for taking the lead in having ambulatory be the first division within this health system to launch a major redesign effort."

"I'm a make-it-happen person," comments Sears. "I'm very goal oriented. If I decide to do something I'm going to do it, there's no doubt about it. I like action. I like to be different. I like to be ahead of the game. I want Jackson Health System's ambulatory care division to shine and be the role model within this system. So, I push people just like I push myself."

The best leaders are humble. The best leaders let others shine and recognize that success is not theirs alone. Sears said, "I'm only a success if they [staff] make me so. For me, a leader's success depends on her ability to get things done through other people." Sears is intent on making sure staff members know how much she values them, regardless of their position or title.

An exemplary leader. An advocate for patients and staff. Bold in her initiatives. Tenacious when faced with formidable challenges. Such is Sandy Sears. A great example of effective health care leadership for this new century.