RACI Saved My Implementation

“Energy is the ability to do work …”RACI, Healthcare, Implementation

I met today with the project team for an exciting initiative at a community teaching hospital. “Patient and Family Centered Care” takes some of the best ideas I’ve seen lately and brings them all together to change the way hospitals care for patients. Our initiative has many Patient and Family Centered Care “practices” that we want all of the hospital units to adopt. Some of them – like the communications tool AIDET – will be hospital wide and used by every employee. Others are specifically for nurses – like rounding on patients every hour to make sure they are doing well and attend to their patients’ needs.

It’s a great project, and it had a fantastic kick off that generated a lot of enthusiasm and energy among the staff. But now, six months later, some of the practices are going gangbusters and others are languishing.


As I thought about which practices were being promoted and taken seriously, I realized that the star performers were those that had a strong project leader. For example, Paula took ownership of the “Bedside Shift Report” practice, and has made significant progress in implementation. As of today, nurses on all units in the hospital are exchanging report at the bedside.

But in other cases, things were stuck. It wasn’t clear who was supposed to promote and champion “Hourly Rounding,” or “Whiteboards,” so nobody was doing it. You could tell when we got to the monthly meeting that certain aspects of the project were orphaned. In RACI terms, no one had really taken the “R” for making things happen and getting things done. It’s not that people were shirking, they just weren’t clear about who was accountable for this work. Some of them probably thought that Dannette, the overarching project coordinator, was going to take care of things. Others hadn’t been given a clear assignment and therefore did not know how they could contribute to the advancement of the practices.

I pulled the team together and gave them a quick RACI training. Once you know how to do this, you can teach the tool in as little as 15-20 minutes. The orphaned practices were given – with an R – to two people on the project team. Everybody got excited. You could see that things were going to start moving. In science, the formal definition of energy is “the ability to do work.” When you use RACI to clarify roles, you see why that’s true. Getting the roles and the accountabilities straightened out always releases a ton of new energy in a team. Now they can get to work. 

RACI, Accountability  

Topics: RACI, Accountability, RACI Case Studies