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5 Must Haves for Clinical Transformation

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As consultants we help our clients deal with the extraordinary change in the health care industry. While we celebrate the many wins our clients achieve, we can also become discouraged at the slow pace, or complete lack of, change that we see in many institutions. We see the toll it takes on leaders and staff. This is why we were so intrigued when we heard about a hospital that has made an extraordinary leap in their patient satisfaction scores while also improving outcomes and quality. We felt compelled to find out why – how had this institution succeeded where so many others were struggling?

In our latest whitepaper, Harrington Hospital Success Story: the Five “Must Haves” for Clinical Transformation, we identify real world levers that are available to create lasting, real world, change.

For example, the role of the CEO is “frequently carried out as a facilitator between Board Committees and the physician staff of the hospital.” In the case of Harrington, Ed Moore took a different approach. He demanded the entire community: administration, clinicians, and the Board itself strive towards achieving better outcomes than historically seen. He backed up his approach with action (removing the change resistors) and he personally attended to the details using frequent meetings to assess progress and retain focus. Continue on to the whitepaper to read more on how simple it is to change, even though it isn’t easy!

Physician Leaders: piloting the ship, or going down with it?

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I’ve worked with and studied a lot of physician leaders. They have all been excellent clinicians, surgeons, and care givers. However, when tapped to lead (a clinic, department, or hospital) there is sometimes a lack of experience and skills that are needed to be an effective leader.

Trained as experts to make life-saving decisions, doctors are sometimes reluctant to listen to others’ opinions. Sometimes this is the result of a conscious decision and sometimes this is a result of an unconscious decision – which can be the result of the type of training they have experienced. Typically this trait of taking a “rely only on myself” quality is most pronounced when multi-tasking, under stress or in times of change, all of which a leader faces on a regular basis.

As we have all seen, leaders have significant impact on the individuals and teams in their organizations. This impact can be either very positive or very damaging. So, when you’re looking to promote a talented physician (and this also applies to other clinical staff as well) to a leadership role, please consider whether or not they possess the following qualities:

  • Good listener: one who can consistently listen and be open to others’ opinions and perspective. Is it “my way or the highway”? Do they always need to be right or act like they have something to prove?
  • Effective communicator: can this person talk to their peers, other leaders and subordinates with the same degree of effectiveness? Can they deliver difficult messages in a constructive manner?
  • Collaborates/relates well to others:  does she/he behave in a way that indicates a core belief that functioning as a team is a preferred and productive way to manage? Or, is it more about the individual and trying to outwork any issue or challenge that needs addressing?
  • Has a shared group vision: is there a singular agenda or is this person open to what is best for the team and organization?  Sometimes called collective thought—there needs to be a clearly defined mission, with ways to measure milestones, successes and, inevitably, failures (so you can learn from them).
  • Will lead, not dictate: ask yourself if this individual is truly a team player and willing to continue to roll up his/her sleeves and do the work and lead by example, not just sit behind a desk in their new corner office expecting the work to be done as they dictate.
  • Humble: Finally, I’ve found that being humble, open and willing to learn goes a long way. Yes, practitioners at this level have become experts in their specialty.  However, when steering a larger ship, there are new qualities, skills and tools that need to be learned and integrated into their job. Are they humble enough to realize this and to do the development work that is required?

If the clinician you’re looking to promote has at least 3 of the above qualities, then there’s a good chance they will become successful and effective leaders. We all know it takes a solid foundation of non clinical skills in order to effectively navigate the stormy waters of clinical leadership.

If you have an already promoted a leader who needs some skill development, contact us. Or if you have a practitioner who you’re thinking about promoting and have some nagging questions, contact us. Coaching for skill development is what we do. Let us help!

Are healthcare providers hearing the wake-up call?

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Sometimes the last people to know that an organization is about to hit a catastrophic iceberg are the leaders of the organization, even though they spend millions on writing strategic plans to avoid such an event.  It can be too devastating to leadership to consider that one’s oftentimes beloved institution, with a culture that has one’s own stamp on it, grown by close colleagues, is about to be threatened to its very foundation.  It can be too devastating to acknowledge that our beliefs may no longer be true, our skills may no longer be adequate, and/or our very way of life within the institution needs to change.  Adults hate change…why look into the abyss?

I’m actually worried for the hospital systems of the U.S.  I don’t think they realize that the game may be changing so radically that it may feel like they’ve hit an iceberg, regardless of the fact that they are wealthy institutions, rich in capital and knowledge.  Consider the following recently publicized facts:

I. The largest company dedicated to meeting the health and well-being needs of Medicare beneficiaries (UnitedHealthcare) and the largest retirement community in the country (The Villages) have formed an exclusive relationship designed to create “additional health benefit options and facilitate coordinated, comprehensive care” at a new patient-centered health system for Medicare consumers.

  • Threat:  The payer has hired the primary care staff, including MDs, and bypassed the traditional health system, except for specialty care which it will better control.

II. The proportion of companies with more than 20,000 employees offering High Deductibles went from 41% in 2007 to 59% in 2012. “If we’re not already at the tipping point for [consumer-directed health plans] — and we may well be — at this rate of growth, it’s coming soon,” said Sharon Cunninghis, Mercer’s U.S. business leader for health and benefits.

  • Threat:  Consumers are beginning to see the “list price” for health care and realizing what Steve Brill so adeptly revealed in “Bitter Pill”, Time Magazine:  prices are too high, and large, insular health systems, basing negotiations with payers on a “discount %” methodology, have not been paying attention to true costs.

III. Memorial Sloan Kettering Cancer Center, IBM, and WellPoint (a managed healthcare company) announced earlier this year that they are teaming to incorporate Watson, the supercomputer, into medical practice.  As “MedGadget” reported, “medical literature evolves at the blink of an eye, and it is impossible even for the most learned of physicians to keep up with all the data involved in [cancer]. It’s in fact estimated that only 20% of what the average doctor practices is evidence-based.”

  • Threat:  if Watson-like technology has the magnitude of impact that Google has had, large amounts of the bureaucratic apparatus of health care may no longer be needed.  Consider a world where the physician really isn’t the person with the answer, the computer is.  Consider how the power would transfer from the health system (who has the docs) to the patient and the payers.  I’m not sure it is possible to fully imagine the impact on the organizational design and management structure required by a health system when it’s the patient who is directing care using their mobile device.

IV. The Harvard Medical School invited David Goldhill, author of Catastrophic Care, How American Health Care Killed My Father, to speak with Ashish Jha, Professor of Health Policy and Management, Harvard School of Public Health.  Clearly, Mr. Goldhill is becoming a force for the voice of the patient in driving health care.  He believes that health systems have treated the payers, not the patient, as the customer in heath care and that they must now be made accountable to the patient.  He is not to be underestimated.  If you remember Ross Perot, you realize that one man, with a platform and a message, can indeed radically change the public debate.

  • Threat:  the threat here is that new institutions arise that really “get it”.  As the UnitedHealthcare example shows, a newly configured organization can develop a new delivery model based on consumer knowledge, price transparency, partnership with the patient and widely disseminated medical knowledge.  Wow.  Are our health systems ready for this?

These are just some of the tectonic shifts occurring on the ground and in the press.  Those who “will not see” these shifts are likely to be doomed.  Those who don’t have the fortitude to address these trends head on could be doomed.  Those who do have the courage to take on the magnitude of change could still be doomed.  And those who have the courage to take on the change and the brilliance to design the future, versus longing for the past, will not be doomed.

Advice to those who want to be part of the solution?  There are 3 changes you can make immediately that would improve the likelihood of weathering the changes to come:

  1. Start hiring from other industries… finance people, IT people, HR people, supply chain people, customer service experts, call center experts, again, you get the idea.  All roles but your core clinical ones should have a good percentage coming in from non-healthcare industries.  Service-based industries, most likely.
  2. Specialize:  put the power with the service line chief.   The challenges are just too large to take on at the global level.  Reduce the power of the central infrastructure, except where centralization is key to cost reduction (i.e. supply chain).  Hold the service line chief accountable for Triple Aim plus revenue growth and staff talent.  (For more information, read our whitepaper on Accountability in Healthcare. 
  3. Get your chargemaster out, look at it and start managing pricing seriously on a rational basis.  Develop cost models based on real costs, not RVUs.  Consumers will get the hang of this soon and the earlier your house is in order, the better it will be.

An accountable healthcare organization – it is possible!

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I was excited to read recently that the Cleveland Clinic took the radical step of eliminating their departments of medicine and surgery! In the article Cleveland Clinic’s 4 radical approaches to care integration, patient satisfaction, by Karen Cheung-Larivee, December 7, 2012, published on FierceHealthcare, Karen states that they were “rethinking the organization based on patient needs.” Radical!?

In my recent whitepaper on accountability in health care, I make the point that physician leaders are not empowered to run a Service Line, not in the sense that they have full accountability for all 5 critical goals:
“Triple Aim”
• Excellence in clinical outcomes
• Value
• Patient Satisfaction
Institutional success
• Revenue growth
• Culture that attracts and retains the very best clinicians, leaders and staff.

Most service line chiefs do not have full authority and consequent accountability for everything that happens to their patients, including inpatient services and nursing. Also, frequently, they must fight political battles with the Chief of Medicine or Chief of Surgery who manage a function rather than a cohort of patients. So the old model of a Department of Surgery and a Department of Medicine are one of the many confounding elements that make service line accountability difficult. Yet, here we have one of the most renowned healthcare institutions tearing away the old assumptions and operating under a new model.

This type of fundamental restructuring of organizations can be a game changer. It genuinely empowers leadership in the service lines to drive improved outcomes, process improvement, staff development and more, all while being able to look at the full financial impact of their decision, whether inpatient or outpatient, surgical or noninvasive.

Once organizations truly begin to rethink how they serve their patients, from the patient’s point of view, I truly believe that improving value (better outcomes at best cost) will truly be within reach. What do you think?

Peace to Perfection: a continuum that impacts performance

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Decision making can sound formal and grand, and it can be. But as managers of people, we make decisions on a daily basis that can have significant impact on both our organization’s results and our personal success. Do we always take stock of our motivations and what our goals should be before we respond in the moment? Or do we let our individual personality preferences impact our decisions in ways that are counterproductive to our own goals? When we do, it can have significant consequences for our individual, team or organizational goals. Emotionally driven decisions can be an ineffective response to what is only a set of facts or circumstances.

Have you ever accepted less than someone’s best because you didn’t have the “energy” to address their sub optimal work product? (Avoiding confrontation to keep the peace.) Have you ever kept at something or someone too long and/or too hard because the vision in your mind’s eye was so compelling that you just had to have the work “just so”? (Demanding perfection.)

My clients do a good job, most of the time, achieving their desired place on the Peace to Perfection continuum. Sometimes, however, especially under unusual levels of stress, they make decisions too close to either end – which can get in the way of creating an environment of maximum performance.

So what?

Staying too close to the “peace” end can end up pushing work from its assigned area to others – including oneself – in order to get things done, ultimately ruining trust and teamwork.

Staying too close to the “perfection” end can end up demoralizing staff and driving good people, whom you want to keep, to other departments or organizations to avoid burnout and in the interest of self preservation.

To remain one of those effective managers that attract and keep good people, one needs to maintain perspective and a sense of what is right in the moment – and that requires the mental ability to process the emotions of the moment and then purposefully respond to the set of facts and needs in a way so as to achieve your desired goals.