Successfully navigating from volume- to value-based care cannot be mandated down from leadership, nor can it rise up organically from a star performer among the ranks. Even though as individuals any one of us might like to believe that I alone can make profound changes in the world or in our organizations, transformations on the scale needed in healthcare require much more than extraordinary personal effort. Healthcare is complicated. Successful transformations don’t come easy or overnight. Navigating to value in healthcare takes solid leadership, the right team, and an organization that not only appreciates what lies ahead but also is fully committed to getting there.
I have come to learn, through both successes and setbacks, there are key attributes that help ensure successful change. These attributes are found in five vital areas—the project team, project leadership, organizational leadership, organizational support, and mindset and expectations.
The Project Team
Perhaps most importantly, members of the project team must know and feel that they are empowered to make decisions that drive improvement. They have to believe what they’re doing is valuable and will make a positive difference. They must also be agile. For transformation efforts to succeed, project team members must be able to adapt quickly to dynamic work environments.
In order to develop the vital sense of empowerment in the project team I mentioned above, you need project leaders who value input and feedback from the team. Leaders need to be able to break through departmental and hierarchical boundaries to develop relationships across the organization. In order to better connect with and lead the team, they must have working knowledge of the data analysis techniques and tools that are being used by the team to help drive the transformation.
Organizational leaders must be accessible and be able to clearly align change efforts with the organization’s vision, ethics and expected outcomes. They need to be visible and actively encouraging change efforts. This type of support is made visible by being attentive and inquisitive about the change process, working to remove barriers, and creating time for high-quality personnel to participate.
To implement change efforts more quickly, create a centralized cluster of coaches, data engineers, and patient architects across the organization that have experience in transformation efforts. These personnel act as mentors for those on the current project team and help to manage rapid change in the organization by sharing the lessons they have learned in the past. Because these mentors also have their own full time jobs in other departments, they, in turn, need support from the organization to give them ample time to participate as mentors.
Mindset and Expectations
Again, healthcare is complicated. Complex systems often require complex solutions. People involved in transformations must appreciate that although lessons learned from prior efforts can be valuable, each project has its own dynamics, and there is no one comprehensive answer that will bring success to every effort. The key is to learn by doing and to keep the organization learning.
So far we have explored how to harness variation in the organization and some of the elements in empowering and building teams to create greater value, but what is value? How do you know it when you see it? In the next article, we will focus on how to look for value opportunities in your organization.
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Variation can be a powerful agent for creating value within healthcare organizations. Harnessing variation can create better outcomes and service for the money we spend and greater value is needed because inefficiency and waste in our current healthcare system create a sizable drag on our economy.
But that is the big picture.
When you are starting a process improvement program, the people on your staff don’t see it in those terms, so getting their buy-in for change needs to happen on a more personal level.
In the previous article, I addressed how efforts to harness variation can create fear in organizations. Taking advantage of the opportunities variation presents means fostering an environment of collaboration, innovation, and adaptation. But how do you avoid progress-killing fear in order to move forward?
One of the greatest sources of anxiety in organizations is the unknown. Why are we embarking on this program and gathering all of this new information? Why now? Why us? What are they going to do with all of this data once they get their hands on it?
As a leader, you need to anticipate these questions and answer them before they are even asked. Your goals need to be well thought out and well communicated. At a minimum, you should be able to comfortably and concisely answer these questions:
The next major hurdle is convincing people that the purpose of your efforts is not to find the “weak links” in the process and punish people who are “responsible” for the variation. It is not sufficient to merely reassure people verbally that the focus of your efforts are not to find fault. The improvement process needs to be designed in such a way that guarantees its conduct is blame-free.
You do this by blinding the data. Remove any identifying features. Although many people like to think they are top performers, their greatest fear is that they are near the bottom. As your improvement process continues, people begin to realize that they likely float somewhere in the middle, with some high marks and some lows. This tends to put them at ease and helps them realize that there are things they learn from their peers, and also things they can teach them.
The improvement process should be designed to build shared knowledge, shared language, and mutual respect—the hallmarks of a learning organization. Taking these small steps can help you remove fear from the variation equation to get everyone past it and moving forward.
In the next article I will address the potential of people to induce substantial improvement and positive change in systems, and the attributes you should be looking for in individuals, teams and the organization in order to make transformation efforts successful.
Exposing variation can inspire investigation, learning, improvement, or excuses. Which will you choose?
A few years ago, when I started writing and organizing my upcoming book, "Navigating to Value in Healthcare," the first outlines I imagined involved starting off with big, bold concepts to address challenges in healthcare and then finally drilling down to detailed explanations of key pieces of building value within an organization. The more I wrote, the more I came to see that I had it backwards.
As it turned out, all of the big-picture healthcare concepts I had thought should be at the front eventually found themselves at the back of the book. The key pieces of building value that needed to be at the front were less flashy but undeniable. And the first element that called for the most attention, was variation.
The major emphasis of my academic and consulting work is helping healthcare organizations create clinical and financial success in a new payer environment that is based on providing value rather than relying on volume. To do this requires instilling a deep understanding into the organization of how the quantity and quality of their services compare to similar organizations, and by driving their performance toward outcomes that matter most to patients.
Variation looms heavy over everything you try to do to get there, and at times can be seen as a dark nemesis. Instead, I would like to suggest it is a shining opportunity. It is an opportunity because the answers you need are frequently “right there” in the data. Best practices within an organization can be identified and by simply asking and listening you can find what is needed to achieve those best results.
While I believe that almost everyone in healthcare wants to provide the best outcomes, and safest, highest-quality care at the lowest cost, reality does not match those lofty goals. Unwarranted variation in healthcare delivery has been studied for nearly a century for its negative effects. It has been consistently shown there are variations in the outcomes, quality, and costs associated with the delivery of healthcare services everywhere, much of which is not easily explained between healthcare organizations that are considered “best in the world.” Moreover, a great deal of variation exists even within “best in the world” organizations and when these findings are revealed it creates fear and anger.
We need to talk about the fear variation can create in organizations because we have to get past that fear so we can do our good work.
The biggest thing people fear about exposing variation is that the organizations or individuals involved will be ranked, and then those on the “bad end” will be spanked—called out for their underperformance and punished. Next, they are often left in the dark by their leaders about how all of this data they are collecting will be used in the end. This creates anxiety around how the data is collected, retrieved, organized, and displayed. This can raise hostility because people can come to feel as if they are unfairly evaluated.
If you want your organization to evolve into one that is characterized by anger, fear, cynicism, and resistance, just dump in a bunch of data without explanation and start “ranking and spanking.”
If you would rather create a transformative, agile learning organization that exceeds the expectations and needs of the people it serves, you need to harness variation and use it to create greater value. To harness variation, wise leaders must inspire people to collaborate, innovate, and adapt, in order to harness the opportunity that variation presents. In the next article, I will offer a few techniques and tips for making that happen.
In order to thrive in tomorrow's healthcare delivery environment, leaders need to be able to build organizations with the capacity to adapt and innovate based on patient-focused methods of measuring healthcare quality and value. It is one thing to understand the concept of value; it is another to figure out what needs to change in an organization and how to make that transformation happen.
Responding to new challenges and improving underperforming areas requires new types of information, knowledge, and skills. Leaders need to raise their awareness of outcomes that matter to patients and financial performance, as well as how the quantity and quality of their services compare to similar organizations. This work is not easy, yet these changes are key to an organization's health and survival.
While well-informed and inspiring leaders are critical for creating decisive action toward success, it is important to remember that healthcare delivery occurs in teams. After creating the vision, achievable first steps must be identified and momentum must be built to overcome resistance to change.
I created this blog to delve into the issues of creating greater value in healthcare, including how to harness variation, look for value opportunities, measure what matters to patients, and then make successful changes to improve the delivery of healthcare. Over a 25-year career, I have been fortunate to work with teams and organizations facing an ever-changing landscape of healthcare reform and navigating the transition from volume to value based payment systems. Now, several times a month I hope to provide insights from my book, Navigating to Value in Healthcare, that will help you on your way. I look forward to sharing my experience and learning with you.