In my last post, using Atul Gawande's TED Talk as an example, I discussed the need for healthcare training to transform itself from educating cowboys and cowgirls (i.e. fiercely independent and self-reliant clinicians) to coaching “pit crew” members.[i] Don’t hold your breath - this transformation will not happen anytime soon; clinicians were trained in a particular way for well over 100 years. Moreover, academia is the last industry in the world from which you should expect innovation. It’s not going to happen. That leads us to the question of knowing what type of professionals and skills are required to deliver on the promises of population health.
Healthcare workforce education has traditionally focused on a siloed approach and rarely offered students of diverse disciplines the opportunity to learn together in the classroom or through experience. This siloed approach has contributed to the constant problems faced in health care. What healthcare needs is a learning organization. A learning organization uses systems thinking to see the surrounding parts as a whole. It is an antidote for complexity and with the scale of complexity at its highest in Population Health initiatives, systems thinking can provide the discipline for “seeing the structures that underlie complex situations.[ii]” Interprofessional education and practice has shown to improve healthcare’s ability to provide high-quality patient-centered care.[iii]
Professional Services
As software and hardware continue their downward spiral toward more and more commoditization, services become the key differentiator. The professional services sector is becoming increasingly critical to the success of population health projects. That is why the main commercial population health vendors have ongoing initiatives to strengthen this part of their value propositions. Even the uninitiated quickly discover the myriad of complex skillsets required for the recipe that delivers on the promise—from HIT professionals to top notch clinicians—spiced of course with professionals who can bridge the gap between the two.
All growth will come from intellectually based services.
—James Brian Quinn
My primary complaint against a professional services led model is not that talented consultants do not bring significant value to the table, but that their business models often work to the detriment of providers, especially in the population health space. Here’s why. Maximizing billable hours is their principal mechanism for increasing revenues. They develop sophisticated techniques for achieving this end, including a never-ending obsession with account control. The goal from a provider’s perspective is to minimize the amount of time and risk it takes to develop and implement population health solutions. These two goals are diametrically opposed. In turn, when revenues begin to fall, they cut corners to compensate and as they push harder they begin to realize that the easy way out usually doesn’t work.[iv]
Consider the fact that for professional services, maximizing revenues for a given project requires providing more warm bodies and billable time instead of fewer. The key for providers is to hire a professional services organization that is thoroughly focused on doing more with less and transferring knowledge as fast as providers have the bandwidth to absorb it.
Although professional services continue to increase in importance, not all service providers have the best interest of their customers in mind, caveat emptor! The question you should ask any service provider is “How do you intend to reduce the number of project hours required for closure?” Enough said.
The Environment
During the dot.com craze, companies thought they could instantly manufacture a corporate culture of creativity by having a fully stocked kitchen, game rooms, casual dress code, and mandatory corporate fun activities. All of these culture creation props, for most of these companies, were as empty as their bank accounts. These perks are obviously nice to have, including a physical work environment that is conducive to creativity and personal productivity, but they are no substitute for a sincere corporate culture. The burden of consistently working 60-80 hour weeks for months at a time, and spending precious little time with those you love, will not be lessened by ten free diet cokes a day.
Shared Values
It is clear that a sustainable corporate culture must be built on a foundation of open communications and a shared set of core values, which include: honesty, integrity, respect, diversity, and profitability. Your shared belief system must permeate the entire organization and manifest itself in the day-to-day operations of the business. This common belief system should be self-evident.
Us Versus Them
The business press quickly killed a good-sized forest with all the print space that has been dedicated to the importance of cross-functional teams and communications. Despite this, organizational silos exist everywhere you look. Why do these walls remain when there is universal agreement that they significantly contribute to organizational dysfunction? Apparently, as previously mentioned, the walls remain because individual stakeholders often have a perceived vested interest in maintaining them. Nowhere are silos more insidious than in population health projects given the enormous amount of cross-functional support required for success.
One way to begin tearing down the walls is to eliminate physical barriers that exist between various departments. Have Nurses and Therapists intermixed in adjacent cubes or offices. While you are at it, throw in a Doctor as well. The daily communal contact will enhance cross-functional communications. Without encouragement from anyone, neighbors will begin to break bread, and perhaps have a drink together after work.
Another, perhaps better, way to improve cross-functional communications is to encourage Natural Leaders and individual team members to open dialogs with all business functions required to accomplish the mission. Frequently line executives prevent cross-functional communication because of their prejudices, fears, and insecurities. Learn to maneuver around these obstacles and watch as the communications process improves dramatically.
Talent Connoisseurs
Our people are our greatest asset. We should all agree to abolish this statement from the business lexicon because at 99.9% of the companies that I have worked or consulted with (unfortunately) this statement is empty rhetoric and corporate propaganda of the worst kind. Most companies do not treat their employees as if they were the business crown jewels, and everybody knows it. Cut the baloney unless you can deliver the goods.
Everything else being equal (and of course they never are), the companies with the best teams will win more often than not. It follows that you will require excellent coaches and talent scouts to sustain an advantage. You better pay these folks well because they will be (and are) in high demand. Recognizing quality talent is a tricky business, and if you rely on Ivy League pedigree nonsense as your principal criteria, one of your competitors is likely to wind up with all the golden needles in the haystack.
The Recruiting Buzz
When I am brought in to help an organization build a team, the first question I ask is “What is your recruiting buzz?” Of course, I always get the expected response, blank stares followed by “What are you talking about?” In a labor market where quality talent is scarce, they are in the driver’s seat and are usually very selective when choosing new assignments—not unlike the best actors and directors in Hollywood.
Why would the best talent want to work for your company, and on this particular population health project? Your recruiting buzz answers this question. It is the story told to candidates to get them excited about your mission. Companies are often engaged in very cool and exciting projects, yet they do not know how to milk it for all it’s worth during the recruitment process. Don’t get me wrong; this is definitely not about selling a story that will vaporize as soon as the newly signed up candidate walks through the door. It is about presenting what your project has to offer in the best possible light. Without a great recruiting buzz you are unlikely to win your fair share of the best candidates. Build it. Practice it. And use it often.
[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.
[ii] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.
[iii] Knickman, James, Anthony R. Kovner, and Steven Jonas. Jonas and Kovner's Health Care Delivery in the United States. 11th ed. New York: Springer Publishing, n.d. Print.
[iv] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.
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