By Rob Thames
This is Part 3B of this three-part series.
Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights.
Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?
By Rob Thames
This is Part 3A of this three-part series.
This Part 3A briefly reviews four change methods and Part 3B will compare them.
“I have no idea how to change anyone. But I carry around a long list of people in case I ever figure out how.” - Anonymous
Eliminate four billion dollars of waste from a large healthcare system next year. Increase the CMS TPS (Total Performance Score) for a hospital from the national average of 38.1 to 60 in two years. Reduce maternal, child and infant mortality in Nigeria by 50% in three years. These are large-scale improvement goals – at healthcare system, hospital and population health levels, respectively.
By Rob Thames
This is Part 2 of a three-part series
“Help! I need somebody! Help! Not just anybody. Help!” – The Beatles
When a cry for help begs a response, how do we assure that productive help, not just good intention, actually happens?
When faced with failure, what does a responder do? As an expert/advisor, you have a choice: correct the specific failure or strengthen the system (Taylor, Just and Lasting Change). To make this decision, it is critical to discern: is this an event-induced “disaster” – Ebola, Tsunami, Hurricane – or is it a chronic, systematic, or lifestyle-induced failure? In medicine, the difference is how a physician treats a patient with emergency trauma vs a patient with a chronic disease. The global relief vs development challenge has a healthcare leadership parallel: rescue or strengthen.
By Rob Thames
Part 1 of a three-part series
“We cannot solve our problems with the same level of thinking that created them.”― Albert Einstein
In the U.S., some refer to healthcare system change as an oxymoron. It is complicated. It is hard. And while progress has been made, we have a long way to go.
But if such change in healthcare is challenging in the richest nation, then imagine it in low resource countries. In many sub-Saharan African countries, healthcare must compete with investment in other more impactful determinants of health such as education, food security, and sanitation that, if present, are weakly established. Layer in different governments, languages/dialects, and cultures; include frontier rural locations, tribal influences and religious differences and the challenge to improve health and healthcare in countries such as Tanzania, Madagascar, and Nigeria can feel truly overwhelming.
By Rob Thames
It happens. The organization is off plan…by a lot; and it is not the first time. More than a modest correction or a “wait until next month.” Many factors were likely involved, but the relentless dynamics of the market have overwhelmed a longstanding management team. It is akin to a cyclist who has slipped back from the peloton due to chronic cadence deficit – and now the gap is widening.
When a leadership change is made while the organization is on plan, it is often political. When an organization is off plan, and a leadership change is NOT made, it is often political (or paralysis). But when performance is off plan and the board and/or corporate office makes a CEO change, what are the key considerations?
Sustainable Population Health:
Part B – Catcher or Pitcher?
Part B of this article addresses how growth plans of healthcare systems distinguish population health management from community and public health.
Part A of this article clarified the terminology and implications of Community, Public and Population Health. So what does all this this mean for healthcare system leaders’ growth plans?
Healthcare providers have historically played catcher, “receiving” patients who sought care. Access meant being available when and where patients sought them. The transition from volume-based care to population health management requires a role change of providers from catcher/receiver to pitcher/initiator. The transfer of utilization and intensity (and possibly actuarial) risk to providers requires providers to be economically accountable for care and the health of a population. The good news is that this is a better alignment with the societal view of healthcare as a service (in economics, a ‘good’ with a cost) that is necessary but not a value-add. The bad news for providers is that this is contrary to traditional culture and payment incentives. This change is not a transition, but a transformation that involves many transitions.
Post-truth, Fake news, Misinformation (Dictionary.com words of the year for 2016, 2017 and 2018, respectively). Let’s be clear: How is population health different from community and public health? How does it relate to health disparities? A senior leader discussion on these topics can begin to sound like a rendition of Abbott and Costello’s “Who’s On First?”
The terms Community Health, Public Health and Population Health are often used with the same broad brush. But advancement in our thinking and action start with clarity of our language and terminology. Clearly there is much common ground with these terms. To start 2019 off with clarity, below is a summary delineation of these terms.
In Part A of this two-part article on decision-making errors, the main categories and types of decision and judgement errors were reviewed along with some associated logic fallacies.
Two practical questions emerge. First, what can we do to improve our judgement? A combination of antidotes is often recommended to mitigate the untoward effects of these decision traps: being humble and aware, knowing yourself and knowing others, and following a process are the top three. The first, being aware, is like telling a pitcher to “throw strikes” (well-intended, but not of great practical help – this is what the pitcher is trying to do but it does not help him/her do it!). The second, to know oneself, is harder than diamonds and steel, according to Benjamin Franklin. The third, following a process, offers the most tangible promise for something we can actually do that can consistently make a difference.
Leadership Transformation Series
Decision Making Traps: Decider Beware
This is Part 4A in this Four-part Leadership Transformation Series (LTS); 4B will follow.
Transformation in healthcare is personal: it requires the transformation of health system leaders. The LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.
This article focuses on how we make decisions: 4A Reviews decision-making errors.
4B Addresses how to mitigate decision-making errors
4A Healthcare Transformation and Decision-making Errors
Leaders – and their organizations - succeed or fail based on their decisions. Yet the evidence is clear that our decision making is perilously fraught with biases and irrational behaviors of which we are not even aware. These biases are so ingrained in our psyche that, like water to fish, we cannot imagine that they are even there, much less clouding our view – regardless of how “well-intended and objective” we believe we are. In short, bad decision-making is largely hard-wired.’ Just as many medical errors are associated with unexplained variation in medical decision-making (How Doctors Think), so too are many leadership errors are associated with unexplained variation in management decision making.
Traditional change is oriented in the past; it involves more, faster, better, but not different (Daniel Prosser). Transformation is future-oriented; it requires the creation of something from nothing, i.e., letting go and giving up something in the past to create something new. This means that, to do transformation well, it is even more important that our hidden decision biases be flushed out and made explicit. Leaders on a transformation journey are at higher risk for decision making traps and consequences than in traditional change. Said differently, leadership decision making in transformation is less forgiving.
A brief review of categories and types of decision and judgement errors include the following:
You have a strategy. How do you rate your organization’s execution of that strategy on a 1-10 scale? For most, it is not high – or as high as they would like. Closing the strategy-implementation (aka, the knowing-doing or what-how) gap is the leadership Achilles heel of any business, but especially for hospitals, a business recognized by Drucker as the most complex organization to lead. Given that his observation pre-dated some of today’s larger and more evolved and blended academic-community healthcare systems, the complexity he referred to then has only increased. Across industries, the results of studies consistently identify unsuccessful execution for the vast majority of strategies; and the results of CEO surveys cite execution as the biggest current challenge, but reasons for such failure and concern vary widely. A sampling of HBR articles on the topic cite too much of an internal focus, poor CEO preparation in both strategy AND execution, “a people problem.”
Perhaps the most common trait about healthcare system strategies is the perception of their authors that their strategy is unique. As JP Morgan Healthcare Industry Conference observers noted, most health system strategies look alike. What is unique is the execution – the How. Notes Rosabeth Moss Kanter, “When a strategy looks brilliant, it’s because of the quality of execution” (Smart Leaders Focus on Execution First and Strategy Second, HBR, 11, 2017). Because transformation is a journey and one size does not fit all, it is more apt to say there are no integrated healthcare systems, but many integrating systems. For healthcare systems to evolve and execute well, they need an operating model that will help them ‘discipline the change process.’ They need to have a way that is lived by all.