A theory for successful healthcare delivery transformation

Middle Managers, Technology, and Widespread Experimentation

Healthcare is changing.

The Patient Protection and Affordable Care Act (the ACA, “ObamaCare”) has been the catalyst for change occurring in the healthcare delivery industry. The Affordable Care Act is almost assured to carry that crown eternally as the industry navigates through this next round of healthcare reform under a new administration.

Though healthcare reform is often spoken of as a discreet event, the reality is that transformation has been, and continues to be, a series of ongoing events. Transformation is occurring and efforts to improve quality, reduce cost, and improve access will only continue.

Three important questions arise from this reality:

1. Where is healthcare transformation occurring?

2. Who is responsible for implementing healthcare transformation?

3. How is healthcare transformation being implemented?

The answers are the story of healthcare transformation.

Empowered middle managers will determine the success of healthcare transformation.

Healthcare transformation is continuously creating new operational requirements. Provider organizations (physician groups, healthcare systems, payers, clinically integrated networks) respond to these requirements, problems and opportunities, with strategies determined by executives. But as they have always been, middle managers are tasked with implementing and executing strategies.

Healthcare transformation is occurring where healthcare is being delivered: in places like the clinic, the radiology department, the contact center, and the case management department. The individuals charged with leading the clinics, the radiology departments, the contact centers, and the case management departments are those that are implementing these changes.

Middle management, often maligned, is crucial to healthcare transformation. We believe healthcare delivery transformation is really a story about empowering middle managers with access to technology. But it’s difficult to be a middle manager today: their plates are full, technology constraints they and their staff experience are real, and the velocity of industry change is increasing.

Middle managers have three resources to implement and execute strategies: people, process, and technology.

Historically, middle managers have only had true agency over people (like hiring, training, and promotion) and process (such as determining the way in which employees do the work and how customers experience the service). Technology (or the systems that managers and employees utilize to do the work) has been the domain of the CIO and the IT department. As healthcare delivery has grown more complex and technology needs more intense, the CIO has been forced to focus on more strategic IT needs like ICD-10, new EMR implementations, and issues related to mergers and acquisitions.

Technology, as a resource for middle managers for which they have decision-making power to implement and customize, is key to successful industry transformation. Cloud platforms are now allowing organizations to truly empower middle managers with all three resources needed to implement the strategies of transformation: people, process, and technology.

At the moment technology is becoming almost necessary, it is also becoming a barrier.

While not every problem is solved with technology, nor does every opportunity require technology, increasingly solutions are dependent upon technology. Just like other industries, technology is becoming central to the actual delivery of service and facilitation of business processes, moving away from technology as a series of support applications. Opportunities abound for technology beyond the core systems already in place to consume process in healthcare delivery organizations.

Healthcare delivery organizations are in need of a new flexible, complementary technology layer to adapt to this new operating environment.

For example, the EMR is a necessary piece of technology. It’s the workhorse technology of healthcare delivery. It ensures stringent adherence to process. But the inherent rigidity and weight mean functionality, existing or promised, hasn’t adapted well to the requirements of an evolving operating environment. The EMR has not adapted to the flexible requirements of healthcare transformation.

Healthcare delivery requires a better way to become responsive to problem-solving and responding to opportunities brought about by transformation. It requires a flexible, complementary software solution that can be implemented anywhere, connect with anything, and is perpetually customizable.

But IT departments are not resourced for this change. And professional services will play an enormous role as departments transition.

The IT department has — unintentionally — become a roadblock.

This is important because the velocity of industry change requires a new commitment to speed, scale, and scope, where speed is the pace at which ideas are implemented, scale is how ideas are spread throughout the organization, and scope is the number of implemented ideas.

IT has unintentionally become a roadblock. Technology now touches almost every aspect of healthcare delivery. Given this growth and new requests that come along with it, IT leaders have been forced to create a bureaucracy that allows only the most important and pressing needs to be addressed. This bottleneck prevents progress in an environment that is demanding more and more technology to support organizational initiatives.

Side Note: I’ve received pushback from IT leaders on this notion of being a roadblock. Of course! Of course! Not every IT department and leader is this way. But if the idea of being a roadblock is something that makes your hair standup, I implore you and your staff to reflect on the following questions:

  • Are you helping middle managers solve their business problems? If the answer is anything other than an immediate “yes,” you might have a problem.
  • What is your initial reaction to a new technology idea? If it’s a project request form, explaining why something is going to be different, or something similar, you might have a problem.
  • Do you employ more business analysts and developers than desktop support or other other hardware jobs? If it’s the latter, you might have a problem.

For good measure — survey the last ten people that emailed, phoned, or stopped you in the hallway asking for help. What was the outcome of each?

There’s still time to make it right if you’re unhappy with the answers.

Okay, back to it.

The same cost-cutting and value-improving pressures facing operational departments are facing IT, too. With pressures to reduce headcount, an increasing number of projects, and rising support requests, increasing needs from operational departments become more difficult to fulfill. Technology needs of operational entities are viewed as a lesser priority with the focus on other strategic priorities and enterprise initiatives like ICD-10, Meaningful Use, privacy and security, EMR replacements, technology issues related to mergers and acquisitions, clinical data integrations, etc.

IT must transition into a role as technology facilitator, helping to diffuse technology-supported solutions as quickly as possible. This mentality will allow organizations to take advantage of new competitive priorities and improvement opportunities.

An organizational commitment to speed, scale, and scope, through IT diffusing technology throughout the organization, is imperative to embracing transformation. It allows departments and middle managers to launch more pilots and find out quickly which operational initiatives work and those that don’t.

Because the secret to innovation and successful transformation is widespread experimentation.

As commonly held as the notion that organizations must innovate to continue to create value is, healthcare delivery organizations continue to struggle to ensure that innovation is systematically part of their culture, part of the day-to-day approach of solving problems or taking advantage of opportunities.

While great progress has been made in finding new ways to deliver healthcare, there is truly only one way to continue to figure it out: try more ideas. Successful innovation is simple: widespread experimentation.

Admirably, healthcare delivery has long been experimenting. It’s the essence of the scientific method, the pilot method, trial and error, Plan-Do-Check-Act cycles, Kaizen, process improvement, etc. Whatever the organization calls it, it’s imperative to do more of it.

One way to approach innovation: Pilot Projects

If innovation is the way into the future, and it most certainly seems to be, healthcare delivery firms must embrace widespread experimentation and make the tools, both tangible and intangible, acceptable, available, and accessible.

Creating responsive healthcare delivery firms.

Organizations that empower middle managers with people, process, and technology are responsive healthcare delivery firms. Creating responsive healthcare delivery teams allow middle managers to more quickly solve problems and take advantage of opportunities brought about by healthcare transformation.

The responsive healthcare delivery firm empowers middle managers with agency over people, process, and technology with the intention of piloting as many new ideas as possible.

Responsive healthcare delivery teams allow middle managers to more quickly solve problems, take advantage of opportunities brought about by healthcare transformation, and move organizations forward.

It’s almost certainly the only way to successfully transform.