The Ultimate Measure of Workplace Trust: You Decide What to Work On

It’s a panic-striking emotional state: I’m not contributing! I’m not on the career trajectory I need to be on! I’m not learning the skills I need to be learning!

That “I’m not a contributing member of this organization” feeling can be vicious.

My first healthcare job was as an administrative fellow, a sort-of management training program intended to provide exposure to the breadth of administrative positions throughout an integrated delivery system. It was a terrific experience and the people I worked for and with get credit for creating the foundations of my management style.

But there was a point early on, maybe a month or two in, when I felt exceptionally useless. The program wasn’t particularly organized — which turned out to be a great thing over two years — and resulted in open days with little to do early in my tenure.

I was gripped by the feeling of uselessness for months and didn’t know what to do about it.

Somewhere, somehow the thought struck me to find projects to work on.

It didn’t come from my boss — the last thing I wanted to share was that I wasn’t busy enough.

It didn’t come from colleagues — I wasn’t close enough with anyone at the time.

It didn’t come from friends or family — “this new job is great!”

I just started finding projects: some were participation only, some allowed me to make small contributions, and some allowed me to explore my interests in the organization. But nothing was particularly useless.

There was no one breathing down my neck. No one looking over my shoulder. No one assumed the burden of becoming my task finder. I was just trusted to find work to do.

[A quick aside.]

Don’t get me wrong, it’s entirely possible that no one gave a shit about me as my status hovered around the level of “intern,” but I take solace in maintained professional relationships with the people in that organization.

[Back to it.]

Trusted to find work. A novel concept.

By my second year I was finding projects to work on that were of strategic importance to the organization. More projects began to appear: from my boss, from the CEO, from managers throughout the system. The feeling of contribution! It’s a drug.

I’ve been coming back to that story lately because I recently started asking my employees to choose what they work on. Initially there was shock — a seemingly normal reaction to a different approach from any other previous school or job experience. After wading through initial resistance and a smidgeon of bewilderment, the experiment seems to have improved two persistent management problems left behind by industrial models of production.

The first is related to trust. We’ve been taught that employees must be managed. Create tasks. Fill their days. Ensure output. But management, in the traditional sense, left me with questions. What is an appropriate level of production in a workplace dominated by intangible things? How do you measure what someone should be producing when much of it is novel and creative thought? How do you trust that what employees do produce is the appropriate amount when no widgets are actually created? How much time should be spent in the office during the week?

The second is engagement. We’ve long abided by the idea that work must be cascaded down a hierarchy — that seems to be the secret to accountability: tell everyone what they work on and what the measure will be. Bosses know best. Do as I say. Why aren’t annual objectives being met? How do you rate an employee’s performance when the annual objectives set at the beginning of the year aren’t actually important any longer?

It turns out that everyone — me as a manager and they as an employee — benefits when employees get to choose what to work on. Here’s what we’ve found so far.

Employees choose work that interests them. We hire job candidates because of their experience and skills, which are manifested interests with documented results. The work that interests them is the work they are good at. It’s why they are working for the organization. It’s the work they want to get better at, too.

Employees choose work that helps the company. Employees deserve more credit for their instincts. They don’t need managers telling them what is the highest priority, although prioritization conversations can be helpful in figuring out what to work on first. Management, if anything, is creating the framework for knowing what is important and what isn’t. Employees know what needs to be created and improved because they work every day for the company. They see what the company needs.

Employees are engaged with the work. When employees lead the objective setting for the work they are demanding of themselves, highly accountable for results, and completely engaged in the work itself. Coaching becomes about helping each employee deliver the work. Reviews are about lessons learned and developed skills.

For managers it’s a win-win-win: trust comes easily, engagement happens naturally, and everyone is striving to move the company forward.

Engagement surveys continue to tell companies the same thing every year: employees aren’t. After years of failed engagement improvement initiatives, perhaps it’s time to point the finger at the organization’s structures and systems (i.e., how we do things around here…) as the culprit for low engagement. And perhaps it’s time to start experimenting with new structures and systems that create the workplaces we all desire. Maybe there are better ways.

Here’s to finding all of them.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

The (in)complete definition of healthcare transformation, part two of many

Photo by Jakob Owens on Unsplash

Healthcare is transforming. It’s become a mantra for consulting companies, a maxim for strategic plans, a rallying cry for vendors, and the go-to buzzword for conference content. Our website isn’t immune to the idea, either.

All that hype must mean there is some level of exaggeratory bullshit attached to the concept. There is.

But an ear-piercing bullshit detector alarm doesn’t mean it isn’t happening. Because it is. In fact, the industry has always been transforming: Paul Starr wrote a comprehensive 528-page, Pulitzer Prize-winning, delightful treatment of the topic published way back in 1982 that is truly worth your time.

In a book that offers many lessons, the most useful in this context is that it is only possible to see healthcare transformation from the future, looking in reverse, after it has occurred. It’s acceptable to desire healthcare transformation and discuss the possibilities: expectations for the future, extrapolations from what we know, and assurances about the direction of change. But projections, predictions, and forecasts can turn out to be true just as often as they miss the mark.

So healthcare transformation — before it has happened — is just a set of possibilities. Of potential. Of hope. Of promise.

That’s because healthcare transformation is not a strategy, it’s an outcome. Healthcare transformation won’t happen until it’s happened no matter how much industry thought leaders desire it. Transformed healthcare delivery is a result of executed strategies.

It is the effect of action.

Present-day activities are not in themselves transformative. It is the accumulation of many actions and many adjustments, over time, that produces transformation. Any current work deemed to be transformative is just the required work of adjusting a healthcare delivery organization to effectively operate within its market environment at this moment.

Because markets steer organizations.

Over the last forty years there has been a significant transition in how healthcare provider’s determine strategic policy: from an organization’s productive capacity (e.g., acute care beds!, inpatient knee replacements!) to one guided by market trends and customer needs (ambulatory strategy!, care navigation!, access!). Market pull steers all organizations now.

Executives create strategies in direct response to problems and opportunities uncovered by shifting market conditions. Market conditions that are created by a complicated mixture of government policy, third-party payers, patients, social and economic conditions, technology diffusion, competitors, suppliers, and a host of other factors.

So healthcare transformation is really happening on two different levels: an industry plane and an organization plane. The industry definition for healthcare transformation: the evolving market forces that cause organizations to change.

For organizations, healthcare transformation is the outcome of the collective response, over long periods, in the form of successive activities, undertaken by an organization to adjust to shifting market forces and effectively serve a customer. It’s the major change “that emerges from the aggregation of marginal gains.” It’s the hard work of incremental daily progress.

So healthcare transformation is most certainly not bullshit. It’s not just industry jargon psychobabble. It needn’t be an explicit strategy. Healthcare transformation is happening to organizations: it’s not about the future, it’s about how organizations get to the future.

Healthcare transformation is the project-by-project changes to an organization’s structures and systems to ensure market responsiveness.

It’s the effect of action.

This is the second installation in an ongoing series of essays attempting to define healthcare transformation. There’s a lot of bullshit in transformation rhetoric. But it’s also real.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

The (in)complete definition of healthcare transformation, part one of many

Photo by freddie marriage on Unsplash

Healthcare transformation is happening now. It’s been happening since the time of Hippocrates, likely before. And it will continue to happen.

Healthcare transformation involves: patients, physicians and providers, nurses, administrators, patient care staff, support staff, community leaders, employers, government, social and community services, vendors, partners, technology companies, consultants, among others.

Healthcare transformation is happening in healthcare delivery systems, hospitals, physician offices, clinics of all types, communities, homes, digital venues, places of worship, schools, workplaces, in New York City, in Denver, in Los Angeles, in Seattle, in Nashville, in Miami and in many, many, many other places.

Healthcare transformation is happening because markets are shifting and organizations are responding. The healthcare delivery industry is becoming more competitive, more lucrative, and more opportunistic.

Thankfully, healthcare transformation is the effort to reorient the entire delivery system around the user of the industry’s services: the patient. That’s a gargantuan endeavor that requires action toward a broad reinvention of just about everything the industry does and the creation of many new things — with the vast majority of activities occurring multiple degrees removed from, but always in support of, the patient experience.

Thankfully, healthcare transformation is the effort to reorient the entire delivery system around the user of the industry’s services: the patient.

For example, healthcare transformation is the creation of a care coordination department. And then it’s everything that is required to make that service a reality: the repurposing of a contact center to focus on specific populations; the human resources activities of job description writing, recruiting, and training; the creation of processes and policies; the redesign of care to include coordination services; deploying the technology necessary to support the operation; finding internal collaborators and external partnerships; the iteration and evolution of the service once it’s launched; and a whole lot more.

Healthcare transformation is the care coordination example repeated ad infinitum. It’s the many, many projects in many, many areas, across many, many organizations, to reorient the healthcare delivery system around the patient in response to market changes.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

Formalizing The Way We Work — An Organized Way of Working

For at least the last decade — perhaps longer — companies have been explicitly trying to adapt to a VUCA world.





Volatility refers to the speed and turbulence of change. Uncertainty means that outcomes become less predictable. Complexity refers to the growing interdependence of social and economic forces. Ambiguity indicates the haziness of reality.

These are the general conditions of our industry (professional services) and the industry we serve (healthcare delivery).

In short, it’s crazy and uncertain out there.

Awareness and readiness become paramount when VUCA is the prevailing reality. Awareness and readiness allow a company to respond to problems and take advantage of opportunities, both of which are in abundance in a VUCA world.

To respond to problems and take advantage of opportunities a company must be organized.

Being organized becomes essential to existence and scaling.

Being organized is a competitive advantage. That’s the key to existence.

Being organized allows more work to be completed. That’s the key to scaling.

Being organized allows decisions to be made by the most appropriate employee. That’s the key to creating a responsive company.

Responsive to customers. Responsive to the market. Responsive to each other.

To become organized, we must:

  1. Share, process, and make as much information available to as many people as possible
  2. Turn knowledge into learning and improvement
  3. Encourage everyone to contribute

With the goal of creating reliable, repeatable, and adaptable ways of working.

Reliable, repeatable, and adaptable ways of working provide exponential benefits.

All of them can be summarized with the “Beamed to Mars” principle. It asks, if a co-worker happens to be beamed to Mars tomorrow, could someone in the organization step-in and fulfill their current responsibilities?

Sadly, Mary was beamed to Mars.

Mars excursions happen all the time: weeks of vacation, a series of sick days, family emergencies.

The red planet is not a lonely place.

Perhaps the greatest benefit of organization is that which rolls up to the individual employee: it allows for greater autonomy and creativity by routinizing the work that can be routinized and creating slack to work on more interesting and difficult problems.

That’s our operating goal. To organize the company, the work our employees do, and how that work is informed and created.

Becoming organized starts with the company’s intention:

  • Help middle manager administrators transform healthcare delivery.

It continues with outlining our company’s principles, the foundational beliefs that drive our behavior and reasoning:

  • Start Now. Go Fast. — as in moving appropriately quickly and efficiently with a willingness to experiment our way to the best solution
  • Know-How — as in expertise and skill in everything that we do
  • Execute. Start Again. — as in getting things done is our ultimate outcome

Then it continues with our performance expectations of every employee:

  1. Be Curious — to explore, to learn, and to improve.
  2. Be Flexible — in your approach, acceptance of responsibilities, and in providing assistance.
  3. Be Ready — be prepared, be responsive, and be aware.
  4. Take Initiative — to get started, to communicate effectively, and to make things better.
  5. Contribute to the Whole. The responsibilities specific to your role are important. We also request that you contribute to building a company.
  6. Commit to the Approach. We have designed a way of operating. Follow along or help us find a better way as everything is open to improvement.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

Rethinking the Role of IT in Strategy Execution for Healthcare Providers

Photo by Thomas Kvistholt on Unsplash

We were speaking with a customer recently who asked, “Does IT even matter anymore?”

And we stumbled over each other to be the first to exclaim, “Yes! More than ever!”

The entire organization is completely dependent on IT’s minute-to-minute successful management because the entire organization operates on technology.

And that’s important because, in many ways, the business has become technology — a major transition since the advent of mainframe computers in the 1960s. Where technology once supported healthcare delivery workflow, that same workflow has come to depend on technology. Nearly every process of the modern healthcare delivery organization has come to rely on technology.

So it’s no wonder that enterprise attention has shifted to strategic information technology concerns such as system uptime, enterprise deployments, network security, and the like. IT is rightfully focused on these very important — the business-stops-operating-if-any-of-it-goes-haywire — activities.

However, as a result, there has been a divergence in prioritization between strategic technology issues and operational technology realities. At the same time that strategic issues have been given increased attention, there has been an explosion in operational needs for additional technology — the specific technology needs required to carry out the work of healthcare delivery.

Organizations have long relied on the electronic health record and enterprise point solutions to address these emerging use cases. But we meet daily with individuals in healthcare delivery organizations whose needs are not being met by the technology currently available to them.

That is important because, at nearly every turn, there are business processes (services, projects, service lines) that struggle to deliver needed results because they are dependent on less than ideal technology deployments.

For example:

  • The case manager that begged and pleaded for six months for a change in the Epic interface, finally got it, and 30 days later is making due with workarounds because a new business requirement came along.
  • The call center manager wholly dependent on outdated telephony and customer database that makes it difficult to report any measure of value.
  • The marketing director that knows they need CRM help, doesn’t know exactly what marketing programs they want to deploy, and knows that whatever does get approved is going to require a lengthy solution selection process.
  • And the population health manager that relies on spreadsheets, email, documents, post-its, home-grown reports, etc., and spends the first week of every month creating reports.

These are small business problems and pale in importance to any strategic IT need.

But they are significant and they are everywhere in the organization. And as such, the sum of these technology needs is actually quite large and has become a barrier for organizations seeking to execute on their growth, revenue, and value strategies.

Given IT’s appropriate focus on strategic imperatives, healthcare leaders are now turning to external assistance to enhance or create their technology deployments.

These leaders are seeking support in solving explicit business problems that are dependent on technology. They desire urgent, affordable, and personalized solutions.

But they also must be secure, supportable, and integrated.

Some of our customers come to us as a result of pent-up frustration with their IT departments. And we understand why. They’ve been told — or ignored — that their idea, their department, or their project which is deeply in need of technology support doesn’t rise to the level of being a priority for IT.

It becomes tempting for business leaders to exclude IT as a result of that frustration. But urgent, affordable, and personalized solutions can turn into problems when that happens. It is the definition of Shadow IT.

Yes, IT is busy. But it’s better for all involved when IT knows all technology deployed throughout the organization. Avoiding Shadow IT should be as high a priority for the business as it is for IT.

The most successful projects require an organizational partnership between strategy, IT, and the business leaders doing the implementing. During this time of urgency, a period that is melding strategy, business, and technology problems like never before, strong alignment between all three has become a competitive advantage.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

A planning tool to help healthcare organizations get started on the next project

Healthcare delivery’s competitive, regulatory, and operating environments are in constant transition. The result is constant change to how the work of healthcare delivery gets done. So it’s no wonder that leaders in these organizations are identifying project needs to keep up with change of continuing industry transformation.

Knowing that progress in today’s organizations requires crossing boundaries, navigating bureaucracy, and collaborating with multiple partners, it can be difficult to even get needed projects started, let alone implemented.

We’ve heard the frustration. It sounds like this: “We need to break down silos.” “We need to be innovative.” “We need to move faster.” “We need to make better decisions.”

And: “How can we get started quickly?”

That’s why we created the Project Building Blocks framework. Click here to download.

Over the past five years, Status:Go has developed the Project Building Blocks framework to help clients navigate answers to these difficult questions.

Healthcare leaders require a way to capture the complexity of a project while simultaneously identifying a path toward execution. An approach that embraces the value of planning while acknowledging urgent timelines require faster responses than organizations have become accustomed to.

Our customers use the Project Building Blocks framework to launch new programs, improve departmental operations, and deploy innovative technology solutions — all while relying on projects.

The Project Building Blocks uses the details of a proposed project to tell a story. That story captures the vision of the project while illuminating the details necessary for successful implementation.

A completed Project Building Blocks framework creates a broad, shared understanding for those involved in the project; serving as a map to execute any project.

​The framework was designed to be used by anyone and our team is here to help. Reach out to us for advice on completing this framework or executing a project at your organization.

Download the Project Building Blocks here.

Every month we deliver an email with project ideas, healthcare insights, and tips to help you do your job better. Sign-up here.

Status:Go creates software for healthcare delivery organizations so they can try new ideas, improve operations, and execute strategies. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

2017 for Healthcare Delivery Providers: Execution

Since sometime shortly after the signing of the Affordable Care Act, healthcare delivery organizations have been moving — some slow, some fast — to craft the strategies of a new healthcare era: the volume to value transition. These ideals, broadly outlined in the industry as improving experience, reducing cost, and improving health, have been the strategy de jure of executive teams and boards of directors ever since.

A question circulating since November 9 is now the topic of most interest for the same executives and directors: Will all the transition work that has been strategized and implemented by healthcare delivery organizations end up being a giant waste of resources?

The answer is almost assuredly no.

Recall that a population health approach to delivering healthcare was around long before the ACA. Its essence will endure in a new administration.

That means that the strategies healthcare delivery systems have crafted in response to a changing operating environment are relevant beyond an ACA-fueled transformation. The ACA acted as the catalyst for diffusing a population health approach to healthcare delivery. The industry’s reaction — fueled by private payers and employers, government payers, and consumers — will continue in 2017 and beyond.

Will there be changes? Will there be consequences? Will there be disagreements? Of course — and reduced access for specific populations will be amongst the most difficult to navigate, should they come. But to decry change is to ignore that industry’s long-constant shifting. And the promise of added maneuvering will require organizations to fully embrace agility and urgency as execution principles if they haven’t already.

The promise of added maneuvering will require organizations to fully embrace agility and urgency as execution principles.

So we believe there will be two intense themes for healthcare delivery in 2017: value and execution.

Value will be the motivating force for what to work on.

Execution will be the driving force for how it gets done.

Here, we briefly explore three safe assumptions about healthcare reimbursement this year and the strategy implications of a value-based transformation agenda.

Spoiler: it’s all about executing existing strategies in 2017.

Value and Three Safe Assumptions about Healthcare Reimbursement Trends

Value — health outcomes per dollar spent — is and will continue to be the driving force of healthcare transformation, with or without Obamacare as a pillar of the transition. Attention to dollars and outcomes will not disappear in 2017 — nor likely for the foreseeable future.

Trump and Co. and the Plan to Repeal

Expect value to remain center stage in industry transformation with a new administration.

President-elect Trump’s healthcare mission is “… to create a patient centered healthcare system that promotes choice, quality and affordability.” Choice, quality, and affordability are remarkably similar to the Institute for Healthcare Improvement’s Triple Aim of improving experience, improving health, and reducing cost — a foundation of healthcare reform in 2010.

Paul Keckley’s idea to frame a President Trump’s views on healthcare as a CEO is instructive. That idea should put value at the core of the repeal and replace agenda — Republicans often cite a lack of affordability in ACA marketplace insurance plans which just means healthcare is expensive, not necessarily health insurance. Value as an aligning aim also holds a reason to be hopeful the Center for Medicare and Medicaid Innovation keeps its lights on, albeit likely with a new programmatic agenda.

A CEO as president also provides a historical frame into how the administration is likely to view government regulation: with skepticism. Expect Trump’s nominees for healthcare posts — Tom Price, Seema Verma, and to some extent Mike Pence — to increase private payer and state flexibility when it comes to federal healthcare policy. While mandatory Medicare bundles may be coming to an end, just about everyone expects MACRA to remain as it received bi-partisan support and the legislation’s Alternative Payment Model provisions provide an additional vehicle for value-based payment in a new administration.

It has been estimated that nearly 30 million Americans could lose access to health insurance should the Affordable Care Act be repealed absent any plan to replace it. That’s a chilling number for many reasons. Those affected will continue to consume healthcare services, but are more likely to be uninsured, underinsured, or paying with cash. Value again rises — reduce costs and improve outcomes.

Private Insurance and the Path to Innovation

The crown of “largest value-based payment supporter” will be abdicated to private payers in 2017.

While discussions persist on the pace of value-based payment diffusion, there’s little doubt that the industry is moving away from fee-for-service reimbursement and toward something else, even if that something else is just anything but fee for service.

The American Medical Group Association reported fee-for-service payments decreased by 20 percent in 2016 as reimbursements moved to value-based arrangements. The transition is expected to continue in 2017. An October report from the Health Care Payment Learning & Action Network indicated that one-in-four medical payments is now linked to alternative payment models.

2018 is an important year for many private payers to meet their public pronouncements about their shift to value-based payment:

  • Cigna has committed to 50 percent of payments in alternative payment models and 90 percent of payments in value-based arrangements
  • Aetna is anticipating more than 50 percent of their annual spend will be in value-based contracts and a further commitment to reach 75% by 2020
  • United Healthcare committed to a goal of tying $65 billion in payments to value-based arrangements, about 25 percent of the value of the payer’s contracts with providers; in November the company announced it had reached over $52 billion in value-based payments

Further, Humana recently announced that its Medicare Advantage members enrolled in value-based arrangements experience better quality, better outcomes, and reduced costs. Currently, the company serves 63 percent of its enrollees in value-based models. United Health is expanding a bundled payment pilot program for spinal surgeries and knee and hip replacements to more than 40 markets by the end of next year (even as a CMS under Tom Price does the exact opposite).

Consumers and their (Relatively) Quiet Influence

The patient experience conversation is going to shift to consumer experience — not that either frame is explanatory or complete.

Often missing from the value-based payment conversation is that the consumer retains choice for where to seek healthcare services, regardless of program enrollment. A recent report from Kaufman Hall and Cadent Consulting Group sums it up concisely, “… the emergence of value-based payment links health system revenue to the ability to maintain consumer loyalty and to engage patients in health improvement.”


High-deductible health plans continue to actively encourage choice. Being part of an accountable care organization, currently, rarely means anything to the person actually receiving care. A patient receiving care as part of a bundle still gets to choose where to receive care for the bundle’s component parts. Even narrow networks still offer choice.

The consumer’s view of value expands beyond the wholly institutional definition of health outcomes per dollar spent. A consumeristic definition grows to include experience: accessibility, service, effectiveness, and cost.

Adoption of convenient care options — retail clinics, standalone emergency departments, virtual visits, etc. — is instructive for how to proceed: make all interactions, from the first call into the contact center to ongoing care coordination, a convenient and connected experience.

Transparent pricing, online reviews, and quality ratings are important to some patient groups. A satisfactory experience — which is often the height of the bar at the moment — is important to all. Respondents to McKinsey’s 2015 Consumer Health Insights Survey indicated they hold healthcare companies to the same standard as non-healthcare companies (e.g., Apple, Amazon) on a range of experience dimensions. More than half of survey takers said providing great customer service was just as important to them for healthcare companies as non-healthcare companies. Additionally, delivering on expectations, making life easier, and offering great value were all important for both sets of companies.

One important key to providing a great experience is understanding customers. Healthcare providers know a lot about a patient’s medical history. They don’t know much in the way of consumer insights. For example, Deloitte Consulting predicts that by 2020, 20 percent of all payments to providers will come directly from patients. Yet most providers know very little information about a patient’s financial profile.

According to a survey of more than 100 healthcare executives in the 2016 State of Healthcare Consumerism report, 66 percent of respondents say consumerism is an above-average priority while 23 percent report their organization has the capability to develop consumer insight. Only 16 percent have the ability to activate strategies based on those insights. Finding consumer insights once was an activity that was turned over to a consultant every year or two. Now administrators are relying on consumer insights in daily strategy execution decision making.

2017: Execution

A new administration, private payers and employers, and consumers will continue to reward improving value in the healthcare delivery system. The strategic reorientation healthcare providers set post-ACA remains relevant and it is likely specific strategies will require few, if any, updates.

That means provider organizations must focus on executing those strategies in 2017.

It’s the application of Jack Welch’s strategy admonition in his 2005 bestselling book Winning, “In real life, strategy is actually very straightforward. You pick a general direction and implement like hell.”

It’s time to implement like hell.

Healthcare Delivery Organizations Must Adopt Agility and Urgency as Execution Principles

It’s no secret that healthcare delivery is changing rapidly.

It’s no secret that getting things done in today’s organizations is difficult. The inertia of silos, complexity, and bureaucracy promotes the status quo.

And it’s no secret that “culture eats strategy for lunch” has been the most oft-quoted, folk-Drucker truism in healthcare boardrooms since 2010 and that an updated “culture beats strategy” idea is ready for primetime: if culture eats strategy for breakfast, then infrastructure eats them both for lunch. The culture could be great, the strategy could be superb, but if organizations don’t have the tools (processes, technologies, expertise) the effort is likely to be a waste of resources.

If culture eats strategy for breakfast, then infrastructure eats them both for lunch.

Take it all together and it is absolutely no secret that healthcare provider organizations are ready for a new execution model with agility and urgency — the response to constant and continuous change — as the central tenets.

Executing in 2017 will require a refreshed orientation around the idea of execution. Here are the three critical requirements to make it happen.

Identifying (and prioritizing) the multitude of projects that make up a single strategy. For example care coordination, management, and navigation isn’t just about creating a new department. It requires a technology platform, data feeds, formalized communication protocols and systems with partners, process integrations with hospitals and clinics, a contact center, and many more. All separate projects and all required to be implemented for a fully-executed strategy to come to life.

Getting started and continuing. Pick a project and go. The answer may be unobvious. The next best step may be unknown. The whole solution may be uncertain. But a do-first model can turn those questions into pivot points rather than the stop signs they have become. Progress. Advancement. Movement.

Giving middle managers — those actually doing the executing — the tools to bring strategy into the real world.

  • A flexible, complementary technology platform to create software solutions for every need. The prevailing enterprise healthcare technology trifecta paradigm of the electronic health record as swiss-army knife, the IT department as technology gatekeeper, and a point solution when all else fails is outdated. Increasingly solutions to any healthcare business problem are dependent upon technology — technology that provides diverse functionality, inexpensive implementation costs, and allows for a test-and-refine approach to service line-specific personalization.
  • A project management approach built on the idea of getting started, finishing, and moving onto the next project. An approach that embraces organizational reality: most middle managers haven’t previously led technology projects and the enterprise project management office has higher priorities. An approach that shortens the idea-to-project timeline with manageable project schedules. An approach that creates functionality in real-time to allow teams to review, react, and reconfigure as a feature of progress, not a barrier.
  • A partner that values shared expertise as a required component of successful project implementation. A partner that combines industry and project experience with your team’s knowledge and ability to find the right answer, not just an answer. A partner that understands and embraces execution as part of a project engagement. A partner that insists on helping the team move on to the next project, because there is always the next project.

We’re Here to Help

Status:Go has helped healthcare providers around the country use a project-based model to execute strategies with agility and urgency.

Our ideas are resonating with healthcare providers of all sizes: the EHR being a necessary, but incomplete technology solution; replacing spreadsheets, documents, and emails as a necessary precursor to relationship-based care; doing as discovery rather than discovery as understanding; personalized solutions on a cloud-based platform that can be cost-effective, supportable, and available to all departments; among others.

In 2016 we helped organizations navigate silos, bureaucracy, and complexity to execute on their strategies. For example:

  • We implemented projects for integrated healthcare delivery providers across care coordination and navigation, population health management, community health improvement, direct-to-employer services, occupational medicine, business development, network integrity, physician referral management and coordination, and oncology navigation.
  • We helped oncology providers prepare for Oncology Care Model participation, orthopedics groups implement Comprehensive Care for Joint Replacement workflows, and GI clinics around the country dramatically improve return visits and patient engagement.
  • We upgraded (and integrated) contact center technology for healthcare delivery systems, behavioral health and substance abuse organizations, and large multi-speciality physician groups.

And that is just a sampling from our year of helping healthcare delivery providers execute. Find out about these projects and more at our Central Management website.

Healthcare delivery organizations have equipped their teams for industry change with strategy. Now, those organizations are giving their teams the tools to execute.

Contact Matt Vestal to explore working together in 2017 to make it a supremely successful year for your teams and your organization.

Status:Go helps healthcare delivery organizations execute their strategic priorities using a project-based model that includes:

  • A “Start Now. Go Fast.” project management approach to get projects started and finished while navigating healthcare’s silos, bureaucracy, and complexity;
  • Shared expertise to deliver project solutions with urgency and agility by combining a team’s knowledge and proficiency with our industry experience; and
  • A flexible, complementary technology platform to augment the EHR and make personalized technology accessible to every need in the organization.

Visit our website to learn more.

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.

Central Management Podcast | Radhika Palta

A podcast for healthcare’s middle managers

Radhika Palta had to call the metaphorical fire department to help fight a fire in her first week on a new job.

Middle management is in a golden age. But it’s harder than ever to be a middle manager. Central Management is stories, tips, and wisdom to make it easier to be better.

Central Management is made possible by Status:Go

Status:Go is a technology implementation partner for healthcare delivery provider organizations. Learn about our work at

This week’s guest on the Central Management podcast is Radhika Palta, administrative director for the surgery department of a West Coast academic medical center.

“Most of the time, I think, your success is how you deal with the outcome of the really challenging stuff that you go through.”

The highlights of our discussion:

4:30 — Radhika introduces the story of her first week on a new job and the near meltdown that met her

7:20 — Details of the drama!

8:20 — Of course, she almost quit

11:10 — A plan comes to light!

12:40 — Of course, she didn’t quit, and tells us why

14:00 — Radhika recounts the steps she took to begin solving the problem

17:10 — The solution!

19:00 — In summary, lessons learned

How brown M&Ms have improved our hiring process

A few thoughts on hiring, and as such, a few thoughts on being hired

We’ve been hiring a lot lately. We still are — and will continue hiring on a rapid pace to address the demand for our services.

That’s exciting.

Hiring is exhausting and difficult.

Resume scrolling. Email sending. Story telling.

Candidate screening. Interview organizing. Hard question asking.

Then the hard part — onboarding, training, finding the appropriate flow rate through the firehose, etc.

I’ve been acting as an ad hoc recruiter for the past twelve months.

Thankfully our search for a human resources manager, whose responsibilities will include, among others, recruiting and hiring, will soon be coming to an end.

To mark this glorious occasion, I’m writing about what I have learned and a few observations I have made. Perhaps it will of interest to you.

Remember that old story about how Van Halen requested a bowl of M&Ms with all the brown candies removed be provided backstage at their concerts?

Turns out it was true.

It also turns out there was a purpose to the request.

From David Lee Roth’s autobiography:

Van Halen was the first band to take huge productions into tertiary, third-level markets. We’d pull up with nine eighteen-wheeler trucks, full of gear, where the standard was three trucks, max. And there were many, many technical errors — whether it was the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through.

The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many human beings to make it function. So just as a little test, in the technical aspect of the rider, it would say “Article 148: There will be fifteen amperage voltage sockets at twenty-foot spaces, evenly, providing nineteen amperes …” This kind of thing. And article number 126, in the middle of nowhere, was: “There will be no brown M&M’s in the backstage area, upon pain of forfeiture of the show, with full compensation.”

The removal of brown M&Ms was a test to signal attention to detail. If brown M&Ms were present in the candy dish, Van Halen suspected other details of the contract had been ignored as well.

The internet and its many tools have made finding and applying to jobs easy. Click. Click. Applied.

Why not apply to every opportunity when the marginal cost of application is already zero?

That’s great for a job seeker. It’s constant resume scrolling for the employer.

For example, we recently received 179 applications for two open positions over the course of one week.

That’s a lot of resumes to review.

As a recruiter (especially as a temporary recruiter with other job responsibilities), I desire to know if the job seeker has at least spent a few minutes contemplating if our company is even a good fit for them.

So we started adding a brown M&M to every job posting.

A brown M&M is a prompt at the bottom of every job description. The prompt instructs a candidate interested in applying to answer a question in lieu of sending a cover letter.

It’s a straightforward ask and the approach the candidate takes in responding to the request is often as informative as their resume. It also tells me the candidate has (likely) spent time thinking about whether or not they would like working with us.

A non-response to a brown M&M is an automatic rejection.

Of those 179 applicants — how many do you think took note of the brown M&M?


A manageable number. And the majority were great candidates.

Status:Go is a technology implementation partner for healthcare delivery provider organizations. Learn about our work at