The Missing Ingredient from Healthcare Transformation

And How to Get Your Hands on Some Magic


As a healthcare administrator, you know there’s a missing ingredient from the proclamations about the Future of Healthcare Delivery™ emanating from conference stages, press releases, and white papers.

The magic to make it all happen.

Until now.

Introducing: Healthcare Transformation Magic Crystals


I was once a let’s-make-this-better, imagine-the-possibilities, nobody-can-stop-us real-life healthcare administrator.

It’s that perspective that gives me levitating excitement for the future of healthcare delivery — the future predicted by the technologists, consultants, and thought leaders: an innovative, data-driven, value-based, machine-learned, digital nirvana.

But there’s a secret every healthcare administrator knows and every disruptor is learning: changing healthcare delivery requires work. A lot of it.

It’s that perspective that makes me think magic is the missing ingredient preventing the promised future from being pulled out of a hat like the promises that come with it.

So I know we’re solving a wide array of healthcare provider execution challenges with a product perfect for boards of directors, executives, and administrators wishing to make healthcare transformation appear in their organizations: Healthcare Transformation Magic Crystals.

Your mileage may vary.

Mined from the deepest, richest, and most magical gem source in the world, Healthcare Transformation Magic Crystals can make any strategy appear out of thin air — no matter where the strategy originates including, but not limited to, conference stages, consultant deliverables, technology vendor promises, and even the hopes, dreams, and wishes of an internal planning session.

They’re easy to use. No wand required. Previous experience with magic isn’t necessary.

Just combine a copy of a shredded project plan document with an ounce of the Healthcare Transformation Magic Crystals into a 9×12 manila envelope. Seal. Place on a shelf. Wait.

Abracadabra.

You could be amazed with the results.

Ignoring the Required Work

Healthcare transformation is real. It’s happening. It will continue to happen. We’re complete believers.

But without magic it’s not arriving via moonshots, grandiose op-ed think pieces, or generality-plagued conference talks. Because without magic those pronouncements, platitudes, and prognostications are going to require a lot of work.

And, from the back of the theater, it seems the future is arriving much too quickly for anyone to be bothered with real, actual work.

That reality is completely irrationally understandable.

Just think about the sheer amount of work that must be accomplished to operationalize a single transformation strategy in a single healthcare provider organization. It’s striking!

This Harvard Business Review article about a completely logical way of involving clinicians in managing the cost of care is a great example.

How long would an initiative like that take in your organization? Think about how much work — how many projects — are required to actually make it happen. It’s a lot. Like a lot a lot.

But at least the thinking is manageable. Ask the same question for this completely sensible way to transform an entire healthcare delivery organization, also in the Harvard Business Review, and you’re likely to struggle just figuring out where to start.

It’s obvious why ignoring the work is such a tempting detail to overlook: it gets in the way of overpromise, hype, and illusion.

The Fine Print and Some Free Advice

It’s here that I must inform prospective buyers that the Healthcare Transformation Magic Crystals come with no product guarantees.

But they do come with this piece of rock-solid advice: Get started and do the work.


It may not be as immediate, it may not be as sexy, and the projects may not be as fun as the promised near-future would lead us to believe.

But it will be successful.

In fact, it’s the only way transformation happens. Project by project.

Of course, looking back, it will have arrived in part through those pronouncements, platitudes, and prognostications, too. But the journey is likely to be much longer than the future-is-coming-sooner-than-you think dogmatists would lead us to believe.

It’s okay to be realistic about making change happen. It’s okay to be content with the day-to-day activities of doing the work. Not only do we think it’s okay not to subscribe to a dramatic vision of the future, we believe it’s pragmatic and practical and the path to real progress.

However, if you’re looking for a shortcut, definitely give these Healthcare Transformation Magic Crystals a try. We’ll send you a free sample if you’re interested. Fill out this form and we’ll drop them in the mail.

They’re real.

Well, as real as magic can be.

But if they seem to have lost their magical powers before you can use them: call us.

We’re ready to work.

With you.

And we know where to start.


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 improve operations, execute strategies, and try new ideas. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

That new innovation center could make the innovation problem worse in your healthcare organization

And why what you need instead is an innovation workshop


“It’s hard. It’s just too difficult,” a healthcare administrator recently shared with me, “But we have a new CEO starting soon and he wants to create an innovation center.”

Healthcare delivery’s innovation problem has become apparent when those managing in the middle of the organization — where strategy is executed — are beginning to express concern.

Innovating inside a healthcare delivery system is difficult. Existing structures and systems (how the work gets done) are designed to say no to new ideas. They are designed to promote profitability, efficiency, and reliability — all great pursuits for an organization but too often prevent innovation from even getting started.

So it’s no wonder the idea of carving out innovation from the rest of the operation is so appealing: without the distractions and barriers of the operation, innovators are freed to innovate!

“Innovation isn’t a core competency of many healthcare organizations,” said a respondent to a recent innovation survey from the American Hospital Association and AVIA, “The industry needs help identifying options for advancing meaningful innovation and building the structure needed to support it.”

It’s the second half of that statement that is so revealing of the report’s finding that “72% of hospitals with over 400 beds are planning to or have already built an innovation center.” An innovation center is a direct answer to the innovation core competency problem in healthcare delivery organizations.

But will it be an effective response?

The Appeal and a Paradox

The difficulty of innovation has led a growing number of healthcare delivery providers down the path of creating innovation units separate from the operation. An innovation center is usually a dedicated space outfitted with all the creative necessities. It’s often set-up and managed outside the normal org chart and management requirements. It is staffed by employees with skills to fulfill the center’s innovation model.

The appeal of the innovation center idea is apparent — by design it overcomes the distractions and barriers that often prevent innovation. Innovation centers create innovation. They produce innovative things. And they do so because of their deliberate focus on innovation.

But the experiences of some early corporate diffusors of an idea similar to the innovation center — the innovation lab — prove cautionary and may be an indicator of what’s to come. Nordstrom, Coca-Cola, The New York Times, Disney, Microsoft, among others have all scaled back or eliminated their once promising innovation lab efforts.

It seems that translating innovation back into the operation proved more difficult than originally anticipated.

“It’s time to ditch your innovation lab,” was the title of a VentureBeat commentary assessing the downscaling announcements.

“Rather than just a team focused on innovation, it’s now everyone’s job,” said a Nordstrom spokesperson at the time of Nordstrom’s decision to shut down its lab.

In fact, one observation from a report compiled by digital product studio Made by Many might end up being the definitive conclusion on innovation labs: “… we found that the innovation lab model often promises a lot without delivering quite so much in terms of tangible success.”

Producing Enabling Innovation

These thoughts are indications that innovation centers might exacerbate the innovation problem in healthcare delivery organizations, not solve it. And if that’s the case what’s an innovation-hungry healthcare delivery organization to do?

It’s not the innovation center (or lab) that is the problem in my estimation — it’s the type of innovation it focuses on that proves problematic. And it’s only problematic because the innovation being pursued in the innovation center isn’t the type of innovation organizations were seeking when the strategy was created.

An innovation center produces emerging innovation — futuristic technology, what-if scenarios, pioneering business models, and the like. The issue in an innovation-poor environment is that most of the organization (departments, service lines, administrators, etc.) isn’t searching for those things. Let’s go back to the survey respondent’s comments, “The industry needs help identifying options for advancing meaningful innovation and building the structure needed to support it.”

Most of the organization is on the hunt for enabling innovation — innovation that makes a job easier, an experience better, moves an operating strategy forward, and the like.

Emerging innovation may be important to the future of the business. Enabling innovation is essential to making healthcare better for patients, providers, and employees right now. It’s critical to the operational leader meeting and exceeding job expectations. It’s necessary to the step-by-step nature of how healthcare transformation actually happens.

It also creates the structure that will allow emerging innovation to become useful in the future.

So instead of innovation centers I think healthcare delivery organizations need innovation workshops to bring innovation where it’s needed most: directly to the operation.

The Innovation Workshop

A workshop is a place to produce useful things. It has similarities to a lab: experiments, investigations, observations, and such. But a lab does those things to discover. A workshop does those things to solve problems.

The innovation workshop embraces projects directly connected to solving problems and executing operational strategy.

There’s no one-size-fits-all approach to innovation workshops. They can be permanent or temporary. They can live in a department or be placed on wheels and move around to where they’re needed next. They may employ in-house resources, or be operated by a partner, or a mixture of both.

They are required to have capabilities (facilitation, technical, domain expertise skills, and the like), resources (agency over people, process, and technology decisions to prototype solutions), financial support, be commissioned to navigate the bureaucracy, and exist as part of the operation.

Innovation workshops would give administrators a path forward to solving real and immediate business problems. The work would build on itself, identifying new needs and implementing new solutions along the way. They could deliver innovation at scale throughout an organization by making innovation available to everyone that needs it.


Innovation workshops would produce the enabling innovation required for healthcare transformation by embracing the constraints and affordances present in the operating environment.

Because when innovation is part of the operation it can answer specific questions, solve real problems, and foster strategy execution. That doesn’t happen when something has been conceived in a lab’s sterile environment. The best place for enabling innovation is right there where it’s needed as a part of the operation.

And that place is in an innovation workshop.


Wouldn’t you know it? We just launched a new solution we’re calling Innovation Workshop designed to overcome the organizational inertia preventing you from innovating. Learn more 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 improve operations, execute strategies, and try new ideas. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.

Transformation on your plate? Pick a project. Start. Execute. Repeat.

Photo by Ross Findon on Unsplash

Healthcare delivery organizations, and departments or service lines in particular, need an approach to adaptation that matches the volume of change within the industry.

The refrain “It’s coming at us all at once” is echoed in organization after organization after organization. The demands of transformation are constant and unrelenting.


Since projects are how organizations change, and change is constant, projects should be constant, too.

Start. Finish. Repeat. It’s the only way to transform.

Constant projects? But how?

Keep it short. Limit the scope of any project to a timeframe that is manageable, keeps participants engaged, and quickly produces an outcome. A twelve-week timeline is a respectable benchmark. Is the initiative larger than the single project? Do another one! More than that? Do another project! What’s that old project management adage — when’s the best time to start another project? Right after you finished the last one! (Oh, maybe that came from sales…)

Ditch the meetings. Instead of using meeting time to update project status or badger slowpokes for the work they promised or manage pending risks or etc., use that time to work on the project. Limited scope projects have timelines that demand constant action. Project participants will actually show up and participate if you get actual work done during a reoccurring calendar block. Save the weekly status updates for the end-of-the-project celebration!

Think real time and show progress. Try new functionality — changes in people, process, and technology — first in the meetings-where-work-is-done and then in the real world. Review it! Validate it! Encourage participants to provide input — “yes, I like this;” “no, I don’t like that” — and make decisions to adjust or move forward — “yes, thanks for your opinion and that’s a great addition;” “yes, thanks for your opinion and we’ll save that for a future phase.”

Enhance! Enhance! Now it’s time to improve. To iterate. No project is ever, ahem, finished. Of course it will be introduced into the world and become the new way of doing but that doesn’t mean it can’t be improved or altered or added to. A solution should be adjusted as the project outcome meets the real world and feedback is received. Add small things. Add big things. Try new things.

Believe in temporary. Maybe something drastic changed and the project outcome needs to be eliminated just a year later — that’s okay!, it was such a short project and great utilization of resources that the project outcome did what was needed. It was the bridge from there to here. And if we really go macro on it: every solution ever has been temporary. Things change. All the time. Projects that help departments move from one state to another are successes. Time to get started on the next project.

Increase the execution rate. Do projects. Lots of them. All the time. Finish projects. Keep going. It’s been said many different ways but the only known way to succeed is to try lots of things. Embrace the 10,000 Experiment Rule.

Train. Train. Train. Train. Train. Train. Projects go off the rails at this most important juncture: the translation of the new project into a live environment (and this advice isn’t only for technology projects). Resource-constrained organizations, most all of them, find that training is a convenient place to trim costs. Trimming costs is a fine objective — but don’t skimp on training time and resources. All that hard work of making a project happen shouldn’t go down the drain at the climax of execution.

Big transformation on your plate?

Pick a project.

Start.

Execute.

Repeat and keep going.


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 improve operations, execute strategies, and try new ideas. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.


This originally appeared over here.

An ode to projects

Photo by Clem Onojeghuo on Unsplash

Projects are how organizations change.

A project is a temporary endeavor to produce something. Something that produces a tangible change in the way an organization does something.

The more projects an organization starts and finishes, the more change that is produced.


Demands on today’s healthcare delivery providers are marked by shifting external forces, rapid technology adoption, required cross-function collaboration, pursuit of new competencies, known knowns, unknown knowns, yes — even unknown unknowns, and probably a few others.

It’s a foggy future. Projects are how organizations navigate to it.

Projects are how an organization creates, how an organization adapts, how an organization eliminates. David Cleland, hailed as the father of project management, said it well, “Projects provide an organizational focus for conceptualizing, designing, and creating new or improving products, services, and organizational processes.”

Yep.

Projects are how an organization gets things done. Projects are how an organization executes. Projects are how an organization transforms.

Projects are the most important pursuit of every healthcare delivery organization.


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 improve operations, execute strategies, and try new ideas. We know healthcare, Salesforce, and how to get things done. Get in touch to get your project started.


This originally appeared over here.

Do the Work: A pragmatic approach to transformation that makes healthcare better for patients…

Photo by Christopher Burns on Unsplash

Part three of many in the ongoing series: The (in)complete definition of healthcare transformation


Part One | Part Two

There’s a lot of work required to transform healthcare delivery organizations from where they are now to where they need to go. That work doesn’t happen at a single point in the near future — there is a long and winding path, not necessarily linear, that must be traveled.

That work is why healthcare transformation calls for constant motion that moves organizations closer to where they need to go. It calls for a pragmatic approach to doing the work. It calls for taking action.

It’s easy to get caught up in contemplating, discussing, and proclaiming the future of healthcare delivery.


Because the future of healthcare delivery is going to be great. Really.

In an industry with widespread agreement about the utility of sweeping transformation, it is exciting to ruminate about the power of health promotion, machine learning, digital health, patient centeredness, universal access, personalized medicine, service systemization, blockchains, partnerships, and the rest of our transformational aspirations.

Since transformation appears generally a desirable ideal and given that transformation is only visible from the future, it seems worth reaching a transformed state as quickly as possible.

But how?

Taking Action

Market responsiveness is what propels transformation. Strategies of expanded access, population health, network integrity, and the like are in direct response to emerging market forces.

But simply desiring transformation does not make it so.

No, that requires action.

The healthcare transformation discourse too often undervalues the present. It skips over the reality of how critical *now* is to enabling the aspirations the transformation rhetoric desires. That’s understandable — the future we desire is better than what we have — yet unfortunate, because the present is critical to arriving to that desired future.

The present, over and over, is filled with moments to transform.

There’s a deeply-held management belief that strategy is superior to execution. Sure, if your organization has shit strategy, it just might be in trouble. But, now that markets steer organizations, most healthcare providers of a similar type are pursuing homogenous strategies.

And that means that execution has become a competitive advantage.

But how does an organization execute on any specific transformation strategy? When should an organization get started? How quickly should a strategy be implemented? How, exactly, does an organization improve patient access, increase provider network integrity, establish a robust population health program, or the like?

Those questions have countless solutions making them nearly impossible to answer definitively. Answers, though, are much more easily revealed.

The specific tactics of executing on any single strategy are often uncertain. That’s not because great thought hasn’t been applied to what must be accomplished. It’s because the tactics of new strategies are uncharted territory for organizations. Replicating others, relying on adjacent experience, or the generalities of big consulting firms get an organization only so far. These uncertainties too often result in failed strategy execution.

William Owen, founder of digital product firm Made by Many, writes it best, “The best way to deal with the uncertainty involved is to move towards big goals in small steps, at progressively finer definition and with ever greater confidence.”

In other words: projects.

Do the Work

Let’s make it a thing. Do the Work:

Administrators execute strategy by creating change through projects using resources as a result of taking action, again and again.

Execute Strategy | The Result

This is what we’re after. It’s the outcome — or rather, a series of outcomes. Strategy execution is an intentional ongoing endeavor. Its success builds on itself and informs what comes next. It’s a rare moment when an entire strategy can be declared fully implemented because there is (almost) always another available tactic that furthers the strategy.

That “one more thing” idea represents a real twist to management dogma: execution is strategy. Somewhere, at some time, strategy was separated from execution. But it was Jack Welch, a noted strategist himself, that said, “In real life, strategy is actually very straightforward, pick a general direction … and implement like hell.”

In William Owen parlance: the big goal is the “general direction” and the small steps are the “implement like hell.” Implement the small-steps-like-hell by continuously creating change.

Creating Change | The Job

Strategy: executives declare it, administrators bring it to life. They do it by creating change: the job they were hired to do.

Writing a policy. Starting a new department. Implementing a new technology solution. Creating a training program. Designing a new service. Analyzing a capital investment. The units of healthcare transformation. There are many, many, many ways to create change. All of them happen as a result of a project.

Projects | The Units of Work

We live in a project-driven world. The work is projects.

Projects are the tactics of strategy.

They are the containers of work. They lead to promotions. They lead to notoriety. Most importantly, projects transform healthcare delivery.

And they are implemented using three resources.

Resources | The Inputs

Every administrator has three resources available to implement projects: people, process, and technology.

Some projects call for people changes (hiring, training, etc.), some call for process changes (how work gets done to serve a customer), some call for technology (the systems used to do the work).

Most call for a little of all three.

Historically, administrators have only had true agency over people and process decisions. Technology has been strictly the domain of the CIO and the IT department. That mentality is shifting as technology has become critical to enabling organizational change as both healthcare delivery and technology tools evolve.

A fully-empowered administrator has decision making authority over all three: people, process, and technology.

That opens the door for administrators everywhere to start Taking Action.

Taking Action | The Attitude and Approach

Taking Action is an attitude and an approach.

It’s a commitment to the reflexive habit of doing. Nothing happens without action. Doing creates and maintains momentum.

The pragmatism of actual action is critical to the future of healthcare delivery.

Taking action, in the moments of now, is how healthcare delivery is transformed.

It’s how a healthcare delivery organization overcomes uncertainty and reveals the answers to the question of “how” for any specific transformation strategy.

The future is going to be great. But we undervalue the present in our transformation ideals. It’s much too easy to forget the time-tested truth that, for the future to become reality, a number of successive nows must happen first. It’s in those moments that a tremendous amount of work must be done.

Taking action ensures the work happens. It’s the only way to transform.

Do the Work. It’s a pragmatic approach to transformation that makes healthcare better for patients, providers, and employees today, tomorrow, and yes, in the future.

And the only way transformation happens.


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.

https://centralmanagement.work/the-in-complete-definition-of-healthcare-transformation-part-one-of-many-e5197cd68226

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.


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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.


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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.”

Value.

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.