That’s a lot. Cut the rate in half and it’s still a lot.
Take a look at your work calendar and count the number of projects you’re spending time on this week. How many of those are you willing to settle for less than expected results? One? Two? Half?
The research is not on your side.
And a failed initiative is just the start. Bad projects have consequences.
Missed competitive opportunities, runaway budgets, vendor lawsuits, and frustrated employees are just a few of the negative outcomes. The more personal results include sleepless nights, crippling anxiety, career speed bumps, and the like.
Separate research tells us the long list of “Why?” includes a lack of executive sponsorship, poor communication, an unprepared project team, scope creep, misunderstood workflow, an inability to articulate requirements, and a mess of other organizational complexities preventing the project team from getting the job done.
Unfortunately, it seems we’ve created an environment in healthcare delivery organizations where perfect conditions must exist if a project is to reach it’s full potential, not to mention within scope, cost, and schedule expectations.
Yet perfect conditions rarely (never?) exist. The list of what-could-go-wrongs is longer than the list of potential project challenges. So it’s time we admitted something: we have a project problem. And it’s a bigger than we think.
Projects are How Organizations Change
The only way to change anything in an organization is through a project.
Yes, a project: a temporary endeavor to produce something beneficial.
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.”
Projects are how organizations improve, innovate, and implement anything and everything. There’s no other way.
So projects have become the de facto way of working for most managers in healthcare delivery organizations. That means projects are happening (and failing?) at all levels of the organization.
Yet as the work has shifted to projects, our ability to implement them hasn’t much improved from already dreadful results: change management initiatives have had a consistent success rate of 30% for decades.
And, in my experience, actually getting better at implementing projects hasn’t recently emerged as a priority in most organizations.
Add it up and it’s no wonder prospective project team members shudder at the idea of adding another responsibility to their project docket. Bad projects are taxing, anxiety-ridden, and full of frustration. It is more work even if the hours in the office don’t seem to change.
Bad Projects are Bad
In the case it isn’t obvious: bad projects are bad.
Change is slowed or doesn’t happen. Resources are wasted. Project teams get frustrated. Careers can occasionally turn on poor outcomes.
A bad project is a project that experiences preventable challenges as a result of factors within an organization’s control. And frankly, most of the factors that lead to challenged projects are within an organization’s control. Unfortunately those factors aren’t usually revealed until a bad project is well into its badness.
In the case it isn’t obvious: bad projects are bad.
Bad projects, just like successful projects, come in an abundance of varieties making bad projects difficult to identify. The thing that makes a bad project a bad project this time, may not be what makes a bad project a bad project next time.
But a bad project does have a feeling. A feeling that something isn’t right. It can be hardly noticeable at first, perhaps brought on by a wasted meeting or missed deadline. The feeling can grow — sleepless nights and dreaded “red light” updates — until it’s obvious to everyone on the project team that this one is nearing disaster.
That feeling, I believe, is caused by the looming failure that arrives with the loss of project momentum.
Project momentum — a fragile and squishy characteristic unmeasurable with project management tools — is the force that relentlessly moves a project toward completion.
Because what’s a project if it’s not speeding toward implementation?
Likely a bad project.
What can we do about it?
Of course some bad projects are bad and still turn out okay. That’s the result of a foggy memory, lowered expectations, dumb luck, or the rescue effort of an individual hero.
Absent heroes — because to be direct, a project should not require a hero for it to be implemented successfully — what can be done?
There’s an easy answer. Truly. But it comes with we-have-work-to-do news: we (us!, individuals and organizations) have to get better at implementing projects.
And I’m not talking about project management. I’m talking about project implementation skills.
Projects are challenging. They require extra work, collaboration, domain expertise, communication(!), critical thinking, situational awareness, problem-solving, faith, support, oversight, planning, preparation, and a whole bunch of other skills, traits, and experience many project leaders haven’t spent sufficient time developing.
It’s tempting, I think, to try and solve the bad project problem with centralized efforts like an enterprise project management office or a One Best Way Edict™.
Neither is a sufficient response.
Even a great project manager outfitted with a sanctioned implementation methodology isn’t enough to wrangle the complexity of a project in a healthcare delivery organization without the full and necessary participation of an entire project team equipped with the ability to make a project happen.
The only way to get better at implementing projects is to learn how to implement them and hone learned skills by implementing more projects.
Which is actually good news, in my opinion, because as we all know healthcare delivery has plenty of opportunities to do better.
Getting Better at Projects Improves Everything Else
Getting better at implementing projects will help our organizations be better at everything else because projects are how organizations improve, innovate, and implement.
Of course, projects will continue to fail because projects happen to fail for a multitude of reasons outside the control of an engaged project team.
But they should not fail because of factors within an organization’s control. That’s a bad project. And bad projects need to be eliminated.
There are real costs to bad projects — not the least of which has made projects a burden to both organizations and individuals, something to be feared and avoided. That’s a real shame because projects are the vehicle to do really great work in making our organizations, communities, and healthcare delivery better for everyone.
Which, you know, is all of us. And the reason we’re here.
I’m scouring the country for people and organizations that have solved the bad project problem and/or are just really good at getting things done. Send me a note if you know someone or an organization that fits the bill.
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.
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.
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.
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.
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.