You have a project problem and it’s bigger than you think

What can be done to solve it?

There’s a better than decent chance a project you’re working on right now is headed for disappointment. The academics tell us that 70% of the projects organizations start will fail to meet their original business intent.

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?

None?

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.

Innovation Autoimmune Disorder is killing your organization’s innovation strategy

And why a heretofore taboo approach to organizational problem solving — vendors — may now be part and parcel to the solution

Every day, almost every employee in your organization is saying no to innovation. They don’t mean to, of course. But it’s happening. And the thing of it is: you are absolutely encouraging it.

That’s because your organization’s structures and systems have been optimized to be profitable and efficient and reliable at carrying out the day-to-day operations of delivering healthcare services.

That’s unquestionably good.

It’s also bad.

Those same structures and systems the organization relies on for normal day-to-day operation are also very much preventing innovation. On purpose.

An organization’s structures and systems can be thought of as an immune system, a defense mechanism against variation — the scourge of profitability, efficiency, and reliability.

That has produced a crushing paradox: at a time when innovation is needed most, most organizations don’t have the capability to innovate.

This paradox is called Innovation Autoimmune Disorder and it’s killing your innovation strategy.

Diagnosing Innovation Autoimmune Disorder

There’s a notion in technology circles that a company produces products in the image of how the work gets done in that organization.

In other words, a company’s products or services come with similar properties and capabilities as the organization’s structures and systems.

The phenomenon even has a name: Conway’s law. The adage goes, “Organizations which design systems…are constrained to produce designs which are copies of the communication structures of these organizations.”

It makes sense: organizational structures and systems necessarily influence the way the work is delivered because structures and systems are what an organization uses to communicate.

This idea, however, isn’t only present in technology companies. All companies design systems. So all companies are constrained by the structures and systems of their organizations, including healthcare delivery organizations.

How does a healthcare delivery organization launch a new service? By designing a system.

The process of launching, creating, starting, building, embarking, initiating, and any other effort of commencement in a healthcare delivery organization follows a similar path: an approach almost always governed by time-tested methods of planning, direction, and control. That’s because accepted methods of planning, direction, and control have consistently produced profitability, efficiency, and reliability.

A business plan is created. Funding is approved. Space is acquired, built out, and outfitted. Staff is hired and trained. Technology is installed and connected. Marketing and internal communication plans are created. All stakeholders are given the opportunity to provide input, concerns are stated and addressed, the project is scoped, a project schedule and budget are established, and the service opens for business according to plan.

Innovation is designing new systems too, of course, and healthcare delivery organizations that attempt to apply traditional planning, direction, and control methods to make it happen often find it doesn’t.

That’s Innovation Autoimmune Disorder: the implicit and explicit rejection of potential innovation caused by an organization’s structures and systems. It is the ultimate statement of “that’s not the way we do it around here.”

Support departments say no to — or fail to make exceptions for — a new idea, a new approach, a new vendor partnership, or some other request because of traditional planning, direction, and control reasons.

Brick Walls by by David Pisnoy, Shoot N’ Design, Michał Grosicki on Unsplash

IT, HR, vendor management, project management, and every other centralized function are all governed by previously established processes. Policies and procedures have been honed over the course of decades. Management practices — for all things: employees, interdepartmental relations, budgeting, performance management, etc. — have been optimized to serve large bureaucracies.

Innovation fails to materialize as a result.

New ideas go unpursued because project charter, scoping, and committee-approval requirements are burdensome. Procurement procedures prevent the purchase of anything outside what the bureaucracy deems acceptable. Administrators concentrate on budgets and efficiency because performance management focuses on short-term deliverables.

So while C-suite survey results continue to indicate that innovation remains an important strategic priority for healthcare providers, desiring innovation is rarely enough to make it so. Organizations that rely on the same structures and systems to innovate that they do for planned, directed, and controlled change are systematically rejecting innovation every day.

Treating Innovation Autoimmune Disorder

The healthcare delivery organization is organized and operated purposely so that each day is unremarkable from any other.

The problem for organizations is that the industry in the midst of remarkable days. The operating environment is changing faster than any organization’s current ability to respond. The challenges are arriving on multiple fronts — regulatory, operational, reimbursement, consumerism, workforce.

Industry norms are shifting. Tactical paths forward are relatively unclear. A dramatic technology conversion beyond the electronic health record is underway.

These are the reasons innovation is so urgently desired in healthcare provider organizations. But Innovation Autoimmune Disorder too often gets in the way. Shifting an organization’s structures and systems to incorporate innovation as an accepted exception is the required long-term approach.

Overcoming Innovation Autoimmune Disorder will require healthcare delivery organizations to craft structures and systems that explicitly support innovation.

While those structures and systems will be unique to each organization’s specific objectives and distinct characteristics, there are three essential objectives every organization must pursue to explicitly support innovation.

Shining light on a different approach. Photo by Crown Agency on Unsplash

Make it okay to try new ideas. Innovation requires trying ideas. Innovation activities will produce unsuccessful outputs, but many can’t be labeled failures until experimentation has occurred. Choosing the right idea to develop further is surprisingly difficult in a planning-oriented environment. It can be made easier by testing in real-world environments. That requires experimenting with ideas which will occasionally lead nowhere but may serve as a building block to something better. It’s impossible to know the extent to which a new idea will improve value, increase revenue, and grow market share until it is tried.

Incentivize working together in new ways. Innovation requires business units, departments, and service lines to collaborate in new ways and be open to the possibility that a predefined outcome may not always be a basis for participation. Traditional interaction patterns should be set aside to explore something different. Take support departments and the operation, for example — instead of being perceived as gatekeepers of resources, departments like IT, HR, and project management can become partners in solving business problems with no predetermined approaches.

Make technology available to support new ideas. Innovation requires making technology available and accessible. While technology is only part of a solution — every innovation project utilizes a combination of people, process, and technology resources to create an output — even prototypes increasingly rely on technology for initial demonstration. Traditionally, administrators have had decision-making authority over elements of people and process decisions, but technology choices have remained the domain of IT. A budget is vital, but to innovate administrators must have access to all resources and, more importantly, agency in using them.

Finding Support Along the Way

Of course innovation-focused structures and systems are a long-term shift — and potentially longer than what organizations may be comfortable with given the pace of industry transformation. That reality is giving way to the realization that a heretofore sacred belief may be open to reexamination.

“More than 75% of leader respondents,” to a recent innovation survey from the American Hospital Association and AVIA, “believe that innovation must include partnering with other innovative organizations.”

Partners can help. Photo by Todd Diemer on Unsplash

The previously taboo approach to organizational problem solving — vendors — may now be part and parcel to the solution. Outside help may not only be needed, but required.

Healthcare delivery organizations have traditionally addressed strategic challenges with a mix of internal subject matter knowledge, technical proficiency, and industry best practice. The limits of that approach are evidenced by the survey results above. This version of healthcare transformation requires organizational capabilities not currently found in most contemporary provider organizations.

The shifting operating environment requires new organizational expertise in digital technology, emerging operating domains, and efficient implementation methods. Vendors, or in this new paradigm, partners — with their products, services, subject matter expertise, industry expertise, technical skill, and ability to execute with urgency — are the most reliable method to immediately leverage required know-how that doesn’t exist in most organizations.

There is no quicker way to overcome Innovation Autoimmune Disorder than to involve partners. Partners offer a plethora of opportunities to operationalize innovation across the organization.

Some organizations are starting to realize a partner approach may prove strategically beneficial for these reasons. GE Healthcare has launched partnerships with several organizations including Jefferson Health in Philadelphia and Partners Healthcare in Boston, AVIA’s innovation network business model is built on the idea, and industry integrator Catalyst HTI is opening a building in Denver explicitly for this purpose.

These partnerships are a good start at the executive level. But the strategy must diffuse deep into the organization if it is to find its full potential. Perhaps partners — of all types and sizes — can help the middle of the organization innovate right now if they were made available.

Industry partners will play an increasingly larger role in the transformation of healthcare delivery given the dramatic shifts on all fronts. To that end, organizations must become comfortable with new people, new concepts, and new ideas coming into the organization.

An organization’s structures and systems will adjust in time. Because just as structures and systems ensure profitable, efficient, and reliable operation, they also adjust as organizations realize the necessity of adapting and evolving.

And until then, partners can help.

As they always have, the competitive, regulatory, and operating environments are shifting. This time, however, the traditional model of adapting and evolving is preventing healthcare delivery organizations from doing just that.

Innovation Autoimmune Disorder is killing your organization’s innovation strategy. Do something about it now that you know: call a partner.

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.

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.

Shitty Work Thing

A … thing … for healthcare administrators braving their way through shitty work things

Airfares in and out of Las Vegas’s McCarran International Airport are relatively inexpensive.

That’s good because that’s where you are.

But you’re not on the strip, nor touring the Hoover Dam, nor hiking in the Grand Canyon.

No, you’re at Clark County’s most infamous tourist attraction: America’s largest landfill.

You’re standing on a mountain of garbage in the middle of the 2,200 acre Apex Landfill with nothing but trash all around you. There are the remnants of bulldozed refuse for as far as you can see. There are neon-colored puddles of liquid at every step. There are so many birds they block the sun.

And that stench! It’s enough to take your breath away.

Standing in the middle of America’s largest landfill wondering how the heck you got here is what it feels like to go through a shitty work thing as a healthcare administrator. People suck. Bosses are assholes. The job’s requirements are out of touch.

You’d love to sit down and rest: trash. No matter how high you try to climb: still standing on trash. The path out: through lots of trash.

It’s lonely. It’s depressing. It’s difficult.

Time and again I’ve seen healthcare administrators get stuck in a rut at work and struggle to climb out — including myself.

This is My Story

Her assistant phoned and asked for my presence. I immediately made my way to her office. We exchanged hollow pleasantries.

“Have you seen the movie Sophie’s Choice?,” she started.

“No,” I responded. It wasn’t the first time she’d attempted to use the premise of a movie to communicate something important. So I knew something was coming.

“It’s the story of a Holocaust survivor.”

“Okay.”

She got to the point.

“Sophie arrives at Auschwitz with her two children. The Nazis force her to choose which child gets to live — her son or her daughter. She agonizes over the decision and ultimately chooses her son.”

That’s dark, I thought to myself.

It was the beginning to the end of something that just six months prior felt like a remarkable opportunity.

It was the beginning to the end of something that just six months prior felt like a remarkable opportunity.

The department I was leading had been eagerly gobbled up by an organizational restructuring as part of a shiny new unit created to carry out an exciting new strategy. I was excited! The forefront of change! A career-altering moment!

But a week into the new world I was ask-told to take leadership over a dysfunctional department in addition to my cutting-edge program responsibilities. “I think you have capacity,” she said.

A few days later I followed with a dutiful yes after convincing myself of the “opportunity.”

But it was too much. The problems on one side kept me from the opportunities on the other. It was an exhausting six months of slow progress, limited access to leadership, murky communication, 30+ direct reports, limited HR support, non-existant IT support, angry colleagues, torturous meetings, missed (unrealistic) deadlines, and even a co-worker backstabbing.

My reward was this excruciating conversation.

“Drew, you have a Sophie’s choice to make,” she presented, “You must choose between this amazing opportunity (it wasn’t), working for a great boss (they weren’t), and doing important things for the company (it was a disaster) or going to work in an area you’re passionate about (true), as part of a new department (uh oh), for someone who until this moment has been your peer (backstabbers are never pleasant to work for).”

“And since both of those leaders are at the director level you’re going to have to become a manager.”

Six months of landfill walking had climaxed with a Choose Your Own Demotion Adventure.

A Shitty Work Thing is Difficult and You Need a Little Help

It wasn’t supposed to feel like this. It wasn’t supposed to be like this. It wasn’t supposed to be this.

But here you are.

Shitty work things are shitty because they get in the way of doing good work — which is the reason we got into healthcare administration to begin with. Being a healthcare administrator is already hard enough. Add a shitty work thing on top and the job can quickly become undoable.

So I created a … thing … for healthcare administrators braving their way through shitty work things. It’s called, wait for it … Shitty Work Thing for Healthcare Administrators.

A shitty work thing is just that: a prolonged period of job dissatisfaction stemming from something shitty at work.

Shitty Work Thing for Healthcare Administrators is designed to help you move through it. It’s part reflection, part inspiration, and part motivation. Shitty Work Thing for Healthcare Administrators delivers twenty emails over twenty work days to help you focus on the work, tune out the noise, and find a path out.

That’s what we’re after: getting to the other side. Because there is a path out of this landfill.

This experience — this right now — is something you’ll learn from. And you’ll get to apply what you learned to new situations with new employees, new bosses, new projects, and new anything else that needs to be managed. Going to work will become enjoyable again.

But that’s getting ahead of ourselves.

My friends made it through shitty work things. My colleagues made it through shitty work things. Employees that worked for me made it through shitty work things. I’ve made it through shitty work things.

As in the cases of all those, you just have this difficult task before you: getting through yours.

They did it. We did it. I did it. You can do it.

And the twenty emails of Shitty Work Thing for Healthcare Administrators were crafted to help you do just that.

Learn More: Shitty Work Thing for Healthcare Administrators

An ode to projects

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.

This originally appeared over here.

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

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 “Now What?” moment is a moment of action

Four days into a department reorganization and my new boss called me in for a conversation that concluded with, “Do you want to be the contact center manager?”

“NO!,” I silently shouted. I had been looking forward to focusing on building the population health program I was originally hired for and I didn’t have the slightest clue of what was required to manage a contact center.

“I think you have the capacity and capability,” the senior vice president ask-told, “Why don’t you take a few days to think about it and let me know.”

There really wasn’t any answer to give except “Yes.” So I did.

Now what?

The healthcare delivery operating environment is regularly producing “Now what?” moments — a moment when an administrator has beed told, asked, or discovered they now “own” a business problem that must be solved and find themselves in a moment of reflection asking, “Now what?”

Often the question is in silence to one’s self. Occasionally, people are more fortunate and get to ask it a little louder to a committee or an executive team. But even that can get tricky because topical expertise is a fleeting attribute in a fast-paced operating environment.

We’ve seen “Now what?” come in a variety of a flavors, but some seem to be more common, including the ask-tell flavor told above.

Another frequent variety is the execution imperative. There is a moment that arrives after the strategic planning activities of analysis, thought, and discussion when the new strategy must be operationalized and there isn’t a clear path forward. “Now what?”

Or our favorite, the innovation mandate. Someone, high from above, declares, “We need to be more innovative!” And proclaims to all in attendance that they must come up with three innovative ideas by the next meeting. “Now what?”

The last, which we cheekily call the oh-shi!, is when it becomes apparent to an administrator that the operation is facing a significant business problem — brought about by internal or external forces — that will impact the department, service line, or organization in some influential way. “Now what?”

“Now What?” moments often come from a place of fear, inexperience, or the unknown.

But the “Now What?” moment is a moment of action.

It means it’s time to do something. It’s time to shift attention to making something happen. Go.

There’s a long list of available actions. Do some research. Phone a colleague. Meet with IT or HR or project management. Plan a pilot. Discuss with your boss. Call a partner.

But the moment is now.

Don’t wait for permission, for more information, or for someone with more expertise to appear like I did in the contact center. Those weeks and months is a valuable time for doing. Because there is a moment that follows “Now what?” when no action is taken.

We won’t talk about that one. That moment is much more painful with much less individual agency. And, crucially, avoidable.

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

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

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.

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

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

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

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

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

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

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

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

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

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

Rethinking the Role of IT in Strategy Execution for Healthcare Providers

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

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

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

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

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

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

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

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

For example:

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

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

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

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

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

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

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

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

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

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

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