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


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

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

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

And: “How can we get started quickly?”

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


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

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

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

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

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

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

Download the Project Building Blocks here.


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

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

2017 for Healthcare Delivery Providers: Execution


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

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

The answer is almost assuredly no.

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

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

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

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

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

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

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

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

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


Value and Three Safe Assumptions about Healthcare Reimbursement Trends

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

Trump and Co. and the Plan to Repeal

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

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

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

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

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

Private Insurance and the Path to Innovation

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

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

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

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

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

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

Consumers and their (Relatively) Quiet Influence

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

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

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.

Central Management Podcast | Radhika Palta

A podcast for healthcare’s middle managers

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

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



Central Management is made possible by Status:Go

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


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

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


The highlights of our discussion:

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

7:20 — Details of the drama!

8:20 — Of course, she almost quit

11:10 — A plan comes to light!

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

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

17:10 — The solution!

19:00 — In summary, lessons learned

How brown M&Ms have improved our hiring process

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


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

That’s exciting.

Hiring is exhausting and difficult.

Resume scrolling. Email sending. Story telling.

Candidate screening. Interview organizing. Hard question asking.

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

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

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

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


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

Turns out it was true.

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

From David Lee Roth’s autobiography:

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

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

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

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

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

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

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

That’s a lot of resumes to review.

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

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

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

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

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

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

27.

A manageable number. And the majority were great candidates.


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

Central Management Podcast | Jordan Woods

A podcast for healthcare’s middle managers

Jordan Woods is a chameleon.

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


This week’s guest on the Central Management podcast is Jordan Woods, heart and vascular service line director for a large healthcare system located in the Midwest.

“I enjoy the challenge of trying to be a chameleon and work well with anybody and be effective and appreciated by a lot of different types of people.”


The highlights of our discussion:

2:50 — job responsibilities of executing on executive project vision, whether he participates in developing that vision or not

8:20 — the impact of dictated quick-turnaround deadlines on manager and employee engagement when implementing projects; and the flip side of that: organizations are under pressure to get lots of things done

14:00 — Jordan enjoys his job and the challenges it presents, especially developing people (he is measured(!) on his success in helping his employees develop new skills that allow them to move into other positions in the organization)

19:30 — the biggest challenge for a middle manager is managing executive expectations about project timelines — and navigating the desires of the executive versus employee engagement (Jordan recently had a conversation with a hospital president where the individual made it clear they think managers and directors are the most important people in the organization)

26:10 — the importance of spending time as a middle manager in becoming a visionary leader involved in organization strategy; middle management, though under appreciated, is a great platform for career development

30:56 — one last brilliant insight from Jordan

Central Management is made possible by Status:Go


Strategy Execution Platform: the future of enterprise healthcare technology


The EMR falls short. IT is preoccupied and cost constrained. Middle managers need access to software. And widespread experimentation is key to transformation.

Strategy Execution Platform: Enterprise healthcare technology designed-for-the-user, won’t-bust-the-budget, and especially-for-your-need.


This is the most exciting time to be effecting change in the history of healthcare delivery. Healthcare transformation is continuously creating new operational requirements for healthcare delivery firms. Executives respond to the shifting operational requirements within healthcare delivery — both problems and opportunities — with strategies.

This is the most exciting time to be effecting change in the history of healthcare delivery.

As they have always been, middle managers are tasked with executing identified strategies. And as they have always had, middle managers use three resources to implement and execute: people, process, and technology.

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

Decisions of whom to hire and promote have long been the agency of middle managers. The same goes for determining how employees do the work and customers experience the service.

Historically, however, technology decisions have been left to the IT department. Continuing this paradigm will only impede progress by creating barriers and causing frustration.

While not every problem is solved with technology, nor does every opportunity require technology, increasingly solutions are dependent upon technology. This makes it imperative to empower middle managers with it.

The responsive healthcare delivery firm provides middle managers the capability to act by empowering them with agency over people, process, and technology decisions. Responsive healthcare delivery firms allow middle managers to quickly solve problems and take advantage of opportunities by piloting as many ideas as possible.

Empowered middle managers create responsive healthcare delivery firms. Responsive healthcare delivery firms empower middle managers.

The rigidity of the EMR and existing industry IT ideals are combining to prevent middle managers from being empowered with technology in the same fashion as they have been with people and process decisions. Fortunately, there is a solution.

The Strategy Execution Platform.

A Strategy Execution Platform provides diverse functionality, allows a sustainable support model, and is inexpensive to implement. It possesses the privacy and security features demanded by the healthcare industry. It allows IT to facilitate technology diffusion throughout an organization by focusing on governance rather than managing a project request queue. Instead of a single-record keeping system that promises everything to everyone with a single usability framework, it allows for many projects to be built upon a single framework promoting usability to match the workflow needs of the user.

Most important, a Strategy Execution Platform gives middle managers access to the technology necessary to promote widespread experimentation. Finally empowered with all three resources — people, process, and technology — middle managers are now truly enabled to implement the strategies of healthcare transformation.

A Strategy Execution Platform gives middle managers access to the technology necessary to promote widespread experimentation.

As continuing healthcare evolution has required us to inventory technology, question processes, and challenge our people, one thing has become clear: It will be the summation of many efforts that will allow healthcare to transform. With the aid of a Strategy Execution Platform, those middle managers able to pilot projects by marshaling their resources, innovating their processes, and taking advantage of new technology will be the leaders to get us there.


The Electronic Medical Record is a Brick Wall

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.




Usability is terrible. It’s cumbersome for entering information and navigating existing information. The data is poorly organized. It doesn’t have a longitudinal view of information making it difficult to capture a snapshot of a patient’s context.

Speaking of data, it’s nearly impossible to get out for enterprise purposes. Creating or extracting reports, analytics, and dashboards requires an analyst, usually one that reports up through the IT function.

Customization of anything requires the consensus of a committee, is impossible at worst, and completed on a lengthy timeline at best.

The EMR controls workflow and process, rather than process and workflow being built into the technology. It offers no insight into productivity or performance. Automation, business logic, and workflow support are maddeningly absent. It recognizes no opportunities for process improvement.

Integrations are difficult or impossible. It lacks any effort to allow patients to enter information. And it doesn’t help market services, monitor health, or promote engagement.

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.


The IT Department Has Become a Roadblock

The information technology department has been the most important department in healthcare delivery over the last forty years.


But 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.

The same cost-cutting and value-improving pressures facing operational departments are facing IT, too. With pressure to reduce headcount, a growing 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 lower priority because IT’s focus is 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.

Data analysis resides as a department, often within IT, instead of as a function embedded within each department. The necessary bureaucracy of the centrally managed IT function does not promote scope, scale, nor speed in new projects.

Given its support department status, IT is too far from the patient experience. Technology should be making it easier to use and consume healthcare services, not making it a more frustrating experience.

Creative technology solutions are viewed as a risk. No CIO has recently been fired for implementing Oracle or Cisco or IBM or Epic. This mentality leaves inexpensive and effective solutions to a wide variety of problems on the table.

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. The IT department should be promoting care coordination, patient experience, team-based care, interoperability, and data sharing at every turn. IT must help other departments become more functional, not stand in the way of being functional.


This is the Golden Age of Middle Management

Where is healthcare transformation occurring?

The answer, clearly, is where healthcare is being delivered: in places like the clinic, the radiology department, the contact center, and the case management department.

Who is responsible for implementing healthcare transformation?

The answer, undoubtedly, is middle managers. The individuals charged with leading the clinics, the radiology departments, the contact centers, and the case management departments.




While executives have the enjoyable task of intellectualizing and philosophizing for the pursuit of creating strategy, it is middle management that has the responsibility to make the strategy happen. The ideas — yes, important — are the easy part. Bringing the ideas to life is difficult.

Peter Drucker, the famed management consultant, relayed it best when he wrote, “… the man who focuses on contributions and who takes responsibility for results, no matter how junior, is in the most literal sense of the phrase, ‘top management.’ He holds himself responsible for the performance of the whole.”

Perhaps a bit more succinctly but equally prescient, Herb Kelleher, the founder and CEO of Southwest Airlines put it this way: “We have a strategic plan, it’s called ‘doing things.’”

This is the golden age of middle management. An era when all the action of improving healthcare delivery is happening on the front lines under the supervision of the often maligned, but unnecessarily so, middle manager.

Middle managers are central to the success of healthcare transformation. As such, they are central to the success of healthcare delivery organizations. Maybe, just quite possibly, more important than the CEO.

But middle managers need to be empowered with the resources to make transformation happen. The job of the middle manager has become increasingly difficult: their plates are full, the velocity of industry change is increasing, and the constraints of the technology they and their staff are using are real.

Historically, with only supreme agency over people and process resources, it is time for healthcare organizations to empower middle managers with a third: technology.



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.


Charles Darwin had it right when he wrote about biology. It appears the same holds true for the modern-day business entity, too: Adaptation is key to survival. How to adapt but one step at a time?

Some ideas pontificated following the passage of the Affordable Care Act are beginning to appear. For many, though, we are still maddeningly far from knowing what is going to be the secret to success in population health, value-based reimbursement, or care coordination, among the many other elements known or unknown of healthcare reform.

Innovation is not a board room strategy, it’s a way of doing. A way of operating. Innovation only happens through experimentation with ideas. Many ideas.

While great headway 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.

Tom Peters, the management consultant, puts it best: Whoever Tries the Most Stuff Wins.

Successful innovation is simple: widespread experimentation. That doesn’t make it easy.

Admirably, healthcare delivery has long been experimenting. It’s the essence of the scientific method, pilot projects, 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.

As Malcolm Gladwell relays in his “Creation Myth” essay, psychologist Dean Simonton notes, “Quality is a probabilistic function of quantity. The more successes there are, the more failures there are as well.”

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.


Strategy Execution Platform


Arthur C. Clarke, the acclaimed futurist, wrote: “Any sufficiently advanced technology is indistinguishable from magic.” That notion has been canonized as the third of Clarke’s Three Laws.

“Any sufficiently advanced technology is indistinguishable from magic.”

How does an organization empower middle managers with technology?

With the magic of a Strategy Execution Platform.

A Strategy Execution Platform provides diverse functionality, allows a sustainable support model, and is inexpensive to implement. It possesses the privacy and security features demanded by the healthcare industry. It allows IT to facilitate technology diffusion throughout an organization by focusing on governance rather than managing a project request queue. Instead of a single-record keeping system that promises everything to everyone with a single usability framework, it allows for many projects to be built upon a single framework promoting usability to match the workflow needs of the user.

Most important, a Strategy Execution Platform gives middle managers access to the technology necessary to promote widespread experimentation. Finally empowered with all three resources — people, process, and technology — middle managers are now truly enabled to implement the strategies of healthcare transformation. The ability to pilot ideas, as many as possible, in response to arising problems and opportunities and then iterating, expanding, or ending the idea is a paradigm changer for healthcare delivery.

As a flexible, complementary solution, a Strategy Execution Platform can be a standalone software system allowing software to be created for any need. It can be an overlay, a way to make existing technology more functional. It can be a way to connect technology with new or existing systems, making integrations the default and not an exception. And it can even be a solution that stands between two other solutions, drawing data from each and recombining to create something new for a related function.

A Strategy Execution Platform is the easiest answer to a problem facing more and more departments and cross-functional initiatives: information management. As organizational efforts take notice of the reality that what happens outside the hospital or clinic is as important as what happens inside, the patient journey continuum becomes a necessary concern. The four activities — acquire, connect, retain, and improve — some pursued collectively, others independently, become important considerations for a firm’s activities as a system of record.

As a platform strategy, a Strategy Execution Platform meets the goals of exponential distribution (scale), widespread experimentation (scope), and expedient implementation (speed). It can be programmed, tailored, and adapted to a department’s needs. It removes the need for IT to conduct a scoping exercise every time a technology request is made. Governance is possible but doesn’t stand in the way of progress. The system is dependable but doesn’t require excessive support. It is a multi-sided technology solution addressing the requirements of a diverse set of stakeholders.

The velocity of industry change requires an approach to solving problems and taking advantage of opportunities where there is a bias for action and an expectation of widespread experimentation. It requires a new commitment to speed and scale and scope. This notion becomes a reality only with empowered middle managers. Agency over people process, and technology decisions is their new domain.

A Strategy Execution Platform makes it possible.




Complementary flexible software is coming necessity for enterprise healthcare IT

If only we had software to __________________, we could __________________.


I’m often surprised when we talk to healthcare organizations how easily some of their operational issues could be fixed if only they had the right software, even more so now that I have departed day-to-day healthcare operations. While healthcare has historically been slow on the uptake of technology, there are now systems and solutions at every turn. Software to improve provider communication. Software to host an online patient visit. Software to manage the credentialing process. There are startups literally everywhere creating new software products daily to improve healthcare delivery.

None of this is surprising — “software is eating the world,” as Marc Andreessen declared in 2011. The inventions of the computer, the microprocessor, and the internet are allowing entire businesses to be built or rebuilt on software with services being delivered online. IBM is in the midst of another transformation, this time into a software company, Amazon has been more of a software company than a retailer since its inception, and even Domino’s Pizza, where 50 percent of sales come from online sources, can now be labeled a software company.

Software allows unprecedented automation, efficiency, and the delivery of creativity.

Healthcare has never demanded new ideas to create value like it is now. Value for providers, for partners, and for patients.

Software is creating opportunities for individuals throughout healthcare delivery organizations — most importantly, those individuals on the front lines of delivery transformation — to create value in an unprecedented fashion. It’s never been cheaper, easier, nor faster to build quality software to support emerging ideas.

Software helps make ideas possible. While technology is often not the entire solution to a problem — it is usually part of the solution. Software can bring ideas to life. It can be the difference between paper and pencil, it can be the difference between having reliable and useless data, it can be the difference in creating a prototype that scales or a pilot project that languishes.

For instance, these are not difficult problems to solve:

  • Timely and accurate discharge information for patients leaving the hospital and being admitted to a long-term care facility (potentially preventing an unnecessary less-than-24-hour return trip to the hospital) should be the standard; instead it’s the exception.
  • Why can’t uninsured patients be easily targeted for a marketing campaign to become insured — good for the both the individual and the organization — based upon basic demographics and data sources readily available in other industries?
  • The standardized operating “rules,” “guidelines,” “resources,” and “protocols” stored in human memory, Word documents, and Excel files, should be readily available to all and logic-based for improved decision support.

Yet these problems exist in organizations around the country. My exploratory conversations with healthcare providers can be boiled down to a fill-in-the-blanks exercise:

If only we had software to __________________, we could __________________.

What a powerful notion. A notion that, until now, would have required great expense, great effort, and bountiful resources. The proliferation of software — and more importantly, the ease of which quality and inexpensive software can be developed efficiently — is changing that. The cataclysm of a world converting to software and a transforming delivery environment holds the potential to improve healthcare delivery for all participants.

That is why today’s healthcare operating environment requires a tandem approach to software: core systems and the flexible solution.

Core systems are traditional clinical software technologies like the electronic medical record, the practice management system, the PACS system, provider order entry, pharmacy information system, the lab information system, etc., etc., etc. They are in a fixed state and customization occurs at implementation. These rigid enterprise systems were built for a fee-for-service environment.

But the rigidity has created a technology gap that manifests as a barrier. By definition, the rigidity creates inflexibility.

To undertake new strategic opportunities brought about by system transformation, core systems require complementary flexible solutions.
Flexible solutions are in a dynamic state and mandatory in a fee-for-value environment.

A flexible solution is a software platform that that can be implemented anywhere, connect with anything, and perpetually customizable. It is not limited to a particular function, not speciality specific, nor does it have to be expensive. It is quick to implement and easy to scale. It does not dictate workflow, it supports the best workflow.

Every enterprise requires both core systems and complementary flexible solutions. Both are necessary throughout the enterprise. Both are required to provide care across the continuum.

Crossposted over here.