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

Photo by Kevin Jarrett on Unsplash

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?


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.

Photo by Ross Findon on Unsplash

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.

Photo by Jack Douglass on Unsplash

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

“No.” Photo by Gemma Evans on Unsplash

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.

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

And why what you need instead is an innovation workshop

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

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

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

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

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

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

But will it be an effective response?

The Appeal and a Paradox

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

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

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

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

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

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

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

Producing Enabling Innovation

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

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

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

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

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

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

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

The Innovation Workshop

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

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

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

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

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

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

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

And that place is in an innovation workshop.

Wouldn’t you know it? We just launched a new solution we’re calling Innovation Workshop designed to overcome the organizational inertia preventing you from innovating. Learn more here.

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

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

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.

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 case for place-based community health improvement

Or why your current amalgamation of programming isn’t improving community-level health measures

As healthcare delivery organizations continue to explore outcomes-based community health improvement strategies, it’s sensible to pursue one focused on “place.”

Places present the parameters for healthy decision making. The social determinants of health (WHO: the social and economic environment, the physical environment, and the person’s individual characteristics and behaviors) are heavily dependent on the concept of place.

We spend all of our time in places both in the real and abstract senses. There are two components instrumental to place in the pursuit of health improvement: the degrees to which it is 1) health supporting and 2) builds community.

Why place? The most successful behavior interventions and population health management efforts cannot be sustained if the environments (read: places) where individuals spend their time don’t support healthy living. Making healthy choices isn’t a problem when willpower and motivation are present; the difficulty comes when those personal resources are low — a tidal process nearly every individual experiences daily. Places of work, schools, and even religious institutions are beginning to offer more and more aggressive health improvement programming and, in the process, are creating health-supporting environments. Meanwhile the most important places — the home, the neighborhood, and increasingly online — remain on the sideline despite public health, hospital, and community foundation efforts.

Health occurs “out there,” outside the purview of a provider, outside the walls of even the most community-focused hospital. The vast majority of Americans — even those with chronic ailments — spend a fraction of their year under the care of a provider. While some may identify this lack of connection to the healthcare system as a problem, it actually represents an opportunity to shift health creation to the places where individuals spend their time, which, in fact, is where it should be. It behooves community health improvement initiatives to help people make the vast majority of their year healthier.

Places also happen to be where we gather, an important concept affecting both health creation and community building. The study of social dynamics has long held that individuals are influenced by each other’s behaviors and gathering is a prerequisite to the existence of community. Noteworthy programs such as Weight Watchers and Alcoholics Anonymous have leveraged both in building successful health improvement programming.

Why not an explicit focus on physical health? Because the physical manifestation of health problems are often signals of root causes. Hospitals, public health agencies, local governments, and community foundations have been working on health improvement initiatives for at least two decades and have little in quantifiable improvements to show for it. Middling attempts at a consumer-centered marketing frame of health have not achieved the widespread acceptance necessary to create impact. In the busyness of American culture, health is commonly the the “to do” left uncompleted on the “to do” list.

That busyness is as much to blame for declining health indicators as a poor diet or a lack of exercise. Declining social ties, lack of access to healthy foods, decreasing levels of spirituality, stressful workplaces, financial struggles, poor education, high rates of crime, strained family relations, among many others, are all contributors to declining health status.

The truth, often, is that physical health issues are the outcome of a complex concoction of life’s realities. But health is life; without it, none of the enjoyment that comes from being alive is possible. While the message of “health is life” isn’t likely to evoke action in the wider population — a struggle experienced by hordes of self-development strategies — it’s mandatory of a competent health improvement strategy to find a frame that resonates to encompass the essence of a “health is life” message.

Improving outcome measures like obesity rates, high blood pressure, managed diabetes, etc. through behavior change intervention is fundamentally arriving at the problem too far downstream. Those programs and interventions are necessary, to be sure, but that work becomes the focus of population health management and clinical interventions.

The future of health improvement will be based upon reimbursement and the preservation of revenue, not the work within a community benefit scope. The importance of behavior change programming can’t be left to volunteers, right place/right time programming, and an underfunded community benefit strategy. Today it requires — and the industry is coming to terms with this notion — the same level of professionalism, individualization, and reimbursement as traditional medical care to counteract the factors responsible for poor health.

Just because there are so many contributors to unhealthy living and the identified problem is deliberately defined with grandiose scale doesn’t mean a community health improvement strategy should microscopically focus on improving physical health indicators. It means the approach to community health improvement should match the magnitude and individualization of the situation. It also means that healthcare delivery systems must ask for their limited community health improvement dollars to do more. That approach is to become a catalyst for creating health supporting places.

Why a catalytic role? There are three reasons to pursue a catalytic community health improvement strategy:

  • The magnitude of the unhealth problem; if the definition is limited to physical health indicators the problem is massive; it only grows with the addition of the factors encompassing whole-person wellness.
  • The traditional consumer’s cognitive connection between health and healthcare providers. Providers can provide a respected connection to health improvement opportunities in the community.
  • The unique role a local hospital plays in a local community. Few, if any, corporatized organizations continue to hold special stature in local communities than “our hospital.”

The magnitude of unhealthiness — both at a national and local level in this country — is too tall a problem to expect that even the combined financial budgets of hospital community health improvement programming, local government initiatives, public health agency efforts, and community foundation grant making strategies to address.

Combine those monies in a catalytic effort with the (much more important) non-financial resources of community and neighborhood development and a recipe for true, impactful upstream change begins to appear. In short, to rival the causes of unhealth, health improvement is in need of a solution that scales: where the audience grows disproportionately compared to production costs.

This means working with households, schools, and businesses as well as local governments, spiritual institutions, and non-profit organizations to catalyze the creation of health supporting and community building environments. Individuals spend their time in an abundance of places and the extent to which their real and abstract characteristics support health and build community are varied.

What does it look like? Healthcare delivery organizations should pursue a place based health improvement strategy because places:

  • provide the necessary scaling opportunity;
  • can be crafted to be health supporting; and
  • are where individuals gather as groups to build community.

First, a conversation about scale. In a limited pilot, a program called Healthy Lakewood (Colorado) shows great promise in improving individual activation. In this scenario, activation is defined as the knowledge, skills, and confidence essential to managing one’s health. The evidence is clear that improved activation leads to improved health outcomes. The success of Healthy Lakewood is based upon the following tenets:

  • People are in need of supportive conversation more than they are in need of instruction.
  • Health education must be paired with an activation opportunity.
  • Change must be self-directed (but can be co-created).

The Healthy Lakewood program adopted a co-creation mindset: improvement driven by the individual and assisted by a supportive health guide. This community-centric model relies upon the organizational competencies of three Lakewood partners: St. Anthony Hospital, City of Lakewood Recreation Department, and the Consortium for Older Adult Wellness and connected participants to additional community services through self-management skill building and action planning.

The pilot results and growing demand for additional implementations of the Healthy Lakewood model are useful guides in the decision to expand the strategy. Given the number of people that would benefit from the program, however, the resource constraint of health coaching becomes apparent. Healthcare delivery organizations do not have, and will not have, the resources required to provide the level of assistance necessary to the number of potential participants required to create movement in population health measures.

But places do.

The true value of the Healthy Lakewood program lies in peer-to-peer conversations of support; not in the expertise of a certain class of professionals or license holders. While healthcare system investment is required to prove efficacy in initial implementations, future investment should trend toward creating and sustaining a peer-to-peer health improvement support model. This is possible given the learnings from Healthy Lakewood.

That same recipe of supportive conversation, activation, and self-direction (+ co-creation) can be applied in numerous settings to begin improving the “places” where individuals spend their time, to develop and redevelop (social dynamics and physical spaces) environments that support healthy living and behavior change interventions. Neighborhoods, workplaces, and places of worship (and Rotary Clubs, after-school programs, and yes, even the local pub, among others) hold additional value in this new community health improvement paradigm because they are essential to the creation of social capital.

The concept of social capital, defined simply as “sense of community,” is explored in Robert Putnam’s seminal work “Bowling Alone: The Collapse and Revival of American Community.” Putnam charts the decline of social capital since World War II and explores potential causes of Americans’ increasing engagement with private life at the expense of civic activities. His writings provide evidence that each generation since the pre-World War II generation has become less socially inclined; a certain problem given that communities with high levels of social capital are more successful while those with poor levels suffer social ills. While not as easily to chart, each generation since World War-II has become increasingly unhealthier, too.

The connection to health becomes clear when Putnam begins to provide the causes of declining social capital: increased television viewing (the average American now watches more than four hours of TV daily), busier families (dual-earning households, growth in youth activities, etc.), and urban sprawl (commute times, reduction in walkable urbanism, big back yards as opposed to front porches). These factors account for declining leisure time and are contributors in creating the perception of busier lives. A perceived lack of time is a major reason not to partake in health creating activities like praying, socializing, relaxation, or exercise. Levels of civic engagement and health status are linked, if only by the same causes.

Combine this reality with the steady societal transition away from a physical labor-intensive workforce, the emergence of processed foods, and an increasing reliance on modern medicine and it’s no wonder former U.S. Surgeon General Regina Benjamin remarked, “We are the last of the accidentally well.” No longer the happy consequence it once was, the pursuit of health has become a choice, rather, an amalgamation of choices. Catalyzing places to support community building in the pursuit of creating social capital is important not only because of social dynamics’ influence on individual decision making, but because community building also leads groups to improve the places where they spend their time.

Community building social capital strategies have been pursued as a means of increasing local civic engagement for a number of decades. The shortcoming of such strategies, often termed “healthy community initiatives,” has been a simple misframing of the opportunity. While health is always a component of these initiatives — along with education, economic opportunity, environmental sustainability, among others — it’s treated as one pillar rather than the overarching feature it should be.

Health is life. A person that is economically secure, educated, and lives in a safe environment is likely to be healthy. If by improved group activation neighborhoods, workplaces, and churches become more health supporting these opportunities become attainable and healthy communities will emerge. Creating places that support healthy living is different than creating healthy communities, it prioritizes the pursuit of health as an end over a means. The two approaches are similar in desire; an effort to create places supportive of healthy living can be informed by the work of those pursuing creating healthy communities. Jo Anne Schneider produced a report for the Annie E. Casey Foundation titled “The Role of Social Capital in Building Healthy Communities.” She writes in the introduction:

… fostering communities where residents have a sense of ownership for the neighborhood as a whole, as well as shared responsibility to other members, requires a complex mix of investment in individuals and institutions combined with measures to build trust and strengthen already existing social networks. Establishing healthy communities also requires that communities develop trusting connections with citywide institutions, markets, and policymakers to ensure that the neighborhood receives the resources that it needs, and that families have a bridge between their local communities and the wider society to achieve their goals.

Before healthcare delivery asks individuals to think about health differently, the industry must truly acknowledge that health is more than just the absence of disease. A reframed “health is living” concept is, at face value, important to most. If it is not important to the individual, it must become so before health improvement can commence. And that is the key to future messaging: the pursuit of health (wellness) is an individually defined undertaking. Surely every person can be encouraged to make healthier decisions but every person is also already pursuing some activities that are health creating. At the individual level, it is about recognizing what those are and doing more of them. The folly is in the expectation that a single message or approach will resonate with everyone. That is an unrealistic expectation in any setting.

The intriguing idea is this: a reframed concept of health — ”health is living” — can resonate with individuals, businesses, governments, organizations, churches, schools — places — because the presence or absence of health affects everyone. A strategy to create places that support healthy living and build social capital is the approach healthy communities initiatives should undertake.

That is the opportunity. It’s a partnership strategy to create and promote health supporting and community building “places.” It’s not about doing the work, rather, it’s about leading the work; launch the ship rather than sail it. Given the unique leadership position hospitals hold within the local community and the impetus provided by the foundations of community health improvement, pursuing a place-based strategy is the first step in ensuring healthy living becomes a way of life.

Putting it into practice

A few ideas:

  • Peer-to-Peer health improvement support/training as described in the Healthy Lakewood example; an organization like Centura would develop, train, and maintain the model through a network of community partners.
  • A self-management, activation, and organization training program for individuals to take leadership and ownership in the pursuit of place development by employing the three tenets of Healthy Lakewood
  • Leverage the Community Health Needs Assessment and Implementation Plan processes to create an ongoing and sustained community leadership conversation around a reframing of health, acknowledging the importance of place and the four broadly defined categories of physical, social, mental, and spiritual. This group should be empowered to lobby for impactful change efforts.
  • An accelerator would provide assistance to individuals and groups wishing to advance place-based-building projects such as expertise in data and analytics, community connections, project planning, capital, access to experts, among others.

Listen to your heart.

Phil Best, this is beautiful:

True innovation requires the adoption of a belief system that sometimes must prevail in the face of other data metrics. Read up on the great inventions and business wins and you will note that at the core of most of them lie belief, dedication, and the passion to succeed. Today’s business leaders are often too afraid to move ideas forward without ironclad data proofs that they will be successful. All too often, they are the losers. Use your head, listen to your heart, and feel what’s in your gut.

Nurse: You forgot to take your pill this morning

This is interesting, from The Daily Mail (UK):

Microchips in pills could soon allow doctors to find out whether a patient has taken their medication.

The digestible sensors, just 1mm wide, would mean GPs and surgeons could monitor patients outside the hospital or surgery.

The ‘intelligent’ medicine works by activating a harmless electric charge when drugs are digested by the stomach.

This charge is picked up by a sensing patch on the patients’ stomach or back, which records the time and date that the pill is digested. It also measures heart rate, motion and breathing patterns.

The information is transmitted to a patient’s mobile phone and then to the internet using wireless technology, to give a complete picture of their health and the impact of their drugs.

Doctors and carers can view this information on secure web pages or have the information sent to their mobile phones.

There’s an obvious privacy discussion here.  Furious Seasons takes a shot:

On one level, this kind of technology is fascinating and interesting for all the usual dorky techie reasons (wow, telemetry has gotten that advanced and so have transmission technologies–it’s all so very sci-fi and high tech triumphant), but on another more important level it’s downright frightening. That’s because I see this “intelligent medicine” technology as a potentially massive intrusion on individual freedom and privacy.

This example is indicative of the debate territory we are beginning to enter.  The balance between life-improving-medical-innovation and privacy is becoming more difficult to strike (well, I suppose that depends on your definition of privacy).

Via Seed.

In: The importance of failure

Tony Chapman, CEO of Capital C, in Toronto’s Globe and Mail:

The only way you’re going to grow your business is innovation.  If you’re going to have an innovative culture, you must understand that that comes with the acceptance of failure. Innovation comes with a lot of mistakes.

Anybody who’s in the business of inventing the future has to be more tolerant of risk and failure because the future hasn’t been created yet.  If you’re in the business of creativity or innovation, software, technology or ideas, you have to be tolerant of experimentation and creativity. (emphasis added)

Much more (worth your time) here.

NYT does health care disruptive innovation

The New York Times:

Instead, the country needs to innovate its way toward a new health care business model — one that reduces costs yet improves both quality and accessibility.

Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy.

Innovation through social interaction

Keith McCandless visited the Center for Integration of Medicine & Innovative Technology to speak about efforts at Billings (Montana) Clinic to reduce HA-MRSA infections.

The Billings Clinic reduced HA-MRSA infections by 89 percent from June 2005 to June 2008.  Astounding.  Even more astounding is that they accomplished the reduction by working together.

McCandless is the co-founder of the Social Invention Group.  They help people work together to innovate through social interaction on the most basic level.  Lots of innovation affecting small stuff with front-line people making big change.  He asks this question in the presentation at CIMIT:

Can we be MORE succesful transforming culture by focusing narrowly on how we tackle our complex challenges within each unit?

The answer is a resounding yes.

From the CIMIT blog (watch the 50 (or so) minute presentation for some great stories that came about through the process and an explanation of the approaches used, the power of this innovation method is impressive):

The Billings Clinic in Montana is getting spectacular results eliminating transmissions of MRSA. A variety of socially-inventive approaches are being used to unleash hundreds of small innovations. The approaches—Positive Deviance, Improv Learning Simulations, and Social Network Mapping—engage frontline staff in discovering tacit and emergent solutions for themselves… not waiting for experts in infection control or managers to solve the problem.

Changes in self-organizing behaviors at the unit level have shifted behaviors toward a more collectively mindful culture. As experts and leaders let go of over-control, front line staff take on more responsibility for safety and innovation. The results include more joy in work, safe practice, and spectacular results.

Imagine that, (good) communication leads to positive change.  It can work in your organization, too.