The Missing Ingredient from Healthcare Transformation

And How to Get Your Hands on Some Magic


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

The magic to make it all happen.

Until now.

Introducing: Healthcare Transformation Magic Crystals


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

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

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

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

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

Your mileage may vary.

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

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

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

Abracadabra.

You could be amazed with the results.

Ignoring the Required Work

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

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

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

That reality is completely irrationally understandable.

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

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

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

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

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

The Fine Print and Some Free Advice

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

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


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

But it will be successful.

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

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

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

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

They’re real.

Well, as real as magic can be.

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

We’re ready to work.

With you.

And we know where to start.


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

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

Rethinking the Role of IT in Strategy Execution for Healthcare Providers

Photo by Thomas Kvistholt on Unsplash

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

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

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


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

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

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

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

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

For example:

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

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

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

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

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

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

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

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

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


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


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.

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.

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.

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.

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.