"Legacy companies can't rely on regulation to protect them from competitive innovation."
Anyone who has tried Uber instead of calling a taxi will appreciate this blog
"Legacy companies can't rely on regulation to protect them from competitive innovation."
Anyone who has tried Uber instead of calling a taxi will appreciate this blog
A recent HBR Blog by Ed Batista, entitled "The Most Productive People Know Who to Ignore" got me thinking about a leading cause of the stress we encounter every day: getting stuck between saying NO in order to say Yes.
Most productive leaders have some form of To Do system - - a way to keep track of what they intend to do. It exists in the realm of discretionary time, where we get to decide what and when to do what we choose.
Real life doesn't respect our discretionary time. It brings a constant stream of interruptions via email, text, phone calls, flat tires, flight delays, etc. We feel this disconnect as stress.
Triage is the art of saying "No" in order to say "YES." The result is less stress.
Emergency responders at the scene of an accident learn to make initial judgements, based upon incomplete information, to say "no" to one patient in order to direct their attention to the patient with the greatest chance of survival.
The greatest obstacle to triage lies within the heart of the responder: the emotional weight of reckoning with what we cannot do. I believe a key to successful triage is to turn this around, refocusing upon what we CAN do.
It starts with a reality check: you and I have only about 120 hours of "life" every week. When the week ends, another one starts; you can't carry any of those hours forward. So we should purpose to maximize the number of those hours that we invest in doing what we really want to do. Being intentional rather than reactive.
By focusing on what we really want, we can better triage the distractions that flow through our day. It's easy to say No to an urgent-but-not-important request when I am choosing to say YES instead to a much more important choice - - because I have a much bigger YES on the other side of the No!
"To three highly effective and successful executives, a boring, often-overlooked ability is one of the most vital skills you can have as a manager — the ability to write."
A great post by Ben Horowitz that confirms my own expeirence as an executive leader with managers who want to influence my thinking.
This is a very insightful blog post by Lindsey Dunn on the topic of innovation in healthcare.
The punchline: Adaptive Design is a path to innovation in healthcare: "Successful organization learn to do what they don't know how to do."
Grateful people are happy people. But when I compare myself to others, it destroys my ability to be grateful and happy.
Why is that? I believe it's because I never compare myself to people who are worse off than I am. I only compare myself to those who appear to be better off.
It takes no effort to compare myself to others who look better off than I am. It's as automatic as breathing. I see what they have - - talent, money, possessions, etc. -- and in comparison I'm always left feeling shortchanged, and not very happy about it.
But here's an interesting question: What would happen if I chose instead to intentionally compare myself to people who have less than I do?
I did that today. I turned my attention to people around me - - friends, family, acquaintances and the guy holding a cardboard sign at the intersection downtown - - and I pondered the difference between their lives and mine.
My first impression was guilt. Why ahould I be doing so well when so many others are not? The friend fighting cancer. The family who lost a child in a car accident. The family whose finances are in shambles. By comparison, my life is literally amazing.
But if I dwell upon guilt, I won't choose to think this way. (Maybe that's why I don't make eye contact with the guy holding the cardboard sign at the intersection?)
All it takes for me to be grateful is to pay attention to just how fortunate, how blessed, I am in the every day matters of life. If something aweful isn't happening to me today, my life is awesome and deserving of my gratefulness! Trials and tribulations are normal life for all of us, so any day that is free of them is awesome and deserving of my gratitude.
Happy people are grateful people who appreciate what they have instead of what they don't!
A growing number of physicians are stepping into leadership roles in hospitals and health systems. As a career health system executive, CEO and now strategic advisor to healthcare leaders, I’ve noticed a critically important difference in how those who really make an impoact view their role.
The transition from “The Old World” into “The New World” of healthcare is unprecedented and wrenching because all the rules are being rewritten. None of us has been where we are going and it will take all the best minds around us, working together, to figure it out.
Health systems are urgently searching for effective physician leaders to fill a litany of institutional roles: chief medical officer, VP of medical affairs, chief clinical informatics officer, chief of clinical operations … the job titles vary. This is driven largely from the shift to value-based payment by CMS. The clinical quality and patient safety metrics that now directly impact the system’s revenue cycle require a new kind of clinical redesign, one that non-clinical executives cannot lead effectively.
This represents what I call the First of Three Tables: doctors being invited to the executives’ Table to help redesign the health system.
In response to this need for physician leaders, executives traditionally looked to the medical staff leaders for help. Nearly every health system has experimented with some form of “physician leadership academy” to develop leaders from within the medical staff. These programs produce widely varying results, but they represent the Second Table: executives coming to the medical staff’s Table, trying to affect change and redesign inside the walls of the hospital through the mechanism of the medical staff.
In the Old World of healthcare, this made some sense. The name of the game was to refer patients to specialists who admitted them to the hospital, and the focus was on building service volume. The medical staff was the only forum to affect change.
But in the New World of healthcare, the name of the game is “population health management,” turning the focus to value, teamwork and coordination of care inside and outside the hospital. Medical staffs are ill equipped to manage such care.
This new reality of life in healthcare is spawning variety of new care delivery models, all under the rubric of “Integration”: hospitals and physicians working in teamwork. Generically, there are 2 methods of integration. One is the employment of physicians by hospitals (i.e., “financial integration”). The second is the creation of a sophisticated structure that enables independent physicians to “clinically-integrate.” Both involve the creation of a new business that assumes and manages financial risk through better-coordinated clinical care of a population of patients. In any Integration model, unlike the hospital or the medical staff, the new structure is some form of a joint-ventured business. It is the Third Table, where physician leaders and hospital leaders partner to run a new business in a new and interdependent manner.
Differing Worldviews Affect Our Table Manners
The people sitting around these 3 Tables are not always aware that the role of a physician leader, and his/her relationship to hospital executive partners, is distinctly different at each Table. Moreover, the basic worldviews of physician- and non-physician leaders could not be more different.
This difference was beautifully illustrated through the story told by a respected physician leader whose twin-sons left home on the same Saturday morning to attend different graduate schools.
One went to medical school while the other left for an MBA program. Both twins called home the next Saturday morning to talk to Dad about their first week in grad school.
The son at MBA school recounted his first morning in class: “I was introduced to five other members of my class who will be my study group. For the next two years my grades will depend on how well we work as a team. We spent the first week sharing the results of our personality assessments and doing team-building exercises.”
An hour later, the son at medical school called home. “This was the most interesting first week! On the very first morning I was introduced to my cadaver!” From Day One the message to the medical student is clear: it’s all on your shoulders, you are responsible and you cannot delegate it to anyone else.
Is it any wonder why autonomy is so important to physicians? Throughout their training they were perpetually drilled on being the expert and never assuming anyone else knew more about their patient than they did. I believe the best of American Healthcare is the result of this ruthless and uncompromising commitment to the personal accountability of the physician. But it represents a daunting obstacle to building the multi-disciplinary, coordinated care teams required in The New World.
“Table Manners” for both executives and physician leaders must blend together, animated by mutual respect for one another’s expertise and experience.
The First Table: Physician Leadership in a Hospital
Historically, executives managed hospitals, and medical staffs were granted privileges to practice there. This often created a contentious relationship. The New World of healthcare requires a fundamental redesign of the health system, and physician leaders engaged in this work can serve as “translators” between clinical and non-clinical staff to find better clinical ways to serve patients and generate the financial margins the system needs.
Chief Medical Officers become the first line of relationship between management and clinicians to set the agenda for advancing clinical quality and patient safety. It works well for hospital-based clinicians, such as hospitalists, nursing, and hospital-based physician services. But the autonomy of the independent physician members of the medical staff often resists the chief medical officer’s ability to drive change alone.
The Second Table: Physician Leadership in a Medical Staff
As hospitals are becoming accountable for the value-outcomes of their patients’ care, management turns to the medical staff officers for help. They become the target audience for physician leadership training. The dubious premise is that leaders on the medical staff can change the clinical behavior of their peers to benefit the hospital financially.
Eventually, everyone realizes that a medical staff is not well designed to change the clinical and business practices of its members. Its primary mandate is to set and preserve standards of quality for membership on the medical staff. Managing “pedigree” is what gets the attention - - proof of education, training and certification necessary to be privileged to practice in the hospital. Managing performance is limited to monitoring quality and patient safety practices and advocating for compliance with minimally required standards.
No independent physician would entrust the management of his or her private practice to the medical staff. Why? Because it was never designed to run a business. And in The New World of Healthcare, running a business that assumes the risk for managing the health of a population is exactly where we are going. A new approach is needed.
The Third Table: Physician Leadership in a New Business
What a medical staff cannot do is to manage the Business Performance of its members -- keeping referrals in-network, assuring high patient satisfaction, and following agreed-upon clinical protocols based upon best evidence-based practices. The real work of Population Health Management will require a litany of new business competencies that combine both the institutional resources of the health system and the collaborative leadership capacity of physicians:
• Linking EHRs from inpatient to ambulatory, with evidence based protocols
• Reduction of Inpatient Readmissions
• Managing cost and utilization of resources across the continuum of care
• Improvement of Patient Compliance
• Managing Clinical Quality Metrics by provider
• Increasing Patient Engagement
• Stratification of patients and targeted interventions to the right people
• Provision of outreach, ambulatory management of chronic diseases
• Connections with Community Based Organizations
Moreover, the physician members of this new business are typically a sub-set of those who compose the medical staff.
Think of a “tree house” that a few physicians have built, in partnership with the hospital, and they are looking down at those who were not invited to join the new club. The criteria for membership in the club go beyond the “pedigree” requirements for medical staff membership. They focus upon the business need and business performance of the physicians invited to join, and there is a “trap-door” in the clubhouse to jettison those who do not maintain high-quality performance. New entrants are selected by criteria that serve the business’ customers (payers, narrow networks, etc.).
The medical staff members outside the new business are accustomed to being entitled to “privileges” to practice, without an invitation, based upon the proper education, training and experience, and subject only to the minimally required community standards of care in their specialty! Conflict will certainly arise when the new business hangs out its shingle for the first time. And the physician and executive leaders of the new business, who often wear hospital and medical staff leadership as well, must be very clear and consistent in remembering which hat they are wearing when managing that conflict.
Because the new business, unlike the medical staff, can exercise the prerogative to choose who will sit at the table of running the new business, executives and physician leaders at The Third Table will be blazing new territory. Both groups will need to convert from their “expert” personas to “learners,” employing the curiosity, respect and emotional intelligence required to blend their business skills and clinical experiences to build the new business.
The Irreducible Ingredient for Success: Leadership
Creating structures to achieve legally compliant clinical integration are far easier to do than is finding and developing the leadership capacity required to actually implement and lead those new enterprises.
And without effective leadership - - particularly physician leadership - - the best strategies will flounder and fail.
Leaders rarely fail because they don’t know what to do. They fail because of how they do it. Behavioral competencies (emotional intelligence and relationship skills) rather than just technical competencies (knowledge of finance, operations, etc.) distinguish highly effective leaders.
Recent research reveals that the behavioral competencies needed by physician leaders are different from non-physician leaders. Collaboration, political acumen, motivating others and adaptability are behavioral competencies that are critical to the success of physician leaders, and are less evident among physicians than the general population. But they can be learned. And they are best learned in an experiential, rather than didactic, environment.
The winners in The New World of Healthcare will emerge wherever executive and physician leaders come together as equal partners around The Third Table with the right Table Manners. And effective physician leaders will be the key to their success.
Courage of one's convictions is among the rarest of characteristics among leaders in any industry.
Harvard professor of change Clay Christensen's says that leaders of legacy organizations -- like hopsitals/health systems -- will not be the ones to disrupt it's own business model to adopt a new one. Yet the author of this article makes a great additional point: "No one looking to make a profit would enter the industry today under the current fee-for-service model. The margins just aren't there. However, there are margins to be made under a new business model, and whoever gets there first will win."
Jim Collins' book, Built to Last, has informed the thinking of leaders in healthcare for years. I like how my colleague, Blaine Bartlett, in his blog today, notes that "it implies solidity, endurance, longevity, and stability. So, how could this possibly be bad?" [Built NOT to Last?]
In healthcare, perhaps more than any other industry, resistance to change is huge. There's good reason in many cases: clinicians are trained to adhere fiercely to protocols with proven results. Adapting to new protocols doesn't come easily.
Healthcare executive leaders will be challenged to learn how to work with clinical leaders to create a culture that makes it safe to innovate. By definition, one cannot innovate without the failures that add up to ultimate success.
In my work with healthcare executives around the country, one very common experience for each and every one is stress - - a low-grade fever of pressure, hurry, and worry that robs them of their productivity, sleep and health.
I loved one executive's metaphor for his life: "My life is like driving a dynamite truck 100 miles an hour, down a winding mountain road, with bad brakes!"
The solution I offer each one I meet is simply this: take time to stop, sit down, breathe and think.
That's why I offer this link to a blog by a former West Point grad and Microsoft exec who learned how to deal with the overwhelming stress in his life through simple techniques for slowing down and thinking.
In my work with healthcare executives, it's important to help leaders think clearly about how to deal with the radical transition facing our industry.
One of the common refrains is that, while we know we're entering a new world of Pay for Value, the huge enterprise we run today is still being funded largely under the old world of Pay for Volume. Moving too fast, or too slow, could be financially catastropic. How can we time our steps in the transition so as to optimize our revenues and margins?
I offer a Strategic Brief from my website entitled, "Facing the Brutal Realities of the New World of Healthcare" that outlines what I view to be "4 Sure Bets" for healthcare executives to employ in the transition to the New World of healthcare payment. It may also be a useful primer for hospital boards, medical staff leaders and others to understand WHY their institution's leaders are taking such actions.