by Scott Chesney –
RCG recently published a white paper titled “Strategic Context”: Life Hacks for your Business written by Thomas Clarke. This paper addressed the problem that, even with the advanced operations techniques and the vast amount of data and analytics available today, many critical line employees are not fully aware of their businesses’ strategies or their role in helping the company execute that strategy.
For health systems, though, the overarching strategy seems obvious and is often stated in terms of the triple aim1:
The simultaneous pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care.
But while the strategy might be obvious, the methods and tactics that a health system use to try to achieve this strategy vary widely. And team members may not be fully aware of these approaches or, more importantly, the role they play in accomplishing them.
RCG’s Clarke2 noted several reasons why enterprises fail to execute on their strategy. Among them, several apply to health systems:
Unrealistic goals: While strategic objectives may stretch the organization, they still must be realistic. If people feel the goals are unachievable, they may not try.
Lack of leadership: This issue is at multiple levels. It is not only about ensuring that each manager at each level is clear about the accountabilities and authorities they have for strategy implementation; it is about all managers understanding their role as a people manager.
Lack of communication: Communication helps with organizational alignment. If a plan doesn’t get communicated to employees, they won’t understand their role or how they contribute to achieving the organization’s strategy.
Getting caught up in the day-to-day: Managers are often consumed by daily operational problems and lose sight of long-term goals. Unless there is an organizational focus on strategy implementation, managers will focus on their day-to-day work.
Lack of clarity on actions required: The actions required to execute the strategy are not specified or clearly defined.
Inadequate monitoring: Managers are unable to assess if the strategy is being achieved. Without clear information on how and why performance is falling short, it is virtually impossible to take appropriate action.
No progress reporting: There’s no method to track progress, or the plan only measures what’s easy, not what’s important, so no one feels any forward momentum.
Lack of alignment: The organization has not been aligned for strategy implementation. Organizational silos and culture blocks execution and/or organizational processes don’t support strategic requirements.
While these are stated in terms applicable broadly across industries, anyone familiar with the operations of a health system can likely immediately see their applicability. Health systems often operate with overworked staff, a perspective gap between the business functions and the clinical staff, and with a lack of systematic operational information analysis and exchange. Further, hospitals are a key example of the challenges that arise when managers have training in fields other than professional personnel management and leadership. As leaders and executives are often originally clinicians, they are often inexperienced in absorbing strategic business goals and developing the tactics required to achieve them, and further communicating those goals and using information to produce consistent measurement and feedback.
The key principals of addressing these challenges are the same for a hospital or system as they are for another enterprise.
RCG focuses on data integration, analytics, visualization, and modeling, as well as web and mobile development, systems operations, and quality assurance and management (QA/QC). RCG looks at the key principals through the lens of providing better, strategically appropriate, information and analysis at the right time to the right people to communicate effectively and to empower their decision making. We help our customers use the following hacks to apply these principals.
“Evaluate basic decisions in context of the strategy or goal”
RCG strongly believes in the power of data to support good decisions. But sometimes data and analytics fail to achieve the desired outcomes. This typically happens when analytics become a goal in themselves, independent of the strategy of the system. Even among systems, there are a variety of approaches to improving care and reducing costs that require different data and analytic focuses.
For example, is the health system focused on reaching out to new patients, or on retaining and engaging an existing population? This choice drives data collection and analysis focused, in the first case, on the entire population in the service area – especially those not currently engaged with the system. For a system focused on engaging their existing patients, data and analysis efforts should be about that patient pool and their conditions, behaviors, and preferences. Importantly, few health systems have the resources to answer “both”, and so they must decide and prioritize – and the key metric for prioritizing is the business strategy.
Another example comes from the whitepaper:
Effective Workforce Enablement – While a shift lead at a healthcare provider is weighing potential staff scheduling options, what key factors should be considered? Is overtime minimization, optimized utilization, or employee preferences the driving factor?
If the company determines that employee engagement through diverse work experiences is a key long-term strategic benefit, then scheduling should consider minimizing the regularity of assignments and providing cross-training to new areas.
Data enables good decisions by increasing knowledge and helping predict outcomes, but a health system’s strategy is what defines which decisions are the ones that should be made, and which outcomes are desired.
“Inject strategy & goals directly into current processes”
Front-line resources often see strategy as the purview of Senior Management, and perhaps not relevant in their jobs. But an effective organization ensures everyone is executing on and supporting the strategy whether they know it or not. Better yet, using the principals of a simple strategy and clear communications, employees are enabled and know how they are supporting the strategy and why their tasks and processes are part of that strategy.
RCG believes that strategic imperatives can be brought to employees broadly both with technology and with people and processes.
Engage your people. Employee interactions with patients represent the “Number 1” form of communication out to the community. More than advertising or web or social media or anything else you can buy, what front line employees say and how they say it conveys the strategy and focus and attitudes of the health system. And even highly trained clinical personnel do not necessarily understand how or what to convey about the system when they are working with patients.
By simplifying your strategy and communicating it clearly and repeatedly to all team members, you enable these voices to convey and embody that strategy.
Review and align your processes. If patient engagement and experience is a key strategic focus, consider how processes may enable or detract from that. A patient’s experience is unlikely to be positive if they have to spend time filling out forms that contain information the system already has. This need not have anything to do with systems or technology – it may be as simple as having clerical staff work through forms with patients, skipping sections that can be completed with information already provided. Similarly, if revenue cycle improvement is a strategic driver, consider the ways that bills, and account information are getting out to payors and patients. Especially for patient responsibility, our experience shows that a single follow-up email or call can improve payment rates and timeliness significantly.
Whatever your team members attitudes and abilities, your processes define how they work with patients. Ensure that those processes enable your strategy instead of hindering it.
Leverage technology. Just as processes constrain behavior, technology can both constrain and enable it. Strategic leverage in technology means getting the right information into the right hands at the right time – and making it transparent so that little to no “searching” is required.
In the past, some health systems have underinvested in user interfaces and the user experience, particularly for systems and tools targeted to staff and clinicians. But it should be clear by now that the user experience for the clinician translates directly to the experience for the patient. A clinician’s time is the system’s most valuable resource and the time wasted hunting for a common medicine in an unwieldy EMR screen is a direct cost. But the patient’s time and experience of the system, not to mention their anxiety level and potential compliance rate are all impacted as well.
This is not about creating “robo-docs”. But with AI and ML today, systems and software can and should have a pretty good idea what information the clinician is likely to need and what tasks they are likely to have to do, as well as having a good sense about the patient’s overall health picture and their community health situation and their propensity to return for follow up and adhere to guidelines. Putting these data and predictions together helps both patients and clinicians save time and improve outcomes.
“Communicate evolving strategies with new stories or examples”
Clarke makes this point:
Storytelling is a proven method for effective communication. A business
strategy, and especially the best approach to apply that strategy, does not
tend to be naturally intuitive.
The first part of this is not a surprise for anyone in healthcare. Clinicians and other professionals have spent years hearing stories – about symptoms and diagnoses, about surgical cases and outcomes, about legal and ethical scenarios and their aftereffects, and about patient interactions and the clinical and non-clinical results that are the ultimate focus of healthcare. Ideally, clinical staff is communicating to patients and colleagues and other staff using stories to increase the depth and breadth of the ideas discussed and to improve understanding and to enable and support feedback to ensure the information is accurately received.
The same approach must be taken concerning organizational strategy and goals. Whether simplifying the strategy or communicating to customers and employees or enabling clinicians with processes and information, stories serve as a memorable vehicle and metric. Storytelling makes communication memorable. A simple strategy can be expressed in a story or allegory or aphorism. Team members can carry stories with them and relate them to their own lives and experiences and better use them to communicate with others.
RCG has a variety of tools and tactics for working with customers to define and clarify strategies and to apply them across an enterprise to people, processes, and technology. The best way to learn the details of how RCG does this is to read the whitepaper.
For health systems, RCG’s Principals and Senior Consultants have hundreds of years of experience successfully working with clients. Not just creating pretty PowerPoint presentations and walking away, instead partnering with systems and organizations to define and then implement strategies, including communications and training and processes and technology. Any system that is not working through this process in an organized, systematic way is paying a cost in underutilized resources, underwhelmed patients, and inefficient processes.
[1] http://www.ihi.org/communities/blogs/a-primer-on-defining-the-triple-aim
[2] Originally sourced from: Business Insider (AU), 12 Reasons Why Your Business Strategies Fail, May 2018, Peter Mills