Hunkering down or Staying the Course… Not betting on particular future, then devising a strategy to reach… David M. Lawrence Not short-terming…cutting costs, finding the February 2015 next profit center, or following crowd to consolidate and/or buy doctor’s practices… Identify many possible futures (scenarios)… Strong, resilient, responsive, innovative organization (people, balance sheet, margins, reputation, ties to communities, innovation Build organizational capacity to succeed engine, etc.) under widest range of them… Obsessed with delivering the best care Consistent with critical outcomes and values possible to every patient, every family, every that define you and determine your future consumer, and the communities you serve. success… Best possible care Scenario-based planning… Innovation Four interlocking, often synergistic capabilities… Competitive Intelligence and Responsiveness Building and strengthening these capabilities over time Strong margins 1
First: Second: Preparing organization for the future is the key job of leaders…Board, management, clinical leaders…everyone responsible for ensuring a future Arthur Ashe: “You start where you are, use what you for your organization. have, and do the best you can.” Even with good balance sheet, strong margins, and exciting new profit centers, the job of leadership is incomplete until these capabilities are established. Leaders, then, must manage the short term while laying groundwork for the future. Especially challenging in healthcare. Goal: establish explicit boundaries around Best Possible Care “what ifs”. Safest and most effective, timely, responsive, efficient and equitable care we know, can find, or can discover. Open minds of those involved to how well Care that improves quality of life for patient, lowers organization positioned to respond. the costs of care, and improves the health of the community (Triple Aim) Agree on key steps must take to build the Results from relentless elimination of waste…poor capacity required to address those scenarios. quality…through focus on elimination of unnecessary and/or inappropriate variation in care and care Recommit to values and core capabilities that processes…the underlying driver of costs and the are non-negotiable. major cause of harm, poor outcomes and poor experiences. Exercise and dialogue as important as An unending journey. outcomes. Variation often misunderstood, especially by Innovation clinicians… Discovering or finding, anywhere we can, then Key words: “unnecessary” and inappropriate” adopting as appropriate, new and better ways of doing Every step in care process must be subjected to that test by what we do now. those who know and those affected. Purposeful and directed, encouraging spontaneity and Rarely able to limit clinical decision-making to single path. creativity. Must construct variation limits based on evidence and clinical consensus. Requires staffing, funding, flexibility and agility Most if not all non-clinical decision-processes (steps) can and should be standardized. But always with ability to “pull the cord”, stop the process, step beyond limits as necessary. 2
Competitive Intelligence (and ability to Margin Protection respond) Margin is what’s left over after expenses are paid. Drives financial stability, ability to reinvest, and to Know and follow what all possible competitors are grow. doing, and understand potential impact on organization if succeed. No margin, no mission. Constant vigilance, discussion, debate, analysis in Top line growth getting harder order to respond appropriately. So bottom line (cost management) increasingly critical Critically important because healthcare is shifting from to maintain margins. small and incremental impacts from competitive threats to large, lumpy losses because of providers and/or consumers switching in blocks. Systems Explicit, designed, managed, accountable, focused, practical, robust, local and nested in Partnerships core values and aspirations of the organization. Personal Leadership Language Language Learning What you say about and do in your organization: its values, purpose and direction. Transparency Requires attention to words, phrases, actions, Innovation symbolism, stories. Information Must assess relative weight of words and phrases: especially mixing “quality”, “patient satisfaction” and Prods “costs”…(for clinicians “costs” especially loud and Accountability and Compensation troublesome. Operating Discipline 3
Learning Transparency Enables organization to learn, discover, challenge, Enables you and everyone in the organization to know debate. what is happening and why; how you are performing; how you are threatened by competition and other Focused on operations, scenarios, and competitors. outside forces, etc. Defined accountabilities and budget. Enables people outside the organization to see into the Method for capturing and disseminating learning organization and its performance. And trying, failing, and learning from mistakes. “No secrets” within reason… Protect organization as required but err on side of disclosure. Protect the rights and privacy of individuals within the organization or once associated with the organization. Innovation Information Already discussed The data, information and insights needed to run, assess, correct, and learn. Both the care itself, and the operation of the organization and its parts. A strategic and operationally driven system not a product. Prods Accountability and Compensation Organizational “Picadores”: provoke, weaken, forestall A communications tool: reinforces mission, values, tendency to spring-back to prior behaviors objectives. Institutes, internal and external consultants and Rewards what the organization needs and values. experts. Group incentives wherever possible (including with physicians) as opposed to individual incentives. Quality gate. 4
Operating Discipline…the big one Difficult to design, implement and manage. Especially difficult to drive into the The overarching system (not a tool) One not many organization. Focuses on how work is done everywhere Cannot be done alone or by the Executive Enables best care possible. Team of the organization. Must engage all Teachable and reproducible the constituents working in and affected by Analytical and data driven the organization. This means Partnerships… Best Known System for Healthcare: Six Sigma. Also the hardest. Board of Directors Board of Directors Accountable for values, objectives, performance, and Executive Team future Employ the executive team Keepers of the moral/integrity of the organization Physicians Thought partners for Executive and Executive Team Workforce Patients, Families, Consumers, and Community Executive Team Physicians Built to have diverse skills, perspectives, backgrounds, Common Ground essential. styles…not diverse values. Acknowledge and honor overlapping ethical Encouraged to debate and disagree both in camera and frameworks: the best for each patient vs. the best for throughout the organization. the organization, in order to reach the most appropriate solution for a particular issue or problem. Encouraged to bring feedback to team from their natural constituencies. Engage, engage, engage. Named members: CFO and HR Leader. Others depend Honor, honor, honor on organization. Remove cancers. 5
Patients, Families, Consumers, Communities Workforce “Marinate in their voices” Same as physicians The super glue for your organization (the “heart” of the Engage, engage, engage matter) Honor, honor, honor The most powerful lever for change you have. The LMP experience The most powerful source of support against competitors you can have. Ordered, educated, coached, and routinely and formally part of decisions at four levels 1. Individual clinical decisions 2. Assessment and design of clinical systems 3. Assessment of organizational performance 4. Participation in organizational strategy and decision- making. Board of Directors Preparing and Leading Executive Team First Steps Physicians Maintaining Focus and Drive Workforce Maintaining Personal Health Patients, Families, Consumers, and Managing Loneliness Communities Preparing and Leading First Steps Your moral core Resignation Date Your flat spots…strengths and weaknesses in skills, Succession Plan experience, and perspective. Communications Network…listening instead of doing 6
Managing focus and drive Managing Personal Health True north as the primary source Exercise, diet, sleep Private/quiet time and space Family…a safe harbor Managing Loneliness Uncertain future. Maintaining perspective…family, partner, hobbies Specific capacities required to create Recognizing the symptoms so can resist the need to organizational flexibility and responsiveness. become part of the crowd. To build need systems, partnerships, and Other leaders…the value of social networks. personal leadership. Read. A moral journey without end. The primary job of organizational leaders. 7
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