1 First: Second: Preparing organization for the future is the key - - PDF document

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David M. Lawrence February 2015

 Hunkering down or Staying the Course…  Not betting on particular future, then

devising a strategy to reach…

 Not short-terming…cutting costs, finding the

next profit center, or following crowd to consolidate and/or buy doctor’s practices…

 Identify many possible futures (scenarios)…  Build organizational capacity to succeed

under widest range of them…

 Consistent with critical outcomes and values

that define you and determine your future success…

 Strong, resilient, responsive, innovative

• rganization (people, balance sheet, margins,

reputation, ties to communities, innovation engine, etc.)

 Obsessed with delivering the best care

possible to every patient, every family, every consumer, and the communities you serve.

 Best possible care  Innovation  Competitive Intelligence and Responsiveness  Strong margins  Scenario-based planning…  Four interlocking, often synergistic

capabilities…

 Building and strengthening these capabilities

• ver time

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 First:

 Preparing organization for the future is the key job of leaders…Board, management, clinical leaders…everyone responsible for ensuring a future for your organization.  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.

 Second:

 Arthur Ashe: “You start where you are, use what you have, and do the best you can.”

 Goal: establish explicit boundaries around

“what ifs”.

 Open minds of those involved to how well

• rganization positioned to respond.

 Agree on key steps must take to build the

capacity required to address those scenarios.

 Recommit to values and core capabilities that

are non-negotiable.

 Exercise and dialogue as important as

• utcomes.

 Best Possible Care

 Safest and most effective, timely, responsive, efficient and equitable care we know, can find, or can discover.  Care that improves quality of life for patient, lowers the costs of care, and improves the health of the community (Triple Aim)  Results from relentless elimination of waste…poor quality…through focus on elimination of unnecessary and/or inappropriate variation in care and care processes…the underlying driver of costs and the major cause of harm, poor outcomes and poor experiences.  An unending journey.  Variation often misunderstood, especially by clinicians…

 Key words: “unnecessary” and inappropriate”  Every step in care process must be subjected to that test by those who know and those affected.  Rarely able to limit clinical decision-making to single path. Must construct variation limits based on evidence and clinical consensus.  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.  Innovation

 Discovering or finding, anywhere we can, then adopting as appropriate, new and better ways of doing what we do now.  Purposeful and directed, encouraging spontaneity and creativity.  Requires staffing, funding, flexibility and agility

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 Competitive Intelligence (and ability to

respond)

 Know and follow what all possible competitors are doing, and understand potential impact on

• rganization if succeed.

 Constant vigilance, discussion, debate, analysis in

• rder to respond appropriately.

 Critically important because healthcare is shifting from small and incremental impacts from competitive threats to large, lumpy losses because of providers and/or consumers switching in blocks.

 Margin Protection

 Margin is what’s left over after expenses are paid.  Drives financial stability, ability to reinvest, and to grow.  No margin, no mission.  Top line growth getting harder  So bottom line (cost management) increasingly critical to maintain margins.

 Systems  Partnerships  Personal Leadership  Explicit, designed, managed, accountable,

focused, practical, robust, local and nested in core values and aspirations of the

• rganization.

 Language  Learning  Transparency  Innovation  Information  Prods  Accountability and Compensation  Operating Discipline  Language

 What you say about and do in your organization: its values, purpose and direction.  Requires attention to words, phrases, actions, symbolism, stories.  Must assess relative weight of words and phrases: especially mixing “quality”, “patient satisfaction” and “costs”…(for clinicians “costs” especially loud and troublesome.

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 Learning

 Enables organization to learn, discover, challenge, debate.  Focused on operations, scenarios, and competitors.  Defined accountabilities and budget.  Method for capturing and disseminating learning  And trying, failing, and learning from mistakes.

 Transparency

 Enables you and everyone in the organization to know what is happening and why; how you are performing; how you are threatened by competition and other

• utside forces, etc.

 Enables people outside the organization to see into the

• rganization and its performance.

 “No secrets” within reason…

 Protect organization as required but err on side of disclosure.  Protect the rights and privacy of individuals within the

• rganization or once associated with the organization.

 Innovation

 Already discussed

 Information

 The data, information and insights needed to run, assess, correct, and learn.  Both the care itself, and the operation of the

• rganization and its parts.

 A strategic and operationally driven system not a product.

 Prods

 Organizational “Picadores”: provoke, weaken, forestall tendency to spring-back to prior behaviors  Institutes, internal and external consultants and experts.

 Accountability and Compensation

 A communications tool: reinforces mission, values,

• bjectives.

 Rewards what the organization needs and values.  Group incentives wherever possible (including with physicians) as opposed to individual incentives.  Quality gate.

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 Operating Discipline…the big one

 The overarching system (not a tool)  One not many  Focuses on how work is done everywhere  Enables best care possible.  Teachable and reproducible  Analytical and data driven

 Best Known System for Healthcare: Six Sigma. Also the hardest.  Difficult to design, implement and manage.  Especially difficult to drive into the

• rganization.

 Cannot be done alone or by the Executive

Team of the organization. Must engage all the constituents working in and affected by the organization.

 This means Partnerships…  Board of Directors  Executive Team  Physicians  Workforce  Patients, Families, Consumers, and

Community

 Board of Directors

 Accountable for values, objectives, performance, and future  Employ the executive team  Keepers of the moral/integrity of the organization  Thought partners for Executive and Executive Team

 Executive Team

 Built to have diverse skills, perspectives, backgrounds, styles…not diverse values.  Encouraged to debate and disagree both in camera and throughout the organization.  Encouraged to bring feedback to team from their natural constituencies.  Named members: CFO and HR Leader. Others depend

• n organization.

 Physicians

 Common Ground essential.  Acknowledge and honor overlapping ethical frameworks: the best for each patient vs. the best for the organization, in order to reach the most appropriate solution for a particular issue or problem.  Engage, engage, engage.  Honor, honor, honor  Remove cancers.

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 Workforce

 Same as physicians  Engage, engage, engage  Honor, honor, honor  The LMP experience

 Patients, Families, Consumers, Communities

 “Marinate in their voices”  The super glue for your organization (the “heart” of the matter)  The most powerful lever for change you have.  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  Executive Team  Physicians  Workforce  Patients, Families, Consumers, and

Communities

 Preparing and Leading  First Steps  Maintaining Focus and Drive  Maintaining Personal Health  Managing Loneliness  Preparing and Leading

 Your moral core  Your flat spots…strengths and weaknesses in skills, experience, and perspective.

 First Steps

 Resignation Date  Succession Plan  Communications Network…listening instead of doing

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 Managing focus and drive

 True north as the primary source

 Managing Personal Health

 Exercise, diet, sleep  Private/quiet time and space  Family…a safe harbor

 Managing Loneliness

 Maintaining perspective…family, partner, hobbies  Recognizing the symptoms so can resist the need to become part of the crowd.  Other leaders…the value of social networks.  Read.

 Uncertain future.  Specific capacities required to create

• rganizational flexibility and responsiveness.

 To build need systems, partnerships, and

personal leadership.

 A moral journey without end.  The primary job of organizational leaders.