Leading Healthcare in Value and Reliability
Parts 1 and 2 of this series showed how traditionally managed companies are Make/Standardize/Sell organizations – great at improving what they know how to do, but finding it difficult to do what they don’t know how to do. Innovation requires a different set of methods, skills, tools and a different level of thinking – Sense/Respond/Adapt.
This Part 3 is a high level view of how to create Sense/Respond/Adapt capability in any organization. Each step applies to both leadership and the frontline. The key to success is to take them together.
The first step is Awareness. Albert Einstein helps us:
“In the middle of difficulty lies opportunity.
The significant problems we face today require a different level of thinking
than we possessed at the time they were created.”
But are times really that difficult? Do we require a different level of thinking? Aren’t we OK? Can’t we just “try harder?” Take the following test and see. Score: 1 for Yes, 0 for No.
- Score = 5 or higher: These are classic Make/Standardize/Sell concerns and actions. You are doing the same thing over and over again and expecting different results. You need a different level of thinking to create new value.
- Score = 3-4: If you are struggling, times are getting more difficult. Start thinking differently.
- Score = 0-2: If you are succeeding, you are unusually adaptive. Keep it up!
If you scored 3 or higher, the data is clear, you are tightening down the screws on the Make/Standardize/Sell healthcare business model. This current level of thinking leads to increasing complexity, change and cycles of profit and loss.
To help with your Awareness, consider the following slide. Do the outcomes illustrated seem familiar? Was Jack Welch correct?
The second step is to make it safe and easy to balance Make/Standardize/Sell and a new Sense/Respond/Adapt level of thinking in the same organization. It’s a step of what not to do that starts with leadership, but needs frontline engagement particularly for #3.
- Never make big bets. Never buy big solutions. Don’t implement expensive technology or someone else’s innovations and Best Practices.
- Don’t try harder at what hasn’t worked in the past. This is a difficult rule to follow because past experience deeply embeds conventional mindsets and methods in both leadership and the frontline.
- Don’t fight the current system. Your goal is not to eliminate Make/Standardize/Sell but rather to add Sense/Respond/Adapt. Leadership and the frontline need to work together to pick a place to start to work differently – small, simple, and safe.
The third step is to know HOW. Don’t reinvent the wheel. Adaptive Design is a low risk, high reward, Sense/Respond/Adapt system that is easy to replicate and scale.
Unlike conventional consulting, Lean, Six Sigma and other project-based, project-reengineering methods, Adaptive Design is a self-sustaining system for designing, doing and improving complex work, both within and across disciplines. Here’s how:
Sense – Adaptive Design is highly sensitive to changes in complex work environments that open the door to innovation. It systematically creates an atmosphere of anticipation focused on identifying opportunities to improve.
Respond – It is an innovation system that accomplishes three important things:
1. Develops the capacity to rapidly identify, investigate, act on and validate new ideas.
2. Creates a flexible, responsive circulatory system for those ideas,
3. Grows a sustainable, purpose-driven culture that thrives on continual change.
Adapt – Adaptive Design builds institutional resilience by giving everyone a clear understanding of the circumstances that either favor or threaten the success of your organization and, simultaneously, linking that information to action as part of everyone’s daily work.
Consider the case of the Mayo Health System. Mayo sought to improve Pay-for-Performance metrics and Diabetic Population Health by having physicians meet Diabetic Scorecard goals. The following slide shows two groups of physicians: Mayo physicians using Adaptive Design (in blue) compared to all Mayo Health System physicians (in red).
Sense – As you can see, conventional Make/Standardize/Sell management (e.g., meetings, consultants, projects, Lean, incentives, technology, Best Practices, monitoring, audits, etc.) failed to improve performance in either group prior to starting Adaptive Design.
Respond – Adaptive Design started (small, simple and safe) in five Mayo Health System clinics and hospitals in Minnesota and Wisconsin.
Adapt – In three months the Adaptive Design Mayo physicians separated their performance scores from all the rest of the system. At one year, Adaptive Design physician-led team scores were 122% higher than the average of all Mayo physician scores.
These clinics also sustained and increased this Population Health success. Four years later (as documented in American J. of Med. Quality, 11 Jan 2013), Mayo did another study focused on a bundle of therapies to improve hypertension in diabetics. Owatonna, one of the five Adaptive Design Clinics, had the lowest initial blood pressures (blue bar) and the greatest percent improvement with the new therapies (gold bar) in the entire Mayo Health System.
In summary, Make/Standardize/Sell is great at improving what we know how to do. But the data also show that even the best struggle to do what we don’t know how to do – e.g., create more value in healthcare. That requires Sense/Respond/Adapt capability.
In Adaptive Design, the definition of “more value” is simple, clear, consistent and easily measurable. You prove you are value-driven when current resources generate:
- More access,
- To better, safer, more reliable care,
- At the same or lower cost.
What are your thoughts? I propose it is likely you work in a Make/Standardize/Sell organization. What do you Sense? How could your organization add a Sense/Respond/Adapt component?