adaptive design

Redefining Success: Designing To Adapt In 21st Century Healthcare

Written by Dr. John Kenagy and posted on website on November, 24, 2017

Modern Healthcare has problems, and that’s our opportunity.

  1. All healthcare organizations are under pressure to maintain financial stability and some can’t. What if you had financial strength?
  2. A recent survey reported 85% of patients and providers say healthcare costs are disproportionate to What if your patients said, “My care is a great value!”
  3. Ninety-six percent of patients believe U.S. healthcare has problems. What if your patients said, “My healthcare system solves my problems!”
  4. An astonishing 80% of patients say their health has not improved in the last year. What if your patients said, “I have access to the Best Care! My health is improving! I can afford it and I love it!”

None of our great Centers of Excellence (CoE) can provide more access to the Best Care at continually lower cost. What if your organization differentiated itself by doing exactly that? You would become a Center of Value and Excellence (CoVE) and have competitive advantage in 21st Century healthcare.

How would that happen? I’ll explain… what is the surest path to success, 1 or 2?

  1. Management ideas, best practices, projects, consultants and technologies?
  2. Adaptive learning and internal innovation?

Most identify #1 as important, but see the key to redefining success is #2. Here’s why: most management ideas, best practices and technologies are readily available to be copied and implemented, and consultants will be overjoyed to have you pay them to do it.

Therefore, adaptive learning and internal innovation are your key sources of differentiation and competitive advantageSo, here’s what to do and not do…

  1. Don’t buy solutions! Our current system is perfectly designed to deliver all our woes. It’s a system problem to solve with no quick fix. We all have intelligent, talented, skilled, committed people. Why not empower them to create system solutions? Use Adaptive Design: the continuous improvement Operating System.
  1. Don’t Implement Best Practices! Multiply the power of your people and resources to develop your own new best practices. The goal is not to copy; it’s to be copied. That’s the objective of the Adaptive Design Online Learning System.
  1. Don’t do big, expensive projects! Think small, simple and safe; then, learn and In Adaptive Design, it’s one unit or service line (the Learning Line) that creates your first Center of Value and Excellence (CoVE).
  1. Don’t use consultants or technology except to solve specific, technical problems! Adaptive Design empowers your people (Learner/Leader/Teachers) to redesign the work, deliver the opportunity and then systematically replicate and scale
  1. Don’t implement solutions! Instead, leadership sets direction with a clear, consistent, meaningful Purpose (Ideal Patient Care), and then uses four simple rules to drive continuous improvement as part of everyone’s daily 

For example, an Adaptive Design Learning Line in a Midwestern community hospital just increased their HCAHPS scores 107%, and improved their Balanced Scorecard results from lowest to highest in the hospital, all in less than six months.

That’s success redefined: low risk, high reward, fast.

Seize the Initiative!

What: Going On Offense in the Chaos of 21st Century Healthcare Workshop

Timeline: Day 1

          8:00 am to 4:30 pm- Workshop (Lunch provided on site)

          5:00 pm to 7:00 pm- Dinner provided

         Day  2

                    8:00 am to 10:00 am- Workshop Review

Objectives:  What got you here, won’t get you there! This strategic workshop explores the transitional care space between acute/post-acute providers for opportunities to seize initiative and set a new line of departure for the 21st Century. For decision-makers from the C-Suite to the Frontline, workshop deliverables include how to rapidly:

  1. Develop self-diagnostic, self-sustaining systems that eliminate readmissions and maximize value across the acute/post-acute care continuum.
  2. Use three, real world, battle-tested, practical leadership tactics to immediately create competitive advantage in complex work environments: Commander’s Intent, the OODA Loop and Workforce Multiplication.
  3. Seize the Initiative! Move from defense to offense by enhancing awareness of opportunities in your community through actionable intelligence. Design, replicate and scale high value information and innovation systems that never stop increasing access to more effective, patient-centered care at continually lower cost.

Seize the Initiative” Detailed Workshop Description


This workshop is led by Dr. Kenagy in partnership with ABCM Corporation. If you are interested in attending or booking a workshop like this, please contact Dr. Samuel Stanton for questions at (641) 580-0562


Adaptive Design in Medical Education

Ohio University’s Heritage College of Osteopathic Medicine and OhioHealth Doctors Hospital in Columbus, Ohio are collaborating to explore creating Ideal Patient Care in both Undergraduate and Graduate Medical Education. Starting November 2016 in a single OhioHealth Doctors Hospital unit, the objective is to develop Adaptive Design throughout the hospital and simultaneously link to Ohio University’s medical student, resident and fellowship education programs.

For more information, contact us!


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Healthcare Innovation: Sense/Respond/Adapt series, part 1

More Consultants and Technologies? Or the Right Consultant and Technology?

 My years as a physician, healthcare executive, academic researcher and patient have taught me one thing for sure: in acute care medicine and management, although our predictions and estimates are usually correct, we really don’t know what’s going to happen tomorrow.

If you are a clinician, you know as soon as you say, “Boy, it sure is quiet tonight,” the ambulances from a crash of a busload of hemophiliacs arrive. For an executive, it’s always another unexpected cost, drop in volume, unfunded mandate, regulation, or audit that disrupts our best-laid plans. We live in an unpredictable world because unexpected, unpredictable things happen.

Most of us intuitively know that is true – but why is healthcare so unpredictable?

Maybe it’s because we don’t have enough rigorous, data-driven management systems in place (e.g., Lean, Six Sigma, Activity Based Costing, Compliance and Control); or we don’t have enough technology (e.g., EHR’s, Data Warehouses, Enterprise Resource Planning systems).

Are tighter management and more data systems the answers? How would we know? One option is to do a Root Cause Analysis. So let’s “Ask ‘Why’ five times,” using the mindset of a traditional executive decision maker.

  1. Why is healthcare unpredictable? Because our work is not standardized.
  2. Why is our work not standardized? Because we have too much process variation.
  3. Why do we have process variation? Because we haven’t gathered and analyzed enough data, done enough projects/Kaizens and implemented enough standard work, e., not enough project-based, process reengineering and control.
  4. Why not enough data, projects and implementations? Because that’s a lot of work requiring many experts doing lots of work to help reengineer processes.
  5. Why are too much work and not enough experts & technology a problem? Because we haven’t hired enough expert consultants and bought enough technology to standardize Best Practices and eliminate variation throughout the organization.

So, the answer must be: hire more consultants and buy more technology. Wrong!

This is exactly what we have been doing at steadily increasing rates and costs for the last forty years. Despite all our hard work and the diligent efforts of many committed intelligent people, no large healthcare organization can consistently provide more access to better, safer care at continually lower cost. That is the value-driven healthcare problem we must solve.

I’m not optimistic that “trying harder” with more consultants and technology is the answer. I see our current situation analogous to Dilbert’s:

Dilbert image

Think about your healthcare organization. Is Dilbert a cartoon, or a documentary?

If it is a documentary, you work in an organization that frequently hires consultants and uses technology to eliminate variation and implement new, machine-like, efficiency systems.

If that fits, don’t feel alone. These traditional “Mindsets, Methods, Strategies and Structures (M2S2)” are present in established organizations, both in and outside of healthcare.

In my four years as a Visiting Scholar at Harvard Business School, I discovered our data up/implement down M2S2 was built on management systems born in the Industrial Revolution of the late 19th Century and then brought to fruition with more consultants and technology in the mid 20th Century.

Now, the problem is our 21st Century world is much more complex, dynamic, and unpredictable, particularly in healthcare. So, should we hire more consultants, buy more technology and try harder?

The evidence shows that is not the right question to ask. Why? – Let’s put it this way: buying more forks will not make it easier to eat soup. It’s not more; it’s the right consultants and technology that will make the difference.

Here’s why (a quote from my book in Chapter 8),

“Exact medicine can no more be achieved than exact history. Because no human story with a foreordained plot can be anything but a fiction.”
Joseph Schumpeter

Traditional 20th Century consultants and technologies eliminate variation and increase control to effectively Make, Standardize and Sell profitable products and services. The objective was to implement “the plot” of standard work, compliance and control. In the simpler world of the Mid-20th Century, it worked and success was built on “Make/Standardize/Sell.“

In the unpredictably complex world of today, the compliance and control “plot” has become a fiction. We are great at improving what we know how to do, but find it almost impossible to adapt and do what we don’t know how to do: e.g., organically innovate. Harvard Business School and many other researchers’ data are clear; 95% of established organizations fail to innovate outside the framework of their current success. They fail to Sense, Respond and Adapt.

This is not a fight; Make/Standardize/Sell systems are still important, but most managers are pretty good at doing that already. It’s just that success in 21st Century, value-driven, healthcare requires a Sense/Respond/Adapt capability that traditional consultants and technology reengineering processes and standardizing work can’t deliver.

Like exact medicine, exact management can no more be achieved than exact history. Key to success in an unpredictable work is the ability to Sense, Respond and Adapt.

So, it’s not more; it’s the right consultants and technology. Fortunately, the history of innovation is clear about what the right consultants and technologies will do. They will:

  1. Support current Make/Standardize/Sell capabilities
  2. Simultaneously enable organizations to Sense/Respond/Adapt to create new value products and services.
  3. Understand the secret of success: it’s not either/or, it’s


What do you think? Do we need more consultants and technology or the right consultants and technology? And, if so, how would you identify them?

This is the first in a series of Agile, Adaptive Leadership Innovation M2S2 Guides designed to help you identify the right consultants and technologies to better manage in the present and Sense/Respond/Adapt to make the future.  In the next we explore the characteristics of Make/Standardize/Sell and Sense/Respond/Adapt in complex organizations.


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Adaptive Design Has “Teal” Characteristics

Many people sense that the way healthcare is run today has been stretched to the limits. And it’s not just a healthcare problem.

“In survey after survey, business people make it clear that in their view, companies are places of dread and drudgery, not passion or purpose. Further, it applies not to just the powerless at the bottom of the hierarchy. Beyond a façade of success, many top leaders are tired of the power games and infighting; despite their desperately overloaded schedules, they feel a vague sense of emptiness.”

This a quote form The Future of Management is Teal; a fascinating history of the evolution of human organizations from 10,000 years ago to the present day by Frederic Laloux in Strategy+Business.

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Improving Excellence in Healthcare with Dr. John Kenagy

This interview originally appeared in the Blog

Dr. John Kenagy is a well-respected physician, executive, academic researcher and lecturer with a unique view of healthcare. Forbes magazine featured Dr. Kenagy as “the man who would save healthcare.”

Success in 21st century healthcare requires more than excellence,
it requires an organization to succeed seeking value rather than volume.

SPEAKING.COM: What are some of the common characteristics shared by successful healthcare organizations?

KENAGY: Excellent care is obviously important, but Centers of Excellence (CoE’s) have been around for a long time – it’s a 90’s term and times have changed. Success in 21st century healthcare requires more than excellence, it requires an organization to succeed in seeking value rather than volume. They work differently than traditional CoE’s, therefore I call them Centers of Value and Excellence (CoVE’s). Characteristics of a successful healthcare CoVE’s include:

a. A clear, consistent, meaningful and patient-centric Value Proposition. 

b. Flexible, responsive, interdisciplinary care teams with everyone working at the top of his or her license.

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17 Years vs. 3 Months

We commonly hear that “implementing Best Practices” is one of the solutions for creating new value in healthcare. I recently came across a social media exchange describing research that shows: ‘it takes an average of 17 years for discoveries about best practices to become part of everyday clinical care.”

17 years?! Yes! It is a well-documented fact. Continue reading

Radiology Video

I have used Adaptive Design in clinics & hospitals nationwide and always see the positive results & innovation that generates more and better care at continually lower cost. But it can be difficult to comprehend working adaptively because “you cannot know until you see; and you cannot see until you do.”

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Quality in Healthcare Then and Now

Our healthcare problems are not new. We have been having these conversations for decades. It’s just that now there are changes that are happening in healthcare all at once – the cost of care skyrockets as baby boomers are retiring, more people are struggling to navigate our increasingly complex systems, regulation increases, complex IT and electronic health records get in the way, etc. It’s simply more difficult for patients to get the quality of service they need and for caregivers to deliver it to them.

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