Enabling Health Professionals to Respond to Their Customers

Daniel A. Gregorie, M.D., M.B.A

Enabling Health Professionals to Respond to Their Customers

Who are their customers?What are their customers telling them?How are they responding?What is required to respond effectively?Why are they unable to do so?What is needed to enable and support them?

Enabling Health Professionals to Respond to Their Customers

Who are their Customers?

The people who pay for and / or benefit from their services

Patients

ConsumersPurchasers (employers and government)Payers ( insurers and third party administrators)

Enabling Health Professionals to Respond to Their Customers

What are their customers telling them ?

The direct $ cost of medical care is untenable

The numbers of un/underinsured are growing.

Enabling Health Professionals to Respond to Their Customers

What are their customers telling them ? (cont)

More is not necessarily better

High Rates of Error and Non Evidence Based Care

Significant variation in process and outcome

Enabling Health Professionals to Respond to Their Customers

What are their customers telling them?(cont)

Poor Service--access, personal attention, and convenience

Enabling Health Professionals to Respond to Their Customers

What are their customers telling them?

In short, they want better VALUE

VALUE=QUALITY/COST

Enabling Health Professionals to Respond to Their Customers

Components of Value

QualityService : access, personal attention, convenience

Care: Evidenced based standardized processes and expected outcomes

Enabling Health Professionals to Respond to Their Customers

Components of Value (cont) Cost

Direct $Morbidity/Functional ImpairmentLost Productivity

Enabling Health Professionals to Respond to Their Customers

What are their customers telling them?(cont)

More than just reassurance of value Transparency Measures of Value Objective Information Involvement in Decision Making

Enabling Health Professionals to Respond to Their Customers

How are they responding?

Struggling to understand

Running faster on the same wheel

Unable to see the path off that wheel

Enabling Health Professionals to Respond to Their Customers

What is required to mount an effective response?

WELL LED AND MANAGED ORGANIZATION OR ORGANIZATIONS (SINGLE AND / OR MULTI-SPECIALTY) WHICH SUCCESSFULLY INTEGRATE THE BUSINESS AND CLINICAL REQUIREMENTS OF HIGH VALUE HEALTH SERVICES DELIVERY AND WORK IN AN ALIGNED PARTNERSHIP WITH THE OTHER COMPONENTS OF THE HEALTH CARE DELIVERY SYSTEM*

*See Appendix A and B

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Unconscious incompetence

They don’t know what they don’t know and don’t know it

INCOMPETENCE COMPETENCE

CONSCIOUSNESS

UNCONSCIOUSNESS

CONSCIOUS INCOMPETENCE

UNCONSCIOUS INCOMPETENCE

CONSCIOUS COMPETENCE

UNCONSCIOUS COMPETENCE

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Unconscious Incompetence (cont) They missed the 20th Century Quality and

Quality of Management Revolution Customer Focus Continuous Improvement Total Participation Societal Networking

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Unconscious Incompetence (cont) They are unaware of major global trends*

and the implications for their world Global Markets Democratization of Technology,

Information, and Finance Decentralization of Decision Making

*Tom Friedman, The Lexus and the Olive Tree

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Unconscious Incompetence (cont)

Leadership and Management Knowledge, Skills & Commitment

You can’t lead and manage a successful organization taking off your white coat and putting on your business suit a couple of hours a week between patients

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers

INDIVIDUAL AUTONOMY

Practicing alone together

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

INDIVIDUAL vs.

TEAM / ORGANIZATIONAL ACCOUNTABILITY

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

ATHENIAN DEMOCRACYElected “political” leaders

The interest of the whole is the sum of the individual interests of its constituents

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

DYSFUNCTIONAL LEADERSHIP MODEL

Unpaid, Unprepared, and Rotating

Political Accommodation vs. Principle Based Facilitation

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

CONSENSUS DECISION MAKING

“Black Ball” Obstructionism

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

PATERNALISM

Patients as “wards” vs. customers

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

PROVIDER CENTRISM

“My time and responsibilities are more important than my patients’ “

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Cultural Barriers (cont)

CLINICAL JUDGEMENT

Standardization and process control is “cook book” medicine

Misaligned economic incentives

Aligned incentives (e.g. performance based compensation) require the organizational capability to respond

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Inadequate Access to Capital

Adequate access to capital requires a successful business model and the organizational capability to execute it

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Inadequate enabling and support resources

Private consultants Project and solution focused “expensive” Variable quality

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Inadequate enabling and support resources (cont)

Association programs Episodic—lack sequential comprehensiveness,

cohesiveness and longitudinal continuity Variable quality

Enabling Health Professionals to Respond to Their Customers

Why are they unable to respond effectively?

Inadequate enabling and support resources (cont)

Institute for Health Improvement (IHI)

Focused on the upper tiers of organizational development—the top stories of a building with no foundation

ORGANIZATION AND LEADERSHIP

CULTUREVALUES AND BEHAVIORS

SUPERORDINATE MISSION

VALUE PROPOSITION

COMMITMENT AND ACCOUNTABILITY

RESOURCES

OPERATIONAL CAPABILITIES AND COMPETENCIES

SYSTEMS AND PROCESSES

MEASURABLE RESULTS

Enabling Health Professionals to Respond to Their Customers

What is needed to enable and support them?

A SHARED REALISTIC INTERPRETATION OF THE INTERNAL & EXTERNAL ENVIRONMENT AND RELATED REQUIREMENTS

A SHARED COMMITMENT TO A STRATEGIC DIRECTION

BUSINESS GOVERNANCE &ORGANIZATIONAL LEADERSHIP AND MANAGEMENT COMPENTENCY

COLLECTIVE PROFESSIONAL CONTROL, RESPONSIBILITY, AND ACCOUNTABILITY

INDIVIDUAL ACCOUNTABILITY FOR INDIVIDUAL AND COLLECTIVE PERFORMANCE

CULTURAL TRANSFORMATION

CAPITAL PARTNER

Enabling Health Professionals to Respond to Their Customers

What is needed to enable and support them?

A Sustained and Adaptable Ongoing Facilitation, Education and Support

Resource with the Requisite Expertise and Experience To Assure A Clear

Viable Vision and the Organizational Capability & Commitment to Achieve It