Enabling Health Professionals V2 E Rev

Enabling Health Professionals to Respond to Their Customers

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


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?


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)


What are their customers telling them ?

The direct $ cost of medical care is untenable

The numbers of un/underinsured are growing.


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


What are their customers telling them?(cont)

Poor Service--access, personal attention, and convenience


What are their customers telling them?

In short, they want better VALUE

VALUE=QUALITY/COST


Components of Value

QualityService : access, personal attention, convenience

Care: Evidenced based standardized processes and expected outcomes


Components of Value (cont) Cost

Direct $Morbidity/Functional ImpairmentLost Productivity


What are their customers telling them?(cont)

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


How are they responding?

Struggling to understand

Running faster on the same wheel

Unable to see the path off that wheel


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


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



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

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



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



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



Cultural Barriers

INDIVIDUAL AUTONOMY

Practicing alone together



Cultural Barriers (cont)

INDIVIDUAL vs.

TEAM / ORGANIZATIONAL ACCOUNTABILITY




ATHENIAN DEMOCRACYElected “political” leaders

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




DYSFUNCTIONAL LEADERSHIP MODEL

Unpaid, Unprepared, and Rotating

Political Accommodation vs. Principle Based Facilitation




CONSENSUS DECISION MAKING

“Black Ball” Obstructionism




PATERNALISM

Patients as “wards” vs. customers




PROVIDER CENTRISM

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




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





Inadequate Access to Capital

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



Inadequate enabling and support resources

Private consultants Project and solution focused “expensive” Variable quality



Inadequate enabling and support resources (cont)

Association programs Episodic—lack sequential comprehensiveness,

cohesiveness and longitudinal continuity Variable quality



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


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


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

Enabling Health Professionals V2 E Rev

Health & Medicine

Transcript of Enabling Health Professionals V2 E Rev