Recently, I had the opportunity to query successful healthcare organizations large and small, academic and non-academic, and ask them, “What are the key factors that enable your organization to perform at such a high level?” Nearly every organization gave the same answers and thus, there appear to be universal attributes that lead some organizations to great outcomes and leave others behind. They are:
I. Commitment to culture
As a quip attributed to management guru Peter Drucker states, “culture eats strategy for breakfast.” It certainly transcends it, as every organization iterated that culture had to be addressed before anything was possible. Hill Country Memorial Hospital in Fredericksburg, Texas, went through a period almost a decade ago that its leadership affectionately call “the purge” whereby individuals who could not or would not live up to the organization’s values were asked to leave and the organization went from a low performer to a 2014 Baldrige Award Winner. It is now considered one of the best small healthcare organizations in the nation.
II. Willingness to seek great leadership
Great leaders inspire followers and unite them toward a clearly articulated vision that is completely aligned with their core values. This is a powerful and synergistic bond once it is created and can seemingly accomplish the impossible. One of the bravest things an organization can do is to acknowledge that it requires a leader that it does not possess in its management ranks and seek the right individual who can take the organization from where it is to what it can become. This is a role that few are put on earth to do.
III. Evidence-based clinical and managerial practices
One of the root causes of mediocre performance is non-value added variation, or a way of doing things that is known to not produce an optimum outcome. One of the most difficult things for experienced clinicians and executives to acknowledge is that the way they have been doing things for a long time may not be the best way according to contemporary research and standards. It requires both character and humility for highly skilled and experienced individuals to acknowledge this and be willing to sacrifice some degree of personal and professional autonomy to excel. Organizations that have gone through this transition have achieved remarkable results in a relatively short period of time and do not consider going back to a place in time where individuals decided what was best on their own.
IV. Customer service and loyalty
Traditionally, management treated physicians like prized customers, and physicians generated revenue and all was well. Today, the landscape is more complex and there are multiple customers whose needs and wants must be addressed. First, of course, is the patient, and as healthcare evolves toward a consumer-oriented culture, it will be imperative for organizations to orient themselves to a market or customer base and away from a sales or provider base. In clinically integrated networks, this imperative expands to: healthcare provider partners (physicians and other care-giving organizations), payers, large employers, regulators (e.g. the Centers for Medicare & Medicaid Services), and community based organizations (e.g. schools, municipalities etc.). Thus, customer service now includes all significant partners who make a significant difference to achieve optimum healthcare outcomes.
V. Continual improvement and reduction of operating costs
Quality is a journey and not a destination. Value determines that the optimum outcome is associated with the lowest possible cost, and these are ultimately unattainable goals that must be continually sought in order to be nearly achieved. High-performing organizations are obsessed with both quality and cost, and everyone knows the score because measurement for everyone within their organization is un-blinded and transparent. This is a scary prospect for low-performing organizations with wide discrepancies in performance; however, it is a necessary attribute to approach the best that we can achieve.
VI. Expanded focus to disease management and population health
The United States healthcare industry is transitioning from a “sickness” to a “health” industry. Fee for service reimbursement rewards those who generate ancillary and elective procedure revenue and not those who seek to keep our populations healthy. Thus, organizations that are serious about healthcare are building a population health infrastructure to include: palliative care, in and outpatient disease management, retail medicine, e-health platforms, and home health all linked with predictive clinical/business analytics. They are also are voluntarily exiting fee for service toward a more risk-based capitated business model that rewards health and cost-effective care.
VII. HIM sophistication
Predictive clinical and business analytics are no longer optional, and organizations that invest in this essential technology along with a health information exchange linking all of the components of a clinically integrated network will achieve optimum outcomes and drive out millions of dollars in waste. Healthy people want 24/7 access to routine healthcare services through their smart phones and androids, whereas older patients want to optimize their lives around their home through the use of wireless technology and predictive clinical analytics to guide them and their providers. The 20th century healthcare model of the hospital and doctor’s office will be replaced by technology that can provide immediate access to healthcare anywhere and anytime.
VIII. Interdisciplinary teams
The aviation industry went through a painful transition from the charismatic leader to the high-performing team through crew resource management. It is intuitive that if you put the right individuals with complimentary skills together, that group can accomplish more than its individual members alone. However, this concept is counter to the traditional cultural norm of the autonomous professional. High-performing organizations restrict autonomy to “when necessary” and perform at a far higher level through the use of well-developed and managed teams.
IX. Exclusion of low- or non-performers
Every organization has low- or non-performers, and they determine what the organization’s lowest common denominator will be. Quint Studer in his classic “Hard Wiring Excellence” aptly put it: “Get them up or get them out.” High-performing organizations must choose between their mission and the security of a few individuals; and for them, the choice is clear.
X. Alignment with key stakeholders
High performance is impossible until all of the key players (e.g. physicians, organizations, payers, employers etc.) are linked together through at-risk contracts. Only then can the organization achieve high clinical outcomes at the lowest cost. The traditional entrepreneurial culture of individual cottage industry professionals working in competition with each other served its purpose and is no longer relevant to the provision of world-class care.