These days it seems every health system is in the middle of a transformation — be it buying, selling or trying to integrate the assets it has amassed over time. Being in the business of transformation, this means we find ourselves invariably and repeatedly answering the question, "What are the big stumbling blocks to avoid?"
Without fail, our answer will include some version of, "Don't underestimate the power of culture." It’s common wisdom, usually met with wizened nods and tales of past battles hard fought and lost. Then an awkward admission that, "We should have done more, but what?"
To quote Mark Twain, "Everyone talks about the weather, but nobody does anything about it."
Luckily, there's plenty to be done. Below we have listed five common traps we have observed — along with some suggestions on how to avoid them.
1. Blaming the culture. Why do transformations fail to achieve their objectives? One of the oldest tropes we hear is, "Our culture is one of our greatest strengths, and our greatest barrier to change." For example, "family-like" culture is blamed for not holding weak performers accountable or "mission-driven, community-oriented" culture is blamed for allowing sub-scale, low-quality service lines to persist. The real story is often quite different — and points to a lack of clear objectives, lines of accountability and the will to make tough choices.
Where to start: Make the culture your ally. Use the deeply embedded, self-reinforcing behaviors, beliefs and mindsets that determine "how we do things around here" in order to change the conversation. No one cultural trait is ever all good or all bad, so emphasize the good. For example, a "family-like" culture is all about creating a supportive environment — but a strong family is also honest with its members and knows when to deploy a little "tough love."
2. Leaving the strategy on the shelf. Many health systems have thoughtful, aspirational, community-focused and mission-driven strategies. Unfortunately, some of these organizations have not taken the next step of translating that strategy into changes in how work actually gets done day in and day out. If we are now a "population health" system, how does this change the job description of a nurse? Until the implications are thought through, the strategy will stay on paper.
Where to start: Translate the strategic objectives into what actually needs to be done differently. A good first step is for senior executives to pick a few implications for themselves and how they lead to model the future in a visible way.
3. Being unclear in setting new behavioral expectations. Most organizations aspire to be more patient-centric, population-minded or quality-oriented. Defining processes and standards that get you there is straightforward. Where many fail is driving adoption of the behaviors that bring those processes, policies or standards to life. The common wisdom is to be very prescriptive about how you want individuals to behave every step of the way. In reality, when push comes to shove, no one will remember the memo — and everyone will revert to their tried and true pattern of behavior. The key to driving behavior change is to pick a few critical, shared behaviors that really matter. Well-chosen behaviors are easy to internalize, they're recognizable by others and they're easy to imitate.
Where to start: Identify a few key behaviors, three or four, that are emblematic of the larger change you're trying to drive. Focus on successfully adopting these, and then come back to add more.
4. Talking past one another. The healthcare industry is already prone to jargon, and recent developments have only made the situation worse. It is hard to find a healthcare executive who does not talk about "population health," "patient experience," and "value-based care" — and don't even get us started on "disruptive innovation." Yet, very few organizations have defined what these things mean — or found a way to measure them in ways that are meaningful and relevant to their customers, such as consumers and employers. Without clarity around key terms, it is hard to have meaningful conversations, articulate a compelling and concrete future staff vision, or create effective incentives.
Where to start: Pare down the jargon and pick a few key ideas that are a clear part of your strategy. Communicate them in plain language and explain what they actually mean. (By the way, the irony of consultants recommending that you use simple English is not lost on us).
5. Leaving the hard conversations until the end. Several conversations in healthcare are an equivalent of a third, electrified rail. Try asking physicians to improve their productivity and reduce the variability in their clinical practices. Try asking hospital leaders to give up a sub-scale service line to another facility in the system. Try asking everyone to get a flu shot.
The temptation is to put these conversations off for as long as possible. And yet, delaying these necessary conversations means trying to transform a health system with one hand tied behind your back. The most effective transformations are physician-led and nurse-led. Engaging them in the proverbial "sausage making" and starting a dialogue is crucial. Building physician and nurse alignment is a step that should be taken early — and often.
Where to start: Identify and start a conversation with the physicians, employed or aligned, as well as nurses, who are seen as authentic informal leaders. These individuals are unique in their willingness and ability to, with or without formal authority, motivate and influence others.
Igor Belokrinitsky is a Strategy& partner based in San Francisco and Chase McCann is a Strategy& principal in New York.