We are now knee-deep and headlong into Obamacare and the Affordable Care Act. The Main Event is set, at least for now, on January 1st, 2014. This is when purportedly all Americans will have purchased their tickets to seek admission to the insured affordable healthcare match. Healthcare organizations, doctors’ offices, and community clinics will begin to see and treat a population of folks that has historically not had access to insurance, and they come sicker than we have seen before. Our operation, fiscal, and quality outcomes resources will be challenged like never before. If your fight card does not include a pound for pound approach to strategy and culture, get ready for a TKO! In this time of focused patient centered care delivery models and innovative transformational approaches to healthcare, there is a real barn burner about to begin.
Peter Drucker said “Culture eats strategy for breakfast”. If that’s the case, where then do we put our efforts? Strategy alone will not be enough. If healthcare organizations expect to come out the winner in the next decade, they will need to condition themselves to go the distance in both culture and strategy. As we begin to see a population that has not had access to routine healthcare for many years, or ever, the strength of our strategy and culture will be put to the test.
Operationally our strategies need to include a focus on culture as it relates to leadership excellence, the empowerment of our workforce, consistency in the delivery of quality service, and creative innovation. Walt Disney did a great job of this. Walt effectively demonstrated with great heart and passion that the actions of one leader, multiplied be the actions of many, can re-shape a culture and an organization. Operationally we need to invest in our leaders, empower them, and hold them accountable to creating a healthy and conditioned workforce that has been well equipped to meet the challenging needs of the populations we’re tasked to serve. Operationally we need to invite every person in our organization that has anything to do with patient care to take part in finding innovative ways to do things better and leaner.
One often missed leadership strategy in creating great operational outcomes is by inviting your customer into the ring. Who are your customers? Remember, everyone is your customer when it comes to operations. Anyone that has anything to do in your organization is a customer. This includes your management team, billers, coders, housekeepers, those that answer the phone, and the patient! Everyone is your customer. Your entire team of customers should be given the title of Personal Performance Partners. Invest in them as a strategy and the organizational culture will win in every round.
Everyone is your customer.” – Susan Thorn Tweet this!
What about the organizational level of fiscal fitness? The promise of more in the way of budget cuts and payment denials has the fight purse getting smaller and smaller. As the purse gets smaller, our number one strategy needs to include a fully engaged culture. Organizations that look at their bottom line without understanding the impact of culture on it will suffer. Culture is like the wind, it is invisible to the eye, but felt by all. Culture is built by the values expressed through its leadership. If you want to assure that you will be at your ideal level of fiscal fitness then your battle cry needs to be “Culture is our bottom line”.
What about outcomes? We are now being held to a new level of accountability when it comes to creating favorable healthcare outcomes for the populations we serve. If we don’t do it well, we are as good as a white-collar boxer, we don’t get paid! As a healthcare leader and consumer I have seen both sides. Quality in outcomes with the resources availed to us will take new and innovative approaches if we expect to go the distance. We are already seeing hospitals partnering with community clinics to prevent hospital remissions. Healthcare organizations are beginning to move toward a case management model approach for the high-end users of our healthcare systems. Population based case management for our most vulnerable populations’ results in a unanimous decision in adding to the way we can all deliver better and leaner quality in healthcare.
So where does your organization weigh in on culture and strategy? If your strategy and culture don’t touch knuckles before the opening round, somebody is going to get sucker-punched. Make cultural competency your organizations biggest innovative strategy to win in healthcare!
About Susan Thorn
I really enjoyed your article and agree with your observations. As you mentioned, the Affordable Care Act is causing the healthcare system to reengineering itself and, as it does, patient engagement and activation is going to be a fundamental component of that transformation. Clinician education and training in culture, behavior change, motivation and self-care accountability is becoming increasingly important as we mover to more performance-based care delivery. The Iowa Chronic Care Consortium(www.iowaccc.com) has been training clinical staff in the effectiveness of clinical health coaching for more than six years(and just recently went live with an online version of the curriculum, http://www.clinicalhealthcoach.com), and we are convinced that we’re beginning to see a change as the sorts of concepts you’re advocating become a key component of the hospital/physician office process.
Thanks for writing this!
Brendan
Brendan, Thank you for your input. I am a long time fan of the Iowa Chronic Care Model and have used it in my trainings and in support of the work we need to do in improving both outcomes and the patient experience. What the Iowa consortium has done has been to define the heart of what needs to occur before we will begin to see the results of what we “say” we are looking for. One of the constraints I encounter as I go through this journey of the Patient Centered Medical Home Models with others is the cavernous gap between our written vision and the proactive implementation of new and innovative ways to get there.
I have viewed your link to the health coaching opportunities and all I can say is congratulations! Very nice work. This will be the exact filler needed for that gap between what we have written as our vision in creating the “way” to get there. Love to stay in touch with how it is going and spread the word as well. In May I will be attending the Institutes of Health Improvement Summit on Healthcare in which Don Berwick will speak as well as other great thought leaders. I am supposing all of this will be discussed and I look to come away more inspired to drive change than ever before.
Very insightful Susan. The notion that everyone is your customer is an elegant way to distinguish the context for the kind of healthy relationships that create a healthy organizational culture. Ultimately how people are treated and the context of their interaction with each other within an organization reflects in the way the external customer is interacted with.
Thank you Susan for so eloquently adding the words that apply the true intent of the message. I read your reply Wednesday morning, just as I walked out the door, It was my monthly meeting day, and as always I had spent the morning trying to find the perfect words to share with the group. What I did was share yours. I read to them your reply. Thank you so much!
Such a poignant post and relevant in many parts of the world. We have a very different healthcare system in Australia AND all of what you discuss are still relevant.
In fact in my experience working in healthcare for over 9 years the times things worked best was when we undertook a year long, whole of staff and volunteers and stakeholders Values exercise to define what we cared about most as an organisation and what we stood for. It was a great time to work there and everything you mention was working because “Culture was our bottom line”.
I love that your organization had committed a year of energy to this. A combined effort of energy over a set amount of time has the potential for such synergy. I did this with my direct group this past year and a half also, but now find our values are not aligned with the rest of the groups values.
Hello Susan. Nice post to point out that culture is a key issue for any organisation in any setting. Thank you for sharing your insight.
Have a nice WE,
Joan
Thank you Joan, The constraint of a less than active and engaged culture is as critical to a healthy organization as a active engaged patient to healthy outcomes.
Hi Susan,
I like how you bring the issues of leadership, healthcare and culture altogether in this article. It really gives each reader something to think about. The missing element to this so far has culture and it’s wonderful to see you giving voice to that piece. Your statements really highlight this point: “Culture is like the wind, it is invisible to the eye, but felt by all. Culture is built by the values expressed through its leadership.”
Well done!
All the best,
Susan
Thank you Susan! I am fortunate to work at an organization that realizes the criticality of equality in all three, leadership, healthcare, and culture.
Not just a US issue Susan, or even just a healthcare issue. Your passionate post has resonance for every organisation.
Thanks.
Warm wishes
David
Absolutely! I just completed a course in global healthcare and yes it affects all countries equally.
Susan, I completely resonate with “strategy and culture don’t touch knuckles before the opening round, somebody is going to get sucker-punched”. How true this is. All my work experience, I can recall only one organization that embodied this. The outcome? A diverse team that delivered well beyond expectations, cared for each other and was the envy of others on campus. Strategy was clear and embraced by all while culture powered that strategy.
It is rare and a refreshing place to be when all aligns for a team where in diversity becomes the strength. True excellence can then begin.
What a thoughtful and timely contribution, Susan. It is sometimes easy to forget that our customers are not only the people external to the organization. We need to take care of our internal customers, too.
My greatest joy is in customer service. I try to remember each of my staff are my customers. I want the to look forward to walking through the door each morning and leave with a positive experience at the end of the day. We all know it oft times does not go that way, but we try. When there are successes I gain great satisfaction, and use that to inspire me to create the next opportunity.
Hi Susan – thoughtful and thought-provoking post ~ thanks! If culture and strategy are not aligned then any agenda, let alone one as vast as the healthcare agenda [equally as true here in the UK as there in the US]. will not deliver real impact ~ that is the outcomes we would all wish to see from the appropriate use of resources, human, fiscal or otherwise, and their blending with clear purpose and core values!
John, I love that you point out the appropriate use of resources. The real cost of care is seen when we employ a 360 view on all resources, HR, Fiscal, and HIT as well as others. Thank you!