Organize around the patient

Vineet Nayar at Inverted Wisdom (a Harvard Business Publishing blog) asks an intriguing question:

As time passes by, people and things change. Now, what if time passes by and people change, but things that should change, don’t?

Health care is steeped in tradition.  While other businesses have flattened their organizational structures and empowered front-line workers, on the whole health care has grown more bureaucratic.  Actually, health care has approached this issue in an almost completely opposite fashion.  Remember the empowered country doctor?  I don’t either, but I have read that they existed at one time.

Mr. Nayar continues:

It is not a stationary relic I’m talking about. I’m talking about the brand new dinosaur on the block – the classical management pyramid. Time has come to dismantle it and adapt to a new evolutionary and unstructured model that leverages the team effect to ensure that companies can lead change rather play catch up or be left behind.

The prevailing notion is that health care is constantly changing, that’s true.  But backward incentives have mucked up our ability to respond.  The reality is that the majority of stakeholders in our industry have become reactive to change instead of leading it.

Again, Mr. Nayar:

Yes, the traditional pyramid management structure needs some unstructuring. Flexibility is the key to survival in the 21st century, and organizational structure is no exception. It needs to be open to change, to take any shape that’s best suited to the organization.

Leadership would do well to shun the ‘Me’ approach and deregulate, decentralize and transfer a substantial part of the organizational control to the frontline.

Logically, the health care organizational structure should be devised so that the complete focus is on the patient’s needs.  The Cleveland Clinic is trying by integrating its service lines into institutes dedicated to health care conditions.  Cleveland Clinic CEO Dr. Toby Cosgrove:

I think the model where we bring together all the expertise (cardiologists and surgeons under one roof, for example) will be a tremendous benefit for clinical care. You get wonderful things from proximity (conversation and innovation). The line between medicine and surgery is blurring. Innovation takes place on the borders of disciplines.

Delivering health care requires a tremendous amount of organization.  The complexities of this industry (uber regulation, 24/7/365 operation, numerous specialties, etc.) make it difficult for executives to let go of their control.  But the complexities also make it that much more important that control is released to the talented workers on the front line. Mr. Nayar:

Simple as it may sound, the truth is that this is a very tough task. The question we must ask ourselves is whether we have within ourselves the fortitude to deconstruct the traditional power centres so that more emphasis is placed on the troops instead of the General.

Difficult it is, but necessary.  Quality would improve if it were released to the people who truly understand quality and can provide it its necessary attention.  Technology may reach its full potential if the people who use that technology become the decision makers on implementation.  Services would benefit the patient if we organized around the patient’s health care needs.  We need to stop building barriers and start tearing them down.

We should organize around collaboration and continuity and integration.

Maggie Mahar at Health Beat Blog recently wrote about the high level of care delivered at the Mayo Clinic and the power of integrated delivery systems:

The variation suggests that it may not be the Mayo “system” that lifts Mayo’s flagship Minnesota hospital above the tide. Rather, some observers suggest, it may be the highly egalitarians and collaborative “culture,” which puts patients ahead of everything and everyone else, that makes the Mayo Clinic in Rochester, Minnesota so special.

Nevertheless, the 2008 Dartmouth Atlas does provide sufficient data to support the thesis that integrated delivery systems are likely to provide the most efficient high-quality care. And the report makes it clear that Mayo is not the only integrated system that stands as a benchmark for excellent collaborative care. Both Intermountain Healthcare (IHC) in Utah and the Sutter system hospitals in Sacramento are singled out for praise.

One last time, Mr. Nayar:

So, do we have the vision to look upon our organizations as collaborative and evolutionary life forms that must keep changing along with the marketplace? Do we have the humility to step out of our egos and hand over the mike to our subordinates? Do we possess the courage to unstructure an existing, rigid regime that we have known to work in the past?

We often accept the verdict of the past and slumber into the cushioned inertia of best practices, until the need for change cries out loudly enough to stir us out of our comfort zones. It is time.

Embrace change, lead change.  It is time, indeed.

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