Healthcare is transforming. It’s become a mantra for consulting companies, a maxim for strategic plans, a rallying cry for vendors, and the go-to buzzword for conference content. Our website isn’t immune to the idea, either.
All that hype must mean there is some level of exaggeratory bullshit attached to the concept. There is.
But an ear-piercing bullshit detector alarm doesn’t mean it isn’t happening. Because it is. In fact, the industry has always been transforming: Paul Starr wrote a comprehensive 528-page, Pulitzer Prize-winning, delightful treatment of the topic published way back in 1982 that is truly worth your time.
In a book that offers many lessons, the most useful in this context is that it is only possible to see healthcare transformation from the future, looking in reverse, after it has occurred. It’s acceptable to desire healthcare transformation and discuss the possibilities: expectations for the future, extrapolations from what we know, and assurances about the direction of change. But projections, predictions, and forecasts can turn out to be true just as often as they miss the mark.
So healthcare transformation — before it has happened — is just a set of possibilities. Of potential. Of hope. Of promise.
That’s because healthcare transformation is not a strategy, it’s an outcome. Healthcare transformation won’t happen until it’s happened no matter how much industry thought leaders desire it. Transformed healthcare delivery is a result of executed strategies.
It is the effect of action.
Present-day activities are not in themselves transformative. It is the accumulation of many actions and many adjustments, over time, that produces transformation. Any current work deemed to be transformative is just the required work of adjusting a healthcare delivery organization to effectively operate within its market environment at this moment.
Over the last forty years there has been a significant transition in how healthcare provider’s determine strategic policy: from an organization’s productive capacity (e.g., acute care beds!, inpatient knee replacements!) to one guided by market trends and customer needs (ambulatory strategy!, care navigation!, access!). Market pull steers all organizations now.
Executives create strategies in direct response to problems and opportunities uncovered by shifting market conditions. Market conditions that are created by a complicated mixture of government policy, third-party payers, patients, social and economic conditions, technology diffusion, competitors, suppliers, and a host of other factors.
So healthcare transformation is really happening on two different levels: an industry plane and an organization plane. The industry definition for healthcare transformation: the evolving market forces that cause organizations to change.
For organizations, healthcare transformation is the outcome of the collective response, over long periods, in the form of successive activities, undertaken by an organization to adjust to shifting market forces and effectively serve a customer. It’s the major change “that emerges from the aggregation of marginal gains.” It’s the hard work of incremental daily progress.
So healthcare transformation is most certainly not bullshit. It’s not just industry jargon psychobabble. It needn’t be an explicit strategy. Healthcare transformation is happening to organizations: it’s not about the future, it’s about how organizations get to the future.
Healthcare transformation is the project-by-project changes to an organization’s structures and systems to ensure market responsiveness.
It’s the effect of action.
This is the second installation in an ongoing series of essays attempting to define healthcare transformation. There’s a lot of bullshit in transformation rhetoric. But it’s also real.
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