Reflections on LTC 100 and NIC

Dec 12th 2011

Real Collaboration To Change Health Care Forever

There is such an organizational bias by many health care leaders that their approach to innovation, creative programming, and proprietary strategy is obviously the best route for their company because they may have helped author it. That may be a great way to have a homogenous battle cry that motivates closely aligned teams, but I often doubt if it creates many industry game changers that stick or grow. We have all been on the pulse of an organization where the command center operates like a one-way firehose to the field without interruption. I have fallen into that trap many times myself, when there is that “passionate rush” to operationalize top-down strategic opportunities that may have incremental impact at best.

When I spoke at the recent LTC 100 Conference in California this year, I called upon other industry leaders to consider their view of transformational breakthroughs as we shared what we believe is sacred at Signature. We disclosed our companies’ bets, socio-cultural theories that need to be considered, and battle cries that we believe can establish an organizational soul that might start a social movement.

After our talks, as we were making time to hear other presentations and visit competitors’ breakthrough sites, I came to several important conclusions that may seem radical at first glance, but with some reflection, I would love to hear your thoughts.

  1. There is not enough distinction between the chain organizations for the line staff stakeholders to really visualize major strategic differences between companies that senior leadership swear by and CEOs believe are obvious. Most of the real differences come from the ratio between the autocratic level, informal authorization matrixes, levels of non negotiables, and management styles that bleed into cultural differences.
  2. We need to find better ways to connect to line staff stakeholders to enhance real life skills, map realistic educational pathways, and incorporate surrogate emotional support in a fractured work space. Ideas like shared career tracks between provider organizations could eliminate the constant restarting obligation for the churned stakeholder, universal-based credentialing and certifications validate competency levels quickly, and non-proprietary performance standards raise the industry image against strong external forces.
  3. 75% of corporate programming has incremental impact at best because it was poorly designed, was not a strategic fit for many locations due to resource differences, unreasonable opportunity cost assumption to downline, and there was too much turnover, requiring a new bold agenda at every turn. Think back to all of the programs you were fed, you created  or consumed – what sticks long, and where does it all go?
  4. The industry needs to realize we are in four to six segments that need a fresh look at the 5% standard management fee approach because the ability to develop deep  completive advantage between segments make it a poor, dated assumption. Most facility operations that are best-in-breed or non-performing consume 50% more or less than that fixed standard, so it creates a social injustice that reinforces they pay for corporate overhead with no grounds.
  5. Most of the existing organizational structures need to incorporate the new management models into permanent structures anyway for real transformation. New divisions to think about are innovation and design, lean and PI, customer experience and NPS, spirituality and medicine, market intelligence, media productions and digital communications, etc. so starting a semi-variable management structure will provide IRR metrics to fully understand what creates the new deltas we have to have to survive.
  6. I think the real game changers can come from strong collaboration structures driven by industry leaders because there is a new requirement for greater speed, a larger application base to draw from, and a dismantling of traditional organizational structures through new thoughts on shared services. Global industry leverage points are stronger through aggregation than stand-alone providers, and merging in relevant research structure is needed for unbiased breakthroughs.
  7. Lastly, right when our industry is ready for transformation because forces have merged to create it, government funding shifts and is cut. Liquidity and state funding is reduced while the federal deficit is growing, so it has been hard to capture all of the amazing opportunities that are sitting at our doorsteps that may be game changers.
  8. We see some emerging trends that Q12 engagement should be embraced more widely over employee satisfaction as a real diagnostic. Mid to larger chains need to see strategic segmentation as a real competitive advantage accelerator, need to reduce dependency on tenured recycled leaders by engaging other industries’ misplaced knowledge groups because their current approach creates unneeded inflation, blocks innovation and creates group-think in many cases.

At the same time, I decided to make several important field trips to locations that were generating so much buzz that I had to see it myself. First, I took time to visit other organizations’ innovative approach to dramatically improving the consumer experience. One was Carespring headed by the famed Barry N. Bortz, who brought military tenacity and discipline with a deep connection to his RN mother, who believed caregivers deserved a new day, which you could see imagery and unique environmental conditions. It was so impressive I actually felt envy and jealousy because it was more than just raising the bar, it was changing the game.

Secondly, in my hometown, I had been hearing about the ambitious plans of some of the best health care organizations anywhere in America –great national forces like Kindred, which is looking at aggressive integration, or ResCare, which is carving out low-margin, billion-dollar divisions at a steady pace.

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