Listening to various speakers at a two-day HIT/Delivery System Transformation Summit last week reinforced my thinking about the concept that reforming (or transforming) the US healthcare system is more like farming than business management.
Transforming healthcare is like farming because it involves cultivating collaborations and coordination among independent people, organizations, and stakeholders who all have varied interests and reporting/governance structures. In this way, “managing” or “leading” health transformation is like growing plants – the soil needs to be prepared, the plants (or seeds) need to be planted, and then they need to be watered, fertilized, weeded, pruned, etc…. And depending on the plant, (i.e. what crop you expect to harvest), the time-frame from planting to results can be weeks, months, or years. This is just like changing healthcare, where seeing the fruits of the labor/investment can take months, (e.g., for new practice guidelines like checklists), to years for some healthcare IT systems. [Note: These time-frames are for seeing value from the change, not the time required to develop the technology or the evidence to demonstrate the value of the changes – which generally takes many years.]
Cultivating successful health transformation also takes coaches, change agents, and data – all of which are used to promote change among independent individuals and organizations by creating and reinforcing internal and external aligned interests and visions. Of course successful alignment leaders are also responsible for cultivating the development the appropriate deployment of these coaches and change agents, as well as the data capabilities and learnings.
This type of cultivation (versus “management”) is something I’ve done in various roles – most recently in an initiative that has brought together the leading stakeholders in a mid-sized city to improve the quality and value of healthcare for the entire region. (My title has been “Project Manager” – Perhaps I should change it to “Project Agronomist.”) In other situations I’ve been more directly responsible for people and projects in matrixed organizations and with virtual teams. But even when working inside one organization, creating shared vision and engagement requires cultivating every individual in different ways – just as every crop has different soil, water, light and nutrient needs. And from observing other people’s mismanagement adventures, I’ve seen how applying traditional management practices to this type of situation can be like tilling a wheat field with a rolling pin, i.e. a rolling pin is effective for wheat, but only when it has been grown, harvested and milled into flour and made into dough.
But back to the HIT/Delivery Transformation Summit. In talk after talk, people from across the country noted the challenges they face in getting their data systems to work together as well as aligning different stakeholders. But while many of the speakers noted the greater than expected technical difficulties in integrating data systems and sources to create information pictures robust enough to guide future efforts, (and inform clinicians and hospitals about their performance), the leadership, coaching and interpersonal “cultivating” challenges were equally (or more) challenging.
The bottom line is that advancing healthcare IT, implementing health system changes, and creating successful broader transformation requires careful cultivation of many different crops of stakeholders who all need to be smelling the same flowers for them to achieve their common desired goals of improving healthcare quality and efficiency, i.e. so they can have their cake and eat it too.