Answering Strategic Questions—Part 1
Recently, I suggested strategic questions, as opposed to tactical questions, were more uncertain with more variables, more changes over time and more uncertain cost-benefit analysis. I also suggested the coronavirus epidemic has exposed the weakness of the current state of health care organizations, so we should be asking ourselves several key questions. What is my organizational purpose? How does my organization contribute to the health of our community? What is our community? Who else in our community has a role to play? How can we interact with these other stakeholders productively and how do we know?
So how do we go about developing viable options? First, we must ask ourselves if we believe we are at a turning point? Will things really be different in the future? I remember getting into conversation with an older man about managed care where I suggested the cost of medical care had reached the point where something had to be done. He questioned my assumptions and took the view concern about the cost of health care had been going on for a long time and the managed care phase, too, would pass. This conversation took place 25 years ago, and so far, he has been right. If this is not a turning point, is radical change necessary? Probably not, but it might still be desirable.
The second barrier to overcome was termed the heroic leader by Lorna Davis. Using her own experience, she points out that many of the problems we face today are beyond the capacity of any one individual or organization to change or “fix.” Yet we still look for the hero leader who has the plan and the answers. She suggests what is needed are leaders who can state a vision of better future and create space for others to join in the quest for making it happen. I tried something akin to this approach the last time I attempted to create a common understanding among medical organizations in my time. I posited a vision of better care and process that were focused on the care of the individual regardless of where they were or who was doing that care under the rubric of “clinical integration.” While there was agreement on the vision, the lack of “a plan” quickly became a dividing line. I could not build a group of people who were willing to let the plan develop organically from the conversations and meetings necessary to create that space. Long-standing rivalries and lack of trust turned out to be insurmountable then and might be for any organization trying to do radical change.
Halla Thomasdottir pointed out another, related issue. We typically overlook the leadership capacity of most people. She argues that national leaders need to find ways to empower and give the skills needed to employees to make their leadership contribution effective. This is akin to “clinical microsystems” that I have discussed here previously. Small informal teams of doctors, nurses and administrators working together to solve a specific problem can improve performance of the entire organization if replicated widely.
Jim Hemerling observed that all organizations are in a period of constant change. He noted the paradox that we find learning new skills or taking on new activities for ourselves to be stimulating but making changes at work produces dread. He suggests there are five leadership tasks needed to improve organizational resilience. First, leaders need to remind people of the true purpose of the organization, which is almost never financial or operational. Second, if you are going to lead change you must be committed to it—going all in as he phrases it. Third, you must give people the tools and skills needed to be successful in accomplishing the true purpose. Fourth, you must develop a culture of continuous learning. Lastly, the leader needs to have a vision and develop a roadmap as well as hold people accountable, but he/she also needs to be as inclusive as possible in developing the roadmap.
Through these speakers I became aware of something called the B Corp. Their mission statement says: “We envision a global economy that uses business as a force for good. This economy is comprised of a new type of corporation—the B corporation—which is purpose driven and creates benefit for all stakeholders, not just shareholders. As B corporations and leaders of this emerging economy, we believe: that we must be the change we seek in the world; that all business ought to be conducted as if people and place mattered; that, through their products, practices, and profits, businesses should aspire to do no harm and benefit all; to do so requires that we act with the understanding that we are each dependent upon another and thus responsible for each other and future generations.” These seem like worthy goals for medical organizations, too.
The third barrier is the “competency trap.” I noted many years ago one of the challenges in instituting systemic change was the people being addressed had been successful doing what they were doing for a long time. Their motivation to change was low. This trap was explored recently by David Robson, who posited companies have two ideas driving them forward: exploiting existing products and exploring new opportunities. Successful organizations often become rigid and blind to potential, they have a constricted vision of who they are, and they are subject to the “sunk-cost bias.” Certainly, medical organizations have these challenges, too.
So formulating answers to the basic strategic question of who are and what should we be doing might start with thinking concretely about what it means to put the patient first. This is true whether we think radical change is in order or not. Personally, I think the current healthcare “system” is unhealthy for the people who work in it and fails to provide the services the patients need as consistently and respectfully as it should. The only way to really make it better is to start the process of recovering our real purpose. Or so it seems to me. What do you think?
21 June 2020
 Davis L. A Guide to Collaborative Leadership. September 2019 accessed 20 June 2020 at https://www.ted.com/talks/lorna_davis_a_guide_to_collaborative_leadership#t-840757.
 Thomasdottir H, Freedman B. The Crisis of Leadership—a New Way Forward. February 2019, accessed 20 June 2020 at
 Hemerling J. Five Ways to Lead in an Era of Constant Change. May 2016. Accessed 20 June 2020 at https://www.ted.com/talks/jim_hemerling_5_ways_to_lead_in_an_era_of_constant_change.
 https://bcorporation.net/about-b-corps. Accessed 21 June 2020.
 Robson D. How to Avoid the Competency Trap. 9 June 2020. Accessed same day at https://www.bbc.com/worklife/article/20200608-what-is-the-competency-trap.
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