The management of change has many options. First we have to believe we have to change. In health care, I continue to be astonished by caregivers who ask me why I am so committed to dramatic change, even at the risk of disrupting what we have. I honestly believe we must innovate or die. I’m serious.
The phrase “Innovate or die” comes from Tom Peters, a fantastically interesting man whom I have had the pleasure of knowing well. His “In Search of Excellence” launched him into the business quality guru limelight. Like Jim Collins, he based his advice on what he found by looking at successful companies. Health care systems are at that point: either we innovate or we will die of strangulation at the hands of fee-for-service medicine as piecework payments drop and we burn out and fail as we try to cover our high fixed overhead with declining fees and declining volume.
I am fortunate enough to be enrolled in a leadership course at Massachusetts General Hospital, where I heard recently that health care systems will have to improve efficiency by 2 percent each year over the next decade, or go broke. Why? Because government, employers, insurers, and, most of all, those we serve can no longer afford us. So the “die” road looks like this: hang onto our old ways of provider centric workflows, attempting to see more volume of reduced-payment services, with little attention to what patients really want. Soon the net revenue will not cover the cost, so many start the downhill spiral of cutting staff, service, and materials, and running the flow faster through a broken system.
The innovate/achieve success path looks like: figure out what out the population really needs (it helps to ask them), shed services we don’t need, enhance services patients need and want, and get really good at customer service so we build loyalty. Generally that will mean fewer decentralized inpatient services with regionalization of high tech care, and much more robust and patient-centered outpatient care. That means providers have to get out of their view of the world through the lens of what providers need, and become everything our customers want. The literature suggests the lists of our customers’ wants includes same day access, extended hours, walk-in clinic services, no waits, talking to a person when they call the office, web access to schedule appointments, emailing providers, and highly personable care. All of these are currently being delivered many places; I have seen it.
Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000
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