People that tell you how they are “out of the box” thinkers are typically the people who think inside the box more than anyone.
Many years ago I had a position with the American Heart Association. In those days, staff’s were consistently arranged with an executive director, senior leader for community programs and education, senior leader for fund raising or development, and a senior leader for communication. Programming, materials, literature were all framed in one of these three venues. A new CEO came on board in Dallas whose communications all included a phrase about how we needed to open the windows, think out of the box, reconfigure the organization in order to reach our goals. In our metro organization, we had an organizational structure that followed the book. After several years we had an idea that objectives and goals could be reached easier if our staff was aligned along market segments – children and youth, women, adults, science.
The idea was definitely out of the box. It was the result of a year’s worth of meetings internally, with our boards, and with our volunteers. Our thought was that is a staff person was working with youth and children, for example, they would create relationships and gain meaningful insights with the market. These individuals would be versed in programming, communication, and fund development – staffing any programs or services lined to their market segment. When the idea was proposed as a pilot it was met with a resounding, “NO.”
There were telephone calls and letters to explain the philosophy. Each was met with a no. At times there were laughs. Needless to say, we didn’t move forward with the construct.
The organization was changing. Change is inevitable. Thirty years in healthcare has been a series of inevitable change. One of the most significant changes has been the evolution of ambulatory care. Most systems today garner fifty-percent of their bottom line from ambulatory or outpatient care. Physician offices were first, outpatient imaging and ambulatory surgery moved quickly. The most recent National Ambulatory Outpatient Survey found that there were 2,149,073,000 physician office and hospital outpatient visits in the United States. This is a visit rate of 361.2 visits per 100 persons. The Healthcare Cost and Utilization Project’s State Ambulatory Surgery Database noted that during the “last two decades (there has been) a steep rise in the number of surgical centers performing ambulatory surgeries: these facilities have increased from 336 in 1985 to 4,707 in 2006.” To quantify their finding, between 1988 and 2006, the number of ambulatory surgeries reported by Colorado, New Jersey, and New York increased from 0.9 million to over 2.3 million.
Add convenience medicine, urgent care centers, freestanding emergency departments, and retail healthcare and the result is a significant business unit with strong profit margins. A couple years ago in a presentation to the VHA Chief Operating Officers Affinity Group about designing ambulatory systems of care, the prevailing attitude was traditional hospital leaders were to least prepared to lead ambulatory care. Their recommendation was to hire leaders from outside of the industry to oversee ambulatory development. This sentiment was echoed in meeting after meeting and by many national healthcare consulting groups.
Several health systems followed the guidance presented and recruited from out of the organization and maintained as a separate business unit from the hospital. The majority of health systems to date have retained coordinated leadership and operating activity between inpatient services and outpatient and ambulatory services. Leaders weaned in a world of ALOS, Medicare and Medicaid reimbursement, physician hierarchy, and bureaucratic decision making have been presented ambulatory portfolios to manage. My favorite story was a system that began employing the majority of its medical staff gave operational leadership of the physicians to its service line leaders. In case after case, the service line leaders have never worked one on one with physicians, in physician offices, or practice-based medicine. With this pedigree they are now positioned to supervise newly employed physicians.
The most recent situation anomaly was a system that is breaking its organization into staff engaged in operations and another group composed of strategic growth staff. Operations will focus on day to day tasks while their colleagues focus on strategic growth. The silo effect of this structure will belie cross pollination or coordinated operational efficiency with profitable and strategic growth.
The leaders and consultants tasked with the projects referenced all came to the table as out of the box thinkers. Unfortunately their decisions were consistently rooted with entrenched, in box thinking; albeit with untraditional dressing. Changing staff titles, brand, corporate division descriptors is not creative thinking. A Harvard Business Journal article a few years ago touted addressing creative, strategic thinking within defined parameters. This is an outstanding approach since it recognizes the need for a common framework to be creative in.
Strategic thinking considered out of the box is difficult to create. Each of us brings tradition, history, and experience to the table that can solidify barriers between the strategy and out of the box thinking. Inviting staff to the table and inviting their creativity, only to be met with defiance is abhorrent. It is unfair to set ground rules that do not reflect reality. Organizations are haunted with the memories of individuals who tool the task of creative thinking and out of the box strategy to heart. Creating an environment of honesty is far more important that building a foundation based on buzz words and current management philosophy.
By the way, the AHA reorganized about two decades later along the lines of market segments.
Leave a Reply