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Changing for Good!

By Mark Watts

EDITOR’S NOTE: This is Part 1 of a two-part series. Click here for Part 2.

At this time, we are forced to change. We have an opportunity with the right leadership and alignment to make this a time of change for good.

When people talk about transformation in health care, they tend to focus on the work that needs to be done to move a health care organization forward, such as changing care processes. But that’s only half the story. Equally important is an assessment of a team’s readiness to take on transformation. And the best gauge of that lies in the question, “Is everyone in your organization aligned?”

When I ask this question to a qualified group of U.S.-based clinical leaders, clinicians and executives who are directly involved in health care delivery – they return a resounding “no.” In a recent leadership survey, “Providers, Executives, and the Power of Alignment,” it was observed that there is a remarkable gap in the alignment that respondents consider necessary between key stakeholders and the degree of alignment they perceive within their organizations. For instance, over 90% of respondents say it is extremely or very necessary for frontline clinicians and top executives (such as the CEO) to be aligned. Yet, only 30% consider their own health care organization to be extremely or very aligned among these stakeholders.

True alignment has numerous positives, not the least of which are better patient outcomes and organizational stability in a dynamic, changing health care marketplace.

To be clear, I am not conflating alignment with agreement. Not everyone is going to agree with every decision, but they must understand why certain decisions are made. The survey results were bleak in this respect – only 21% of respondents say alignment approaches are formally stated in their health care organization, while just under a quarter say the approaches are tacitly understood. Nothing this important should be left unstated. These findings, from personal experience and study, are not an acceptable foundation if you are to successfully transform your organization.

How to Achieve Alignment

One place to start gaining alignment among key stakeholders is in the definition of the term. The largest share of my respondents say alignment is achieved when “the organization’s mission, vision and goals are supported by governance, strategy and incentives.” One in 20 label alignment as a “financial model that incents providers and executives toward common goals.” This result is unsurprising, since the predominant financial models today are not aligned with patients’ best interest, physicians’ best interest or even organizations’ best interest. There’s huge overuse in health care that has at its root a payment system based on more tests and more procedures — a production model that doesn’t serve anyone well.

The next step is figuring out which stakeholders require the most alignment. According to my survey, these are frontline clinicians and clinical leaders such as the chief medical officer; 93% of respondents score their necessity of alignment as extremely or very necessary. At the other end of the spectrum are executives and patients, for which 55% of respondents say alignment between the two is extremely or very necessary.

As you then chart the actual degree of alignment within your own health care organization, in comparison, you’ll see what needs to be bridged. In my survey, despite calling alignment between frontline clinicians and clinical leaders a necessity, only 36% of respondents say there is a high degree of alignment in their own organizations. That’s an incredible mismatch that must be addressed.

So, how can you drive your health care organization toward alignment? I would suggest looking at it from two different perspectives: within the leadership team, and among the leadership team and clinical providers. For both groups, agreement on vision and strategic plan is most important, according to our survey. Interestingly, my experience has found it far more important for administrative leaders to have clinical training/experience than for clinical leaders to have business training/experience. We think this is short-sighted, as new models will require clinical leaders to have business and financial savvy to make the most impact.

As you seek to align your own organization, physician compensation models are one place to start. Only a quarter of respondents say physician compensation for employed physicians is extremely or very aligned with organizational strategy, mission and goals. With so many physicians turning to employment in recent years, the hiring organizations likely expected more alignment in exchange for putting salaries on their books. The situation is even worse with affiliated physicians, where only 10% are highly aligned.

Leaders and clinicians alike must evaluate the degree of alignment at every level of their organizations. Otherwise, as you dive deeper into health care transformation, you will encounter a lot of friction and wasted energy.

In the face of the new force in the transformation of health care delivery, it is important for us to consider the leadership and the alignment to change for good.

Mark Watts has over 20 years as an imaging professional with vast expertise in imaging informatics and IT issues. He has served in many roles in both hospitals and industry as a health care vice president, imaging director and IT consultant. His knowledge and experience in the convergence of IT and imaging has made him a sought after author, speaker and consultant. He has authored a textbook on informatics and was a pioneer in the adoption and development of PACS and VNA technologies.

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