Friday, November 14, 2008

All Things to All People All the Time

Today I just started wading through a series of white papers from IBM Global Business Services titled “Healthcare 2015 and Care Delivery.” The series consists of three parts; Delivery models refined, competencies defined, Healthcare 2015 and U.S. health plans, and A portrait and path to successful transformation. These are not light tomes. Because I have a closet full of propeller beanies, I will be happily devouring the 100+ pages. They will provide great conversation starters for days & weeks to come.

I buzzed through the executive summary today and already like where they are going.

The fundamental thesis of the piece is that “Historically, care delivery organizations (CDOs) could declare broad and abstract targets, or even attempt to be ‘all things to all citizens’ and still compete effectively. But in the future, we believe it will be harder to maintain an undifferentiated service delivery model, whether it be a public or private healthcare system model.”

I couldn’t agree more. We’ve likely all worked at places (either as insiders or advisors) where the Mission and/or Vision statement included some variant on the phrase, “the communities we serve.” The trouble for us has historically been that these CDOs have rarely, if ever, defined “communities” beyond some geographic criteria.

IBM goes on to say, “the increasing focus on value, the rising need to activate responsible citizens, and the changing requirements of care delivery will force many CDOs to adopt and develop service delivery models with new and sharper strategic focus.”

Can I get an “Amen!” from the congregation!

They go on to assert that all CDOs currently fall into one of four service delivery models:
  • Community health networks focusing on optimizing access across a defined geography
  • Centers of excellence, focusing on optimizing clinical quality and safety for specific medical conditions
  • Medical concierges, focusing on optimizing the citizen/patient experience and relationship
  • Price leaders, focusing on optimizing productivity and workflow
They are kind in not admonishing many (most?) CDOs for two common faults; not being intentional about who they are, and trying to be 2, 3 or even all 4 of these things simultaneously. The word I keep hearing over and over again is “focus.”

GE got a lot of press—deserved or not—under Jack Welch’s leadership for his infamous, “number one or number two in an industry” strategy. Perhaps more marketing than true business strategy, the sentiment is “focus.” Be good at a finite number of things. It’s the Sony story writ large by new chairman Sir Howard Stringer: “If Apple can create a company with a market cap of $50 billion on the basis of a handful of products and we (i.e., Sony) do it on the basis of a thousand, aren’t we then too much of a department store?”

Said another way, those who try to be 2, 3, or all 4 of these different types of CDOs will lack the focus and differentiable distinction that will make them susceptible to more focused, more excellent competitors.

IBM asserts there are 5 key competencies that CDOs must consider and, depending on the service delivery model they strategically settle on, emphasize in different combinations. Those competencies are:

  • Empower and activate consumers
  • Collaborate and integrate
  • Innovate
  • Optimize operational efficiencies
  • Enable through IT
What I see here is an powerful framework for strategic planning.

Their final piece of advice: “Develop a plan to transition to the new delivery model—or new ways of implementing existing models [that is, choose what your future is, and, by reduction, explicitly state what it is not, and design the plan to become it]—and develop the new competencies required to support the roles models.

“Last year plus a little more” is not a viable strategy in these transformative times. Healthcare organizations have a long history of reacting—to new regulations, payment model changes, shifts in consumer behavior—instead of planning and executing the plan. This looks like a good framework through which healthcare strategists could organize their thoughts and prepare to influence the future direction of their organizations.

I look forward to sharing more from these books.

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