Hospitals and health systems face any number of challenges in managing the health of a population. Most important, perhaps, is putting in place a successful population health strategy and changing a health care organization's culture to one that embraces the Triple Aim as a core tenet. Leaders must have a clear vision and be collaborative, empowering, innovative and tolerant of failure. They, along with their teams, must also learn what creates success and brings value to their communities, networks and organizations.
Leaders would be wise to recognize the following:
They must maintain clarity of vision, and continually communicate and reinforce that vision to become a population health–focused organization. A mutually understood and agreed-upon vision must become the base to drive the organization. There are many levels of change required, and organizational inertia will tend to pull behaviors back to the old ways of doing things. Organizations that are successful in moving to population health management have leaders that consistently reinforce their message as well as the end game. They are skilled ship captains — knowing how to sail against the wind and how to trim the organizational sails to keep moving forward. Successful leaders don’t just deploy population health as a strategy. They refocus the organization to embrace population health as a culture.
The right leader is one who embraces collaboration, creating purposeful partnerships and win-win relationships to meet the needs of the population. Population health isn’t a solo undertaking — internally or externally. Cross-organization collaboration must create vision, frameworks and incentives to foster innovative ways to promote real partnerships in the organization, network and community. A multifunctional cross-organizational team of clinical, operations, information, communications, quality, financial and actuarial leaders can help solve the problems inherent in population health. Also, engaging entities outside the four walls of the organization that can provide needed skills, capabilities or resources to manage risk is critical. With the social determinants of health increasingly recognized as key drivers of variation in health status and spending, community relationships become even more important than before. Health system or hospital leaders will need to urge community partners to support and access resources in dealing with patients’ socioeconomic struggles.
Leaders must create a culture of transparency to empower change and promote discovery and innovation. Transparency is required to confront the brutal facts where performance improvement is most needed. Health care needs people who are willing to disrupt the status quo — to engage patients in creative ways in managing health conditions, preventing illness, and avoiding unnecessary or duplicative interventions and treatments. Leaders must demonstrate a willingness to confront reality, encourage change makers, and foster and incubate innovations. They also must be willing to share internal information, sometimes information that is traditionally rarely shared, without hesitation and in full sight of the team.
Tolerance of failure is critical and goes hand in hand with a willingness to take risks in trying new things. There will be initiatives that do not yield their intended results, and the best leaders are the ones who can learn and adapt quickly from these failures. Having a clear picture of the intended goals and metrics that will determine success helps determine whether an initiative is having its desired impact. Once successful initiatives are identified, it is critical to quickly spread a consistent approach based on them – otherwise, innovations become one-offs that fail to yield meaningful results. This again requires leaders to implement systems to accelerate change. Teams must understand one another’s goals and needs, and they need to recognize how – using the talents, influence and resources of each — they can help choose which ideas are piloted, tested, and ultimately adopted or discarded. Whether there is too much or not enough change, or it comes too fast, will depend on leaders’ skills in assessing and influencing all those involved.
Leaders in this new world must be the “consumer advocate in chief.” Consumer experience and satisfaction is central in our increasingly consumer-driven health care world, and creating a more patient-centric environment is key. Consumers are taking an active role in managing their health care costs, including out-of-pocket costs, and making more-informed decisions when choosing health care services. Patients also are increasingly expecting instant, Uber-style on-demand access to care and advice. Leaders must make a patient-focused perspective a key priority throughout their organization and empower providers and care teams to implement changes. Those not involved in direct patient care must also embrace this priority — billing staff, customer service representatives, housekeepers and front-line phone responders all contribute to the overall experience of the health care consumer.
Mobile technologies have become key tools for patient engagement and shared decision-making. Innovative technologies to track patients along the care pathway have been developed to manage the health of populations. These technologies allow clinical care teams to identify risks and costs associated with patients’ lack of compliance and to deploy resources and interventions mitigating risks and engaging patients in their care. As cutting-edge health care technologies are developed, organizations will feel pressure to adopt them to compete in the marketplace; leaders’ role in prioritizing investments to achieve the greatest impact and return on investment is critical. Leaders need to reassess capital budgeting to balance brick-and-mortar needs against information and other technology to allow health care to be delivered anywhere. Leaders must demonstrate the organization's commitment to what it will do, and to identify, support and help orchestrate what will be accomplished.
Leaders must demonstrate a relentless focus on quality of care and patient safety and spread it throughout the organization. Clinical and administrative leaders must measure and quantify their organization's quality-of-care performance and share the information, as well as that generated by external entities such as payers. Ongoing and close monitoring of these measures is required to ensure continuous delivery of high-quality care, to address outliers or poor performers, and to implement changes that will improve outcomes. Leaders must be ready to take decisive, remedial action involving those who consistently fail to comply with established guidelines. Compliance monitoring by teams and their leaders, reported and overseen by the board, demonstrates a commitment to quality at the highest level of the organization.
Data and advanced analytics help an organization improve population-based outcomes. Leaders must be highly involved in decisions to invest in collecting and operationalizing data. Data often pose challenges for organizations because immense amounts of it are available but are not always helpful. Real-time data must support operational processes and decisions by leaders, clinicians and other front-line staff on a daily, if not moment-by-moment basis. In addition to reviewing historical dashboards and analytics, leaders must direct their planning and design. They must also use real-time dashboards to assess resource availability, inform decisions, and act immediately to benefit the individual patient as well as the organization’s effectiveness. Specific moment-by-moment tracking of patients, data on them and results allows for immediate feedback and action and can limit transition-of-care misses as well as patient and provider frustration. Data analysis can predict the future and help leaders decide on investments and care redesign. For example, predicting future capacity and risk associated with changing utilization patterns can drive facility and human resource planning.
Successfully activating change takes a lot more than just buy-in. Leaders must engage individuals closely related to the change at hand, which will help guide and refine change that will have meaningful impact. Those closest to a problem have the perspective needed on how proposed changes can be successfully implemented and sustained. Empowering front-line leaders to find solutions will create a collaborative culture deep within the organization. Leaders must create a culture of honesty that allows for safe ways to discuss and inform. Without honest feedback from front-line leaders, implementation will fail. Leaders should consider adding a change acceleration process to speed and sustain transformation. Providing context, vocabulary and methodology for an organization's leaders will create trust among all parties involved.
As organizations move toward population health, the ones that will be successful will be the ones with clarity of vision, a dedication to innovation and change, a commitment to the consumer, and the ability to confront the brutal facts with relentless optimism and focus.
Erin Byrne is a senior consultant and James Smith, MBA, FACHE, is an executive vice president at GE Healthcare Camden Group in Chicago and Rochester, N.Y., respectively.