Disruptive Change : The Evolution of Organized Systems of Care

Transcription

1 Disruptive Change : The Evolution of Organized Systems of Care Iowa Healthcare Collaborative August 28 th, 2013 Erick J. Laine, M.D. Executive Vice President / Chief Operating Officer UnityPoint Clinic 8/19/2013 1

2 Part I: Evolution of Complex Systems A. External Environmental Forces: 1. Static environments 2. Dynamic environments 3. Climate Change B. Internal Environmental Responses: 1. Static response 2. Dynamic response 3. Transformative change C. Evolution (Transformation) 1. Thresholds (Orders) of Complexity 2. Emergent Properties 8/19/ Evolution Change Time 8/19/2013 4

3 Evolution Change Time 8/19/ Evolution -Physics -Biology -History -Organizations Emergent Properties Emergent Properties Thresholds Of Complexity Dis-Integration Emergent Properties Integration Higher Orders Time 8/19/2013 6

4 Part II: Evolution of Complex Organizations A. Healthcare Climate Change B. Organizational Responses 1. Necessity and Sufficiency 2. Organized Systems of Care 3. Lumpers and Splitters 4. Type II (Transformative) Lumpers C. Evolution of Complex Organizations: 1. Thresholds of Complexity a. Space b. Time 2. Emergent Properties 8/19/ Healthcare Environment Third-Party Payers Fee-For-Service (FFS) Quality (Access) 8/19/2013 8

5 Environmental Shift (Climate Change) Economic Sustainability Fee-For-Service (FFS) Crisis Value/Risk-Based Contracts (VBC) Quality + Access + Cost of Care 8/19/ New Environment : New Organizations Fee-For-Service (FFS) Economic Sustainability Value/Risk-Based Contracts (VBC) Organized System Of Care () Necessary but Insufficient Necessary and Sufficient Quality + Access + Reduce Cost-of-Care 8/19/

6 Organized Systems of Care (s) IV. Population Health: III. Care Coordination: D. Long Term Health Maintenance C. Intermediate Disease Prevention B. Utilization Management Facilities Diagnostics Therapeutics. A. Disease Management Diabetes CHF Asthma. C. Medical Home AMT. My Nurse. Portal. Home Health. Palliative Care. B. A. II. : I. Episodic Care: 8/19/2013 MD offices Hospitals Amb Services NHs Pt Homes 11 Mother Nature Splitters Lumpers Dis-Integration (Differentiation) Integration (Unification) 8/19/

7 Human Nature Splitters Fear Lumpers Dis-Integration (Excessive Differentiation) Integration (Excessive Unification) 8/19/ Transformative Tension Splitters Lumpers (Excessive Differentiation) Integration Differentiated Unity (Excessive Unification) 8/19/

8 Strategic Responses to Environmental Change Splitters Lumpers Dis-Integration Integration 8/19/ Type I Strategic Response: Protectionist Splitters Lumpers Small Volume Systems The organizing entity remains the same Strategy = Niche Avoid change End = Preserve the Status Quo Big Volume Systems The organizing entity remains the same Strategy = Growth Avoid organizational change End = Bigger versions of the Status Quo 8/19/

9 Type II Strategic Response: Transformative Splitters Lumpers Small Scale Value Systems The organizing entity changes Strategy = Niche Performance Niche = Innovation Innovation = New Value? Large Scale Value Systems The organizing entity changes () Strategy = Performance > Growth Growth = means to and end = Innovation/Value Value = New Emergent Properties (Sustainability) 8/19/ Organizational Transformation OLD World 1. Individual Patients 2. Individual Providers 3. Individual Organizations Crisis NEW World 1. Pt Populations / Care Coordination 2. Integrated Team-based Care 3. Organized Systems of Care 4. Performance = A or B or C or D 5. Autonomy 4. Performance = A + B + C + D 5. Accountability Sustainability 8/19/

10 UnityPoint Health 8/19/ UnityPoint Clinic 8/19/

11 4 Constrained (Ambition) : Crucible Recruitment Acquisitions Affiliations Growth -Integration -Function -Performance -Value Transformation * Value Sustainability Triple Aims Care Coordination Population Health Aggregation 8/19/ Growth-Performance: Tipping Point Sustainability FFS: Volume Broad Network High-Value Network Value VBC: Value UnityPoint Clinic Regional s UnityPoint Health Performance Platform Highly Integrated Highly Functional High Performing High-Value Volume 8/19/

12 Aggregation vs. Alignment vs. Integration High order Threshold Shift Highly Integrated Integration Organizational Development Alignment Low order Aggregation Do your own thing Performance Risk Burdens Low order High order 8/19/ Expanded Complexity Expanded Scope Expanded Scale Exponential Complexity 8/19/

13 Expanded Complexity : Complex Challenges Human Nature Stages of Grief: 1. Denial 2. Anger 3. Negotiation 4. Resignation 5. Acceptance Change 8/19/ Expanded Complexity : Expanded Identity Human Nature Radius 8/19/

14 Expanded Identities : Expanded Responsibilities Human Nature Radius 1. Expanded Parties of Consideration 2. Expanded Categories of Consideration 8/19/ Expanded Responsibility: Parties of Consideration Patients Corporate System Collaborators System-Wide Medical Group Payors Community Small Group Region MD 8/19/

15 Expanded Responsibility: Categories of Consideration Clinical Operational Business / Financial Legal Organizational 8/19/ Expanded Considerations Medical Group Parties to Consider Categories of Consideration Organizational Clinical Operational Financial Cultural Reg/Legal Patients + Physicians + Hospital + UnityPoint Clinic It Works! 8/19/

16 Expanded Considerations Medical Group Parties to Consider Categories of Consideration Organizational Clinical Operational Financial Cultural Reg/Legal Patients + Physicians + Hospitals + Clinic It Doesn t Work! 8/19/ Expanded Considerations Organized System of Care Parties to Consider Categories of Consideration Patients + Hospitals Ambulatory Home MD Offices + + Services + Health + Patient Home Providers + Payers + Communities It Works! 8/19/

17 Expanded Considerations Organized System of Care Parties to Consider Categories of Consideration Patients + Hospitals Ambulatory Home MD Offices + + Services + Health + Patient Home Providers + Payers + Communities It Doesn t Work! 8/19/ Expanded Consideration In Space Radius Space 1. Expanded Parties of Consideration 2. Expanded Categories of Consideration 8/19/

18 Expanded Consideration In Time Radius Space 1. Expanded Parties of Consideration 2. Expanded Categories of Consideration 3. Expanded Periods of Consideration Time 8/19/ Full Consideration In Space and Time Radius Space 1. Expanded Parties of Consideration 2. Expanded Categories of Consideration 3. Expanded Periods of Consideration Time 8/19/

19 Part III: Leadership in Complex Organizations A. Complex Organisms and Complex Organizations B. Expanded Consciousness 8/19/ Team-Based Decision-Making! Bright Idea Team-based thinking Compelling Concept Realm of Ideas Realm of Reality Site Go do that.! Pilot Multiple sites Demonstration Project Real Innovation Assets vs. Real Big Oops Liabilities 8/19/

20 Beyond Subjectivity Rational Standardization Unreasonable Reasonable Artistry Science Literature Science Art Reasonable Unreasonable 8/19/ Physician Leadership External Realities Leadership Internal Realities Advocacy 8/19/

21 Part III: Leadership in Complex Organizations A. Complex Organisms and Complex Organizations B. Expanded Consciousness C. Transforming the Organization 1. Structure 2. Roles 3. Process 8/19/ Evolution of Complex Healthcare Organizations First Generation Second Generation Third Generation Medical Staff Structure Line Management Structure *Governance Committees Self-Employed MDs *Data Systems (Accounting) *Leadership *Managemnt Employees 1 st Operating System *DS-II (Analytics) *DS-I (Accounting) OS-II OS-III Cottage industry Performance-Engineering (structure, process, data, metrics) Transformative (Complexity, Big-Data, Dynamic, Real-time) 8/19/

22 Part III: Leadership in Complex Organizations A. Complex Organisms and Complex Organizations B. Expanded Consciousness C. Transforming the Organization 1. Structure 2. Roles 3. Processes 8/19/ Organizational Complexity: Roles Clinical Operational Business / Financial Legal System CQO COO CFO Region Management Teams Small Group Manger Practice MD Different Levels Different Domains 8/19/

23 Org Structure: Role Clarification Organizational Roles: 1. Medical groups 2. Hospitals 3. Other Op entities System Key Positions: 1. Executives 2. System positions 3. VP dyads 4. Associate dyads 5. Dept dyads 6. Site dyads 7. MD employees Key Forums: 1. Governance/Oversight forums 2. Leadership/Management Forums a. System level b. Regional level 3. Advisory Forums Decision-making Authority 8/19/ Part III: Leadership in Complex Organizations A. Complex Organisms and Complex Organizations B. Expanded Consciousness C. Transforming the Organization 1. Structure 2. Roles 3. Process 8/19/

24 Planning Process Transformation Old-World POINT A POINT B New-World Quick Dip Hasty Retreat Ice-cold River 8/19/ Planning Process I. Articulated Vision II. Strategic Plan Point A Point B Year 1 Year 2 Year 3 Year 4 Year 5 Clinical Model Operational Model III. Fiscal Year Plan Budget Business Model Investment / ROI Organizational al Model Now 5 Years from Now 8/19/

25 Environmental Pressures Mother Nature Human Nature 8/19/ Better Relationships Better Value Better World Better Natures 8/19/

26 Transformation. UnityPoint Clinic really is something New 8/19/ Summary Part I: Evolution of Complex Systems Part II: Evolution of Complex Organizations Part III: Leadership in Complex Organizations 8/19/

27 Thank you. Questions? 8/19/