Several years ago I was asked to facilitate a strategy session for a large HMO that wanted to change business models. The executives realized they needed to do an overhaul on their business model to remain competitive in the marketplace. Medicare fees were being reduced again, and they no longer could survive with inefficient methodologies. A cultural change would be needed that would reach from top to bottom and back again. It would be a tedious process, but one that meant the company could continue to prosper in spite of the upcoming changes in the health care revenue cycle.
The change would include an electronic medical record (EMR) implementation and raising the bar on staff credentials, as well as raising expectations of health care providers’ and employees’ skill levels. This would not be an easy task. They were already in the midst of a labor-management dispute, so adding anything more to their agenda was going to be an uphill battle. Leadership knew the plan must be a strong one and had to be well thought-out to succeed. It would be difficult but well worth the effort in the long run.
Daily operations were impacted from the beginning because so many people had to participate in discussion groups. Leadership needed input from the staff level. Communication was key for this project. Trust had to be established and strengthened from both directions for a culture shift to occur. Operational strategies needed to be identified for the current model to continue functioning while building a new one on paper. We spent many hours with task forces and work groups to dream, create, and document the new model. Project management teams were created for the EMR implementation, labor-management work groups were created to identify new skill level requirements, and education teams were created from top to bottom to teach new skills. Patients were interviewed to find out what they wanted and expected from their health care delivery system. Management consultants were brought in at various levels to help keep daily operations going and to assist in redesign and process improvement efforts. And, at times, staff augmentation by contractors was necessary to keep work flowing.
This organization identified that changing a business model, and therefore creating a new business environment, was not only imperative for survival but absolutely necessary to respond proactively to market demands. It determined the overall plan would take five years to succeed. I didn’t always agree with their decisions, nor did all their decisions work out as expected, but this organization developed a strategic plan that became an actionable road map to their future. It identified responsibilities, expectations, and desired outcomes. Most importantly, the entire organization from top to bottom worked together to make sure they continued providing care to their patients while moving into a new business model to meet the upcoming changes in health care.
