Harvard Business Review
by Mark Britnell
December 28, 2015
Key messages by
Joaquim Cardoso MSc.
Instituto para Transformação Contínua da Saúde (ITCS)
(Institute for Continuous Health Transformation (ICHT))
July 8, 2022
What is the problem?
- Every country wants to deliver safe, consistently good, financially sustainable health care, but no one has been able to do it.
- Health systems the world over list a strikingly similar set of ambitions, but no country is delivering these transformational changes.
- … the failure of different parts of the system — payers, providers, patients, professionals, policy makers, politicians, the public, and the press — to pull in the same direction is a serious drag on innovation and progress.
- Health organizations find collaboration difficult even when they are not competing.
What are the causes:
- Instead of rewarding leaders for transforming health care, our systems reward leaders for making narrow improvements within them.
- What stops skilled, motivated people from making health care better, more integrated, and ultimately more sustainable? The answer is the organizations in which they work and the pressures, incentives, and regulations under which they operate.
- At the heart of this problem is a paradox: transformation in health care can only be achieved by continuity and consistency.
There are three compounding problems that inhibit large-scale, sustainable change.
- 1.The first is organizational myopia
- 2.The second is the ability for transactional reform to trump transformation.
- 3.The third is that large-scale change is as much an emotional issue as a technical one, which is rarely understood.
What are the solutions?
The antidote to this fragmentation is integration, the most hotly discussed concept in health care today.
The Institute of Medicine in America’s landmark report (Crossing the Quality Chasm), identified four ingredients for a high-quality care system:
- 1.the right vision,
- 2.designing clinical processes from the patient’s perspective,
- 3.integrating organizations into systems, and
- 4.getting environmental factors such as regulations and financing right.
ORIGINAL PUBLICATION (full version)
Transforming Health Care Takes Continuity and Consistency
Harvard Business Review
by Mark Britnell
December 28, 2015
In six years of working across 60 countries in search of the perfect health system, I have been fascinated by the fact that every country wants to deliver safe, consistently good, financially sustainable health care, but no one has been able to do it.
At the heart of this problem is a paradox: transformation in health care can only be achieved by continuity and consistency.
… every country wants to deliver safe, consistently good, financially sustainable health care, but no one has been able to do it.
At the heart of this problem is a paradox: transformation in health care can only be achieved by continuity and consistency.
Health systems the world over list a strikingly similar set of ambitions:
- moving to value-based care that improves outcomes, reduces costs, and increases patients’ satisfaction;
- turning hospitals into health systems;
- focusing more on preventing ill health rather than treating it;
- implementing technology to make care more efficient; and empowering patients.
But no country is delivering these transformational changes.
Instead of rewarding leaders for transforming health care, our systems reward leaders for making narrow improvements within them.
Health systems the world over list a strikingly similar set of ambitions …
… but no country is delivering these transformational changes.
Instead of rewarding leaders for transforming health care, our systems reward leaders for making narrow improvements within them.
I have seen examples of great health care all over the world, but too often the inspiring individuals delivering this care have been impeded, rather than helped, by the system in which they are working.
Imagine the global potential if these local pockets of excellence could be harnessed for the benefit of whole populations.
I am one of the 15 health experts on the World Economic Forum’s Global Agenda Council on the Future of the Health Sector.
We have been looking at why sustainable change in health care is slow, fragmented, and difficult.
It is clear to us that the failure of different parts of the system — payers, providers, patients, professionals, policy makers, politicians, the public, and the press — to pull in the same direction is a serious drag on innovation and progress.
… the failure of different parts of the system — payers, providers, patients, professionals, policy makers, politicians, the public, and the press — to pull in the same direction is a serious drag on innovation and progress.
This failure to work together across a system continually exercises me.
Organizations have a strong sense of their own value and an unswerving commitment to high quality care but little appreciation of others’ worth in their local, regional, or national systems.
I have often been struck by the way companies operating in industries as diverse as telecommunications and transport manage to collaborate in a competitive environment, yet health organizations find collaboration difficult even when they are not competing.
Organizations have a strong sense of their own value and an unswerving commitment to high quality care but little appreciation of others’ worth in their local, regional, or national systems.
… yet health organizations find collaboration difficult even when they are not competing.
The antidote to this fragmentation is integration, the most hotly discussed concept in health care today.
What stops skilled, motivated people from making health care better, more integrated, and ultimately more sustainable?
The answer is the organizations in which they work and the pressures, incentives, and regulations under which they operate.
What stops skilled, motivated people from making health care better, more integrated, and ultimately more sustainable?
The answer is the organizations in which they work and the pressures, incentives, and regulations under which they operate.
There are three compounding problems that inhibit large-scale, sustainable change.
- 1.The first is organizational myopia
- 2.The second is the ability for transactional reform to trump transformation.
- 3.The third is that large-scale change is as much an emotional issue as a technical one, which is rarely understood.
There are three compounding problems that inhibit large-scale, sustainable change.
1.The first is organizational myopia.
Organizations have a tendency to think they are basically good but the health system in which they operate is poor at supporting them.
2.The second is the ability for transactional reform to trump transformation.
I define transactional as “doing things better” and transformational as “doing better things.”
Often, it is easier and less threatening to make seemingly important but small changes than it is to hold individuals, organizations, or systems to account for transformational change that will produce better care and value.
I define transactional as “doing things better” and transformational as “doing better things.”
3.The third is that large-scale change is as much an emotional issue as a technical one, which is rarely understood.
A compelling vision of a better future needs to be communicated in a way that creates energy and motivation.
This means that staff members have to be able to relate to it, shape it, and, crucially, feel empowered to challenge the status quo.
This is simple to say but difficult to do.
Health care is not the only industry that is resistant to change.
A recent KPMG global survey of 3,000 leading executives across 20 industries found board leaders were twice as likely to focus on short-term efficiencies as they were to prepare for major business model change.
However, health and life science leaders were nearly three times as likely to focus on the urgent issues of today and not the important ones of tomorrow.
In a separate recent survey of hundreds of health care leaders across the developed world, we found that while 73% of them thought their country’s health care system required “fundamental” change, only 35% felt change was needed in their own organization.
Health care leaders often see the need for system-wide change before they see the need to transform their own organizations.
They realize the scale of transformation required but believe it is somebody else’s problem.
When this belief is coupled with a deeply transactional culture focused on incremental improvements, the status quo is unassailable.
Health care leaders often see the need for system-wide change before they see the need to transform their own organizations.
So what can we do?
“Crossing the Quality Chasm,” the Institute of Medicine in America’s landmark report, identified four ingredients for a high-quality care system:
- 1.the right vision,
- 2.designing clinical processes from the patient’s perspective,
- 3.integrating organizations into systems, and
- 4.getting environmental factors such as regulations and financing right.
“Crossing the Quality Chasm,” the Institute of Medicine in America’s landmark report, identified four ingredients for a high-quality care system:
I have seen health systems in Japan, Singapore, Spain, New Zealand, and the UK that show how population-scale health care with these ingredients can be achieved.
But the best one I have worked with is the Geisinger Health System in Pennsylvania, which provides complete care for more than 2.6 million people.
But the best … health system … I have worked with is the Geisinger Health System in Pennsylvania, which provides complete care for more than 2.6 million people.
Its core way of working, ProvenCare, is built around population health and using data and clinical evidence to redesign care systems.
Its structures and processes have been reengineered to maximize value.
There is a culture of safety and quality, and patients are involved in their own care.
The payments system incentivizes the organization to get care right the first time, in the most appropriate setting.
Geisinger had the audacity to try to change the way health care is provided and paid for in America, and it has succeeded in reducing mortality and costs while substantially improving quality.
Its journey to become one of the world’s most innovative health systems has largely taken place during the 15-year tenure of Glenn Steele.
When I spoke to Glenn about his leadership style and what he learned as president and chief executive from 2000 to 2015, several things stood out.
First is staying power.
Glenn was only the fifth leader that Geisinger had had since its establishment, in 1915, and his strategy remained consistent throughout his decade-and-a-half at the top.
The first clinical specialties started adopting ProvenCare in 2003, and the organization has been working through the rest for the past 12 years.
This consistency, twinned with early successes, has made wider change possible.
Glenn freely admits that some of the founding principles of the transformations he drove were built more on beliefs than evidence.
But once years of data had been amassed, bigger and bolder transformations could be achieved.
But once years of data had been amassed, bigger and bolder transformations could be achieved.
Making these changes required skill, will, and time underpinned by rigorous process. This is the paradox of change: It requires continuity and consistency.
Making these changes required skill, will, and time underpinned by rigorous process. This is the paradox of change: It requires continuity and consistency.
Health care leaders do not spend enough time with other parts of the system, and they do not place enough faith in their ability to develop and implement sustainable solutions to problems they know exist.
So it is easy to see why they spend their energy doing things better rather than doing better things.
Nobody gets held to account for producing a more sustainable health system; they just get rewarded for surviving in the existing one.
Nobody gets held to account for producing a more sustainable health system; they just get rewarded for surviving in the existing one.
Health leaders need to recognize that they are not alone in grappling with their health systems, and they should not be afraid of attempting to change them.
They should remember, however, that transformation is impossible without continuity.
Health leaders need to recognize that they are not alone in grappling with their health systems, …
… and they should not be afraid of attempting to change them.
They should remember, however, that transformation is impossible without continuity.
Originally published at https://hbr.org on December 28, 2015.
