This is Part 7 of an eight-part series featuring thought-provoking insights from the Leadership in the Age of Personalization Summit. Here is Part 1, Part 2, Part 3, Part 4, Part 5 and Part 6.
“We have never rewarded our employees for doing more, we have always rewarded them for doing the right thing.”
One of the most important decisions a leader makes is what will be measured to determine success – success of the business, success of a project, success of an individual.
Because whatever it is – that is what people will focus on. Maybe that sounds obvious, but I think we forget how powerful our metrics are in determining what people actually do.
- What kinds of things are you rewarded for?
- What kinds of things do you reward your team for?
Are they truly transformative actions or behaviors, or are they simply the things that are easiest to measure?
There is perhaps no industry grappling with this issue more than healthcare, as it tries to evolve from a system based on volume
– getting paid by the test, so we should perform more tests –
to one based on value
– getting paid for keeping people healthy (and not needing tests in the first place).
At the heart of this transition is that tension I’ve been discussing throughout this entire series – the tension between standardization and personalization. Healthcare has to figure out how to maintain standards of care while also incorporating aspects of people’s individual humanity.
Top healthcare visionaries addressed this topic at the Leadership in the Age of Personalization Summit, where senior leaders from industries spanning healthcare, automotive, finance, consumer packaged goods, retail, technology, apparel and more, gathered to explore the tension we’re all feeling as our society transitions from an age of standardization to our current age of personalization.
Throughout the day we discussed building economies of scale around human dignity, how to escape the extremes to achieve balance, how assimilation destroys individuality and inclusion restores it, how to allow personalized values to influence your brand identity, Wall Street’s perspective on how companies are not prepared for what is about to hit them and how a company’s mission is worthless without individual contribution.
We can’t make progress on any of those themes if we’re not open to new methods for inviting and empowering people to have individual influence on the way we do things. During this discussion, healthcare leaders got real about the challenges and also shared some bright spots that we can learn from and apply within any industry.
Tom Mihaljevic, MD, is CEO and President of Cleveland Clinic. He leads an $8 billion medical system, including a main campus, 10 regional hospitals, 18 family health centers, and healthcare facilities in Florida, Nevada, Toronto, Abu Dhabi and London.
I asked Dr. Mihaljevic how Cleveland Clinic deals with the challenges of maintaining standards while allowing for individual contribution – even among multiple campuses around the world.
He said a lot of the fundamentals of the organization have been in place for nearly 100 years, since its inception in 1921. He talked about the importance of establishing an organizational culture and making it clear what is valued and what is measured, so people can address challenges with confidence.
Cleveland Clinic has several distinguishing features – including the fact that most of its physicians are salaried.
“We have only one-year contracts, and none of us is tenured,” he said. “The CEO does not have a long-term contract either. So that means that I’ve renewed my contract 15 times, I hope to renew it 16 times. Each one of us undergoes the yearly evaluation, so it’s a very complex process. But for us to be salaried and so patient-centric has really helped us address all these issues [of personalization].”
Dr. Mihaljevic said another distinguishing feature is that they call each one of their 66,000 employees a caregiver.
“So if you were to walk down our hallways and you go from one office to another, and you take a look at the names of the offices, there are no titles,” he said. “You wouldn’t be able to tell what a person does in the organization. We like to say that we distinguish the value of the person based on their character, and based on their impact, rather than on their title.”
Each of those decisions affects the way people see their own role within the organization.
Another aspect of the culture gets to the heart of what’s rewarded or not within the organization.
“We have never rewarded our employees for doing more, we have always rewarded them for doing the right thing,” said Dr. Mihaljevic. “Our annual performance reviews for physicians don’t reflect the volume of work they do but rather the quality of work they do – the way they interact with their peers, with their residents, with their patients. Then, obviously, their academic contribution and contribution to the greater organization.”
He had this advice for leaders who want to build a culture where expectations are clear: the first step is to define what really matters.
“For us, our ethical framework is very simple,” he said. “We always say: ‘you have to take care of your patients and your fellow caregivers as your family, and this place as your home.’”
Having a clear framework makes problem-solving much more straightforward.
“Whenever someone comes to my office with any type of complex question, I always ask them the same thing: what would you do with a family member and what would you do if this were your own home? And all these complex business approaches turn out to be very simple because that simple framework is applicable. Culture can be taught.”
Changing the Reward System
But what if you don’t have immediate control of the metrics that at least partly define the culture?
One of the most pressing issues in healthcare is the payment model. The industry is shifting from volume to value, but that shift is difficult when volume is still what determines how much organizations get paid.
A panel of healthcare leaders addressed this challenge.
Thomas E. Jackiewicz serves as Senior Vice President and CEO for Keck Medicine of USC. He said he was chatting with a group of doctors about the primary care physician experience. He asked the doctors: what percentage of your patients could possibly be seen by another caregiver or a care team, but they didn’t really have to come into the office?
“The consensus was one third to one half,” he said. “That is a lot of physician time and a lot of patient inconvenience for care that could be delivered by someone else. This is a problem that we really need to solve. This is an opportunity.”
Mark Laret, President and CEO of UCSF Health, agreed and expanded on the challenge.
“Part of the challenge is the economic model of our fee-for-service system,” said Laret. “Those visits happen because that’s how the doctors get paid. But as we move to a population health model where our incentive is to keep people out of the hospital and keep them well, it starts to put a premium on exactly what Tom [Jackiewicz] was talking about.”
This point was reinforced by Dr. Jack Cox, a seasoned senior healthcare executive with more than 25 years of experience in regional and national senior leadership positions including both large integrated healthcare delivery systems as well as national corporate experience. He was most recently the Senior VP and Chief Quality Officer for Providence St Joseph Health and the System CMO for Swedish Health Services.
“The elephant in the room is, as a family physician, even though I’m concerned about your health and wellbeing – I don’t get paid for that,” said Dr. Cox. “A lot of my research early in my clinical career was around smoking cessation. But the truth was, which I heard my colleague say, ‘I get paid when somebody has a heart attack, I don’t get paid to spend 30 minutes to help somebody quit smoking.’”
This is why methods are so important, and why focusing on results can trap us.
Let’s take his smoking cessation example. The procedure for treating the patient’s heart attack may have been a success. But if that’s how you track results – successful treatment AFTER someone has a heart attack – then you’re not really considering or rewarding methods that might prevent the heart attack in the first place.
This may seem extreme, but we do this in business all the time, no matter the industry. We focus on what is being measured to such an extent that we forget to question whether or not there’s any value in that thing in the first place.
Change is Hard, Even When There’s Success
Change should be a no-brainer when the metrics show that a new initiative has been successful, right? Think again. That’s how trapped we are in standardization.
Jackiewicz addressed the complexity of merging the two ideas – standardizing some of the things that we do in healthcare for evidence based and efficiency but, at the same time, personalizing care.
“Healthcare at its core is people taking care of people,” said Jackiewicz. “We realized that one of the ways we could improve outcomes was with a program called Enhanced Recovery After Surgery – which is about evaluating patients as individuals before their surgery. Looking at them as people – looking at their exercise level, their diet, if they’re diabetic getting their diabetes under control, and bringing in integrated pain management. And when you look at people like that, the impact is fantastic.”
He said they saw a dramatic improvement in outcomes.
“Our opioid use dropped by 60% on surgical patients,” he said. “We do a ton of surgeries and we obviously want to be really standardized. But it’s amazing when you have the impact of looking at each surgical patient as an individual. When you deal with people like that you have a tremendous impact.”
But even with proven successes like that, it’s hard to escape the traps of standardization and the methods that have been entrenched for so many years.
In fact, Jackiewicz said even with the success of Enhanced Recovery After Surgery, 85% of their surgeons were opting out of the program. “It’s stunning, actually,” he said. “All the data is out there, but people say ‘we’re used to doing it this way.’”
But Jackiewicz found a way to push change forward anyway.
“One of the ways we’ve been able to get new initiatives through is to work with the willing,” he said. “We have a good group of younger, open-minded physicians – getting initiatives started there and letting things begin to spread. If we had tried to get everybody on it from day one, we’d still be talking about it. So the coalition of the willing is a really effective way to get stuff started.”
How Individuals Can Expand Your Mission
A focus on individuality is not just reflected in the care provided by a healthcare organization, but also can expand or re-energize that organization’s mission to serve the community.
Laret said UCSF is re-thinking the way it serves the community, thanks to the influence of the younger generations – to the point where they’re trying to change the narrative for what it is to be a caregiver in the healthcare system.
That’s an interesting take that brings the focus to identity – “what it is to be a caregiver” – and once we start asking questions about identity, that opens us up to letting individuals have influence.
As Laret put it: “One of the great advantages is the trainees who choose to come into medicine or healthcare professions. The profile of that cohort has changed dramatically. If you went back far enough, people did it for the prestige, or they were the smartest person, and this is where they went for their career or to make money.”
But that’s changing.
“Now,” said Laret, “the smartest person who wants to make money doesn’t go into medicine. It’s the person who cares most about the community and about other people, that’s who goes into medicine. And I think we’re very fortunate to have a growing cohort of those individuals who are also tech savvy, and they’re wanting to take on things that we have not, historically, taken on.”
He mentioned the homeless crisis in San Francisco as an example.
“It’s a crisis in epidemic proportions,” he said. “Many of us in leadership positions at UCSF said, well, our job is to run the Emergency Department and deliver healthcare in the way we do. But our students and trainees said, ‘That doesn’t cut it. Those individuals are coming into our emergency department, we’re buffing them up, we’re sending them back down to live in Golden Gate Park for another 24 or 48 hours until they have another crisis and they’re back in. That is not a healthcare system.’”
This is what can happen when people feel empowered enough to speak up, and when leaders are wise enough to listen.
“I put a lot of faith in this next generation of forcing us to think more broadly about what our social responsibilities are,” said Laret. “And to think about how we engage every individual, and see the worth in every human being.”
How Partners Can Expand Your Mission
Victor Crawford is the CEO of the Pharmaceutical segment at Cardinal Health. He talked about the role that organizations can play as strategic partners in the healthcare ecosystem. Cardinal Health has traditionally had a B2B focus, but in an effort to get closer to the consumer they are shifting to B2C.
“I think the beauty of what we have in our organization, is that most of our 50,000 employees have been a patient, or may be a patient, or know a patient,” said Crawford. “So at the end of everything we do, is a patient or a healthcare consumer.”
“There is a unique space even for us as a B2B provider, and we had to start with our organization culture. We had to go back to the core and say, ‘Okay, why do we exist?’ And it’s to deliver products and solutions that impact people’s lives every day. We want to be healthcare’s most trusted partner. And our values, when we laid them out, they actually ended up spelling I am: integrity, inclusion, innovation, accountability, and mission-driven. And so we go from the we to the I.”
He said Cardinal Health has spent the last few years acquiring assets that let them get closer to the consumer – from pharmacies, to a cloud-based solution that reminds people when they need a refill and educates about drugs they’re taking.
“We’re trying to move a little closer to the consumer just because we know how important it is,” said Crawford.
Crawford underscored the role partnerships can play in reducing healthcare costs overall: “We’re approaching what, $4 trillion in medical spending [as a country]? And one thing [everyone] probably agrees upon, is that healthcare spending is out of control, and we have to address that. And the only way we do that is through a high level of collaboration.”
It All Comes Down to Identity
It’s interesting how a conversation about a challenge as complex as healthcare still ends up being about who we are as individuals.
- At Cleveland Clinic everyone is considered a caregiver and people are rewarded for quality.
- At Keck Medicine of USC change begins with “the willing” – again, an aspect of identity.
- At UCSF, younger people are exerting their identity and influencing the identity of the institution and its role in the community.
- Cardinal Health is making big changes in the way it does business to get closer to individuals.
In this age of personalization, identity is about much more than knowing ourselves. That’s a huge first step, of course. But it’s also about individuals knowing they have can influence, and leaders understanding the full value of individual influence.
Earning the trust of your patients, customers and employees means something more than results in the age of personalization. Results are about doing; they lead to success. Methods are about what you solve for; they lead to success and significance. Leaders need to learn how to escape the tyranny of results and outdated metrics and find the freedom of methods that what you solve for can influence.