Category Archives: Population & Public Health

Driving organizational success in children’s healthcare

In 1998 Jeffrey Pfeffer published an article in California Management Review describing what he sees as the seven practices of a successful organization. Comparing these practices to your typical health care organization today portends a crisis (some say the crisis has arrived).   Here is the list (with sarcastic commentary included for comedic effect – because if we didn’t laugh…) :

Employment security – apparently the data suggests that when employees fear for their jobs, they under perform – who knew?

Selective Hiring – the larger the applicant pool the better your workforce…mmmm – pediatric professionals weren’t in abundance as of … yesterday. Choosing employees to your organizational culture and the unique needs of your teams… is currently a luxury.

Self-managed teams and decentralization as basic elements of organizational design – uh – I’m not sure Dr Pfeffer realizes this… but it’s hard to empower practices and units in health care to actually manage their own performance – it takes time, training, dedicated people and robust real time data management – not to mention team meetings and engagement of front-line staff in analysis, action plan formulation, testing ideas, and managing sustained change. It’s easier to just tell them what to do, even if it’s wrong.

High compensation contingent on organizational performance – define performance, define high.   Is it ok to do high compensation no matter what? That would be great, because then we wouldn’t have to change anything.

Extensive training – Doesn’t everyone come into the health care workforce already trained?  Can’t they train themselves?

Reduction of status differences – we might actually be improving on this one in health care, but I’m not sure it’s having the impact we had hoped for.  Instead of collaborating we created more silos. Professionals who do shift work can’t make it to meeting where having reduced status differences allow for free exchange of perspectives and ideas.  Physician burnout has increased, because more and more tends to be dumped on them in this new order of everyone is equal and no one should do menial work, except the person who is ultimately responsible (oh, right, that difference still exists).

Sharing of financial and performance information throughout the organization- we have been tying to get better at this, but it’s …well… complicated.

So, what is the secret sauce for changing our organizational practices?  Sarcasm aside, let me put on my sunshine hat (yes, I actually have one). Accountable care will create the forces needed to shift health care into the realm of organizational success.  Fee for brief units or services of care has created a system of volume rather than value with regulatory and tort systems that drive fear rather than rationale thinking.

Working in teams, driving local continuous improvement, and driving true waste out of our processes, using the data management and sharing necessary to do so, with the staff training and professional development required, which will attract people to health care where professional joy is a given, will get us to the seven practices, and will create a care system that patients and families find value in and the workforce is proud of.

Getting to the Moon was Easy

In Health Affairs (December 2014) were multiple articles on children’s health, including The Changing Nature of Children’s Health Development: New Challenges Require New Policy Solutions.  The authors, Neal Halfon et al., suggest that the current health care system is poorly designed to ensure optimal lasting health of children into their adult years.   Using the science of life-course health development to support their view, they assert that factors present in early during childhood impact health throughout life more so than we appreciate, and that our current approach to health in the U.S. doesn’t address these early influences.

This new science provides an explanatory framework for understanding how poor health and social adversity during childhood can affect lifelong health. Early interventions, especially in early childhood, have been shown to lessen the impact of these social and environmental influences. The authors contend: “Studying life-course health development has left little doubt that a nurturing and materially sufficient early life is an essential component of a healthy society.”

The authors call for a national action plan, with involvement of public, private, philanthropic, and faith-based sectors, where local and regional partnerships would link child health care providers, city and county governments, payers, employers, and schools. They suggest that most health creating interventions need to have its roots at the local and regional level. They propose the child health care community drive the creation of community accountable health development systems designed as integrated networks of medical homes, early childhood programs, school health centers, children’s hospitals, and other community health services.

What the article doesn’t do is reveal the secret to achieving this vision. Those communities that have made some progress all have one thing in common: funding.   And the funding typically comes from a mix of local, regional and national sources, many of whom consider themselves partners in fulfilling the vision, which generally leads to the funding being somewhat sustainable over a long period of time, enough to discover how to make a difference, and demonstrating some results.   In addition to funding, perseverance may be a critical ingredient to the formula.

If We Can Put a Man on the Moon is a book by William Eggers.  Mr. Eggers provides some thoughts on why we are failing to solve our biggest social problems.   Lots of great insights except for perhaps one when it comes to children: the social transformation that needs to take place to improve the health and wellbeing of our children will take a lot more people believing in it and participating in it than what it took to put someone on the moon.  It will require the public thinking more long-term than ever before and more about the children than themselves.   The Moon was easy.