The North Carolina Healthcare Information & Communications Alliance, Inc. (NCHICA) is a nonprofit consortium dedicated to accelerating the transformation of the U.S. healthcare system through the effective use of information technology, informatics and analytics. NCHICA’s focus areas are Collaboration, Engagement and Thought Leadership.
The health care industry is in transition and because of this, new leadership styles need to be implemented to effectively lead and manage in this new paradigm. With the introduction of new laws, regulations, care coordination and payment models, health care providers need to adjust not only how they treat patients, but also how they work together. Long established leadership beliefs may need to change for physicians and other health care professionals as a team based approach becomes more necessary to be effective.
Healthcare is a very regulated industry and there have been numerous new laws implemented over the last few years that have changed how health care providers work within their organizations. This increase in health care usage can put pressure on the existing infrastructure and require new management techniques to lead teams through this transition.
Physicians, who are typically leaders within health care, now must balance changes in the industry along with new demands required to effectively lead teams through these exciting times. What may have worked in the past may not be successful today, so changes in leadership styles may be required to be successful in today’s environment.
When I think of a physician, I imagine a person who has intelligence, self-confidence, determination, and integrity – all of the attributes that fall under the trait approach of leadership. Beyond having the “right” personality characteristics, they also would have to have the appropriate technical skills to be considered a leader. Both of these leadership styles are described by Northouse in the text “Leadership: Theory and Practice”, whereas the trait approach has its roots in leadership that suggest that certain people were born with traits that make them great leaders, the compliment to trait theory is the skills approach that shows that effective leadership depends on three basic personal skills: technical, human and conceptual (Northouse, 2012). I have always felt that due to the extensive training a physician must complete, as well as their skills and experience, they have a certain “gravitas” that instills respect and admiration. This lends itself to the perception that doctors would naturally make great leaders.
But what makes a physician a great doctor, may not necessarily make them a great leader. Dr. Atul Gawande stated “Health care is moving towards teams, but that collides with the image of the all-knowing, heroic healer. We’ve celebrated cowboys, but what we need is more pit crews. There’s still a lot of silo mentality in health care.” This same sentiment was shared by Dr. Thomas Lee who stated “The problem with health care is people like me – doctors (mostly men) in our fifties and beyond, who learned medicine when it was more art and less finance. The only way to ensure quality was to adopt high personal standards for ourselves and then meet them. Now at many health care institutions and practices, we are in charge. And that’s a problem, because health care today needs a fundamentally different approach – and a new breed of leaders.” So the lone-ranger approach to health care may have worked better in the past when physicians managed solo practices and were in charge of their domain, but with the changes in health care, maybe this style of leadership isn’t the most applicable to be effective.
As physicians take on more leadership roles in organizations, the importance of having the right leadership style matched with the demands of the situation becomes apparent. This is described with the contingency theory approach where the leader’s effectiveness depends on how well the leader’s style fits the context. So for physicians that have not evolved their thinking in regard to how best to work in today’s health care environment, they may not be successful, but for those who recognize the changes going on and adjust their leadership style, they will likely be more successful.
The team leadership model provides a framework in which team members can figure out the best way to work together to accomplish their goals and work together. Within the health care industry, there has been a shift to new models such as the Accountable Care Organization (ACO) and patient-centered homes where care is conducted through teams of health care providers who share information and support each other in the care of the patient. These shifts within the industry are encouraging a more collaborative work-environment which supports a team centered approach but the specifics of what clinicians need to do can be unclear. Surveys suggest that clinicians want a greater leadership role but may feel unprepared or dis-empowered. Front line clinical leadership should be encouraged by giving physicians the authority to make micro-system changes, tolerating failure on some new delivery ideas, and creating pathways for clinicians who want to move into more leadership roles (Bohmer, 2013). By working on their leadership skills, physicians can transition from purely patient centered roles to that of leading broader teams.
When speaking about teams, I don’t want to lose sight of some of the most critical team members who are often leaders in their own right. This would be the nurse who is on the front line working with patients and leading teams of their own. Many of the same leadership skills that physicians have are also apparent with nurses. In a systematic review that looked at nursing leadership, after reviewing 48 papers it found that a combination of leadership styles and characteristics were found to contribute to the development and sustainability of a healthy work environment. Many of the same leadership skills such as teamwork and continued learning were mentioned, but the one topic that I think has even greater importance is that of emotional intelligence. This is the ability to motivate, communicate and manage conflict and can have a positive impact on staff, patient, and organizational outcomes (Pearson et al., 2007).
There are a number of different qualities that the health care leader of the future should possess as they will need to lead teams while navigating a difficult changing environment. Below are five qualities that will help define dynamic health care leadership in the future: (J. Stephen Lindsey & John W. Mitchell, 2012)
- The healthcare leader of the future will be an independent thinker who understands the emerging healthcare market.
- The healthcare leader of the future will be passionate about serving the needs of the customer.
- The healthcare leader of the future will be a change agent for their organization.
- The healthcare leader of the future will have the ability to motivate and inspire.
- The healthcare leader of the future will run a lean, high-quality organization.
Changing established norms can be very difficult, especially for physicians who have been trained in a certain way or hold long established beliefs of how they should function.
It wasn’t really until the concept of emotional intelligence was introduced that this started to resonate with me. As Goldman described in the Northouse text, “emotional intelligence consists of a set of personal and social competencies. Personal competence consists of self-awareness, confidence, self-regulation, conscientiousness, and motivation. Social competence consists of empathy and social skills such as communication and conflict management.”(Northouse, 2012)
The one thing that seems clear to me now is that times have changed and that there is much more value on a leader who is open to listening to others and participating on a team. Georg Vielmetter of the Hay Group speaks about how leaders in a “quick and nimble” management culture are able to engage with diverse employees more successfully if they come from more of a humble perspective. Vielmetter sums it up nicely in the following quote, “The time of the alpha male — of the dominant, typically male leader who knows everything, who gives direction to everybody and sets the pace, whom everybody follows because this person is so smart and intelligent and clever -this time is over. We need a new kind of leader who focuses much more on relationships and understands that leadership is not about himself…who knows he needs to listen to other people…to be intellectually curious and emotionally open…(and) needs empathy to do the job.” (LaBier, 2014)
I feel fortunate to be working in an area such as Health Care that is in such a state of transition as this is the time that true leadership can really make a difference.
Dan is a digital health evangelist with a BS in Industrial Engineering, an MBA, and an MS in Health Informatics along with 20+ years’ experience in product development, innovation, and marketing. Connect with Dan on LinkedIn or via email firstname.lastname@example.orgThe health care industry is in transition and because of this, new leadership styles need to be implemented to effectively lead and manage in this new paradigm. With the introduction of new laws, regulations, care coordination and payment models, health care providers need to adjust not only how they treat patients, but also how they work together. Long established leadership beliefs may need to change for physicians and other health care professionals as a team based approach becomes more necessary to be effective.
I recall a couple of years ago walking through the aisles at the mHealth Summit in Washington D.C., I was amazed at all the different exhibitors (181 listed in the program guide) many of whom were selling (in their words) the next great solution that would revolutionize health care. I’m sure some of them did have great products, but as I explored further, I found many offered a very niche solution, which failed to demonstrate how they’d have a revolutionary impact. Many of the vague or flimsy solutions suggested mHealth was just the latest rage, and companies were simply trying to get something out there to attract market attention.
Fast forward to June, 2016 when the American Medical Association’s CEO, James Madara” shocked the digital health community by stating “From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality – it’s the digital snake oil of the early 21st century.” The idea that digital health could be considered “snake oil” was a smack in the face, but it reminded me of my time walking those halls years ago at the mHealth Summit.
Interestingly enough, “snake oil” actually started off as a true medical cure brought over to the United States by Chinese railroad workers in the 1800s. It consisted of the oil of the Chinese water snake that is rich in omega-3 acids which help to treat arthritis and bursitis. Only later on did fake snake oil tonics appear; touted to be a cure-all, it failed to provide any real health benefits.
Which version of snake oil describes digital health? Rock Health reported that in 2014 there was $4.3B in venture funding for digital health, and in 2015 investments rose to $4.5B – if nearly $9B has being invested in digital health over the last couple of years, surely most of that wouldn’t be considered snake oil – right?
That got me thinking why some of these digital health products could be considered snake oil. Are they truly shams, or is it something else? I think the problem is that many may be following Eric Ries’ Lean Startup methodology where you get a Minimum Viable Product (MVP) out to market quickly and then refine based upon customer feedback. Maybe that can work, but it’s also possible you will develop something that doesn’t solve a real market need. In the rush to get to market, due diligence and basic product development practices can get lost…Chinese water rich snakes lose out to fake tonics.
To help weed out those snake oil tonics, here’s a budding digital health entrepreneur’s tool. First, spend a little time with either Alex Osterwalder’s Business Model Canvas or Ash Maurya’s Lean Canvas to quickly help define your business model strategy (get the big picture). Second, focus on the actual product – for this think about:
- Who is your target market?
- Consumers, patients, providers, payers? You can’t be all things to all people, and you can waste a lot of money trying.
- What problem are you solving?
- Remember, customer’s don’t care about your solution; they care about their problems. Preliminary market research can help you understand your customer’s needs.
- What is your solution?
- This doesn’t have to be a full product requirements document, but you should be able to list your top features.
- How are you differentiated from others?
- What is your unique value proposition? What’s your elevator pitch that includes the customer’s experience?
- How does your product/service fit into existing work-flows?
- Do you need to integrate with others? Getting people to change behavior is rare, so understand where you can adapt to their world (this is especially true for providers).
Creating a simple one page product canvas can help with product ideation or product innovation as it will force you to really think through what you hope to accomplish. Product development consists of everything from defining the strategy all the way through execution and implementation.
In future posts I will focus on specific aspects of product development that are relevant to digital health and provide some insights and tools intended to help you revolutionize the health care market! If you are interested in learning more about Product Development there are a number of great resources such as the Association of International Product Marketing and Management (AIPMM) and the Product Development and Management Association (PDMA) that can help guide you in creating a great digital health product or solution.
Using a well-defined process based on proven methods will help you be more successful in delivering products that are truly revolutionary and not just snake oil.
Dan is a digital health evangelist with a BS in Industrial Engineering, an MBA, and an MS in Health Informatics along with 20+ years’ experience in product development, innovation, and marketing. Connect with Dan on LinkedIn or via email email@example.comI recall a couple of years ago walking through the aisles at the mHealth Summit in Washington D.C., I was amazed at all the different exhibitors (181 listed in the program guide) many of whom were selling (in their words) the next great solution that would revolutionize health care. I’m sure some of them did have great products, but as I explored further, I found many offered a very niche solution, which failed to demonstrate how they’d have a revolutionary impact. Many of the vague or flimsy solutions suggested mHealth was just the latest rage, and companies were simply trying to get something out there to attract market attention.
- Who is your target market?
With the final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) released by CMS in October 2016 and the rule going into effect in CY 2017, healthcare providers are now tasked with the readiness and implementation plan to meet the parameters of the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The Department of Health and Human Services (HHS), in collaboration with partners in the private, public, and non-profit sectors, launched the Healthcare Learning and Action Network (LAN), to assist in advancing the adoption of value-based healthcare and alternative payment models. As part of this effort, the LAN developed an APM framework that categorizes the transition from fee-for-service to population-based quality care. The framework is categorized by 4 different payment models (see footnote):
- Category 1: Fee for service – no link to quality & value
- Category 2: Fee for service – link to quality & value
- Category 3: APMs built on Fee-for-Service architecture
- Category 4: Population-Based Payment
The general summary of the technology implications are based on a health IT framework developed for ONC (see footnote). Current health IT infrastructure for most providers already support Category 1 and 2 with capabilities such as an organizational EHR, elements of care coordination, pay for reporting, data aggregation/sharing and integrated workflows. Given the complexity of MACRA and the vast IT requirements to transition towards the full APM model, this document will only highlight some key points around Category 3 and 4 as they offer the highest risk but also the most reward. Providers planning for MACRA should first conduct an objective assessment of their readiness along with careful evaluation of options to pursue the path chosen. From an infrastructure perspective, providers may consider using multiple systems for these functions or rely more on their vendor partners to build out the platforms that incorporate these capabilities into their current environment.
This summary was not meant to minimize the vastness of the MACRA rule and the efforts required to achieve it but rather an attempt to provide some clarity on how organizations should allocate resources for a formal evaluation of their readiness and options to meet requirements at different category levels.
Health Care Payment Learning & Action Network (hcp-lan.org) under work products, APM frameworkWith the final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) released by CMS in October 2016 and the rule going into effect in CY 2017, healthcare providers are now tasked with the readiness and implementation plan to meet the parameters of the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The Department of Health and Human Services (HHS), in collaboration with partners in the private, public, and non-profit sectors, launched the Healthcare Learning and Action Network (LAN), to assist in advancing the adoption of value-based healthcare and alternative payment models. As part of this effort, the LAN developed an APM framework that categorizes the transition from fee-for-service to population-based quality care.
Featuring these Annual Conference Presenters:
- Cybersecurity: Clyde Hewitt (CynergisTek)
- Healthcare Innovation: Michael Levy (Bluedoor)
- Artificial Intelligence: Vivian West (Duke Center for Health Informatics)
- Mobile Healthcare: Bobby Park, MD (RelyMD)
- HIPAA Audit: David Holtzman (CynergisTek)
Click here to listen. Our podcast host is Janet Kennedy of Get Social Health.Check out our podcasts featuring presenters from our upcoming Annual Conference!
NCHICA Member Spotlight:
Our podcast host is Janet Kennedy of Get Social Health.