Tag Archives: Health Care Reform

Performance Transformation, LLC™ and Talent Sprocket™, LLC Announce Formation Of New Partnership

Innovative leadership, strategy, and organizational development company to integrate Talent Sprocket’s machine learning and predictive analytics technology into its approach to deliver business intelligence and clear ROI on leadership development.

PRLog (Press Release) – Jun. 19, 2013 – VENICE, Fla. — Performance Transformation, LLC™ (Venice, FL) and Talent Sprocket™, LLC (St. Petersburg, FL), announced today the formation of a collaborative partnership to jointly market their technology and services.  Talent Sprocket is the first true machine learning platform designed to deliver Human Talent Analytics™.  Performance Transformation provides custom leadership development, collaboration, and innovation acceleration programs for knowledge worker-based companies and institutions.

“We’re very excited to be working with Talent Sprocket to strategically enhance our portfolio of services,” said Terry Murray, founder and Managing Partner of Performance Transformation.  “We’re the first leadership development company that brings with us a technology that allows our clients to accurately measure their ROI on developmental investments.  This level of accountability is truly revolutionary in our market space.”

The Talent Sprocket platform employs machine learning, a sophisticated algorithm that continuously teaches itself to recognize subtle patterns in complex data sets too large for human beings to accurately evaluate.  Applying this technology to leadership development, succession planning, recruiting, and collaborative team formation provides business intelligence and insights that, heretofore, were unavailable to most enterprises.

“Terry’s passion and leadership have laid the path for Performance Transformation to become one of our industries most thoughtful and innovative talent management companies,“ commented Tony Duda, CEO of Talent Sprocket.  “Our belief is that by bringing our diverse but equally innovative cultures together, in a collaborative way, we will achieve some truly exciting and breakthrough solutions, not only for our customers but for the entire talent management industry.”

Founded in 2008, Performance Transformation has pioneered advanced, professional development processes through the integration of more than a dozen, peer-reviewed, scientific disciplines ranging from the neurosciences to applied behavioral economics, emotional intelligence and quantum physics.

“The growing complexity of today’s business environment demands innovative solutions for talent development, retention and collaboration,” added Terry.  “It is through the integration of seemingly disparate disciplines and creative learning modalities that truly adaptive thinking emerges.  Most talent management software on the market today automates yesterday’s processes.  Talent Sprocket delivers predictive analytics, enabling business leaders to look over the horizon in anticipation of their human capital needs.  This represents a distinct, competitive advantage that will only increase in strategic value over time.”

Progressive, high tech companies like Google®, IDEO® and Apple® are already leveraging their sophisticated, internal core competencies to retool HR around people analytics.  The new partnership between Talent Sprocket and Performance Transformation integrates advanced technology and thought leadership to make this approach available to businesses and institutions that, until now, couldn’t access this level of business intelligence.

“Just like the internet leveled the playing field for access to strategic market intelligence, this partnership levels the playing field when it comes to talent intelligence.  Any company, no matter their size, can now operate with the same level of insight as Google or Apple.  It’s truly a new day!”

© 2013, Performance Transformation, LLC™

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Creating a Foundation for High Performance Health Care

As health care delivery systems embark on their transformational journeys, the complexity of their environment begets the question; where best to begin?  Some are pursuing a model of Total Quality Management, a.k.a. Six Sigma. As complex as they are, the process controls necessary to ensure the quality build of a GE 777 jet engine do not have to contend with the greatest variable set of all; a continuous stream of ill, suffering, frightened human beings and their families.  As proven as TQM methodologies are in industrial settings, how will these approaches deal with the human emotional element?

The emotional landscape of every patient is effected at each touch point of the delivery system.  The breadth of this challenge elevates it to the level of being cultural.  Changing organizational culture is seen to be fraught with risks, but that needn’t be the case.  Through their interactions, people create culture.  Change the tone of the interactions and the culture will follow suit.  To create lasting change, however, one must go deeper than the behavioral interactions of clinicians, to the causal elements behind the impetus for said interactions.  This speaks to each clinician’s particular emotional style.

Emotional Styles.003Affective neuroscientist Rich Davidson, of the University of Wisconsin, has demonstrated that human beings have six emotional styles.  Each dimension is a continuum upon which we reside…our orientation point, so to speak.  Dr. Davidson’s research has identified, using advanced imaging technology, what parts of the brain respond, at differing degrees in each individual, to various emotional stimuli.  He’s also created a simple assessment to measure each dimension and shared it in his 2012 book, “The Emotional Life Of Your Brain”.  Our emotional style is not set in stone, however.  Thanks to the plasticity of the brain, we can actually change where we are on each continuum through conscious effort.  These dimensions of emotional style culminate in our level of emotional intelligence; how we connect, engage and interact with both our internal and external emotional landscape.  Basically, how we show up and great the world at each and every moment.

Ample peer-reviewed research exists that supports how emotional intelligence contributes to positive clinical, financial and organizational outcomes in health care settings (drop me a note and I’ll be glad to send along the bibliography).  If we look to the patient-centric environment the HCAHPS assessment is attempting to create and measure, the importance of strong communications skills, sensitivity, empathy and responsiveness jump off the page.  Key attributes of emotionally intelligent clinicians.

Hi Perform Emotional Styles.001Here’s another strong indicator as to where to begin; today’s high performers, in highly volatile, challenging environments, share ten demonstrated competencies* that emerge from a strong blend of their dimensions of emotional style.  It’s not a stretch to see how these competencies would bring both immediate and long-term benefits to any clinical environment.  It’s also not a stretch to see how by cultivating these competencies throughout an institution would impact both real and perceived quality of care.  This approach to capacity building reaches an inflection point, once enough associates are consistently demonstrating these skills, that shifts the culture.

By assessing for emotional style and targeting for high performance, observable skills, specific developmental opportunities are revealed and can be measured.  Incorporating a talent management analytics platform (we work with technology partner Talent Sprocket) enables an institution to baseline competencies and styles.  This foundation of data sets can be used to measure developmental investments, correlate HCAHPS scores, and identify best fit candidates in the pipeline.  Over time, as the data base builds, predictive analytics can emerge to further guide strategic decisions.

Of course, it all begins and ends with leaderships’ buy-in and support.  But by taking a scientifically-substantiated approach to targeted skills development health care systems can begin to shift their culture without introducing elements of risk.

© 2013, Terry Murray.

*“Breakthrough Performance in the New Work Environment – Identifying and Enabling the New High Performer”, Executive Guidance for 2013, CEB, December, 2012. http://www.executiveboard.com/exbd/executive-guidance/index.page.

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April 17, 2013 · 2:11 pm

How the Seeds of Culture and Relationship Dynamics from Fifty Years Ago Effects Health Care Today

I was recently having a conversation with a leader of a nonprofit organization about their strategic planning process.  Nonprofits have an additional facet of execution for profits rarely have to consider; the payer of the services provided is typically not the one who is receiving the services.  Not only must a nonprofit secure funding, but then they must conduct outreach to recruit the population they wish to serve and only then can they actually execute on the delivery of their mission.  Perhaps the only for profit business models that are similar are auto body repair shops and human body repair shops, or in other words, our health care system.

That got me to thinking, why is our health care delivery system so disjointed, and at times, remarkably out-of-step with more modern approaches to leadership, strategy, and organizational development?  This is a sector I’ve worked in for more than twenty years, so I have a fairly long perspective of how things have evolved over time.  Two months ago I wrote a blog entitled, “Signs Health Care Needs to Transform Before it can Reform“, in which I explored some of the patient hand-offs, disconnects and complexities of today’s health care continuum.  But that blog explored where we are and what we need to do, at a very fundamental level, to transform leaderships’ approach to delivering health care services in the face of reform.  What it didn’t fully explore was the root cause of this discontinuity and the peculiar provider/patient/third-party payer dance we witness every day.

I have a hypothesis as to what may have set us on the course we’re mired in today.  It has to do with the historical relationship dynamics that emerged between doctors and patients.  In every other economic exchange, the balance of power in the relationship tilts towards the consumer.  The customer holds sway.  Traditionally, this hasn’t been the case in health care.  The doctor was the authority and held domain over the relationship.  People of my parents’ generation simply didn’t question doctor’s orders.   In what other industry does the seller of a service dictate the relational dynamics between provider and consumer?

While this may seem subtle, I believe it may be at the root of the dysfunction we see today.  I invite you to take a look at some of the research I uncovered in the blog I refer to above and see if you come to a similar diagnosis.  The key facts that jump off the page to me are a lack of self-awareness on the part of many health care providers.  The research indicated a prevalent attitude that, “Yes, health care is broken, but not at our hospital or in our practice.  We’re just fine.”  This hidden blind spot, that everyone else is the problem, not us, has engrained over time.  If you have all the power in a relationship, and have no intention of relinquishing that power, you will rarely be held accountable for your behavior or attitudes.  Relationships, on all sides, become dictatorial rather than cooperative and co-creative.  Communication erodes, medical errors occur, nurses are abused and burned out, and adverse events go unreported (the Department of Health and Human Services recently discovered 7 out of 8 adverse events are not being reported as mandated by law).

Exacerbating this relationship-based imbalance is the third-party payers’ role in our system.  Consumer behavior in a typical marketplace sets the competitive tone of the market.  Firms working in that marketplace respond to both the consumers’ demands and competitive pressures.  Yet in health care, the role of third-party payers (i.e. Medicare, Medicaid and the insurance companies) sets the reimbursement levels for services.  This has followed a downward spiral of reimbursement cuts for procedures that has led to doctors doubling the size of their patient load in order to maintain their overhead, staff, and income.  As a result, physicians have even less time to establish authentic relationships with their patents.

Until we address the causal effects of what brought us to where we are today, any efforts to improve the quality of care and efficiency of delivery will only be treating the symptoms, not the disease.

© 2012, Terry Murray.

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Hospital Leadership, Strategy, and Culture in the Age of Health Care Reform

With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come.  The delivery of health care is unique, complex, and currently fragmented.  Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century.  The evolutionary pace of health care culture is about to be shocked into an entirely new reality.  One that will inevitably require health care leadership to adopt a new, innovative perspective as to the delivery of their services.

First, a bit on the details of the coming changes.  The concept of Value-Based Purchasing is that the buyers of health care services (i.e. Medicare, Medicaid, and following the government’s lead, private insurers) should hold the providers of health care services accountable for both cost and quality of care.  While this may sound practical, pragmatic, and sensible, it effectively shifts the entire reimbursement landscape from diagnosis/procedure driven compensation to one that includes quality measures in five key areas of patient care.  To support and drive this unprecedented change, the Department of Health and Human Services (HHS), is also incentivizing the voluntary formation of Accountable Care Organizations to reward providers that, through coordination, collaboration, and communication, cost-effectively deliver optimum patient outcomes throughout the continuum of the health care delivery system.

The proposed reimbursement system would hold providers accountable for both cost and quality of care from three days prior to hospital admittance to ninety days post hospital discharge.  To get an idea of the complexity of variables, in terms of patient handoffs to the next responsible party in the continuum of care, please take a look at Figure 1.  Each circle represents a functional unit within the current health care system.  A unit that functions and communicates both internally and externally with teams of professionals focused on optimizing care.  With each handoff and with each individual in each team, variables of care and communication are introduced to the system.

Figure 1. Click to Enlarge

Historically, quality systems from other industries (i.e. Six Sigma, Total Quality Management) have focused on wringing out the potential for variability within their value creation process.  The fewer variables that can effect consistency, the greater the quality of outcomes.  While this approach has proven effective in manufacturing industries, health care presents a collection of challenges that go well beyond such controlled environments.  Health care also introduces the single most unpredictable variable of them all; the individual patient.

Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered.  The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out.  Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.

Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect?  How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS?  The fact of the matter is, health care is the most human of our national industries. The shifting demographic needs and economic constraints of our society required change.  Hopefully this change will prompt leadership to revisit how they choose to engage and integrate the human element within the system.  The scope of change demands no less.

In contemplating this approach, a canvasing of the peer-reviewed research into both quality of care and cost containment issues points to a possible solution; the cultivation of emotional intelligence in health care workers.  After reviewing more than three dozen published studies, all of which confirmed the positive impact cultivating emotional intelligence has in clinical settings, I believe contemplating this approach warrants further exploration.

Emotional intelligence is a skill as much as an attribute.  It is comprised by a set of competencies in Self-Awareness, Self Management, Social Awareness, and Relationship Management, all leading to Self Mastery.  Fortunately, these are skills that can be developed and enhanced over the course of one’s lifetime.

Keeping the continuum of care patient flow chart in mind (Figure 1), let’s examine how emotional intelligence factors into the proposed quality measures the Department of Health and Human Services will be using come October, 2012:

1.)  Patient/Caregiver Experience of Care – This factor really comes down to a patient’s perception of care.  Perceptions of care are heavily shaded by emotions.  Patients consistently rate less skilled surgeons that have a greater bedside manner as better than maestro surgeons that lack, or choose not to display, these softer skills.  Additional research into why people sue over malpractice demonstrates people don’t sue over a medical mistake in and of itself.  People sue because of how they felt they were treated after the error occurred.  There’s a difference between curing an illness and healing a patient and that difference lies in the expression of authentic empathy through healthy, professional boundaries.

This is a key driver in patient decision-making as well.  Patients tend to choose a hospital based upon one or two criteria; the recommendation of their primary care physician (with whom they have an established relationship) and/or upon the recommendations from family members or friends that have experienced care in a particular hospital.  A quick look into the field of Applied Behavioral Economics supports this finding.  Economic decision making is 70% emotionally driven with the remaining 30% based in rational thought.  In many instances, it would appear that hospital marketing doesn’t seem to reflect an understanding of this phenomena.  Waiting room times in Emergency Rooms have little to do with why patients choose a hospital, yet we see billboards everywhere that have the actual E.R. wait times electronically flashing along the roadside.

A patient’s experience of care can be highly impacted at the handoff points within the continuum of care.  Any new model of care will require exceptional cross-organizational communications to emerge.  This requires a high level of engagement and commitment to the new vision at every patient touch-point.

This metric also addresses the caregivers’ experience of care.  This speaks largely to the experience of nurses that are delivering that care.  The research related to the impact of cultivating emotional intelligence in nurses clearly demonstrates a reduction in stress, improved communication skills, improved leadership and retention, the ability to quickly connect and engage patients, as well as a reduction in nurse burnout (which leads to turnover and additional stress amongst the remaining staff).

2.)  Care Co-ordination – Again, this will require optimal engagement and pro-active communication intra-organizationally and cross-organizationally.  Each handoff introduces opportunities for variable care to emerge that must be seamlessly co-ordinated.  Poor co-ordination also introduces the risk of eroding the quality of the patient’s experience.

3.)  Patient Safety – Research shows that the cultivation of Emotional Intelligence competencies in nursing contributes to positive patient outcomes, lowers the risk of adverse events, lowers costs at discharge, and reduces medication errors, all while lowering nurse stress, burnout, and turnover.  Each time a nurse resigns it adds to the nursing shortage on the floor, requires additional hours from other nurses, and costs the hospital approximately $64,000, on average, to backfill the open position.  Improving how an institution cares for its nurses improves the level of patient care and safety as well.

4.)  Preventive Health – Elevating Self-Awareness and Social Awareness in clinicians helps them quickly connect and effectively communicate with patients.  Subtle, non-verbal cues become more readily apparent, helping clinicians understand the fears and emotions of their patients.  Self Management and Relationship Management helps clinicians communicate appropriately and supports the expression of authentic empathy through healthy, professional boundaries.  All of these factors come into play when speaking with patients about lifestyle choices, course of treatment, and preventive health care.

5.)  At-Risk Population/Frail Elderly Health – Like preventive health, being measured on the care of the community’s at-risk population and elderly will require a fresh, innovative approach to community outreach and pro-active communication.  These are not populations that can be easily reached via Facebook or Twitter.  This requires human contact and deep engagement with each population, both of which are supported through the development of a mindful approach (i.e. emotionally intelligent) to the challenges at hand.

It will be interesting to see how reform unfolds and how leadership within the health care delivery system chooses to respond to the challenges that lie ahead.  Systems and hospitals that choose to take an honest, evidence-based look at how they choose to lead, how they create and execute strategy, and the organizational culture they’re cultivating will be well served in preparing to successfully navigate this unprecedented change.

© 2011, Terry Murray.

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Filed under Health Care, Leadership Development, Organizational Culture