Wednesday, July 7, 2010

Scaling Up

Recently I submitted a proposal for some personnel changes to a healthcare organization. The proposal was extensively researched. Despite the cost of the new positions, there would be a 3 to 14 fold return in improved capacity of the organization depending on the program area. Overall, the proposal is extremely compelling and anyone reading it would question how an organization could not make the decision to support it. But of course, then there comes the million dollar question.

Since there is no room in the budget for a million dollar investment in new staff, the inevitable questions arise. Is there any other way to achieve this outcome? Is there any other way to convince the senior leadership and finance department? Are there any ways to minimize associated risks? Because of the improved capacity, the new positions could be funded by bed closures and the improved capacity would more than offset the reduced capacity associated with the closures.

Eventually, as I listed the numerous ways to move forward on the proposal, one option that received some acceptance was to implement the changes in just one program area, thereby scaling the proposal down significantly, but all along I expressed that this is not the direction I would take the proposal. I am quite confident that in a showdown, the vast majority of the proposal would be approved as anything otherwise would be confound logic to an extreme. Most importantly, I explained, the solution would not be found in scaling the proposal down. This was received with a certain degree of bewilderment.

“What possibility could be wrong with starting on a small scale?” I was asked. My answer: “You still have the same problems inherent in the current decision if you try to scale back up.” In other words, the decision to allocate a million dollars would be just as hard to make after a successful small scale implementation… which everyone seems to agree would be the end result… as it would be for executive management to make now. So why not ask executive management to make the decision now?

What this experience to me reinforced is that despite other’s perspectives of the big picture, certain mindsets are hard to change. Currently there is a mindset that any request for more funding in a time of financial constraint would be politically incorrect. In my mind, I would rather trust the executive management to see the big picture and (hopefully) make the right decision.

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