IPoC - Pull

Working for a health care organization that is trying to transform itself, one thing they are trying to implement is an Integrated Plan of Care (IPoC) for new in-patients to the hospital. This practice has been implemented a the Mayo Clinics as well a number of other hospitals across North America.

One important feature of their implementation is using the idea of "Pull" to draw in the other health care providers in a timely, efficient, and effective basis to both make the outcome of the hospitalization likely, but also to control the costs (such as reducing the length of stay).

Unfortunately, most hospitals still function from a "Push" perspective. They model, analyze, and predict what resources are most likely to be needed and budget for them on this basis. In the end there is usually too few resource most of the time. There is little, if any, flexibility to ensure the timeliness, efficiency, and effectiveness of the service delivery.

What do you do if you implement an Integrated Plan of Care and there are no professional staff to meet the needs identified? Is the organization really ready to move from a Push perspective to a Pull one?

PTWonk

Transformation

I recently read an article titled “Transformational Leadership and Organizational Culture: The Situational Strength Perspective” by Masood et al (2006). Masood and his co-authors provide a framework for understanding the interrelationship between leadership (transformative or non-transformative), culture (hierarchical, market, clan-based, or adhocracy), and context (weak versus strong situations).

In applying this to healthcare organizations that I have worked for in the past and currently, such organizations are typically hierarchical in structure, lead by non-transformative leaders, and present a strong situational context which, on the whole, impedes transforming changes to occur within the organization.

(Note, I do not mean to imply that some leaders do not have transformation qualities, but simply that those qualities are not allowed to be expressed within the organization except in a tight, controlled manner reflective of the hierarchical structure).

In order for transformational change to be most successful, leaders need to not only have transformational qualities (good visioning, rhetorical, and impression management skills, and ability to use these skills to develop strong emotional bonds with followers) but they also need to work within a situational context that allows these qualities to flourish. Similarly, clan and adhocracy cultures are more adept at recognizing opportunities for change, accept ambiguity, and have the energy and motivation to elevate issues to a higher level and produce not just action but results.

To implement “transformation” within a hierarchical organization we often asking leaders and front-line staff to “buck-the-system” which goes against the grain of everything they may have been told (or experienced) the organization values and rewards. This contradiction is simply too much for many leaders and most staff and the transformation effort is destined to fail.

Lastly, implementing transformation is not about achieving the deliverables in a project plan. True transformation starts with leadership and culture and leads to production (i.e., the manner in which work is performed). Transformation, once in place, is ongoing, never ending.

It’s the people – not the processes and policies and products – that highlight a transformative organization. If you are talking about transforming patient care within your organization, ask yourself if you have focused on the people first.