The following post is an edited version of CEO Briefing Room: Culture as a Transformative Force, a collaborative report from Health Evolution Summit and Oliver Wyman. The inaugural CEO Briefing Room, which took place earlier this year, brought together a select group of innovative CEOs from payer and provider organizations to discuss re-invigorating healthcare culture. Joined by Laszlo Bock, former SVP of People Operations at Google and the author of WORK RULES!, the group explored the interplay between culture and the path to greater agility. By sharing insights from his work at Google and beyond, Laszlo helped the group catalyze their thinking and move from aspirational thinking to actionable strategies.
Here, Oliver Wyman’s Sam Glick, who served as lead partner for the gathering, synthesizes the discussion and summarizes what members envisioned as the next steps to creating truly agile healthcare organizations.
Much of the discussion regarding transforming healthcare in recent years has focused on healthcare strategy – new innovations, new products, new regulations, and new ways of reimbursing those who provide care. All of these activities are important, but what about the people behind them? Peter Drucker is said to have declared, “Culture eats strategy for breakfast.” So what is the culture of healthcare? Are those on the front lines of the system engaged in a way to allow new strategies to succeed?
If we want culture to keep pace with industry transformation, where should we look? There are certainly impressive examples of healthcare organizations on the cutting edge; however it is always wise to explore novel ideas and best practices from organizations beyond healthcare. And to catalyze transformation, it is critical to step outside organizational comfort zones to consider new – and perhaps disruptive – approaches to culture and people strategies.
Consider the following cultural pillars through the lens of an outside perspective, compared with what healthcare does, and positioned against what healthcare could do.
Outside healthcare: When it comes to mission, Laszlo says Google keeps it clear, simple and aspirational. Google’s mission statement is a single sentence: “Google’s mission is to organize the world’s information and make it universally accessible and useful.” This is a lofty goal, and intentionally so. Despite popular perceptions, Laszlo insists that the Google culture is not about “beanbags and lava lamps,” but instead is about three things: having a mission that matters; providing transparency; giving people a voice.
Healthcare baseline: On the surface, the mission for all healthcare organizations is meaningful; after all, what’s more important than providing quality of life for our fellow human beings? Yet, in focusing on quality measures, affordability goals, service standards and the like, many of us in healthcare often lose the forest for the trees.
What healthcare could do: To foster a motivational culture, we must give teams something to which they can aspire. Turning cancer into a chronic disease? Making primary care available anywhere on the planet? Ensuring no one ever goes bankrupt from healthcare costs again? What that mission might be certainly varies, but the spirit is the same.
While we’re unlikely to move away from “pay for performance,” we can think differently about how we motivate and engage people to improve.
Sever link between performance and pay.
Outside healthcare: At Google, goals are simple: tie them to the mission, and then recognize good behavior and positive results financially. In fact, compensation conversations happen completely separate from performance management conversations – and compensation is kept private. Performance management should be about helping people improve, not rewarding or punishing them financially.
Healthcare baseline: In healthcare, we spend a lot of time talking about incentives – how to design them, change them, implement them and respond to them. What’s the best way for the government to shape the system? For a health plan to get a provider to do something differently? To motivate physicians? The answer always seems to be the same: financial incentives!
What healthcare could do: While we’re unlikely to move away from “pay for performance,” we can think differently about how we motivate and engage people to improve. Rather than cutting “bad doctors” out of networks, could we work with them to develop performance improvement plans without the initial threat of reduced reimbursement? What about delivering performance reviews at a different time of year than bonus conversations? With an increasing number of doctors on salary, now is the time to re-imagine how we reward value added and value created.
Expect more from HR
Outside healthcare: Laszlo comes from a non-HR background (former management consultant); and when he was at Google, he focused on building a team with non-traditional competencies. Nearly one-third of the Google People Operations team (as they call it) has deep analytics expertise, including people with PhDs in fields like statistics and psychology. The profiles of people who lead People Operations and support talent throughout an organization have a big impact on culture. The choice of PhDs and deep analytics experience is especially interesting for healthcare to consider given healthcare’s focus on evidence-based decision making.
Healthcare baseline: The typical healthcare HR team (in fact, the typical HR team in most industries) spends its time focused on compensation, performance management, union negotiations, benefits, compliance and the like. It’s a group of well-intentioned functionaries, largely looking out for costs and risks. HR executives tend to spend their lives immersed in important – but not necessarily strategic – personnel topics, and don’t always have a full seat at the table when it comes to strategic decision-making.
What healthcare could do: What would happen if we asked HR to tackle the hard questions of customer satisfaction, physician burnout, incentive design and variation reduction, rather than delegating them to business leaders or a Chief Medical Officer? In fact, what if the CHRO was as important as the CMO at a healthcare company – and maybe even had an MD rather than a traditional HR background? Just as healthcare has leveraged consumer experts to innovate, there is strong potential to make change with this type of empowerment.
Google is not most healthcare organizations, and most healthcare organizations are not Google. Those in healthcare have to deal with challenges that innovation-centered companies like Google rarely, if ever, faces – from HIPAA to FDA to licensing requirements and a market that is nowhere near efficient.
Yet we all know culture matters. Viewing healthcare culture through a transformative lens can help to guide even the most successful healthcare organizations to further improve their organization’s culture.