To make the world a better place, a cultural transformation is necessary

Introduction

As part of the project “Diagnosis: Transforming Western Healthcare” we met with John Mattison and asked him about his vision regarding the future of healthcare, the most important technology trends and the lessons learned during the transformation process. In this blog we will share part 3 of our conversation: John’s vision about the transformation process.

What are necessary elements in a transformation?

Mattison: There are four things that are involved in a transformation, and the three that come directly to mind are people, process and technology. But I’ve actually had disagreements with others that you can only achieve those in a ritually transformational aspiration without deliberately, explicitly and comprehensively targeting cultural transformation. I’m a big believer in having a change management strategy that first and foremost targets the cultural transformation. Not because it is the easiest or the fastest, but because it is the most important and sustainable of those four elements. If you neglect the cultural transformation, you can make a lot of incremental gains, but you’re missing the truly transformational opportunities.

How did you accomplish a cultural transformation?

When we implemented the electronic health record, I led a world class team who implemented that. As a result, we came in a year ahead of schedule and $267 million under budget. That is a cultural transformation, and not people, process or technology. One of the things that I did was that I used the parlance of Daniel Pink. He wrote the book ‘Drive’ and gave the motivation 1.0, 2.0 and 3.0. Motivation 1.0 is about food, water, shelter and sex. Motivation 2.0 is about carrots and sticks, financial incentives and punitive measures. Motivation 3.0 is making the world a better place. In all the experimental psychology that he reviewed, the most striking thing is that motivation 3.0 is what motivates most of us. What my team did with the implementation of the electronic health record, and what we are trying to do with digital care in much of the same way, is to focus on motivation 3.0. The reason we are doing this is not just to lower cost, to raise patient satisfaction or to raise the quality of care, but because we all want to make the world a better place.
I’m very explicitly conscious of how I use those tools to shape the way that I manage teams and organise work. I constantly talk to my teams about why we’re doing this, about how it is going to revolutionize our opportunity to accelerate and how quickly we’re going to improve the lives of the people we’re responsible for. It is common to tell them we have to hit the bottom line, we have to hit our targets, but people then fatigue very quickly.

What kind of people did you put in your transformational team?

When you want to have a human-centred design, you have to make sure that you put the people that you try to help at the centre of the discussion. There is a common mistake in healthcare that says that we are all patients. It’s amazing how much a physician learns when they get sick and are admitted to the hospital. They have a whole new appreciation of what it’s like to be a patient. I think that the notion ‘all healthcare people are also patients’ is adequate to represent which perspective is fundamentally flawed. I believe we need not only professional patients to come in, but also people who have had recent experiences and include them in a human-centred design process. We do a lot of that and we have consumer advisory groups to heavily rely on. They help us think through our priorities and our design, not just in our processes and our workflow, but also in how we deliver care in facilities and the whole way we think about the patients’ experiences from end-to-end in the process.
The other thing is that large bureaucracies tend to squeeze out the maverick, the person who has unconventional abuse, because they can be disruptive to discussion. Most of the times those people slow down the process. However, when you get to a really rough spot where things just aren’t working, the mavericks will save your life. You need to find those people and, as long as they are dedicated to the same values and ethos, you need to bring them into the process. In short, bring in those who are the basis of human-centred design and also bring in the mavericks’ point of view and protect them from the natural instincts of the tribe to marginalize them.

You have experienced a couple of transformational processes. What are the lessons learned during these transformational processes?

I have had a couple of mantras that we live by and they were short, sweet, few and numbered.
Firstly, the reason we are doing this is because we want to make the world a better place. That is most important overall. We didn’t just say it, we felt it, we believed it, we communicated it and everybody believed it. Everybody knew they were part of the team and everybody felt appreciated for how they contributed to the larger team, no matter how small their task or contribution was.
Secondly, in order to be efficient in transformation, the cycle time for learning and problem solving has to be very fast. So what you don’t want is to have someone who is afraid to escalate a problem. I would rather have a problem being escalated too early than too late. This leads to the second mantra: never escalate a problem if you haven’t come up with a couple of solutions or recommendations. In this way, people started solving 95% of the problems without having to escalate and they became more and more confident as they experienced the discipline of performing an option analysis themselves. They started solving their own problems without even knowing it.
Thirdly, if you have troubles with budget or timeline, never cut on testing and training of the project. Inadequate testing or inadequate training is suicidal. You might need to ask for more time or money, but you have to take the hit sometimes. In every project management matrix, for every deliverable, task, budget and timeline, there was a ‘red, yellow or green’. It means the following: red is big trouble, yellow is some concerns and green is good to go. This comes to another mantra, namely: red is our friend. It means that the purpose of making something red is because it allows the leadership team to focus their attention, resources, creative energy and escalations on those things that threaten the project. However, depersonalize the whole process and don’t tell individual people they blew it. In short: depersonalize the whole process and focus on results, learning continuously, mentoring people, in a rapid cycle decision making process and a no-blame approach.

The final mantra that I use routinely is that when you have a series of emails or texts and you’re not making progress: pick up the phone! One of the big problems of running big projects these days is in general that millennials are so digital, they don’t talk anymore. Use modern technology to restore ancient wisdom, not to distract them. There is a reason our brains are wired the way they are, because we had an oral tradition for a couple millions of years before we had a written tradition. Technology has only shipped the purpose from a written to a digital tradition. Our brains, values and trusts are completely wired around the oral tradition.

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