Chris MillerLast week on this Blog, I wrote about three elements that are critically important for fostering organizationwide commitment to development of an effective accountable care organization (ACO). Briefly, these elements are:

  • Involved top management
  • Engagement of a highly skilled project manager with broad experience
  • Organizational patience

I noted that these elements can help promote continued care accountability, clinical care quality improvement, and an overall environment of standardization that results in significant cost containment. These three elements warrant a more detailed discussion, including consideration of risks involved with not having these three elements well established.

Involved Top Management 

The willingness of top management to actively enforce the strategic vision is essential to a successful ACO implementation. As I noted previously, executive-level commitment provides direction and sets specific outcome expectations across the organization, including among lower level managers. It also engages senior physician leaders in structuring and reviewing improvements in quality of care. The nature of a large scale ACO implementation naturally involves executive leadership within the operations of the enterprise because it necessarily touches most of their areas of control. 

Risks. Without executive support and guidance, an ACO project can lose focus and stakeholder support, which can cause the project to fall short of expected outcomes. In the absence of highly visible C-suite project support over the course of the project, two considerable risks are likely to become strikingly apparent. 

First, misalignment of strategies at the highest executive levels can result in dissonance over the need for an integrated corporate organizational structure versus autonomy for individual facilities.

Second, even if the executive sponsor remains laser-focused on the objective, a few project stakeholders may begin to question their role both in the project and in the transformed organization and, as a result, only partially uphold their commitments. The lack of, or limited, stakeholder participation can result in significant project friction and noncompliance. The role of stakeholder buy-in should not be underestimated.

It also should be noted that, although these risks may seem obvious and important to address, the need for strong executive-level support and guidance can be all-too-easily overlooked at the project’s start if there is a perception that the executive sponsor’s span of control is appropriate and sufficient.

Engagement of Highly Skilled Project Manager with Broad Experience

Engaging a project manager suited to this type of large-scale, multisite, multistakeholder project is one of the most critical components a successful ACO implementation. The skill set for this position is fairly unique; in addition to broad hands-on experience as an absolute essential, this individual should demonstrate the following qualifications: 

  • CIO or IT director level knowledge, principally from the strategic information perspective
  • Supply chain experience either from direct supply chain management experience, or from a supply chain information system implementation experience
  • Experience in finance and/or revenue cycle management
  • A high level of communication skills
  • The ability to apply terminology appropriate to the stakeholders and project team members and to clearly convey important strategic concepts in a way easily understood

Risk. If a qualified project manager is not engaged to lead the project, or if the project manager who is engaged has only limited operational experience, the project will be at risk from a potential lack of foresight in making the sound decisions necessary for success on these types of projects. 

Organizational Patience

It may seem odd to talk about organizational patience, but we all have witnessed this need—repeatedly. Organizational patience, in this sense, hinges on having a common definition of the goal and an understanding of the commitments and resources necessary to achieve that goal. 

Risks. There are two specific areas of risk posed by a lack of organization patience. The first is the risk that of waning interest and energy over the project’s duration—a year or more in many cases—due to the constant need for intensely repetitive work at a highly detailed level (e.g., comparing clinical cohorts at the level of drug and device, by procedure, by type of specialty, etc.). The second risk stems from the potential for political infighting. Again, it is a common characteristic of human nature for people to be satisfied only if they see their idea “win.” However, they are much more likely to encounter the friction of different, competing, ideas. This risk is exacerbated if the executive sponsor is disconnected or the organization is being smothered by an overabundance of political “issues.” 

Many predictable roadblocks also can get in the way of the commitment required to maintain organization patience, including the political tensions that can cause stakeholders and sponsors to question their level of commitment. In some instances, team members may become disengaged if they come to perceive that the projects end goal may result in reorganization and position eliminations (e.g., Does the organization truly need people at every facility managing the same single master files set?) Long-term project team members and stakeholders who are expected to act on an official recommendation or decision, but see it as posing a risk that their positions might be eliminated, may act in a way that does not support the primary goal.

As healthcare organizations pursue enterprisewide projects in 2014 to create an environment for continued care accountability and clinical care quality improvements, they should clearly understand the risks they face if their projects lack the three key elements highlighted here. It is also important that they not underestimate the challenges that piloting significant change inevitably presents. Special attention should be given to helping stakeholders, particularly at the project resource level, embrace the new unified approaches to care delivery. 

Chris Miller, MT (ASCP), MSSM, is Senior Delivery Manager and EACOE Enterprise Architect, CTG Health Solutions, Buffalo, N.Y.


Publication Date: Monday, March 31, 2014