A Fine Mess

Healthcare is a mess in many respects. The unsustainable rise in costs. The substandard care for so many Americans. The “Animal House” food fight over Obamacare.

But here’s the deal: One of the very best places to look for insights on how to nurture an outcomes focus and performance culture is, you guessed it, healthcare. Healthcare is years ahead of human services, education, and so many other fields within the social sector.

One important driver is increasingly strong external incentives linking payments to outcomes. But a bigger driver is that an increasing number of healthcare leaders are intent on getting out ahead of the policy changes and figuring out how they can deliver better care, to more people, at lower cost.

This topic is worthy of a long article—and probably a book. But we’ll highlight a few recent and related examples of these drivers at work.

First, take a look at “Obamacare: The Rest of the Story,” by former New York Times executive editor Bill Keller. Both of us are Democrats (and perhaps Bill Keller is too), but please don’t get stuck on our politics or the politics of Obamacare. Just focus on how public policy has started to change incentives in, well, healthy ways. For example:

Accountable care organizations have sprung up across the country…. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries…. These organizations have invested heavily in information technology so they can crunch patient records to identify those most at risk, those who are overdue for checkups, those who have not been filling their prescriptions and presumably have not been taking their meds. They then deploy new medical SWAT teams—including not just doctors but health coaches, care coordinators, nurse practitioners—to intervene and encourage patients to live healthier lives.

In terms of internal drivers (i.e., great leadership!), we will highlight two pioneers. The first is Dr. Jeffrey Brenner, the founder of the innovative Camden Coalition of Healthcare Providers. We say “highlight,” but the light is already shining very brightly on Dr. Brenner. Two weeks ago, he won a MacArthur Fellowship (aka “genius grant”). If you want to understand the performance mentality in less than three minutes, take a look at this short video or this one, in which Dr. Brenner explains his work to improve care and cut costs.

Another great example is Dr. John Toussaint, who runs the ThedaCare Center for Healthcare Value. As profiled by our friend Rick Wartzman in a recent Time blog post, Dr. Toussaint brought Lean management principles, originally developed by Toyota, to healthcare and created a system that pays for value rather than volume. When Dr. Toussaint was running ThedaCare’s 6,000-employee health system in Wisconsin, his results were extraordinary. According to Wartzman, ThedaCare raised quality, “with nearly 100% of its patients now rating their experience a 5 out of 5 … while controlling the cost of inpatient care (down 25% since 2007).”

Let’s not think of healthcare as a world apart. We all have much to learn from relentless leaders like Brenner and Toussaint.

And now for updates from around the Leap of Reason community:

  • You may be tired of hearing about it, but we strongly encourage you to take a look at the December 3-4 conference we’re putting on in DC with the brilliant team behind PerformWell. We often hear people pooh-poohing conferences. In this age of instant, 140-character communication, we suppose conferences feel “old school.” But PerformWell has assembled the highest concentration of “just do it” leaders we’ve ever seen in one gathering. We’re talking about no-excuses leaders cut from the same cloth as Brenner and Toussaint. Leaders who have big brains and huge hearts. Leaders driven to ensure that all the brains and heart are adding up to lasting life change for their clients, patients, and students. Please join us.
  • To build on The Atlantic Monthly’s “Can Government Play Moneyball?” article (and capitalize cleverly on the World Series), Results for America has just launched a yearlong Moneyball for Government series. Take a look at this Politico op-ed by Peter Orszag and John Bridgeland and this very creative video. The thesis in a nutshell: “Less than $1 out every $100 spent by government is backed by even the most basic evidence that the money is being spent wisely…. In the era of impact-blind, across-the-board budget cuts, how do we get government to make better decisions and get better results with existing resources? Government can drive public resources to programs that demonstrate success, and away from those that fail—in short, government can play Moneyball!”
  • Earlier this week, Mario spoke in Milan at “The Effectiveness of Doing Good” philanthropy conference organized by the Fondazione Lang Italia (FLI), which published Leap of Reason in Italian. The morning session on nonprofits and philanthropy had more than 200 attendees and a great panel discussion, moderated by Corriere della Sera journalist Maria Teresa Cometto. The afternoon session on corporate philanthropy also was well done and well attended. The core Leap of Reason message—we must support and encourage high performance, not just hard work—seemed to resonate well. Our big thanks to FLI President Tiziano Tazzi for including Mario and for spreading the high-performance gospel to colleagues all over Italy.
  • In October 2012, representatives from seven ministries sponsored by the Congregation of St. Joseph (CSJ) attended a “Managing to Outcomes” workshop facilitated by Leap of Reason essayist Isaac Castillo. They wanted to begin work to determine how they could measure outcomes more effectively to deliver greater benefits to those they serve. Sr. Rita Petruziello, Executive Director of River’s Edge, shared that they have completed the first year of using surveys and focus groups with program participants to analyze program effectiveness and make data-informed decisions about future work. “Isaac’s work was instrumental in being able to do this.” CSJ Ministries, the oversight organization, has also been working on demonstrating its own commitment to high performance. The organization recently received the Best Practices Award from the National Leadership Roundtable on Church Management. The award honors well-run and action-oriented organizations that demonstrate high standards of collaboration, accountability, and transparency.
  • As we’ve been tracking seismic changes in our economy and society, we’ve been collecting information on the fields feeling strong foreshocks. Higher education is one of the biggies. HBS Professor Clay Christensen predicts that “more than half of the universities will be in bankruptcy, including the state schools” 15 years from now. Researchers Jay Halfond and Peter Stokes recently conducted a basic “stress test” to assess changes in higher education in New England. They reported that 71 percent of the college presidents they surveyed “felt it necessary for their schools to consider significantly different models of education in order to compete successfully.” The shocks are hitting law schools as well. The American Bar Association has just called for “sweeping changes in legal education, such as greater flexibility in what law schools must teach and how,” according an article in the San Jose Mercury News.
  • University of Maryland Professor Rob Sheehan offered this positive assessment of the new version of McKinsey’s OCAT, a free tool for assessing your organizational capacity, originally developed with Venture Philanthropy Partners: “Now the 2.0 version is out, and it is even cooler,” Dr. Sheehan wrote. “McKinsey has sharpened the questions asked in each section. But more important, one of the drawbacks of the first version is that it was only available as a pdf version…. Those days are over. Version 2.0 is available as an online tool.”


Events for Raising Performance:

Our best,

Mario and Lowell

Mario Morino is Chairman of the Morino Institute and Venture Philanthropy Partners and author of the lead essay in Leap of Reason. Lowell Weiss is president of Cascade Philanthropy Advisors, co-editor of Leap of Reason, and advisor to the Leap of Reason initiative.