Break the daily rhythm to foster creative insights

HOW DOES YOUR RESEARCH SHAPE THE FOCUS OF THE MANAGING HEALTH CARE DELIVERY PROGRAM?

My research focuses on health care delivery, which typically involves the time patients spend in the hospital, with a physician, and, increasingly, in providing aspects of their own care. The latter is a reflection on how health care is changing as consumers are getting more involved with monitoring the chronic conditions they might have, such as diabetes and hypertension, and in pursuing healthy behaviors to avoid getting sick in the first place. There are many conditions where wellness comes together with other forms of treatment to try to keep someone healthy. The role of the consumer has become even more critical in light the challenges created by the COVID-19 pandemic.

Specifically, my research deals with how we can improve the value of the care that we deliver to patients. Value comes from doing one of two things—either improving quality without unduly increasing costs or reducing costs without unduly compromising quality. In the United States, for example, we have a limited amount of money to spend on caring for the needs of our population. Right now, roughly 18 percent of U.S. GDP goes into health care, so we need to find ways to provide care more effectively. And again, that comes back to either getting more quality for the dollars we spend or spending less for the quality we get. While this challenge is particularly pronounced in the U.S., it is certainly one of concern for countries throughout the world.

HOW WILL PARTICIPANTS FROM COUNTRIES OTHER THAN THE UNITED STATES BENEFIT FROM THIS PROGRAM?

Health care systems in every country need to continually look at the health outcomes they're achieving for the money they're spending. Many countries have solved access to health care insurance by having single payer systems, but they still need to figure out how to deliver care in as effective and as efficient a manner as possible. Even in the systems that have universal coverage of their population, there are still budget limits on how much the system can spend to care for that population. The major premise of the Managing Health Care Delivery program is that every health care provider should continually look for opportunities to improve. Those opportunities may vary from country to country, but this program provides health care delivery leaders from a variety of contexts with the tools they need to help their organizations continue to improve.

One thing I've learned from the participants in this program is that, when we get into issues of how care is delivered, we start to surface more similarities than differences across systems. The program focuses on challenges that are universal: What are the best ways to deliver and manage health care? How do we treat patients in the most effective and efficient way? How do we continually learn from our experience of having treated other patients? How do we learn from the care delivery experiences of other organizations?

HOW DOES THE PROGRAM DELIVER BENEFITS TO BOTH CLINICAL AND NONCLINICAL PROVIDERS?

The health care delivery model is moving away from an individual physician working with a patient toward a patient interacting with an organization of caregivers that will face issues around human resources, information technology, and organizational structure. A major challenge to address is: Should we be more decentralized or centralized in terms of our management? For a long time, many in health care said, "We're different. Other industry models don't apply to us." When it comes to clinical expertise, they're absolutely right. But when it comes to issues around organizational structure, developing leadership qualities, working in teams, and understanding strategy and financial management issues, participants can learn from examples in both health care and other industries.

Many of the clinicians who come to the Managing Health Care Delivery program are moving into positions where they're playing more of a managerial role. What they often find in the program is examples of other leaders who are going through similar transitions. This program allows you to take a moment to step back and think about some of those more general characteristics that play a huge role in your day-to-day life as a leader.

THE PROGRAM IS DELIVERED IN THREE MODULES. WHAT TOPICS ARE COVERED IN EACH MODULE?

The program is structured in three modules—Design for Excellence; Analyze, Perform, and Apply; and Innovate for Impact—each of which corresponds to a critical aspect of improving care delivery. The program also features a combination of in-person modules on the HBS Campus (Modules 1 and 3), and a virtual module that combines self-paced learning and live online classes (Module 2).

If you're going to run any sort of system well, you have to first design that system. Then you have to come up with ways to examine and track the performance of that system, specifically identifying where it is and isn't doing well. And finally, you have to come up with an approach for changing that system. Each of the three modules relates to a different step in that process.

• In Design for Excellence, we focus on building fundamental tools in areas such as operations management, strategy, and personal leadership. How do you set the initial conditions for operating the system? What impact will external influences, such as regulation and policy, have on the delivery system?
• In Analyzing, Perform, and Apply, you'll use the self-paced Financial Analysis course provided by Harvard Business School Online to examine how financial metrics can be used to create a deeper understanding of the operational, strategic, and leadership issues that health care organizations face. We will also look at control and management systems across several organizational domains as you prepare your own leadership or business case. You will highlight an issue you need to address within your organization, the situation and constraints you face, the approach (or options) you are considering, and the questions you are still working to resolve. You will then receive feedback from—and provide feedback to—other participants in the program.
• In Innovate for Impact, we explore ways to make an organization flexible enough to innovate in a landscape that is constantly changing. How do you reconceive how a product is delivered? How do you design a service that you offer to patients? How do you change the model in your primary care practice or operating rooms to improve operational flow? How do you lead a change process? These are all questions that health care organizations face as the context in which they operate shifts, often in a radical manner.

HOW ARE THESE NEW MODELS CHANGING THE ROLE THAT CONSUMERS AND PATIENTS PLAY IN DELIVERING THEIR OWN HEALTH CARE?

Traditionally, clinicians have provided health care to consumers who are their patients. However, these roles are starting to meld—now a patient needs to act and think more like a provider, and a provider needs to think and act more like a patient. Many aspects of maintaining health are not technically complex. So patients can take a more active role around issues such as measuring their blood pressure or blood glucose level and knowing when their results might require consultation with their physician. This can help on both cost and quality in terms of improving performance. This shift began well before the COVID-19 pandemic, but has certainly accelerated due to the constraints that the virus has placed on daily life throughout the world.

Providers need to understand that patients might have very different preferences for care. Some patients with low back pain might view surgery as their preferred approach to treatment, while others may be anxious about the risk of infection or the cost of being away from work. Helping providers understand how to guide patients through decisions in a more personalized way is one of those changes where you can really talk about innovating in how care is delivered. It starts with a conversation: What are the things you worry about at this point as a patient? How would you define "success" in terms of an outcome? Having those kinds of conversations creates a very different model for health care delivery.

IS IT DIFFICULT FOR CLINICIANS WHO HAVE NO TRAINING IN BUSINESS TO MASTER THE HBS CASE METHOD?

Clinicians are trained to listen to their patients and to take a history, synthesize it, and communicate an opinion—and those are exactly the things we want them to do in class. The case method is similar to going on rounds with 70 other people who've had a different set of experiences. I always tell participants, "Don't worry about the case method, because you live this every day. Just think of this as a larger format of what you do in your routine rounds, with the exception being that you have many more viewpoints to process in one of our class sessions." I've noticed that clinicians typically have no problem integrating themselves into the requirements of our case method, which are simply to listen, think, and participate when you have a contribution that's going to push the group's discussion forward. Overall, our classroom is an extremely welcoming environment.

WHAT DO YOU SAY TO HEALTH CARE DELIVERY LEADERS WHO QUESTION THE VALUE OF LEARNING IN A ROOM FULL OF THEIR PEERS?

Even though participants are unified by their interest in health care delivery, I'm always impressed by the variety of perspectives that we have in our classroom. Some people are coming from academic medical centers where the issue may be: How can we interface clinical programs with educational programs or medical education with research programs? We have people from for-profit providers who may ask: How do we improve the efficiency for specific activities within our organization? We have representatives from public hospitals or health authorities whose concern may be: How can we provide care for a broad population, not just for patients who happen to come through their doors with defined medical needs?

The fact that everyone happens to be involved with health care is not restrictive, particularly in economies where health care might represent 10 to 15 percent of the entire economy. When you look across all those different perspectives, you benefit from a wide variety of opinions. There can be participants from more than 25 countries—and each one brings the experience of operating under a different type of health care delivery system.

IF SOMEONE WHO WAS CONSIDERING THE PROGRAM CALLED YOU AND ASKED FOR ADVICE, WHAT WOULD YOU SAY?

Bring your best listening skills. As I said before, all clinicians have honed their listening skills in providing patient care. When they come to the program, so much of the value is in the perspectives of their peers in the classroom. The faculty member is a facilitator, but the outcome of the program is entirely dependent on the experience and insights that the individual participants bring to the conversations. So come in with the assumption that you're not going to be learning simply from the faculty or from the cases—the vast majority of the learning is going to come from the input of you and your colleagues.

Very often, someone might take one insight from a particular case that the faculty member never would have anticipated as being the big takeaway. The cases are chosen based on what we think the relevant issues are for the participants, but the specific takeaways will differ from person to person.

WHAT DO YOU ENJOY MOST ABOUT TEACHING IN HBS EXECUTIVE EDUCATION?

I truly enjoy watching people who have many years of professional experience return to being in a classroom environment. They all find the classroom entertaining and fun. One thing I hear more than anything else is, "I haven't prepared like this or studied like this since I was in college."

They find the program enjoyable because they have succeeded in taking that pause from their day-to-day to engage in a bit of professional development. One of the important pieces about doing any form of leadership or professional development is that the program has to have a different feel and rhythm from the participants' daily activities to generate breakthrough insights and takeaways. I certainly feel that we are successful in creating such an opportunity for participants in this program.