1. Pursuing an Inspiring Purpose

How can we (re)define our purpose as a health-care organization so that it inspires everyone to pursue extraordinary cost innovations and offer world-class medical care?

How can our organization nurture doctorpreneurs who are committed to providing affordable, world-class health care for all, and who can encourage everyone to pursue value-based care?

How can we encourage innovation at all levels of the organization, including frontline staff, and how can we foster a commitment to lean production?

How can our organization educate people about how to lead healthy lives and prevent disease, rather than simply treating them when they are sick?

How can we prevent the overutilization of health-care facilities? How can we serve the real needs of health care rather than the unnecessary conventions created by perverse incentives?

How can we care for more uninsured and underinsured patients without increasing our total costs? For example, how might we dramatically improve the productivity of our people and facilities to free up money to serve the poor?

Can we embrace transparent, bundled pricing so that patients and insurers know in advance how much a standard procedure is likely to cost them?

How can for-profit organizations develop a “social heart” and nonprofit organizations develop a “business brain” so that both have “social hearts and business brains”?

Is there a “hero” in our organization’s history and story? If yes, who is it and why? Does that person’s example support value-based, patient-centric health care?

Who in our organization is the most purpose-driven individual—regardless of department, title, or role? How can we help that individual to assume a greater leadership role?

Does our stated organizational mission reflect value-based and patient-centric goals? If yes, how is that mission manifested throughout the organization? If no, what would it take to get there?

Can we craft a five-year strategic goal of reducing health-care-delivery costs by 30 percent of current levels, without adversely affecting quality?

Purpose informs the reason for your existence, and strategic intent expresses a stretch goal. Topics two through five below will help you develop strategies to achieve your intent.

2. Configuring Assets in a Hub-and-Spoke Network

How can we streamline our network (or become part of someone else’s network) so that we separate complex care from straightforward care?

Can we concentrate the most expensive equipment and the scarcest talent in “hubs” or “centers of excellence” to treat complex procedures, and can we house less-expensive equipment and less-scarce talent in “spokes” that can treat simpler procedures closer to where patients live?

Can we leverage our own spoke facilities (or those of partner organizations, including critical-care facilities or community hospitals) to provide quality care closer to where patients live?

When appropriate, are we using hubs and spokes as “focused factories” that perform either complex or simple procedures, but not both?

Are we using our hubs and centers of excellence to develop clinical innovations that simultaneously improve quality and lower cost?

Are we using volume to maximize utilization of expensive equipment? Are we ensuring that such equipment is used day and night? Are we “making our equipment sweat”?

Are we using the volume in “hubs” to accelerate learning and skill development by medical professionals and other staff?

Are we using high volumes to continually develop better protocols for various risk categories?

Are our volumes high enough that we can create specialists even for relatively rare conditions?

Which essential services should always be delivered in the spokes? What services should always be centered in the hubs? What services does that leave for managers to assign creatively?

How can we ease the transition for patients who must move from spoke to hub? What transportation services, family supports, or cost reimbursements might we institute?

How can the organization build brand in the spokes without replicating services that belong in the hub?

How do we ensure that workers in the hubs and spokes are “on the same page” about the organization’s overall mission and approach to value-based health care?

3. Leveraging Technology

Are we using technology to link hubs and spokes and create a telehealth network?

Can we leverage technology to better monitor patients remotely and provide home-based care for those with chronic conditions, rather than treating them in hospitals?

Are we exploiting innovations in medical technology to provide better, cheaper, and more convenient care for patients?

Can we lower costs and reduce errors, while also preserving patient confidentiality, by using electronic medical records and IT systems?

Can we sponsor internal or external research to develop low-cost alternatives to expensive supplies such as medicines, instruments, and consumables?

Can we nurture frugal innovations to develop ultra-low-cost devices and tests?

Can we leverage wearable technologies, smartphones, big data, and artificial intelligence to generate earlier and better diagnoses, to customize treatments, and to improve population health?

Can we help change regulations that impede the adoption of such telehealth practices as reimbursing doctors for teleconsultations and email consultations?

What single problem that you encounter every day might have a technological solution? How would you make that solution happen? Who would you bring the problem to? Where would the resolution go from there?

If we do not have tech savvy in-house, how can we bring it to us?

What incentives and supports can we offer professional staff to pursue continual adoption of new technologies?

What outdated technologies are holding our organization back? What can we do to move past them?

4. Promoting Task-Shifting and Continuous Process Innovations

Can we leverage task-shifting to use doctors and nurses at the high end of their credentials while passing on less-skilled work to other health and service professionals?

Can we create new job categories, such as health coaches or medical intensivists, to which tasks can be shifted in ways that lower cost and improve care and patient well-being?

Can we rethink our policies for right-sizing headcount so that it doesn’t overburden doctors and specialists with tasks that are best done by less-expensive and less-skilled staff?

Can our workflow and processes be improved to reduce the time required for procedures and the downtime between procedures, especially in cases where scarce expertise (e.g., specialists) and sophisticated facilities (e.g., operating rooms) are involved?

Can our patient flow be improved to make our health care more patient-centered?

Can we continually improve our processes and protocols and make sure everyone follows them to both lower costs and improve quality (e.g., by avoiding needless injuries, infections, and death)?

Can we encourage patients and their families to take on tasks normally done by nurses or other medical staff, in ways that lower cost and improve continuity of care?

How can we encourage patients to take ownership of their own health and become equal partners in their treatments?

Have we developed practices that address the psychological dimensions of well-being, such as anxiety disorders, stress, and depression? Are we clear about which workers “own” behavioral health?

Who does our organization really serve? Are we patient-centric or are we staff-centric? Or do we mostly serve headquarters and the bottom line?

Do the job descriptions in place in our organization match the work that needs to be done? Can human resources lead a review?

What barriers are there to making task-shifting changes in our organization? Regulations? Union interests? Employee training? Recruitment pools? How can we overcome those barriers?

Can we work with area schools and workforce-development agencies to train workers for new paramedical and service positions that we need?

If you could empower your closest subordinate to take over three of your current tasks, what would they be? Would that subordinate be interested in doing that work? What would the barriers be to shifting those tasks? Conversely, if you could take over three of your boss’s tasks, what would they be? Are you qualified to do that work? What would it take to get there?

What work in our organization does nobody want to do? Can it be outsourced?

5. Creating a Culture of Ultra-Cost-Consciousness

Above all, how can we avoid unnecessary tests, procedures, and hospital admissions that increase costs and sometimes worsen outcomes?

Can we reuse any of our medical supplies or devices instead of throwing them away after one use? What protocols would such a policy require (related, for example, to sterilization)?

Can we implement “activity-based costing” to understand the full cost of each medical procedure during the entire care cycle: from admitting the patient to treatment to discharge to postdischarge visits?

Would bundling prices and publishing those prices help rein in our costs and improve our outcomes? How could we make up lost revenues?

How should we enforce our protocols to ensure that all required tests and procedures—no more and no less—are performed properly?

Are we minimizing capital outlays on medical facilities (e.g., by using simple and standardized hospital designs, inexpensive materials and furnishings, and multipurpose spaces where appropriate)?

Are we purchasing equipment with only the features we need, and can we avoid unnecessary duplication in our various locations?

Should we lease rather than own land, buildings, or equipment (e.g., by opting for pay-per-use arrangements)? Can we take the same approach to hospital beds, considering that there will likely be a surplus of beds in many hospitals in the future?

If we have persistent excess capacity, can we mothball some hospital beds or lease them to other users?

Can we extend the useful life of costly medical equipment through better repair and maintenance contracts?

How can we encourage doctors to consider the costs and value implications of their decisions when prescribing medicines, tests, and treatments for patients?

Are there sensible ways to share financial results and cost data with our staff so that they better understand our efforts to provide value-based care?

Are we doing all we can to identify and share best practices in value-based care across our various locations and medical departments?

What incentives and supports can we offer frontline workers to help them find cost-savings in every corner of the organization?

How can we transform cost savings into value creation for patients and for our company?