At Our Core

Healthcare Strategy: Forming a More Perfect Union

By: Scott Orsey

It’s really remarkable to think about. Our Founding Fathers not only paved the way for the democracy we enjoy today, but their actions inform some of our modern day organizational structures in healthcare.

Surprised? Let’s take a look!

One example centers on the formation of Connecticut Children’s Office for Community Child Health (the Office).

When we first formed the Office in 2012, we set out to do three things: strengthen community-oriented programs, encourage synergies across programs, and incubate new innovations that address contemporary community child health issues.  Even the most skeptical observer when given a cursory review of these blog pages should be convinced that we have achieved great success on all counts.

Not inclined to sit on our laurels, we regularly ask ourselves what’s next? What do we do well? What priorities might we add? Where are we going?

I would like to share with you the impact that a simple concept known as “Strategy Deployment” has had on accelerating our progress.

Roughly defined, Strategy Deployment is a process that aligns activities with an organization’s strategic objectives. It uses tools that articulate how priorities of subgroups align with the whole. Normally, Strategy Deployment is employed in hierarchical organizations where objectives cascade from the Board to executives, from executives to divisions, from divisions to departments, and so on.

Connecticut Children’s Medical Center, took the first steps to install Strategy Deployment in late 2017. Deployment became a mandate across the organization for 2018.  But could it be effective for the Office? Could Strategy Deployment succeed in flatter, less hierarchical structures, such as the Office?

The verdict is yes.

So, how do the Founding Fathers fit in? I’ll get to that after a quick explanation of how the Office is organized.

Currently, the Office consists of 15 programs. Some of these programs are run by Office staff, others are run by non-Office employees of Connecticut Children’s, and still others are run by outside agencies. We have a small Office team that serves as an organizing entity – a “lean and mean” backbone that develops program tools and coordinates communication across all programs. But, it’s the 15 programs, largely left to their own invention, that do the heavy lifting and improve the well-being of children across our community. The programs create the impact.

Increasingly, our most pressing priorities cut across all programs. We know, for example, that if we are to strengthen the well-being of children, we must seek measures that span multiple domains and sectors. Similarly, if we are to reinvent how community programs are paid in the pursuit of long-term cost savings, we need models that factor a multitude of, if not all, influences on outcomes. These are not priorities that can be solved within a single program or by a few, centrally-located resources. Moreover, our past efforts in these areas have made only modest progress. These priorities demand deep engagement across all our programs and beyond.

Simultaneously, we are challenged by the high caliber and potential of our staff – admittedly a nice problem to have. How might we offer our current and future leaders the opportunity to hone their skills and prepare themselves for bigger roles? Most of our programs are modest in size, consisting of a team of five to 10 people. Even our largest groups number only in the teens. At first, we might not think this structure gives individuals much room to grow and lead. That is, unless we think about supporting leadership across multiple programs or at the “Office level.”

Now let’s circle back to our Founding Fathers.

History buffs know that after the end of the Revolutionary War, the United States was organized initially as a confederacy – a coalition of states with a small central government that handles the few affairs that affect every state. Soon after the Articles of Confederation were ratified in 1781, the challenges faced by a nation tied together by a “weak” central government became apparent. In a mere eight years, the Articles were abandoned in favor of the Constitution, and the federal structure we know today was born.

While a stronger federation proved to be the answer for the United States, might it also be an effective strategy for the office? We recognize the value of each program’s independent leadership and do not aspire to centralize control. Yet, we must seek options that tackle complex, multi-factorial issues and give room for programs to actualize their individual goals.

Returning to Strategy Deployment. Here’s how we made the process work for the Office.

Late last year, we convened the program leaders of all Office programs along with key support staff, a total of about 25 people. As a group we participated in visioning activities that resulted in seven strategic priority areas. We then distilled nine, what we call, “major tasks” that align with the priorities. This is the core of Strategy Deployment: creating actionable tasks that cascade from and are married to priorities to ensure that progress is made and tracked. But for the Office, this was just the setup; next came the magic.

Having just engaged all of these stakeholders in a process to create alignment, we then asked for volunteers to lead the tasks. There was some concern that since each of the major tasks cuts across programs, volunteering could be viewed as a heavy lift. This work wouldn’t directly advance an individual program’s priorities, so the payoff would be secondary or longer-term at best. Nor would leadership come with a new title or promotion. Leaders would need to recognize an intrinsic value to their involvement, an opportunity to explore new ways of working with colleagues, and the benefits of practicing leadership skills. Would people rise to the occasion?

Of course the answer was yes. Yet the magic didn’t stop there. Teams have now formed under our major task leadership, all voluntary, that have built action plans, shared accountability, and started to advance each of these tasks, and more importantly, our strategic priorities.

It is still early in the process. We are less than a year in, but already we can see the impact of these cross-Office teams. This was new, and the task leaders have bravely navigated uncharted territory with attention toward building a common non-program-specific agenda and action plan. And there certainly have been challenges, yet we maintained our commitment to learning, adjusting and improving. The energy of our task leaders and the expanded capacity gained by involving many programs has brought new action to priorities that in the past were more conceptual. And all the while, we’ve kept our programs’ autonomy intact.

Thankfully our Office is not saddled with the divisive issues that have challenged our nation over time.  That our republic stands tall today in the face of these issues, due to our Founding Fathers’ thoughtful efforts to draw the States closer together, gives me hope that strengthening the federation of our Office programs through tools like Strategy Deployment will bolster us for years to come.

For, “if we do not hang together, we shall surely hang separately.” – Benjamin Franklin

Scott Orsey, is the associate director of operations, business strategy and institutional engagement for Connecticut Children’s Office for Community Child Health.

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