Issue link: https://beckershealthcare.uberflip.com/i/576097
FINANCE STRATEGY AND INNOVATION 21 return; if there were financial repercussions from the decision, CVS could not simply return to selling tobacco without com- pletely compromising its commitment to its mission, and the mission itself. How certain do you need to be that halting is the right choice? According to David Crosswhite, senior vice president of Kaufman Hall and co-author of e Innovator's Field Guide, lead- ers will be confident with the decision to stop something when they believe that the outcome expresses the organization's goals and values in a more effective way. "Deciding to stop something can be a very hard choice to make," says Mr. Crosswhite. "However, even if tobacco was a profitable product for CVS, somewhere in their calculations was the business case that CVS would be better off in the long run being a healthcare company. If that means it has to stop selling a particular profitable product to achieve that goal, it's the right choice, both from a financial and a social responsibility stand- point." Although the decision to stop selling tobacco products was risky, CVS essentially had no alternative if they were serious about being a healthcare company, as opposed to just a pharmacy or convenience store. When innovation is a moral obligation Peter Pronovost, MD, PhD, a critical care physician, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Balti- more-based Johns Hopkins Medicine, felt morally compelled to stop something at Johns Hopkins. He read about the number of patients who die during low-volume surgeries, which U.S. News & World Report pub- lished in May. According to the report, as many as 11,000 U.S. deaths may have been prevented from 2010 through 2012 if pa- tients who went to the fih of hospitals with the lowest volume had gone to the fih with the highest volume. Although the data supporting the association between high-volume surgeries and better outcomes has existed since 1979, the latest findings struck a new chord with Dr. Pronovost. He and his colleagues had to act. "It was a moral moment for me, and we knew we had to do something about it," says Dr. Prono- vost. Soon aer the report came out, Dr. Pronovost connected with two other physician leaders: surgeon John Birkmeyer, MD, chief academic officer at Lebanon, N.H.-based Dartmouth-Hitchcock Medical Center, and Michael Mulholland, MD, PhD, chairman of surgery at Ann Arbor-based University of Michigan Health System. Together, the three systems consulted with surgeons to iden- tify 10 high-risk procedures with the strongest correlation be- tween volume and mortality. ey agreed to bar them if their hospitals and surgeons fell into the lowest fih by volume of pro- cedures. Analysis by Dr. Birkmeyer found doing so could save 1,300 lives a year, according to U.S. News & World Report. "Other health systems and professional associations have expressed an interest in moving in this direction as well and ma- turing the idea," says Dr. Pronovost. "I think it's an enormous and important shi for patient safety. Too oen we think safety relies on the individual clinician — people think if you have a medical degree you're qualified to do anything, but that's not always in your best interest or the patient's." Understanding resistance to change Hospital executives, industry observers and even physicians say medical providers are generally resistant to change. Some re- sistance stems from physicians' concern for patients. "Healthcare is a very evidence-based industry," says Dr. Her- nandez. "Many healthcare professionals want to see the data to demonstrate that the changes being proposed will have the im- pact promised to them. ey're concerned about making chang- es at the risk of negatively impacting quality." When physicians affiliate or become employees of hospitals and health systems, they worry about compromising the "art of medicine," or their ability to maintain independence in their practice style and clinical decision-making. In some healthcare organizations, physicians see monitoring as punishment opposed to facilitating collaboration and learning, according to Dr. Her- nandez. Fear of litigation also contributes to resistance to change. When it comes to stopping, the feeling of absence can trans- late to loss, which can lead to resistance. Stopping is not an easy decision — it will be disruptive and upsetting to some people. A high level of trust in leadership mitigates such turbulence. "Much of perceived loss is around stature, power and pres- tige, and this fear can grow like cancer if you don't have a way to communicate why you are making the change," says Dr. Pro- novost. "What we've found in our own change work is we need to improve our skills at leading change. We approach it like a technical solution, but peoples' feelings about it can pose a huge barrier." Strategy execution is more important than ever, and at the same time, healthcare organizations must zero in on a narrower set of goals. is oen means pulling the plug on systems and products that are resource intensive and no longer create value. Stopping also sends a clear message to hospitals with competing demands and multiple priorities. "Imagine everyone in the organization walking around with backpacks, and the leaders keep filling them up with new ideas. Everyone eventually becomes too burdened with every new ini- tiative and rule until they can barely walk," says Mr. Jarrard. "is has historically been the case in healthcare. Now lighten the load. is makes the organization faster and leaner in clarifying what it is and what it's about." Stopping can turn strategy into action just as effectively as starting. It requires a different perspective and acceptance of risk and even failure, but it is a critical capability for healthcare lead- ers. n