Becker's Hospital Review

99 PRACTICE MANAGEMENT THOUGHT LEADERSHIP e educational component of launching a successful health plan is rather substantial. You achieve this by bringing everyone into the same room — creating opportunities for the health plan employees and providers to understand the inner workings of both business components now housed within one health system. Believe me, nothing changes the culture of an organization faster than launching a health plan — and it's a positive change. Physician leaders begin to understand risk. ey understand the importance of categorizing patient membership, insurance membership and the value of data analytics. e more you integrate the healthcare delivery side with the payer side, the more they educate each other. Be resilient. Launching a health plan is not for the faint of heart. In the beginning, everyone told me other insurers in our region would not be fond of a competing health plan and try to hurt us. But I knew I had to do what I thought was right for our organization. Furthermore, insurance companies are equally interested in transcending the boundary between provider and payer. Some insurance companies own physician practices, including practices within our service area. As it turns out, we actually have a good working relationship with other insurance companies. If you decide to launch a health plan, you must understand that you're in it for the long haul. You have to think in five-year spans of time, and expect some issues and setbacks in the beginning. So far, we've been very fortunate: CareConnect has been successful and is growing. But that doesn't mean there isn't the potential for problems to occur in the future — it is still a young company. Although it requires massive efforts in planning, recruiting and education, launching a health plan is incredibly exciting. No matter how much you think you know, no one on the provider side fully understands how the payer side really works. You can't understand until you actually become one. n Don't be the Borg: Listening is the First Step for Healthcare Leaders Involved in Changing an Organization's Culture By Nick van Terheyden, MD, CMO, Dell Healthcare H umans are a tribal species. Throughout our history, we have formed groups to help ourselves compete for resources, defend against threats and provide a social milieu. In modern society, one of our tribes is inevitably the people we work with. Bonds form and norms develop that become important to the people in the workplace. A culture develops that differentiates one organization from another. This is especially true for groups of people who work together in challenging environments where the stakes are high, including most hospitals. Because healthcare workers know people's lives are in their hands, they take organizational culture seriously. They identify with it and guard it fiercely. My colleague, Charlotte Hovet, MD, is a family physician with years of experience in helping hospitals with physician leadership and culture issues. She offers a pretty good description of organizational culture and why it is important: "Culture is made up of individual and collective values, attitudes and beliefs that translate into unwritten rules of behavior. These rules, or norms, clue us in to what others in the organization expect of us, and they allow us to predict behavior. Thus, culture has a significant impact on how people in an organization relate to one another and communicate." Once a culture is established, it doesn't easily change because people learn to behave in ways that allow them to fit into the culture. (If they don't fit in, often they either leave or are let go.) Changing workplace culture means changing the way people think and behave, which is never easy. The issue of organizational culture is an important question for healthcare leaders for two reasons. First, mergers and acquisitions have become common, and the melding of two organizations inevitably requires reconciling two cultures that may be different — sometimes significantly different — from each other. Secondly, a larger sea change — the move from fee-for-service reimbursement to value-based payments — also requires culture change. Mergers and acquisitions pose a culture challenge that will take patience and thoughtfulness to overcome. The temptation, if you are part of a larger organization acquiring a smaller organization, is to be The Borg. Fans of the Star Trek TV series will remember that The Borg was a culture comprised of cyborgs that subsumed other cultures into it, whether they wanted to or not. As The Borg told its hapless victims, "Resistance is futile." And while The Borg was a powerful culture, it brought chaos to the galaxy and spawned active resistance everywhere. They were hated and feared. You won't make any friends and you will possibly create quite a few enemies if you try to impose your organizational culture on a smaller organization. Dr. Hovet suggests the key to effective, and peaceful, culture melding is to first understand the culture of the organization you are acquiring. "If you understand how they do things, and even more importantly, why they do things the way they do, you'll have a better chance of a smooth transition,"

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