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Leadership, Operations Improvement

What the Science of Motivation Can Teach You about High Performance


Daniel Pink

By Cindy Lorah

The opening keynote address of the American Medical Group Association (AMGA) meeting in Orlando, March 15, featured Daniel Pink, author of A Whole New Mind and Drive, who shared his insight on the science of motivation and some of its implications for health care.

First, he looks at our “intrinsic” knowledge of motivation – what people generally believe and act on regularly. Namely, that rewarding a behavior gives you more of it and punishment for a behavior gives you less.  Social scientists have basically been testing this “hypothesis” for years, and the result is that “sometimes” this holds true, but not nearly as often as we generally think…and this can lead to big mistakes.

This type of “IF – THEN” motivation (IF this action happens, THEN you will get this reward/punishment) has been shown to be great for simple and short-term tasks. However, it is not great for complex, long-term situations. One key study showed that as long as a task involves only mechanical skills, bonuses work as expected. However, once the task calls for “even rudimentary cognitive skills,” a larger reward led to poorer performance. Although this may seem wrong on a profound level, it is not surprising to social scientists. People love rewards and tend to focus intently on achieving them. However, if people need to think creatively and multi-dimensionally, you do not want to motivate single-minded focus.

An example pertaining to health care are studies looking at pay-for-performance initiatives. One study showed there “is not evidence that financial incentives can improve patient outcomes,” and a second showed that there is no evidence that pay-for-performance in hospitals led to a decrease in 30 day mortality.

To be clear, it is a fact that money is a motivator. It matters a lot, but its effects are nuanced. People are exquisitely tuned to norms of fairness. People need to be paid enough to “take money off the table” and to be perceived as being paid fairly.

Assuming “fair” compensation exists, there are 3 motivators for enduring performance:  Autonomy, Mastery, and Purpose.  Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

Improved Economic and Employee Health is Goal of Blue Zones Strategies

37740635By Stephanie Hegland, MBA

In this age of health care reform, corporations are looking to innovative care delivery models – such as accountable care organizations and patient-centered medical homes — to bend the proverbial cost curve by improving the health and well-being of their employees. Recently, Kare 11 News profiled a different approach to improving employee health by implementing Blue Zones principles.

Salo, Oberon and NumberWorks – three affiliated Minneapolis contract staffing companies – became the first organizations to seek a Blue Zones Certified designation. “Workplaces with greater well-being have fewer health care costs and are among the best places to work,” said Dan Buettner, founder of Blue Zones, when he introduced the six-month initiative last September. The Blue Zones Certified Workplace designation is his effort to systematically create an environment of health by focusing on four optimal behaviors: move naturally, have the right outlook, eat wisely, and connect with family and friends.

Collectively, Blue Zones principles represent what Buettner has discovered during his global research to identify communities where more people reach the age of 100 than anywhere else, communities which he termed Blue Zones. Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

Optum’s strategy for ACO development

docsMinnesota is proud to be the home town of UnitedHealth Group (UHG), the largest health insurance and health services company in the United States. UHG provides services to over 97 million Americans.

On January 31, 2013, Chris Pricco, senior vice president of accountable care solutions at Optum, presented the UHG perspective on accountable care organization (ACO) development over the next 5 years. This event was co-sponsored by the Minnesota Chapter of the American College of Healthcare Executives.

If you were to attend one event that would encapsulate the future of the American health care system – this was the event. Here are some key points from Mr. Pricco’s presentation.

The most important trends in health care delivery today:

  • Providers are under market share, profitability and consolidations pressures
  • Cost shifting is rising to unsustainable levels
  • CMS is radically revising its payment methodologies
  • Commercial providers are implementing aggressive pay for performance systems
  • Providers are beginning to take and manage risk

As providers move into the ACO and quality payment environment, several key strategies must be effectively executed:

  • Redesign the organization’s care delivery model to be attractive to the market
  • Develop methods to manage risk
  • Optimize contracts with payers and providers in the system
  • Effectively integrate all providers into the system
  • Measure and improved consumer engagement
  • Increase effective branding and marketing at the retail level

The need to move from a fee-for-service environment to a value-based payment system is challenging for most delivery systems. However, Optum’s experience is that this shift is happening to all systems today.  Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

The Health Care Execution Challenge

This article was originally published in the spring 2012 issue of B. Magazine.

Health care organizations lag behind most successful businesses in executing high-quality business plans

In 2001, the Institute of Medicine published Crossing the Quality Chasm, a seminal work identifying the chasm between what is known about providing high-quality health care and what actually is being delivered. Ten years later, this chasm still exists and was a key factor leading to the publication of Make It Happen: Effective Execution in Healthcare Leadership, a book published by Health Administration Press, a division of the Foundation of the American College of Healthcare Executives.

As director of the Center for Health and Medical Affairs at the Opus College of Business, I long have been engaged in the health care delivery system throughout the Midwest and the nation. The focus of the center is to “support improvements in the leadership and management of health care systems through research, community outreach and the collaborative development of innovative professional and executive education programs.” Conducting research for and writing this book not only furthered the goals of the center but can, as a member of HAP’s editorial board notes, “advance health care leaders from developing a plan and letting it sit on the shelf to full and robust execution.”

The Challenge

The failure to execute is a common problem in many organizations but more so in health care. Barriers include an incredibly complex system, splintered leadership, strategies that vacillate between financial goals and patient care, and no external pressure strong enough to force change.

Effective execution, however, is the key to high performance for most of America’s successful corporations. Executing strategies effectively and quickly is well-known in the general business world, but it appears not to have crossed the chasm into the health care field. One way to bridge this gulf is to provide more effective education and training to health care leaders nationwide in the area of practical and efficient execution.

In 2009, during the Health Care UST MBA Washington, D.C., seminar, I had the opportunity to meet Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. A primary goal of AHRQ is to improve the processes needed to effectively move major clinical research findings from scientific literature to widespread use by the clinician.

AHRQ agreed to provide funding to the Opus College of Business to develop a new, effective execution curriculum for health care leaders and managers. For more than a year, I consulted with OCB faculty members on best business practices outside of health care and also visited some of the leading health care delivery organizations in the Midwest, including HealthPartners, Essential Health – Duluth, Marshfield Clinic in Marshfield, Wis., and Twin Cities Orthopedics to examine their systems for execution.  Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

Initiatives for Responding to Health Care Reform

By Noi Oan, Full-time UST MBA class of 2013

On June 27, I was excited to leave work a little early to attend the “Initiatives for Responding to Health Care Reform” event at the University of St. Thomas. It was one day before hearing the decision from the Supreme Court regarding the future of the Affordable Care Act. Curiosity and anticipation of what going to happen next was the main driver for me to come to the event.

The panel included Jim Eppel, chief operating officer of Blue Cross Blue Shield of MN, Brian Rice, the vice president of Network and ACO Integration at Allina, and John Herman, the president of Fairview Northland Hospital and Maple Grove Medical Center. Dan McLaughlin, the director of the Center for Health and Medical Affairs, moderated the event.

Each panelist brought to the table a unique perspective about the current health care system and the necessary moves to a better future for their organization. However, one theme arose as the common ground for all panelists: the necessity of patient engagement to improve health quality and control total cost of care. Continue Reading

Health Policy, Leadership, Operations Improvement

Health Care Technology Impact: Cloud Computing

By Rex Njoku

As a final year student of Health Care UST MBA cohort 18, I have been challenged with in-depth knowledge regarding the current health care system and the various problems that still exist, such as the rapidly-increasing health care costs, number of uninsured individuals, questionability of the ongoing health care reform, shortage of primary care physicians, etc. The new age of increasing technological advancements, though phenomenal and advantageous, has also brought with it more complexity and problems to resolve, most especially in the health care industry.

A key part of the health care reform involves the use of technology to address a number of health issues such as access, value and cost. Hospitals, if not fully transitioned yet, are now transitioning from paper records to Electronic Medical Records (EMR), a digital and portable version of the medical records used in health care systems that allow storage, retrieval and easy modification of records. To support health reform’s goal of collecting data on providers, determining what treatments are improving outcomes, linking care to payments, determining quality measures, etc., computer support systems are being used everywhere. Increased medical knowledge has brought about more technological advancements in treatment and devices that require computer support. Increases in medical/research data has brought about the need for highly complex computer support systems to analyze and retrieve information. The increase in patient-centric care and social media popularity has also required health care systems and providers to become more technology-savvy. The cloud, social, mobile, consumer, apps, enterprise technologies and more are needed, more than ever, to support these technologies.

The Cloud

Cloud computing enables computers and various other devices in different geographical locations to access shared computer services or applications over the “cloud” or internet rather than a local environment. Cloud technology is at the heart of health care’s transformation and health care industries are now, more than ever, utilizing various cloud technologies.. With tablets and EMRs replacing paper medical charts, private clouds are now being used to access medical records and promote information sharing among medical professionals. Cloud health care services are also currently being used to solve a wide range of health care challenges, such as fraud, remote diagnostics and patient CRM.

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Financing, Leadership, Operations Improvement

A Focus on Women’s Health

This article was originally published in the spring 2012 issue of B. Magazine.

Dr. Donna Block ’05 M.B.A. has opened two women-centered clinics that provide care to women, by women

By Lisa Guyott

Women’s health issues have traditionally been narrowly defined as those specific to the female anatomy and to issues surrounding reproductive health. As late as the early 20th century, a large portion of health concerns brought forward by women were attributed to the catch-all diagnosis of “hysteria,” an ailment which had more symptoms than the common cold and could potentially be cured by bed rest, bland food, seclusion and, most importantly, refraining from taxing tasks such as reading or writing. Laundry, housekeeping, child care and cooking were still permissible.

Today, a rapidly growing number of organizations and practitioners include in the definition of women’s health not only reproductive health, but social and emotional well-being. As defined by the World Health Organization, the topic of women’s health includes biological differences between men and women as well as the study of those illnesses unique to women, more common or serious in women, with distinct occurrences in women, or with different outcomes or treatments in women. Since the 1980s, research on gender differences in health and disease has influenced new treatment and prevention of serious illnesses, including heart disease, stroke, lung cancer and depression.

Clinic Sofia in Edina subscribes to this revised and expanded definition. Launched in 2004 by Dr. Donna Block ’05 M.B.A., the clinic’s mission is to “nurture a community of confident, healthy women,” a mission taken seriously not only by Block, but by the all-woman staff and the clinic’s clients.

The clinic’s name evokes Sophia, the Greek goddess of wisdom, fertility and nurturing. Its waiting room is the first and most visible sign of this mission. Bearing a greater resemblance to a 19th-century literary sálon than a medical office, it is furnished in comfortable couches and lounge chairs. A large bowl of chocolates sits on a side table and soft music issues from a portable CD player. The waiting room also is an exemplar of the clinic’s – and Block’s – approach to business: a carefully crafted, deliberate implementation of disciplined intuition.

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Leadership, Operations Improvement

Capital Investment Decisions in Health Care – Five Questions for Prof. Southard

Peter Southard

We recently talked with Peter Southard, Ph.D., an assistant professor of operations and supply chain management, about his research on capital investment decisions in health care.

Q: Why did you decide to examine capital investment decisions in health care?

A: Increasing competition and artificially-imposed price controls in health care are forcing caregivers to rethink how they manage their delivery systems. Health care delivery systems must be able to provide extremely high-quality care at reasonable costs. Any variation in the systems and the processes needed to deliver the health care “product” serves to increase the costs and reduce the quality of that health care. The variation does so, partly, by increasing the time needed to deliver the service. One of the primary goals of health care must be, then, to identify and reduce the root causes of variation in its processes and systems.

This need is also true in all decision making processes in which variation, or lack of a consistent framework by which to make decisions, can lead to not only inefficiencies but also costly errors that reduce the hospital’s competiveness and its ability to deliver cost-effective care. One of the decisions impacting a health care system’s cost is the make/buy decision: when to outsource a process and when to maintain the process in-house. If the decision is to “make,” then the next decision is a capital investment one. Our research looks at adapting a framework from another area of business to this decision situation. We apply a Six Sigma quality tool, the Technology Function Deployment (TFD), to develop a practical framework that hospital managers can use to make consistent and effective decisions regarding capital investments versus outsourcing.

Q: Why is this topic of interest to you?

A: Professor Sameer Kumar and I have been doing quite a bit of research in this area of process improvement in health care. While researching our last paper, we noted the lack of uniformity in the laboratory equipment purchasing decisions of our subject hospital and decided to try and apply this approach to standardizing that process.  Continue Reading

Leadership, Operations Improvement

Segmenting the Future of Health Care

By Cindy Lorah, Associate Director, Health Care UST MBA

Last Tuesday, the University of St. Thomas hosted the Minnesota Chapter of the American Marketing Association’s final Health Care Special Interest Group event of the program year. Bart Reed of UnitedHealthcare Medicare & Retirement and Michael Brousseau of OptumHealth shared how their segmentation work is driving business growth throughout their organizations.


The UHC Medicare & Retirement Group wanted to create a shared perspective on consumers over age 65 that would provide a common language in how they talk about consumers; a common approach to targeting; a clearly defined customer value proposition; a clear understanding on where growth opportunities lie; and a focus for messaging, innovation, product development, etc. They developed a methodology to answer the following questions:

  1. Which consumers and segments present the most attractive opportunities for growth?
  2. What are the current, latent, and emerging needs of attractive consumers and segments?
  3. What is the total value proposition – benefits, services, pricing, communications – they should deliver to drive differentiation and growth?

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Financing, Health Policy, Leadership, Operations Improvement

Industry Insight: The future of coverage and care delivery

37878562This post is part of the Industry Insight series which is designed to highlight the most significant new reports on health care management or policy–ranging from government reports to health care business studies.

We will highlight and briefly analyze reports that may be useful to the thoughtful and busy health care leader. Our health care programs at the Opus College of Business emphasize leadership, organizational transformation, and operational excellence. The reports we select will reflect these themes and can be helpful in strategy formulation, operations improvement and leadership activities. 

This series will show you at a glance what you need to know about current developments in health care management and policy.

This edition features:

  • The Oregon Health Insurance Experiment. Does having health insurance improve health?
  • Modernizing Rural Health Care: Coverage, Quality and Innovation. What is the state of rural health care in America and where is it going?
  • Large Employers’ 2012 Health Plan Design Changes. What is the future of employment-based insurance?

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