🎙 THE STRATEGY GAP PODCAST
Putting Strategic Plans in Motion During Significant Change
JANUARY 25, 2024
About this episode
The healthcare industry is expansive, comprising of large organizations and companies. Navigating change, particularly the recent paradigm shift towards value-based care, poses challenges for both leaders and employees.
In this episode, our hosts Jonathan and Joe are joined by Teresa Patterson, a Strategy and Growth Leader with extensive experience in guiding the transition from fee-for-service to value-based care. Teresa emphasizes the crucial role of leadership in fostering a culture of change and effective communication within healthcare organizations. Where does one even begin?
Together, Teresa, Joe, and Jonathan delve into the following topics:
- The challenges and strategies involved in the healthcare industry's transition from a fee-for-service model to value-based care.
- The intricacies of change management, encompassing the role of leadership, effective communication, and the active engagement of employees throughout the change process.
- Insights into the art of balancing empathy and accountability in healthcare leadership, including motivation strategies, organizational behavior considerations, and aligning frontline employees with broader organizational goals.
Jonathan Morgan 0:03
Welcome, everybody to another episode of strategy gap. Joining us today for an exciting episode is Theresa Patterson. Teresa is a dynamic business growth leader and industry expert. Having spent nearly two decades in the world of healthcare. She has a proven track record of optimizing sales, implementing strategic plans and driving organizational transformations. With experience spanning from both startups all the way up to Fortune 500 companies. She's here to share her insights and expertise that she's learned throughout her career. So, Teresa, welcome to the show. Thanks, Jonathan. When today's conversation, we're going to discuss a wide variety of different topics related to your experience. And it's really your passion of creating an environment for delivering the best care and the best service. Certainly, there's a lot of places that we can start with that. But I think given your expertise in healthcare, I think it makes sense to dive a bit into maybe what makes healthcare unique in this regard. One thing I picked up on from our first conversation, so I loved hearing about the impact that value-based care has had on your career. But certainly, we have listeners that are from healthcare, not from healthcare. So for those that may be a bit unfamiliar, do you mind briefly kicking things off by explaining value-based healthcare? And the shift that many healthcare organizations have had to make because of it?
Teresa Paterson 2:32
Yeah, so we've been in a fee-for-service model for quite some time, which is basically when you go into your senior physician, there is a code for everything that the physician does in that exam. And those codes then reimbursed that physician for their services. With the cost of health care, rising, insurances have had to cut the reimbursable amount for those codes. And so physicians are and healthcare providers are having to shorten the time with an individual person, and cut out essential preventive care questions, in order to get more patients in in an hour to make the same amount they used to make. Well, that's not working anymore, because things are getting missed. And when you miss something, and then it's caught after the fact, it becomes much more expensive, with hospital admissions, treating the disease versus preventing it. So the shift we're seeing is moving from fee for service to value based care, which is all about whole person care, preventive care. And I've seen this in my career throughout my nearly two decade journey, and it has been a very interesting ride. And I have to say, from my perspective, you know, there's a lot of frustration from the provider side, because it requires a lot of time and resources, but it's something that has to happen, otherwise our health care won't survive.
Joe Krause 4:03
Your point is well taken. I mean, I started my career in the pharmaceutical space, and I know you have some medical device experience as well as a variety of others. But back in 2006, I've been working in New Jersey, specifically, single shingle doctors were pretty much the norm, like, you might have a doctor, medical group of three doctors, and that was considered big, but a time I exited that space. About seven years later, everybody was pretty much an employee. This example I was given was, this gentleman had a pretty sizable medical practice in Westfield, New Jersey, and he was the king of the town. He loved everything. And he was like, Finally I'm at the end of my career. I don't want to deal with value based care. Let me then become part of a bigger system. And I'll work my last couple years in relative peace. So he does the science, the papers, he now has another shingle on his door for the bigger health system, and the first day of the new regime. He eats lunch in his office, and he gets an email from HR saying that it's against policy to eat your own food in the office because of potential rodent infestations and bugs and then this Since its first morning, so you went from, from one thing to the other, to avoid this journey from fee for service to value based care, at least in the relative sense. And to bring it back, this whole idea around what we were talking about in this podcast is change management is really what is forced by strategic planning. And I can't think of a bigger phase shift, at least in any industry than what you just mentioned. And so how have you seen it now, years later, like the people that have been dragged kicking and screaming? Have they come along for the journey? Have they jumped off the carousel? Is there a combination of it? And how have you seen like, we are changing, so you're either coming or you're not? How have you seen that evolve over the last decade or so.
Teresa Paterson 5:39
So those who are, you know, sharp in the realm of business, have jumped on board and have captured the low hanging fruit of how to work in this new kind of healthcare system that we're in. And they're learning how to thrive and thrive very, you know, very well, those who have kind of been kicking and screaming for a while, either they've closed their doors, because it's like, okay, well, I'm just going to retire, or they have joined forces with the larger umbrella because they don't, there's just not enough left over in their own smaller business, to pay for the resources that it takes to, to do the value based care. And they haven't figured out, you know, as compared to those who have a stronger business acumen. They haven't figured out how to balance the two. So yeah, so they've had to join, essentially, a corporation who, you know, it's they carry the financial burden of supplying the resources. But then now you're you're not, you're not the owner anymore. Yeah.
Joe Krause 6:52
And to really just finish that thought to it. The interesting thing is, if you talk to doctors, especially the ones that were they came up maybe 15 years ago, they'd say, you spent a week during medical school learning about diabetes, right, big, big disease state, you have about a week, if you're lucky, obviously, if you go into more specialized medicine, you'll have a lot more. But they receive zero training on how to be a business owner, oh, I have to be an HR manager, now I have to be a real estate investor I have to be all the things that you need to do to be a single shingle doctor, or even part of the Medical Group is simply not taught. So most people coming out of medical school now, their only option is to join a larger system, which obviously has its ups and downs. But it's a complete difference from when you're driving down the street 15 years ago to now the types of systems that you see, it's very rarely Dr. Smith's practice. And so the your point that that was going to happen no matter what. So anybody who didn't want to join, it is no longer probably even in business. And that is really speaks to the idea of when you are proposing change management. It sounded like you said some doctors said I want to do this because it was clearly articulated. What's in it for them, as opposed to I don't want to change I like the way we do it. So what techniques have you used to really drive the point home to maybe those reluctant resistant folks to say, This journey is going to take some work, but I promise you on the other end of it, you're going to be better for it, how do you put that carrot out there so that they actually come along for the ride.
Teresa Paterson 8:15
So it's, it depends on the environment. So if they're working for a corporation, and I'm a part of that corporation, it's and you're not coming down on them like this, but it's their job, and they don't have it as an employee, they don't have the option. But of course, you're not going to approach it that way. So you have to kind of empower them to say, look, you know, you're working for you're not with a small practice on the corner of the street mystery, you're, you're with this large organization where your career as a physician, or nurse practitioner, or PA, you can take it anywhere you want to go because the sky's the limit here. We're an organization of 100,000 employees, and you know, you don't have limitations. So in that sense, you kind of use that as motivation, where do you want to see your yourself in 510 years, maybe they want to still be patient facing? Maybe they think they'll get burnt out eventually. And that's kind of like okay, but this is these are the things you have. It's your in the corporate world. Now. On the other hand, if it's, you know, a smaller practice, and it's, it's the owner, I mean, I've had I've had clients where I've said, look, and I've had the relationship, but I've had clients where I've said, Look, you either you either figure out how to play the game, or your doors are gonna close. And so that's, you know, I'm kind of a straight shooter like that. And so they they kind of get angry and I'd let them and then when they're finished, okay, let's get to work. How we're going to do this, you know what I mean? So that's so it depends on the situation.
Jonathan Morgan 9:55
Makes perfect sense. Yeah. Yeah, makes perfect sense as well. So I think this is certainly a very specific change that we're talking about. But if we're taking a step back, it's not. It's not unique that organizations face large changes like this, there are a lot of competing factors, a lot of competing players that are trying to figure out what it means for them. So taking a step back and thinking about, in order to make any sort of change like this at a large scale, obviously leadership has to be involved in they have to take the right approach to enable that successful change, it often can't just come from the ground up. So in your perspective, from this experience from others, what is leadership's role in creating a culture that then supports that change? How do they get everybody on board? How do they then push it forward into the organization?
Teresa Paterson 10:39
So I think communication is key. And it's all about involving them in the in the vision, the end result, this is where we want to be, instead of just treating them as you know, you're, you're an employee, just do your job. So involving them in the process as much as you possibly can, involving them in where you want to take it, where that what the end result looks like. And encouraging them all along the way that yes, okay, don't don't deny that the changes will be painful. But the end result is going to be worth it. And this is why, and so a constant reminder of that. And then I like to, you know, with my team, I like to open their eyes, because sometimes they're already there. But sometimes they're not. But I like to open their eyes to how going through this change is developing their own career and where that can take them. Sometimes they're not even thinking in those terms. And sometimes they are, but when you open that door, and you say Do you understand what this is going to do to your resume, or what this is going to add to your experience, and then they kind of go Oh, and you know, you use those kind of tools to get them on board and to get them. And that's how you're going to create a culture of more positivity about it instead of complaining that the lunchroom or whatever is going on. So. So yeah, using ways to empower them, and encourage them and involve them and communicate, communicate, communicate, because that's the one thing that I think a lot of employees complain about is I'm not being communicated with.
Joe Krause 12:12
I mean, if you look at the literature that the Project Management Institute puts out, if you're studying for your PMP, and all that lovely stuff, they say 85% of an effective project manager's job is simply communication. And I say simply because communication takes many forms. But the idea that when you're making a project plan, and this would be a big project we're talking about, sometimes people skip the idea of the communication cadence, like I'm gonna send a weekly note, I'm gonna do a monthly note, this is when you can expect it. Because I think we all can relate to the idea of you're waiting for a job offer, and you're just sitting by the phone, like, why don't they call me back, I spent five interviews with them, and they're not calling me back or, you know, you're waiting on hold for your airline to change your ticket. Nobody likes that feeling. So when there's a combinate, when there's a situation like this, especially with the big change, and there's just kind of radio silence, and people make their own narrative at that point. And it's such an easy thing. It's like in tennis an unforced error, right? You just hit the ball into the net, just because you messed up. It's the same idea. And so I guess, have you figured out what the right level of communication would be where you're not? Spoon feeding them, but you're also making sure that it's consistent, what have you seen be effective with the appropriate level of communication?
Teresa Paterson 13:18
So the first thing I do is I tell them, I'm going to communicate as best as I possibly can. I'm going to have misses. Okay, so if there's something I, you know, and miscommunicating, come to me, my door is open, right? But as we're going through the changes, and you kind of have to stop. You know, sometimes you get your tunnel vision on when you're in the midst of something, you kind of have to step back every, every so often it's okay. Put yourself in the shoes of your team. If, if this is rolling out, how is this going to affect their day-to-day, okay, then I need to communicate something right. The other part is I do tell them, sometimes I cannot share or communicate things with you. And that just is these other rules I have to live by I don't make them. And this is how it works. And I'm but I'm going to do the best I can to communicate it as much as I can. The other thing I also love to do is and this takes a little bit of humility in the leadership roles is where you, you lean on your team members for their input, and they feel valued, but they are a value. You're not faking it. This is this is true. They're frontline. And as many years as a leader has been in their role, you still have so much value to get from your employees. So I'll pick up the phone, I'll talk to different members of my team and say, Hey, I need to get your input on something. This is where we're at in this piece. How do you think this is going to affect XYZ? And then we have that open dialogue? And I get tons of valuable information from that.
Joe Krause 15:00
Nothing worse than working with a with somebody that hasn't done the role in a long time. And then you came, I mentioned before I started my career in pharmaceutical sales. And many of the managers I worked with, for a number of years were folks that hadn't actually carried the bag and eight 910 years. And so yes, some of their insights were valuable, but it was always a little bit like you haven't really sold in this environment that we have now we don't have the ability to do golf trips and things that they used to be able to have it was more truly are you bringing value from a scientific perspective? Yes, we brought some lunches, but it was very strict. And the people that we were working with management wise, wasn't doing the best job to say, I kind of understand your role. And here, I'm going to bring value. So the idea of connecting with your frontline folks, and maybe having a little bit of humility, like trying to do the job and really spending a day in the shoes of the people that you're in. It's the idea that we I think we brought up in previous podcasts like Lean Six Sigma, one of the big things is like, do a gimble walk, go see the work. Like it's such a crazy thing that people want to sit in their office, like no, go and actually do a field visit, go meet people go do things, and then everybody will then realize, ah, at least they're making an effort. And that communication will hopefully be better because of it. So I really resonate with your comments.
Teresa Paterson 16:11
And just think of how that affects the culture of your team. Because you're now a leader going to them asking for their input asking for their expertise. And now that you know, this is that's a part of you're getting like you're hitting two birds in one stone there because you're transforming culture, but you're also gathering valuable information.
Jonathan Morgan 16:31
Yeah, yeah. I mean, a lot of this kind of ties back to the age old question of like, is it better to use a carrot or a stick? I think, obviously, there's, there's more inherent positivity around the carrot, but it all comes down to kind of having empathy for employees and the teams, but also being able to hold them accountable, you kind of really can't sway too far, one way or the other. But you need to strike that right balance between the two. Because if you're too empathetic and too kind and too caring, well, maybe then you're not holding your team accountable. Or if you're on the other end too accountable and focus just on holding people to what they say they're going to do, well, then you're going to lose people, because they're not inherently motivated. So kind of through your experience in this conversation. How do you find that balance? Right? How do you not overcorrect too far to one of those sides where we end up missing out an opportunity through engaging your employees the right way?
Teresa Paterson 17:21
Yeah, I think it's, again, back to communication, you know, if someone is, maybe they're not your highest performer, and you're having issues with them, it's not about coming to them and saying it with a hammer and saying what's going on, you're not doing this, this, this and this, even though you know, they're not your highest performer, it's about coming to them and saying what's going on, I know that you have so much more potential. And let's talk about where you know, where I see, you know, you could have improvement, and that kind of approach is going to result in a better response than coming down on them. So you and you, you create, obviously clear cut accountability that's across the board for everyone, no matter what, you know, what level they are as an employee as far as Higher Performers, lower performers. And there's an observation that occurs when I'm outreaching, my higher performing team members for their advice for their input, you're not kind of playing favoritism, you're just kind of saying, hey, I want you to get your input, the others are observing that. And so they're making mental notes in their head, you're not necessarily treating them like the redheaded stepchild the whole time, you're still encouraging them to to, you know, grow outside of their, their comfort zone, but they can see what lies ahead if they push themselves. You know what I'm saying?
Joe Krause 18:53
100%. I mean, I took a variety of org behavior classes in business school, Jonathan as well. Interesting name for a class because orgs don't behave typically, organizational misbehavior. But the idea that every team you manage for the most part in life always demonstrate this as a it's a standard distribution, your bell curve. And on the far right, you have your top performers, the ones that you do, not only are going to them for their advice for lip service, you're doing it because you value their input, it's really about 10% of your team that you would say it would be those are the people that I would go to war with. On the other side, there's 10%, that you know who they are, they're the ones that are just constantly having to be dragged along. But that does leave the 80% in the middle and they aren't to your point observing and looking well, how are they being treated? Are we trying to make the squeaky wheels happy, even though they'll never be happy? Are we really putting the the people that are exhibiting what we want on a pedestal and pointing to them? And if the 80% see the pedestal happening, they're going to gravitate over there. And so what you're referencing there is great and people are more observant than we give them credit for even in the remote environment. They could see who's being who's going to speak at the all hands meeting who's going to Add to the slide who's gonna do that? And some people catch when and want to join that. And that's, that's great. And it's a fairly low impact exercise to get your team energized. Right, it doesn't take that much to pull that lever. So I 100% agree with what you said.
Teresa Paterson 20:13
Jonathan Morgan 20:16
I mean, taking a step back and thinking more about healthcare, and this is after these transformations are important, but they're not important because they're going to help you generate more revenue or get more leads and more pipeline in the typical business since right all of this comes back in health care at the end of the day, to helping patients and how do you help patients by delivering the best customer experience possible, and making sure that that is your organizational priority, and all the efforts that you're doing through this change is pointing you towards there. So I love to spend the rest of our conversation focus on customer service and making that a priority. So in your experience, and throughout your career, kind of what, how do you make customer service an organizational priority, so that you can then deliver the best level of care and service to customers, patients, whoever that may be.
Teresa Paterson 21:05
So it's it's kind of going back to that, you know, your team and, and the communication and helping them to understand that what their role is and how it impacts the end. You know, the bottom line the revenue, right, so sometimes, those frontline employees don't really get it, they don't connect it. So it's about helping them to truly taking the time to help them to see how how critical their role is, to the end result. I mean, I have had situations where those employees, just with those conversations, we turned around our usage rate. And just because the experience with the service bureau provided had turned around completely. And so when that happens, then you've got those people who are experiencing a different service than they did prior are going and telling everybody else and they're telling more people and more people. So it's really about, you know, getting to the level of your employees and helping them really truly understand.
Joe Krause 22:19
The understanding that you're talking about as obviously, the connection to the bigger picture versus just right, going through the motions and bringing up the Project Management Institute. Again, we use this statistic a lot when we're talking to potential customers of achievement. If you if somebody in your organization can articulate why they're working on something, it could be as simple as I'm doing this to reduce the amount of preventable falls we're having in our hospital, right? That if they can articulate that, just like that 73% chance of them being successful at that endeavor. If they have no clue why they're working on it, they're like, oh, yeah, I'm doing the safety protocol, is it something to do with a fall 42% chance of that work getting done. So that delta multiply by an organization as big as a hospital or medical group really starts to pay dividends? So the idea is getting those people going, and I guess, what you mentioned was an individual conversation potentially with some of these employees.
But have you had any suggestions around maybe instilling it into maybe onboarding? Or if we have a group meeting, we always start with certain things, because I'll let you answer in just a moment. But I brought up before in the, in the utility space, they start every meeting with a safety factor. They say, before we start today, we're going to talk about safety, and it could be something related to plant safety. It could be related to something as you check your brakes. It's the Winter's coming. Make sure you check your brakes and fill up your fluids and have a blanket in the car. But every meeting no matter what level the organization, there's a safety moment. Have you had any experience with that sort of cultural shift to make sure it's like part of the DNA that people can't avoid it?
Teresa Paterson 25:14
I mean, I think it's just a matter of when you're getting on these meetings, and you're able to kind of, kind of check in with your, with your employees, you know, as the meeting is getting started and have that, you know, informal talk before you're officially started, I think that helps to kind of pave the way of a meeting where we can all kind of come in, in, be open and be open-minded, and provide our input. But yeah, I think there's not, I haven't found one, one trick to really work. And it also depends on the meeting size, you know, if it's, if it's a small group, that's one, a different method versus a very large group of, say, 5050. Team members.
Joe Krause 26:00
That's fair. And I've seen that work in the past where it's for all team sizes I've seen, especially if people are rolling out a strategic plan, they would make sure that the template they're using for PowerPoints internally would have a slide or two dedicated to the strategic plan. And they would start their meetings with that to say, as a reminder, our four areas of focus is here, this, our KPIs are that this is what we're rarely measured on and then kind of start the meeting. So it's little less aspirational, per se, and more just constant repetition of here is what we're focused on. Anything you're recommending that you do this year, that doesn't align to those four things, I would really ask you to reconsider them and make sure they align there's a bright line. So that's a small thing that I've seen be successful. But to your point, it really depends on the organizational culture.
Teresa Paterson 26:44
And I just thought of this as you were talking, you know, starting off meetings with a couple of thank yous, you know, hey, you know, Jane, you really did a great job on XYZ, I just want to thank you for that. So you know, a little bit of gratitude first, and then kick off the meeting?
Jonathan Morgan 27:02
Yeah, I think, you know, we're obviously talking about making customers an organizational priority, it's not to say that it's not a priority for any individual in the organization, I think healthcare is a certainly a unique one. But in most organizations, and in most consumer facing industries, right, the people that are the frontline workers, the nurses, the bank tellers, the the retail workers, they're the ones that are interacting with customers. So that's what they're constantly thinking about. But then typically, as you go further up and up and up that organization, you then lose that because they aren't exposed to it, they aren't thinking about it, their goals are different, their daily job is different. So, you know, outside of just making it an organizational priority, how do you focus on each level of that organization to make sure that they don't forget, at the end of the day, what's ultimately driving that success?
Teresa Paterson 27:50
I think touch bases are very important. So you know, and as you get up and up in a, in a structure, you're, you your touch bases are going to be still higher level. So I think it's important to if you're not having regular touch bases, with those frontline workers, no matter what level you're at, you got to do that once in a while, so you can understand what they're experiencing at their level. If you if you miss that completely, you're you're missing a piece, right? Because you can't really, you know, part of growth and business development is you want to keep your team performing at their highest level, because that's what's gonna bring more business in, in addition to obviously, you know, your sales side, but in order to keep them working at their highest level, you have to understand what challenges they're facing what's, what's working, what's not. So those touch bases are extremely important. And
Joe Krause 28:53
we all know the brands that we really come to mind when we think about great customer service, and then also bad customer service, we know what they look like. And it usually is to Jonathan's point, the frontline employee, really embodying the values of you, you know, different politics, society, you go to Chick fil A very consistent experience, Apple, Apple Stores, things like that. And we realize there's a certain kind of personification of the values of the organization that permeates all the way down to groups that have a lot of turnover. I mean, there's a ton of turnover in the food industry and retail, but no matter who they bring in, they somehow still have a consistent experience. It just shows that it can be done. But it's also not an easy thing. So it's it's not something you can just roll out once and go on from there. This idea of ideation versus realization, hey, we need ideation and we need to have a better customer facing culture. And we're going to do all this training realization as if they didn't actually do anything there are people like us better or is our brand better? I mean, up here in the northeast, we have a very heated cable company that all they keep doing is keep changing their name. They just keep it no matter what they do. Like oh that Optimum is the worst, we're gonna another called spectrum. So they like, get rid of all their baggage. So that's the other extreme example, where you have such bad customer service, you're forced to change your name and leave town. So we don't want that. But ultimately, if the time invested and the time that you're spending on it, is well, well worth it, because the results speak for themselves, those brands are, are the best for a reason. Yep.
Jonathan Morgan 30:24
Well, perfect, Teresa. Well, certainly we've had a blast chatting today. Before we close out, we have one final question that we ask all of our guests. And you think about everything you've learned in your career and go back to 20 years ago, however long ago when you were just starting your career in strategy and transformation and healthcare, and give yourself one piece of advice. What would that advice be?
Teresa Paterson 30:47
Oh, I mean, I wish I would have gotten my degree in business. But I wish I wish it would have done that instead of psychology, but I didn't know where my path was going to lead. So that's the first thing that comes to mind. Because every time I talk to, you know, college kids or potential, I'm like, get your degree in business. If you don't, if you don't know that you're going to be a lawyer. This is not about get it in business. But other than that, because that's, you know, I can't change that. It's really you have to you have to let your career play out the way it's supposed to, because there is while you think you have complete control, opportunities arise, and industries change and evolve. And as long as you're open minded to all of that, you're going to you know, you could have an amazing resume.
Jonathan Morgan 31:50
Yeah, as a civil engineer who has never done a day in his life, I completely agree with what you're saying. By study, I should say by study. It was the same thing. And great advice and even better advice to not try to control your own destiny too much. So, Teresa, we loved having you on the show and appreciate all your insights.
Teresa Paterson 32:09
Thank you so much for having me. I really enjoyed it. Thank you.