One of my more vivid memories from my days in healthcare leadership were the painful and adversarial struggles over productivity that seemed to constantly escalate over the past several years.
Payers expected productivity and they set their reimbursement rates accordingly. Industry standards for productivity were cited at every professional meeting I attended though no one seemed able or willing to talk intelligently about the multiple factors and assumptions that went into the mythical and extravagant productivity rates that were promoted. As a nonprofit organization serving a high risk and low income population, we were required to meet an excessive level of clinical documentation while providing services that, while clinically effective, stretched the definition of medically necessary and appropriateness so that many of the most effective services often could not count toward productivity. Meanwhile, the client population experienced a high level of economic and psycho-social stresses that frequently created chaotic family environments which in turn made their attendance at treatment appointments much less reliable.
Al of these factors combined to make it very challenging for clinicians to achieve the mythical industry standards of productivity while the steadily decreasing reimbursement rates made it an economic necessity to do so. “No margin, no mission” was a slogan that characterized the ongoing challenge and “productivity” became the battleground between those focused on the financial realities and those dealing with the realities of traumatized and often marginally functioning people with immense needs that did not fit neatly into a financial analysis of productivity.
One of my greatest disappointments was my inability to contribute more to a productive organizational conversation about productivity. The demands seemed to push everyone into a defensive posture in what seemed like a zero sum game of balancing mission and margin. As I have gained a little more perspective since leaving this organization and I have had the opportunity to observe other healthcare organizations, I have come to appreciate that this dilemma really is systemic and that it seems to be ubiquitous in healthcare. What a tragedy that it was so often seen as a personal/professional issue and that committed, well-meaning professionals are turned against one another in the battle over productivity expectations.
Clinical services have come to be seen as commodities to be managed like any other input in an industrial process. As the costs of healthcare continue to escalate, everyone is looking for someone to blame and the quality of relationships and the work environment deteriorate. How ironic that the health of providers in a healthcare system has been forgotten in the drive for productivity (a very, very industrial concept that is inappropriate for thinking about the health of human beings).
With this as the backdrop, I have found the following series of articles to be very interesting. They are written by Fred Kofman, the President and CEO of Axialent, a large coaching and consulting company working largely in the private sector. Fred is a master at communicating ontological principles in common language and making these concepts relevant to real-life business challenges. So, I found it very interesting that his most recent series of articles focuses on productivity killers – those infamous “PKs” – and that he has been able to look beyond the surface issues and to identify universal productivity killers that are related to human interactions and are not specific to any line of work.
If an organization were truly committed to eliminating these PKs, how much energy could this free up? How much wasted finger pointing, blaming and defensiveness could be avoided and what else might be possible if that energy were available for collaborative problem solving? From my perspective, this is a fundamental challenge in transforming healthcare. Healthy care needs to begin from with healthy relationships and healthy conversations.
Following are links to Fred Kofman’s articles about PKs (a free registration with Axialent may be required to access the full articles but it will also provide access to a wealth of valuable resources):
PK1: Productivity Killers: Introduction
PK 2: Ethical Myopia
PK3: The Victim Virus
PK4: Ontological Arrogance
PK5: Narcissistic Negotiation
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