When it comes to change management, there are numerous theories on how to execute it. Many of those, however, fall flat for one main reason: the disconnect that inevitably exists between the those implementing the change and those being asked to absorb it. It’s a gap that can only be bridged, according to Jason Joseph, Chief Digital and Information Officer, Corewell Health, through shared accountability.
In order to make that happen, “You have to be willing, you have to have the right cultural foundation, and you have to have people engaged.” In a recent interview with Kate Gamble, Managing Editor at healthsystemCIO, Joseph spoke about how he is working to build that culture at Corewell, which was born out of the merger of Spectrum Health and Beaumont Health.
He also discussed why he believes technology is only a small part of the equation when it comes to initiatives like ERP, Corewell’s decision to rebrand IT and IS as ‘digital services,’ his concerns about the long-term impact of remote work models, and the advice he would offer to his younger self.
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- The objective of the merger that created Corewell Health wasn’t just about expanding coverage, but also “providing more value for customers” throughout the region.
- The key to success with any merger? “Be very clear about your goals and your strategy.” In Corewell’s case, it was to “unify our systems, unity our operations, and become a standardized organization.”
- On driving change: “It’s daunting sometimes to think of the amount of work and the amount of change that we needed to go through as an organization to get there. But it’s the right type of change. It’s change that’s moving us forward.”
- Another critical aspect of change management is accountability, which can’t fall solely on project management. “The people closest to the work know the impact, and you need to make sure that those voices are there.”
Q&A with Jason Joseph, Corewell Health, Part 1
Gamble: Hi Jason, can you start by giving a brief overview of CoreWell Health?
Joseph: Sure. CoreWell Health, formerly known as BHSH System, was formed from Spectrum Health and Beaumont Health in Michigan coming together. CoreWell Health is our new name. We are a combined system with 22 hospitals, a little over 5,000 licensed beds, and about 64,000 employees. We’re a $14 billion enterprise, and that includes the main hospital system, the post-acute, full continuum of care, as well as our health plan Priority Health, which serves the entire state of Michigan. It has about 1.2 million members; it’s the second largest health plan in the state.
Gamble: We’re seeing a lot of M&A movement. In Corewell Health’s case, what was the key driver? What is the organization hoping to accomplish?
Joseph: In the healthcare landscape right now there’s a lot of focus on being able to scale practices as well as innovations. If you think about the landscape that we have as an integrated healthcare system, it has both care and coverage. We have a lot of coverage growth that was starting to spread into other geographies where we really didn’t have a lot of presence. You can do a lot more when you can integrate that care and coverage umbrella.
That was a huge driver for us: being able to balance and expand our ability. But overall, we believe that by creating best practices that are of the highest quality, looking at common care pathways, and integrating our technology foundations, we can provide exceptional care and coverage at an affordable cost because we can do things at scale, which we can also innovate on as well. That’s the value proposition for us — to take that entire package and be able to continue to scale it and move it forward across the entire state.
Gamble: It’s something that seems so basic, but as organizations start to increase their coverage, there’s a need for more resources.
Joseph: Yes. The game isn’t just about traditional coverage now, it’s about moving toward value and finding ways to provide more value to our customers. One of the main ways that we can do that is by offering unique products and services that integrate care and coverage. In order to do that, you have to have the assets to do it, as well as the coverage. We’re really excited about this combination. It’s going to be great for our communities and for our state.
Gamble: Anytime there’s a major change, there are going to be some rocky points. I want to get your thoughts on the keys to leading through something as big as this.
Joseph: There are a few things. We’ve done M&A work with the legacy Spectrum Health organization and the legacy Beaumont organization, and I think the lessons that those organizations collectively brought really informed this one as well.
Principles of M&A
A few principles stand out. One, be very clear about your goals and your strategy. We do have a goal and a strategy to unify our systems, unify our operations, and become a standardized organization.
You can look at this in two ways. There’s the holding company model, which is, we’re under one flag but it’s completely different operations. And there’s another, which is, we’re going to take a best practice and be able to scale that repeatedly. That’s the game we want to be in. That brings with it a host of other requirements as to what you do with your technology and your systems and the level to which you’re going to integrate. We have a pretty aggressive plan to integrate and standardize across our strategic platforms.
“We had a pretty aggressive plan”
The second is speed. These things take so much organizational focus regardless of whether you give them a 3 years or 5 years. We don’t want to be in this focused area for the next decade. We want to get through it. And so, we had a pretty aggressive plan to say, ‘this is what we’re going to do. This is how we’re going to do it and we’re going to do it well. But we’re doing it quite fast so that we can get beyond that and start getting to the benefits.
There’s a big upfront investment, obviously, in the technology, the people, and the effort required to do this. There’s also a lot of value on the backend once you start to say, ‘we’re standardizing. We’re rationalizing applications. We’re simplifying our processes. We’re integrating across the continuum.’
And as those things come into value, you want to get there as quickly as you can. The organization only has so much attention span you can devote to these things. And if you drag them out for too long, it feels like a perpetual thing. And so, we wanted to get in there, be really focused and go quickly while still making sure we’re doing it well.
Aligning with leadership
Gamble: When you set a goal to standardize across the platforms, I imagine that has to be introduced pretty early.
Joseph: It goes. On day 1, we were planning how we thought we would go about this and aligning with our leadership team and with our board to gain a shared understanding of what we want to be, what are our goals, how we want to go after integration, what level of quality standard we want to see, and how we were going to take the best practices of care pathways across our entire system and make those the standard.
“Pockets of excellence”
When you think about that, you see that there are pockets of excellence all over the place. It’s not like one organization has all the good stuff and one organization doesn’t. You have to bring that together. And what you’ll see across the healthcare industry most often are organizations that don’t have that common foundation to build on. You can’t scale those ideas because implementing the way you do it in one organization won’t necessarily work in another. It’s the old adage, if you’ve seen one healthcare organization, you’ve seen one healthcare organization. And that doesn’t work to scale practices or processes or data collection or analytics, because if it worked here, you have to retrofit that somewhere else, which is what a lot of people are dealing with today.
Variation and chaos
For us to make this work — and for M&A in general to work — you have to have that common foundation, almost like a franchise model where you say, these are the standards. Not to say everything is exactly the same, but the core business or the core clinical systems or functions all work this way. When we find a better way, we’re going to do all those together and we can make that change together versus having that variation. Anybody who studies this knows variation is the killer to efficiency because if you have too much variation, you wind up with a level of chaos.
That’s hard, because healthcare is ripe with lots of independently minded folks who might say, ‘I have this figured out.’ Getting those shared, agreed upon, and moved forward with the technology to support the process change is really the game.
The “broken squares” game
Gamble: It’s interesting because you have to be able to see the big picture, but you have to see the little pictures as well, if that makes sense. I’m sure that can be challenging in the beginning.
Joseph: Absolutely. We have an analogy. We call it the broken squares game. Sometimes you can see your piece of the puzzle, but you don’t necessarily see the big picture. As a leader, it’s about helping our entire team, all 64,000 people, start to see they’re a part of the game, but also to be able to see the big picture. Once you take on that perspective, it’s a little bit easier to think about where we’re headed and how we’re going there together.
It’s a very exciting thing to do, but it’s also a bit daunting sometimes to think of the amount of work and the amount of change that we needed to go through as an organization to get there. But it’s for the right reasons and it’s the right type of change. It’s change that’s moving us forward in a positive direction. We’re going to harness that energy as much as we can and get to that new destination as quickly as we can.
Digital Services (IT and IS organizations rebranded)
Gamble: I’m guessing part of that is having a good leadership team that’s bought in to the message and can translate it to their teams in a good way.
Joseph: Absolutely. We actually rebranded our integrated IT and IS organizations as our digital services group. Because if you think about the work we’re doing, it’s not just information technology, it’s the full suite of digital transformation that we’re really about.
“Rethinking the operational platform”
This transformation we’re going through for integration — people see it through that lens. They see the technology involved, but it’s really not about the technology; it’s about rethinking your operational platform in terms of how you do your work and being able to think about that in a common way across your organization. The technology then becomes the enabler to hard wire that into practice. You can’t do one without the other, and you certainly can’t lead this from the technology perspective.
There are certain things that we do with technology. We’re putting in Microsoft 365 across the board. Those types of things are mostly about technology, but we you’re talking about ERP systems and clinical and revenue cycle systems — those are 100 percent about how we do work. That’s our core operation; it’s the work we have to focus on. We put our operational leaders out in front of that. They’re the ones doing the messaging. They’re the ones talking about change management; talking about how we’re going to adapt to the things that are coming our way.
It’s hard to get everybody on that same page. I’d be lying if I said we’re there. We’re 10 months into this. But I have a lot of confidence that we have the right people and the right mindsets that are forming, and there’s a lot of positive intent from team members.
Sometimes you get these integrations of people coming together and there’s a lot of noise — you’re going to have that naturally. But we also see so many people that are committed to the long-term vision, which is really inspiring to see.
Gamble: Is it important to make sure that vision is shared, but to also give people the latitude they need when communicating the message? How do you approach that?
Joseph: We have a pretty robust structure around the programs that are doing the change management work. Those teams have representation from all sorts of different areas, and so a lot of our messaging actually doesn’t necessarily just come from me or traditional department hierarchies; they’re driven cross-functionally.
I may be out there talking about the digital transformation side, but I need our division presidents and our clinical leaders and service line vice presidents and physicians out there also talking to their peers and their groups about what it means to them. Our structure really is based around that.
Change management & accountability
We have a tool that I think is one of the greatest tools of change management. We call it a change radar. People often think of change management as the way you message and inform. And that is part of it. But the change radar says, here are all the things that are changing, down to the last mile; at the management and the staff level, what do you need to change in your workflow to accommodate this? It shifts the accountability from, ‘Why didn’t the project team think about my unique circumstance,’ which is impossible in an organization of this size, to, ‘This is what’s changing. You need to figure out how you’re going to adapt. And if there’s something that is absolutely not going to work, you need to raise your hand now.’
The idea of accountability is really important when you’re doing an integration of this scale, because if you think that there’s going to be one team that gets it all figured out, you’re wrong. You’re changing so much. The people closest to the work know the impact, and you need to make sure that those voices are there. But the accountability is there as well so that people can’t just say, ‘That’s not going to work, change it.’ Instead, you have to say, ‘the way that’s designed is going to cause a problem. We can adapt this way, but we really need this to be accounted for.’ It’s a conversation that needs to happen. You get that conflict in trying to solve the problem versus the conflict that’s just about resisting the change. That’s healthy.
Those are the kinds of things that you really need to look for, because there’s no way everything is going to go well. The question is, are people just closing their eyes and blindly saying, ‘this is going to be terrible,’ or are they leaning in and asking how we can make it better?
Because the difference between success and lack of success, quite frankly, is less about whether the project team got everything right. Things are going to happen. It’s really about whether the people on the ground are going to take ownership of their area and make the change work. That has to do with their attitude and their commitment. That can’t come from talking heads at the central office. It has to come from their leader and their teams working all of that out and getting that program together. That, I think, is the secret sauce as to whether these things go well.
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