Report: Cultivating Operational Excellence: Strategic Leadership and Culture in Digital Health

INTRODUCTION

As digital health continues to evolve, operational excellence is crucial for healthcare organizations to thrive and deliver high-quality patient care. Healthcare CIOs and strategic leaders face many challenges in driving digital transformation, but they also have many opportunities to innovate and improve patient outcomes.

This report, which is sponsored by Rubrik, will explore the critical aspects of operational excellence in digital health, focusing on strategic leadership, organizational culture, and key areas such as cybersecurity, AI implementation, and IT service delivery.

Operational excellence is the cornerstone of sustainable digital transformation. Understanding its principles sets the stage for implementing strategies discussed later in this report.

DEFINING OPERATIONAL EXCELLENCE IN DIGITAL HEALTH

Operational excellence in digital health goes beyond mere technological implementation; it’s about aligning the right technologies and processes to achieve optimal outcomes for patients and providers.

In the CHIME Fall Forum 2024 session on “Flight Simulation: Pragmatic Piloting of Health Care Innovations,” Jordan Firfer, JD, Vice President, CPT Product Management at the American Medical Association (AMA) challenged healthcare leaders to find inspiration in the operational successes of other industries. “The same tools, the same strategies, the same checklists, the same approaches apply, whether you’re talking about an Amazon, whether you’re talking about a Google, talking about Netflix, or you’re talking about a health system or a health plan or any of the vendors that serve them.”

Regardless of the industry, operational excellence is a multifaceted concept that encompasses:

• Efficiency - Streamlining workflows, optimizing resource allocation, and automating tasks.
• Effectiveness - Achieving desired outcomes, improving patient care, and meeting organizational goals.
• Adaptability - Responding to change, embracing innovation, and continuously improving processes.

FRAMEWORKS AND STRATEGIES FOR OPERATIONAL EXCELLENCE

To foster operational excellence in digital health, healthcare organizations can utilize a variety of practical frameworks. These tools enable leaders to strategically align innovations with organizational goals.

Opportunity Corridor: A visual tool that helps healthcare organizations identify and assess potential areas for innovation and growth. It maps out current capabilities and assets, as well as potential new products, services, and markets. It can identify areas where the organization has a “right to win” and can achieve a competitive advantage.

“The opportunity corridor is not intended to say what you will do, it’s intended to say what you could do,” Firfer explained.

Lean Canvas: A one-page business plan template that helps startups and existing companies assess the viability of a new product or service. It focuses on key assumptions, risks, and value propositions. It helps teams make informed decisions about whether to pursue a new product or service, and how to adapt their approach based on market feedback.

Firfer erased some of the gap between startups and existing companies, asserting, “If you are bringing in new technologies and new services, and you’re getting into the LLM/AI space, etc., in one way shape or form you’re thinking like a startup.”

Growth Canvas: A strategic planning tool that helps organizations map out their path to sustainable growth. It focuses on key factors such as customer segments, value propositions, channels, and revenue streams. It identifies opportunities for improvement and expansion, and track progress towards growth targets.

“A growth canvas is for organizations that are looking to transform,” Firfer noted. “They don’t just want to select one or two new things to do, new technologies to bring into their ecosystem.”

Platform Strategy: A business model that creates value by facilitating interactions between different groups, such as consumers and producers. In healthcare, platform strategies can connect patients, providers, payers, and other stakeholders. It can foster innovation, improve efficiency, and create new revenue streams.

Beachhead Strategy: A market entry strategy that focuses on gaining a strong foothold in a specific niche market before expanding to other segments. In healthcare, this could involve targeting a specific patient population or geographic area. It reduces risk and provides valuable insights for future expansion efforts.

Leaner, More Agile Approaches

In addition to the strategies detailed above, healthcare leaders in pursuit of excellence can explore other relevant frameworks, such as Lean methodologies and Agile principles, to streamline workflows, optimize resource allocation, and drive continuous improvement in their pursuit of operational efficiency.

Agile principles are a set of guiding values and concepts that promote iterative development, continuous feedback, and close collaboration between teams and stakeholders. They emphasize flexibility, adaptability, and customer satisfaction in project management and software development.

Lean methodologies focus on maximizing value while minimizing waste. Here are a few examples readers could explore:

Kanban: A visual system for managing work as it moves through a process. It emphasizes visualizing workflow, limiting work in progress, and continuous improvement.

Scrum: A framework for developing and sustaining complex products through iterative and incremental processes. It involves short cycles of work called “sprints” and daily meetings to track progress.

Lean Startup: A methodology for developing and launching businesses and products quickly and efficiently by focusing on validated learning and iterative experimentation.

Value Stream Mapping: A lean tool used to visualize all the steps involved in a process, identify areas of waste, and streamline the flow of value to the customer.

Kaizen: A Japanese philosophy that focuses on continuous improvement by making small, incremental changes over time.

By understanding and applying these Agile principles and Lean methodologies, healthcare leaders can foster a culture of operational excellence, driving innovation and efficiency in their digital health initiatives.

THE ROLE OF STRATEGIC LEADERSHIP AND CULTURE

Strategic leadership is the linchpin of operational excellence in digital health. Leaders must not only possess a clear vision but also the ability to align organizational goals with digital transformation initiatives. This sentiment is echoed in the Fall Forum session “IT as a Member of the Care Team,” which emphasized that IT needs to be a part of the care team and part of the C-suite — it is important for the CIO to be at the table when decisions are being made.

Effective leaders foster a culture of innovation and collaboration where IT and clinical teams work together seamlessly to improve patient care and outcomes. They must possess a deep understanding of both the healthcare industry and the technical capabilities of IT, allowing them to navigate the challenges and opportunities of digital transformation effectively. As highlighted in the “Getting Generative AI Right: A Support Group for the Confused Executive” session, the CIO needs to be a visionary leader who can articulate the benefits of AI and guide the organization through the process of adoption.

Furthermore, strategic leaders must be adept communicators, ensuring that the vision and goals of the organization are understood by all stakeholders, including clinicians, patients, board members, and staff. The ability to build consensus and collaboration across different departments and disciplines is crucial, especially in initiatives involving AI implementation.

Building a Culture of Innovation, Collaboration, and Accountability

A robust organizational culture is the bedrock upon which successful digital transformation is built. This culture should be characterized by trust, psychological safety, and shared values, enabling open communication and collaboration. Employees need to feel empowered to take risks, experiment, and innovate without the fear of retribution.

To foster such a culture, leaders should:

• Lead by example: Modeling the desired behaviors and attitudes sets the tone for the entire organization.
• Communicate effectively: Ensure that the vision, goals, and values of the organization are clearly and consistently communicated to all employees.
• Facilitate collaboration: Create opportunities for employees to collaborate, share knowledge, and learn from each other.
• Encourage feedback: Promote a culture of open feedback, where employees feel comfortable sharing their ideas and concerns.
• Empower employees: Provide employees with the autonomy and resources they need to make decisions and take ownership of their work.
• Promote continuous learning: Encourage and support employees in their pursuit of continuous learning and development.

KEY PILLARS OF OPERATIONAL EXCELLENCE IN DIGITAL HEALTH

Cybersecurity

Challenges and Opportunities: The increasing use of technology in healthcare creates opportunities for innovation and improved patient care, but it also increases organizations’ vulnerability to cyberattacks. Healthcare organizations must keep up with evolving threats, such as ransomware and phishing attacks, while managing limited resources and ensuring compliance with regulations.

Contribution to Operational Excellence: Robust cybersecurity protects patient safety, maintains the trust of patients and stakeholders, and ensures business continuity in the event of a cyberattack. It enables healthcare organizations to focus on their core mission of providing high-quality care without disruption.

Relevant Frameworks: The National Institute of Standards and Technology (NIST) Cybersecurity Framework provides a comprehensive set of standards, guidelines, and best practices to manage cybersecurity risks. Other relevant frameworks include the Health Insurance Portability and Accountability Act (HIPAA) Security Rule and the International Organization for Standardization (ISO) 27001 standard for information security management systems.

Crisis Response and Recovery

Challenges and Opportunities: Healthcare organizations face the constant threat of cyberattacks and other crises that can disrupt operations, compromise patient safety, and damage reputation. However, effective crisis response and recovery planning presents opportunities to minimize downtime, maintain continuity of care, and enhance organizational resilience.

Contribution to Operational Excellence: Robust crisis response and recovery capabilities are essential for maintaining operational stability and safeguarding patient care. By establishing clear decision-making processes, business continuity plans, and comprehensive recovery strategies, healthcare organizations can navigate crises effectively and emerge stronger.

Relevant Frameworks:

• Business Continuity Planning - Develop comprehensive business continuity plans that address potential disruptions, including cyberattacks, natural disasters, and pandemics. Regularly test and update these plans to ensure their effectiveness.
• Incident Response - Establish clear incident response protocols that outline roles, responsibilities, and communication channels for efficient and timely crisis management.
• Decision-Making Frameworks - Implement decision-making frameworks, such as the “cure and consequences” approach used by Ardent Health Services, to streamline decision-making during critical incidents.

AI Implementation

Challenges and Opportunities: AI implementation in healthcare presents challenges such as ensuring data quality, managing ethical considerations, and integrating AI solutions with existing systems. However, it also offers opportunities to improve patient outcomes, reduce costs, and enhance operational efficiency.

Contribution to Operational Excellence: AI can automate tasks, improve the accuracy of diagnoses, personalize patient care, and optimize resource allocation. It enables healthcare organizations to deliver more efficient, effective, and patient-centered care.

Relevant Frameworks: While there isn’t one specific framework for AI implementation in healthcare, organizations often refer to guidelines and best practices from organizations such as the World Health Organization (WHO) and the Organization for Economic Co-operation and Development (OECD). These guidelines address ethical considerations, data privacy, and responsible AI development.

IT Service Delivery

Challenges and Opportunities: Healthcare organizations face challenges in delivering reliable and efficient IT services due to factors such as complex systems, limited resources, and the need to support a 24/7 clinical environment. However, effective IT service delivery creates opportunities to improve clinician satisfaction, enhance patient care, and support innovation.

Contribution to Operational Excellence: Reliable IT service delivery ensures that clinicians have uninterrupted access to the tools and systems they need to provide high-quality care. It minimizes downtime, improves productivity, and supports the seamless integration of technology into clinical workflows.

Relevant Frameworks: The Information Technology Infrastructure Library (ITIL) framework provides a comprehensive set of best practices for IT service management, focusing on aligning IT services with business needs. Other relevant frameworks include the Control Objectives for Information and Related Technologies (COBIT) framework for IT governance and management, and the FitSM standard for lightweight IT service management.

Data Governance

Challenges and Opportunities: Healthcare organizations manage vast amounts of sensitive patient data, creating challenges in ensuring data quality, protecting patient privacy, and complying with regulations. However, effective data governance creates opportunities to improve decision-making, support research, and enable the use of data for innovation and quality improvement.

Contribution to Operational Excellence: Data governance ensures that data is accurate, reliable, and accessible for AI implementation, analytics, and clinical decision-making. It enables healthcare organizations to leverage data as a strategic asset to improve patient care and achieve operational efficiency.

Relevant Frameworks: The AHIMA Information Governance Principles for Healthcare provides a

comprehensive framework for managing information as a strategic asset. Other relevant frameworks include the National Committee on Vital and Health Statistics (NCVHS) data governance principles and the European Union’s General Data Protection Regulation (GDPR) for data privacy.

Cloud Strategy

Challenges and Opportunities: Cloud adoption in healthcare presents challenges such as ensuring data security and privacy, managing compliance with regulations, and integrating cloud services with existing systems. However, it also offers opportunities to improve scalability, reduce IT costs, and enhance agility.

Contribution to Operational Excellence: Cloud computing enables healthcare organizations to access innovative technologies, scale their IT infrastructure as needed, and improve the accessibility of data and applications. It supports operational efficiency, agility, and the development of new digital health services.

Relevant Frameworks: The Cloud Security Alliance (CSA) Security Guidance for Critical Areas of Focus in Cloud Computing provides a comprehensive set of security best practices for cloud environments. Other relevant frameworks include the NIST Cloud Computing Security Reference Architecture and the FedRAMP authorization process for cloud services used by the U.S. federal government.

Patient Experience

Challenges and Opportunities: Healthcare organizations face challenges in delivering a positive patient experience due to factors such as complex processes, long wait times, and limited resources. However, prioritizing patient experience creates opportunities to improve patient satisfaction, loyalty, and outcomes.

Contribution to Operational Excellence: A positive patient experience is essential for patient

engagement, adherence to treatment plans, and overall satisfaction with care. It contributes to

operational excellence by aligning technology and processes with patient needs and preferences,

improving efficiency, and supporting better patient outcomes.

Relevant Frameworks: The Beryl Institute’s Experience Framework provides a comprehensive model for understanding and improving patient experience. Other relevant frameworks include the Planetree Person-Centered Care Certification Program and the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey for measuring patient experience.

MEASURING AND MONITORING SUCCESS

In the realm of digital health, the pursuit of operational excellence demands a keen understanding of how to measure and monitor success. It is not enough to simply implement new technologies and hope for the best; leaders must establish clear metrics and key performance indicators (KPIs) to track progress, demonstrate return on investment (ROI), and ensure accountability.

“Innovation is only innovation if it produces data and usable information for decision-making. And as leaders, we have to be accountable,” said Gretchen Jakway, Director Delivery Partner Executive - Clinical Experience Leader at Kyndryl.

This emphasis on measurement underscores a critical aspect of leadership excellence: the ability to make data-driven decisions and course correct as needed. By continuously monitoring progress, leaders can identify areas for improvement, optimize resource allocation, and ensure that digital health initiatives are delivering the desired outcomes.

In the “Getting Generative AI Right” session, Baptist Health showcased concrete metrics like reduced service desk call volume and time saved for nurses through AI-powered solutions.

To effectively measure success, leaders can leverage various frameworks and reporting tools:

Frameworks: Balanced Scorecard, Digital Health Measurement Framework (DHMF), and Logic Models help provide a structured approach to evaluating performance across various perspectives, including financial, customer, internal processes, and learning & growth.

Reporting Tools: Dashboards, data visualization tools, and outcome tracking systems enable leaders to monitor progress, gain insights from complex data, and track patient outcomes.

Cybersecurity and other incidents triggering significant downtimes are times when leaders can measure not only their ability to guide teams through stressful times but also the effectiveness of recovery plans and preparations.

In the session on “Cyberattack Recovery: The Good, the Bad, and the Hardening,” Anika Gardenhire, Chief Digital and Information Officer of Ardent Health Services, detailed how her team’s recovery strategies and dedication to restoration brought Epic back online in record time.

“From the time we got our first message [about the downtime] to the time we had clinicians back

documenting in Epic was 12 days,” she said. “This is unheard of.”

This was a significant measure of success because it demonstrated Ardent’s ability to restore critical clinical and financial systems in a short amount of time, allowing them to get back to providing patient care while minimizing further disruption to their operations. Clear decision-making processes and the ability to adapt to unexpected challenges played a crucial role in their successful recovery. The success was a testament to the collaboration between IT teams, operational leaders, and other key stakeholders.

By embracing a culture of measurement and data-driven decision-making, healthcare leaders can demonstrate the value of their digital health initiatives, drive continuous improvement, and ultimately enhance the quality of patient care.

CONCLUSION

Operational excellence is not merely an aspiration but a necessity for healthcare organizations to thrive and deliver exceptional patient care. This report has explored the multifaceted nature of operational excellence, emphasizing the critical role of strategic leadership, a collaborative culture, and a focus on key pillars such as cybersecurity, AI implementation, and IT service delivery.

Key Takeaways:

Operational excellence is crucial for success in digital health, encompassing efficiency, effectiveness, and adaptability.

Strategic leadership and a collaborative culture are essential for driving digital transformation and achieving operational goals.

Key pillars such as cybersecurity, AI implementation, IT service delivery, data governance, cloud strategy, and patient experience are foundational to operational excellence in digital health.

Measuring and monitoring progress through clear metrics and KPIs is vital for accountability, demonstrating ROI, and ensuring continuous improvement.

Call to Action:

Assess your organization’s current state of operational excellence in digital health.

Identify areas for improvement and develop a roadmap for implementing the frameworks and strategies discussed in this report.

Foster a culture of innovation, collaboration, and accountability to drive digital transformation and achieve operational goals.

Continuously learn and adapt to the evolving digital health landscape to ensure the delivery of high-quality, patient-centered care.

Develop continuity plans with clear decision-making processes for cyber incident response, including clear decision-making responsibilities.