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How do you prioritize in a world that demands more, more and even more from you? Recently Deloitte published a report “Six alignment strategies health systems can consider“.  It is a nice example of demanding more instead of less. The report describes six alignment strategies healthcare systems can use to ensure consolidations of medical practices result in the outcomes eyed. However, how to implement such recommendations when your plate is already full? Just piling up more work is not an option. You will have to prioritize, but how?

Overarching objectives

If you are interested in reading the six alignment strategies health systems can use to achieve these objectives, I certainly recommend reading the Deloitte report: “Six alignment strategies health systems can consider“. For a quick overview of the recommended strategies in the report, see below.


Courtesy of Deloitte

The report also mentions the main trends driving consolidation, which are:

  • Increasing challenges to stay compliant with ever changing healthcare rules and regulations
  • Reducing the ever increasing administrative burden
  • Switching to value-based care – as prescribed by MACRA
  • Taking advantage of new technologies that provide efficiency of scale

So the recommendations are certainly useful. How to implement them, that is the problem.

Undue burden on physicians

In the end, it are the physicians who have to make it happen in their practices. Thus, while the above checklist and associated objectives are laudable, the Deloitte report fails to address the main challenge of such mergers: 

The undue burden it puts on physicians.

The physicians in the health system have to somehow deliver better care, increase access, and lower costs, while staying complaint, dealing with the ever-increasing administrative burdens, switching care models, while taking advantage of efficiency of scale from using new technologies.

What no consolidation effort can change is that a day has only 24 hours and a workday about 8 hours.

So unless there is something that no longer has to be done, it will be impossible to execute on all the objectives indicated by the checklist.  

Prioritize, one project at a time

To achieve any of the objectives outlined as objectives of consolidation efforts, it would be extremely helpful if the goals and strategies would not be stated as more, more, and even more. I therefore suggest to also described what to focus on this first. Once that has been implement, then, move on to the next objective.

Focus on one thing, do it well, before moving to the next project and objective.

Without clearly prioritizing, it will be impossible to achieve anything. A golden rule should be that you can only work on one project at a time.  That is, focus on one project until that project has ended or reached a natural pause – such as accomplishing a milestone. 

For most healthcare providers, especially in academic hospitals, it is not uncommon for clinicians to be engaged in 5- 20 “projects” that all come on top of their daily duties. These projects can range from minor change- and quality initiatives, to major improvement- and research projects. As a result, all projects are delayed and little gets accomplished in any given period. 

How to prioritize?

Why is prioritization so challenging in healthcare?


In order to prioritize top down, you need to have the authority to do so. In most health systems, management does not have the authority to tell a physician what to do or what not to do, and for good reasons. The autonomy physicians have, applies to the decisions they make when taking care of a patient and to the decisions they make whether or not to actively engage in a research, improvement or innovation project.

Most of the latter activities take place in their personal time anyway – at least in my experience – time over which management has little to say.

And  I am not even considering the impact forced participation or rejection have on moral, motivation and job satisfaction.

However, that does not mean that these projects cannot be prioritized. It just means that physicians have to be part of the decision-making and prioritizing process.

Misaligned metrics for project selection

Another problem with prioritization is that most project selection models focus on the what and how much. That is, they compare:

  • What a project entails
  • How much it will cost to execute
  • What the expected return is

There are two problems with a selection model that uses such criteria.

First, the criteria are based on predictions of the future.

First, all of the criteria above are based on predictions of the future. Often, during the execution of a project, the scope changes. That is part of life. When estimating costs, we always underestimate. The actual budget needed is always higher. In addition, in general, we overestimate returns. That is, in reality, the expected return is always lower. As long as this is consistent over all projects, these biases should not a problem. What is a problem, however, is that none of the criteria are fact-based. They are elusive.

Second, the wrong criteria are used to predict performance of innovation and improvement projects

Second, the performance of innovation and improvement projects in healthcare (and any other professional service organization for that matter) is not predicted by any of the criteria above.  A project that is cheaper to execute or a project with a higher expected return on investment says nothing about the likelihood that the project will succeed.

The best performance predictors are related to the who and how of the execution of innovation projects. That is, is there a team capable and dedicated to the execution of the project and is this team capable of iterating their way to awesome. Is the team learning and becoming better over time, while searching for and implementing the optimal solution?

Until the criteria for prioritization are aligned with the predictors of performance and agreed upon by the involved clinicians, achieving objectives of better care, increased access, and at lower cost remain illusive, also for a consolidated healthcare system.

So prioritize based on team dedication and team learning, and then implement the recommendations above one by one.

Now, go out there and change the world for your clients / patients, organization, and profession!




P.S. For more information on how our training sequence facilitates project selection and provides metrics on team dedication and learning, see here.

P.P.S. Interested in learning more? Join the discussion online and sign up for the Innovators in the Professional Services LinkedIn group.