Beyond Hierarchies: A New Paradigm for Healthcare Technology Teams
In the healthcare sector, various technical leadership and governance models are at play, with centralized governance and execution being the most prevalent. This model consolidates decision-making, control, and the management of technology into a single, unified source, adopting a highly hierarchical structure favored by many healthcare technology groups.
However, an alternative, gaining traction among some institutions, combines centralized governance with decentralized execution. In this model, while strategic governance remains centralized, the implementation of technology concepts and applications is distributed across individual teams. This approach is particularly advantageous in healthcare due to its vast and complex nature. Decentralizing execution acknowledges that a central IT unit cannot fully grasp the diverse needs of the myriad distinct departments within healthcare.
This shift towards a hybrid governance model marks a significant improvement over the traditional, fully centralized method. Yet, I believe there are more effective strategies to be explored.
For instance, at HIMSS23, a leading health informatics conference, I gave a podium presentation with a colleague of mine, Kent Stein, the potential and advantages of adopting General Stanley McChrystal’s “Team of Teams” approach in healthcare. This method could offer profound benefits, enhancing collaboration and adaptability across the sector and I think is absolutely necessary given the lessons learned from the COVID pandemic.
Let’s talk a bit about General McChrystal and the origin of the Team of Teams concept. In 2003, General McChrystal assumed command of the Joint Special Operations Command (JSOC) task force. Their mission was to combat and overcome Al Qaeda, an adversary that, at the time, consistently outmaneuvered us. This task force comprised elite special forces and personnel, including special operations teams, strategists, and analysts — the best of the best. They were exceptionally well-equipped, with top-notch training and technology. Despite these advantages, we were still falling short.
So, why were we falling short? Al Qaeda in Iraq (AQI) represented a new kind of foe. Our large, cumbersome task force couldn’t match the pace of AQI, which operated as a nimble network of agile teams capable of swift strikes, immediate reconfiguration, and global action integration. Iraq’s complex environment, marked by rapid and unpredictable events, differed vastly from the scenarios for which the military had prepared. In essence, AQI thrived amidst chaos.
This brings us to a parallel with healthcare overall. The pandemic highlighted significant flaws in our systems. Faced with a rapidly evolving, fast-moving disease spreading worldwide, we realized the necessity for new, agile methods to tackle such challenges.
General McChrystal identified that a rigid structure and outdated organizational models were the primary obstacles preventing his elite team from achieving success. It became clear that a dynamic approach is essential to combat a dynamic enemy in a dynamic environment. And this insight is where we find most of our similarities with healthcare.
Let’s explore what this means from both a leadership and healthcare perspective. Generally, most teams operate within a fully hierarchical model, similar to the image below:
This model is quite traditional, with a top-down approach where information and decisions trickle down from the top, eventually reaching those at the lower tiers. Periodically, perhaps daily, information is relayed back up the chain, enabling top-level decision-making processes.
This structure creates order and is tailored to address specific problems effectively, particularly in smaller organizations. However, issues arise when information needs to be conveyed horizontally across levels. Typically, this results in significant delays. In a hierarchical model, actions must navigate back up the chain, then possibly through a ticketing system of another department, which itself may be bogged down by multiple governance councils and decision-making stages before the action finally makes its way back to the originators. While this method yields predictable outcomes and gets things done, it’s incredibly inefficient. Despite being the operational backbone of many healthcare organizations today, it’s far from optimal in our ever-changing environment.
In stark contrast, Al Qaeda in Iraq (AQI) functioned as a loosely connected network of associations like the image below:
They were not organized hierarchically but rather through relationships, friendships, and connections. This structure granted them exceptional adaptability since they weren’t constrained by any set manual or rules. They had the freedom to act as they pleased.
Thus, when a highly structured and efficient organization comes up against one that prioritizes adaptability, it’s the latter that prevails. Adaptability becomes the most valuable asset, marking the difference between adhering to established processes (“doing things right”) and implementing practical solutions (“doing what works”).
Despite their best efforts, JSOC’s commitment to “doing things right” — not deviating from taught processes — made efficiency a casualty in the face of adaptability.
Certainly, it’s not feasible to eliminate all forms of structure from healthcare. However, finding a middle ground is essential to maintain both order and the flexibility needed to tackle challenges like a pandemic. Integrating these systems is crucial.
Enter the Team of Teams approach, a concept I frequently discuss and explore through our adaptive model, encapsulating Trust and Inspire, and the empowerment of the workforce. These principles form the foundation of the Team of Teams methodology, which is structured around four main pillars:
1. **Bonds of Trust**: This pillar emphasizes a strong sense of trust and purpose within the team. It’s about having faith in and familiarity with your colleagues, knowing with certainty that you can depend on them for their actions and motives. This changes the fundamental dynamics between individuals, fostering a cohesive unit.
2. **Shared Consciousness**: This is about achieving a common understanding and mindset among team members. It doesn’t imply unanimous agreement on every issue but cultivates a shared intelligence and comprehension. Such unity leads to exceptionally effective teamwork.
3. **Sense of the Whole**: With established trust, shared goals, and freely available information, team members gain a comprehensive awareness of the entire “playing field.” This broader perspective enables a dynamic workforce, laying the groundwork for adaptability.
4. **Empowerment**: Contrasting with a top-down command and control model, empowerment emphasizes a bottom-up approach. Achieving true adaptability, alongside maintaining order and procedures, necessitates empowering team members to make decisions independently, without the need to navigate a rigid hierarchy. We’ll delve deeper into the significance of empowerment and its implications for healthcare as we progress through these discussions.
By integrating these four elements, healthcare organizations can develop a responsive, adaptable structure capable of addressing the complexities of modern healthcare challenges, including pandemics.
I believe that healthcare technology groups could greatly benefit from adopting these approaches, given their enhanced adaptability to the swiftly evolving landscape in this field. The ways we’ve implemented some of these strategies internally, along with examples and anecdotes, will be explored in a forthcoming post. So, stay tuned for insights into practical applications and the tangible impacts of these methodologies in the healthcare technology sector.
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