There is certainly some validity to this argument. In corporate America, the pendulum between centralization and decentralization in decision making has swung back and forth many times over the years. However, in an era of 21st century communication tools and analytics, it's no longer clear to me that there needs to be a meaningful tradeoff between these forces. Organizations should have nearly complete visibility into on-the-ground performance challenges at all sites, in much the same way that an airline or railroad has a command center that allows them to seamlessly manage operational challenges from one central location. This doesn't require a massive investment in technology.
For instance, I'm particularly impressed by Intermountain's daily huddles, which go well beyond the safety conversations that many health systems use. Within 90 minutes every morning, Intermountain's most senior executive team gains full visibility into any operational challenges that need responses across the entire system. These huddles have allowed Intermountain to remain agile in supporting local performance—at the same time that it's moved to a more centralized operating model.
In my view, there is an inarguable case that health care organizations need to be able to achieve, at minimum, this first level of systemness. With industry margins at historically low levels, the imperative to achieve best-in-class operational performance has never been greater. Further, organizations that are unable to achieve level one of systemness stand very little chance of engaging their clinicians in a conversation around level two—creating a clinical advantage.
Stay tuned for my next blog post where I'll dive deeper into that second level and explore more about what's required to work towards shared, but difficult, objectives.