Transforming healthcare systems to facilitate healthy communities is driven by extensive collaboration and integration among network members. Read how to transform you healthcare collaborative into a successful integrated community healthcare system.

1. Are you a
Transforming healthcare Transformer?
systems to facilitate healthy
communities is driven by
extensive collaboration and JJourney to Transfform
ourney to Trans orm
integration among network Heallthcare Collllaboratiives
Hea thcare Co aborat ves
members. iinto Successffull Integrated
nto Success u Integrated
Is your collaborative having difficulty
Communiity Heallthcare
Commun ty Hea thcare
with the transformation process? Systems
Systems
This white paper explores building a
successful healthcare collaborative. By A Whiite Paper
A Wh te Paper
improving internal and external connections
and using integrated network ties you can
transform your collaborative into a multi­
organizational healthcare system that
delivers care and services at the right time
and at the right level.
Wriitten By::
Wr tten By
Candace JJ.. Chiitty
Candace Ch tty
Insight 1: Transformation Presiident
Pres dent
requires a change in thinking. Qualliity Fiirst Heallthcare
Qua ty F rst Hea thcare
Consulltiing,, IInc..
Consu t ng nc
Insight 2: Successful community
health collaboratives rely on
effective internal and external
connections.
Insight 3: Effective connections
promote integration through
community linkages and
information sharing.
Fallll 2007
Fa 2007

2. As I have traveled across the country working with healthcare collaboratives of all sizes, I have
discovered many collaboratives experiencing difficulty with sustaining forward momentum. In my
experience I have observed three common obstacles to transforming a fragmented and ineffective
healthcare delivery model into an integrated community healthcare system. First, there are
collaboratives that are waiting for a big policy change with mandates, hoping this will force forward
movement in areas where internal collaboration has been difficult. Second, some collaboratives have
simply begun without a defined end in mind, requiring multiple refinements in their initiatives over
time. Third, some groups have an end in mind and a strategic plan but progress is slow because
consensus is fleeting or absent. Are any of these scenarios familiar to you?
Probllems tthatt are creatted by
Prob ems ha are crea ed by IInsiight 1:: Transformatiion Requiires
ns ght 1 Transformat on Requ res
our currentt llevell off tthiinkiing
our curren eve o h nk ng
can’’tt be sollved by tthatt same
a Change iin Thiinkiing..
a Change n Th nk ng
can be so ved by ha same
llevell off tthiinkiing..
eve o h nk ng
Analytic Thinking vs. Systems Thinking
­­Allbertt Eiinstteiin
A ber E ns e n
How does your collaborative think? A change from
analytic thinking to a systems mindset is necessary to transform a fragmented healthcare system.
Successful integration will follow once this change begins to take shape. With analytic thinking the parts
are primary and the whole is secondary. In a systems mindset the whole is primary and the parts are
secondary. A systems thinking approach views the healthcare system as a whole, an integrated and
indivisible entity. This approach systematically integrates key concepts of efficient, effective and quality
healthcare in a continuum that builds bridges through community linkages. It removes gaps in care and
services by internally and externally sharing necessary information.
In healthcare this concept is often poorly understood and generally not applied. The following table
demonstrates a comparison between the two thinking approaches. Which thought process best fits
your collaborative?
Analytic Thinking Systems Thinking
(Analysis of Today) (Synthesis for the Future)
We/They Customers/Stakeholders
Independent Interdependent
Activities/Tasks/Means Activities/Tasks/Means and Outcomes/Ends
Problem solving Problem solving and solution seeking
Today is fine Shared vision of future
Silo mentality Cross‐functional teamwork
Closed environment Openness and feedback
Individual goals Shared core strategies
Strategic planning project Strategic management system
Hierarchy and controls Serve the customer
Not my job Communications and collaboration
Isolated change Systematic change
Linear/Begin‐end Circular/Repeat cycles
Short term Short term and long term
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3. Analytic Thinking Systems Thinking
(Analysis of Today) (Synthesis for the Future)
Separate issues Related issues
Symptoms Root causes
Isolated events Isolated events and Patterns/Trends
Activities/Actions Activities/Actions and Clear Outcomes
Source: Haines Centre for Strategic Management Integrated Lines of Businesses
www.hainescentre.com
Insiight 2:: Successfull Communiity Heallth Collllaboratiives
Ins ght 2 Successfu Commun ty Hea th Co aborat ves
Relly on Effectiive Internall and Externall Connectiions..
Re y on Effect ve Interna and Externa Connect ons
Internal Connections: Understanding the Collaboration behind the
Collaborative
How is your collaborative wired? Understanding internal connections across the collaborative
increases the ability to influence and promote progression to an integrated community healthcare
system.
Healthcare organizations often are members of community collaboratives. These collaboratives require
cross‐organizational initiatives such as alliances or other forms of strategic partnerships to leverage their
organizations' unique capabilities. However, leaders participating in these collaboratives usually have
minimal insight into their counterpart's organization. In addition, the collaboration can be heavily
conditioned by legal restrictions, cultural and leadership differences as well as differences in each
organization’s level of expertise. A significant challenge is to recognize when appropriate points of
connectivity do not exist or are failing across organizations and/or when governance is restricting
collaboration.
Examining how your collaborative is connected is critical to understanding the differences between the
Collaborative‐Structure‐on‐Paper and the “Real Collaborative”. Although organizational charts
demonstrate that work and information flow in a hierarchy, the reality is usually something quite
different. Work and information sharing actually flow through a web of informal knowledge
communities and information channels known as the “collaborative behind the collaborative”. How do
you determine if your collaborative is a subterranean and unmanaged process that actually restricts
your community healthcare system transformation?
One way to address the informal collaborative network is through an Organizational Network Analysis.
Organizational Network Analysis is a network mapping assessment that takes a hard look at informal
personal contacts through which decisions are made, work gets done and information is shared. It is a
powerful means of causing invisible patterns of information flow and collaboration in strategically
important groups to become visible. The use of network analysis illuminates the realities of your
collaborative connections and helps to identify clear breakdowns in cooperation and sharing.
Additionally, it helps to highlight opportunities to strengthen viable but less than perfect elements of
the collaborative framework.
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4. The first step in organizational network analysis is to cast a wide net. Oftentimes, the best source of
information about work processes and information sharing comes not from collaborative leaders but
from the people directly involved in day‐to‐day healthcare delivery.
Identifying the existent or fractured connections allows healthcare communities to influence local
interactions. This exercise can be especially effective when the mapping indicates how a few key
connectors play a major role in what flows through the collaborative. The ability to influence the well‐
connected individuals often synergizes more effective results than continuing to try to access the top
person or calling on random players in the collaborative. If you can identify and synergize the
collaborative connections, you will have a significant influence on building an integrated healthcare
community.
When key connectors are identified, the assessment then moves to an interaction survey among the
connectors and a map of the results.
Organizational network mapping can be accomplished using several data collection methods. The most
efficient method is to use a short survey designed to assess key communication relationships across
collaborative members both inside and outside the organization. Other methods include tracking email
communications and direct observations of people over a specific time frame.
When the data collection is completed, a mapping diagram can be used to display the data in a visual
form. There are numerous resources and network mapping software products available. For online
resources that include two free downloadable mapping tools see the list at the end of this document.
Other resources to help in network analysis include books, periodicals and management consultants
who have expertise in network analysis. Several of these resources are listed at the end of this
document.
External Connections: Improving Connections through Information Technology
(Making a Smart Technology Investment)
How prepared is your collaborative to make a smart technology investment? Large‐scale
change is fundamentally an issue of network integration. Before you can achieve full network
integration and complete the transformation process you need a technology infrastructure that
supports external connectivity and interoperability across the healthcare network. However, moving
data from place to place is not enough. You also need tools that translate the data into actionable
information that will impact outcomes as well as the quality and cost of care. The shared information
must be given business and clinical context. It must move as freely as possible to the person who needs
it at the given point in time, translated into the language that he or she understands best. Though
providers, pharmacies and labs have databases full of valuable patient information, the databases most
often do not interoperate. When information is shared between such databases, it can be leveraged to
more quickly identify patients with health needs. They can be immediately connected to the care
management system that will best manage those health issues at the right time and at the right level.
In order to make a smart technology investment, your collaborative should take the time to thoroughly
design and execute an information technology plan. Proper due diligence can assure your investment
meets your current and future needs.
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5.
Ten Tips for making a Smart Information Technology Investment:
1. User buy‐in is critical. Although users are often not the leaders in your collaborative, it is staff
level healthcare employees who will have the greatest impact on the success of your
integration. It is very important to identify these key system users at the beginning of the
process; to foster continued participation and support of the process by developing a user
advisory group; to understand their workflow processes; and to seek their input about how they
see themselves using the system. Listen to them and take heed.
2. Jump the HIPAA hurdle early. There have been many before you that have successfully jumped
this hurdle. Starting this process early and consulting with other community collaboratives to
learn how they managed HIPAA compliance across the network should save you some legal
counsel time.
3. Experts in the field of information technology and interoperability are essential. Identify
available internal resources first. Acquire external expertise if needed.
4. Build a sustainability plan into the information technology budget. Collaboratives that
incorporate funds beyond initial purchase/licensing assure a fixed number of years in
sustainable operation during the pursuit of long‐term sustainability solutions.
5. Develop a detailed information technology project management plan. Designing and
implementing a comprehensive integrated community healthcare system is a multi‐faceted
project of immense proportions that is best executed by a project manager or a project team.
The best advice is “Leave nothing out.”
6. Identify information technology gaps. Visit each network site and perform a comprehensive
assessment of hardware and connectivity needs. Develop a plan to address all gaps.
7. Identify healthcare access or quality of care barriers areas across the network. Examples
include points in care where there is fragmentation and/or duplication of healthcare services.
Form multi‐organizational work teams to design process flows to reduce barriers.
8. Due Diligence is essential when selecting an information technology software. This is an
important step and should start only after the integration framework has been thoroughly and
completely mapped in regard to structure, process and outcomes (metrics). Make sure a
flexible solution is chosen. Ensure that the software is customizable and workflow friendly,
taking into account the differences in your members’ operations. The standard is to utilize a
detailed and formal Request for Information (RFI) or Request for Proposal (RFP) process. Or, to
maximize time and cost‐effectiveness, you may want to identify software solutions that fit your
needs first and then coordinate initial demonstrations before deciding whether to implement a
full blown RFP process.
9. Script the demonstrations. The demonstration should be based in part on a set of
requirements/case scenarios provided to the vendor after development by the collaborative and
community user advisory group. When the vendor is selected be sure to negotiate the contract.
Your collaborative is at an advantage during the pre‐contract period.
10. Start integrating slow and grow. Pilot the information technology system before implementing
it full‐scale.
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6.
Insiight 3:: Effectiive connectiions promote systems
Ins ght 3 Effect ve connect ons promote systems
iintegratiion through communiity lliinkages and iinformatiion
ntegrat on through commun ty nkages and nformat on
shariing..
shar ng
The Integrated Community Healthcare System Framework
How well is your collaborative
integrating? The diagram to the right
demonstrates a systems thinking
framework for an Integrated
Community Healthcare System (ICHS).
An ICHS is a system of care that
coordinates and delivers health
services at the right time and at the
right level across a network of
healthcare and social service
providers. An ICHS embraces a
systems thinking approach to solving
healthcare issues.
Network ties formed by effective
community linkages and information
sharing promote integration.
Integration fosters inherent
collaboration by building bridges
across gaps in healthcare access. The
system is circular and focuses on the
whole – improved health and quality
of life.
In Summary
In Summary
The current community healthcare
environment is complex and under
increasing scrutiny. To succeed,
collaboratives must have effective strategic initiatives to transform healthcare delivery models into fully
integrated healthcare systems and must have metric‐driven feedback to ensure results. Not only will
they achieve success and sustainability – these collaboratives will become leaders and will increase
stakeholder value.
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7. The Integrated Community Healthcare System
movement is gaining momentum and it will be
met with resistance. But you can minimize this Resources
Resources
resistance by: 1) understanding the make‐up and
motivation of your collaborative; 2)
understanding how the members of your Collaboration: What makes it work. 2nd
collaborative formally and informally connect; Edition. Paul. W. Mattessich, et al.
and 3) aligning your systems thinking integration
strategies with smart information technology The Systems Thinking Approach to Strategic
Planning and Management. Stephen G. Haines
investments.
Project Management. A Systems Approach to
Planning, Scheduling and Controlling. 8th
About Quality First Healthcare Edition. Harold Kerzner, Ph.D.
Consulting, Inc. Executive Services Corp Affiliate Network – a
nationally recognized organization that promotes
Quality First Healthcare Consulting, Inc. (QFHC) growth and development of non­profit
has extensive operations management experience organizations through free consulting and related
involving the successful start‐up of healthcare services performed by volunteer consultants who
access projects for underserved populations. have had senior level positions in business,
Services provided by QFHC consultants include government, and nonprofits.
large project management, collaborative www.escus.org
development, implementation of volunteer
physician access programs, integrated care
management program development and medical Online Resources
management decision support software design.
QFHC’s goal is to provide guidance to maximize www.systemsthinkingpress.com (Listings of
the collaborative’s success, providing creative and systems thinking books/publications)
innovative solutions developed through relevant
hands‐on experience. Organizational Network Mapping
Tools
GraphViz
www.graphviz.org
InFlow
www.inflow.com
Netdraw and UCInet (Free download)
www.analytictech.com
For questions or comments, please contact: Link collection of network visualization tools
www.caida.org/projects/internetalas/viztools
Candace J. Chitty, RN, MBA, CPHQ /html
President
Quality First Healthcare Consulting, Inc.
352‐473‐0580 or visit
www.qfhc.com
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