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Managing Health Care in a Complex World

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Christine Springer
October 2, 2015

The ultimate challenge for public managers in managing health care today is an inability to forecast accurately the future and a necessity to make sense of it. More and more dilemmas have emerged in health care due to situations becoming more complex and puzzling. This requires managers to choose, prioritize and operationalize strategic initiatives such as the Federal Occupational Health’s Operation Five Star did in 2008.

It is important to think at least 10 years ahead, to apply sense-making skills to dilemmas and to move from insight to action. Five driving forces allow the flexibility to act effectively in a changing world:

  1. Personal empowerment.
  2. Grassroots economics.
  3. Smart networking.
  4. Polarizing extremes.
  5. Health insecurity. 

With regard to personal empowerment, engaged citizens and consumers have three behaviors:

  • Self-agency (acting with independence but with close links to others).
  • Self-customization (adapting and applying core products and services to individual needs with the expectation that customization will eventually occur).
  • Self-organization (organizing responses and initiatives in ways that shift from consumption to creation). 

Personal empowerment is shaped by aging baby boomers as they move from retirement to redirection, regeneration and refinement. For grassroots economics, economies of scale are moving from bigger always being better to you are what you can organize.

In smart networking, the trend is toward global connectivity where six factors are important to success:

  1. Group participation.
  2. Referral behavior.
  3. Online lifestyle.
  4. Personal mobility.
  5. Locational activity.
  6. Computer connectivity. 

Finally, in polarizing extremes, more than half of the world’s population now lives in cities. This poses a challenge for public managers to engage extreme groups, when it is impossible to please all of them or to develop common themes.

With regard to health insecurity, baby boomers are funding and fueling a new health economy. This new economy focuses on how to grow a culture of health in the shadow of looming global health crises by doing things like bodybuilding, medical modification and financial planning. They are planning for long-term care and getting what they and their families need to know about home care, nursing homes and assisted-living. They are also analyzing Social Security, whether they should apply for full benefits before or after age 70 and how to make the most of both Medicare and Medicaid.

In order to deal effectively with these and other driving forces, public managers need to design organizational structures that can be modified to adapt and succeed. They need to use flexible as well as formal structures and emphasize principles instead of rules. To do so, also means conducting after action reviews, like the military, police and fire agencies use, as a regular discipline for debriefing and documenting lessons from every significant event. By doing so, managers are able to learn from what has happened and apply that learning to an understanding of future possibilities. The best managers develop an instinct for response, a discipline of readiness and an insight into what first steps need to be taken so that as actions unfold, they know what next steps need to be taken.

From my experience, one example of an organization effectively managing change has been the Federal Occupation Health Agency reorganization in 2008 to become a one-stop shop for health services. This is a non-appropriated agency within the U.S. Department of Health and Human Services and it is the largest provider of occupational health services in the federal government. Created in 1946, it serves more than 360 federal agencies and 1.8 million federal employees.

To begin the reorganization, Operation Five-Star was created to choose, prioritize and operationalize strategic initiatives. Among the first steps initially taken was the reduction of 12 initiatives to six:

1. Workforce planning.
2. Acquisition management and planning.
3. Establishment of a project management office.
4. Improving interagency programs.
5. Integrating health and wellness programs.
6. Creating branding of agency products.

By focusing early on expanding employee recognition, creating a uniform new employee orientation as well as creating new awards and recognition for employees and contractors, the organization demonstrated both progress and senior leadership commitment.

Operation Five-Star continues today and several of the first-stage initiatives have already been implemented. Second stage initiatives involve focusing on change management while assessing the actions that have been taken and adjusting initiatives and the process. Key to their success was the creation of cross-functional teams, support from senior leadership and a business-case format that helped the executive team weigh the pros and cons of proposed initiatives objectively, enhanced the team’s decision making, and ultimately, accelerated implementation.

In the final analysis, success in managing large scale and complex processes requires that public managers be flexible and use foresight to address issues as change occurs. That means being willing to identify what forces outside the organization are affecting outcomes and creating initiatives that involve all levels of the organization so as to design and evaluate organizational structures and processes and how they can be modified to adapt and succeed.


Author: Christine Gibbs Springer is the director of the Executive Masters Degree in Emergency and Crisis Management at the University of Nevada- Las Vegas. She is founder and CEO of a strategic management and communications firm, Red Tape Limited. To contact Springer, email [email protected]

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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