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Strategic Management in a Changing Health Services World

By Christine Gibbs Springer

The ultimate paradox for public managers today is the inability to forecast the future, yet the necessity to make sense of it in order to survive and thrive. To be successful, public managers must devise strategies rooted in their own point of view and then get there ahead of the crowd. However, many managers are content with getting there just in time and some are even willing to settle for getting there fashionably late. Those behind the curve focus on quick-fix problems, avoiding the kind of long-term dilemmas and solutions that characterize the future. More and more dilemmas have emerged due to situations becoming more complex and puzzling making it increasingly critical to choose, prioritize and operationalize strategic initiatives such as the Federal Occupational Health’s Operation Five Star has done since 2008.

It’s important to think 10 years ahead and to apply both sense-making skills to dilemmas and to move from insight to action so as to be flexible enough to continue to act effectively in a changing environment. According to one forecast, there are five driving forces that will shape the next 10 years. Those forces are personal empowerment, grassroots economics, smart networking, polarizing extremes and health insecurity. 

With regard to personal empowerment, engaged citizens and consumers are increasingly characterized by 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 be available) and self-organization (organizing responses and initiatives in ways that are difficult to anticipate but that shift from consumption to creation). This personal empowerment will also be shaped by aging baby boomers as they move from retirement to redirection, regeneration and refinement by working older, facing greater health expenses, receiving lower levels of social security and expanding, not narrowing their horizons.

With regard to grassroots economics, economies of scale are moving from bigger always being better to economies of organization or you are what you can organize. The challenge is to grow financially in an environment where large and small scale are equally important to success.

With regard to smart networking, the trend is toward global connectivity where smart networkers live at the leading edge and six factors are important to success: group participation, referral behavior, online lifestyle, personal mobile commuting, locational activity and computer connectivity.

With regard to polarizing extremes, strong opinions will become more prevalent on the internet and for the first time in history, more than half of the world’s population will live in cities challenging public managers to engage extreme groups when it is impossible to please all them or to develop common themes.

With regard to health insecurity, baby boomers will fund and fuel a new health economy which will focus on how to grow a culture of health marketplace in the shadow of looming global health crises by doing things like body building, medical modification and death denial.

In order to deal effectively with these and other driving forces, public managers need to design and evaluate organizational structures and how they can be modified to adapt and succeed. To do so, managers will need to use flexible as well as formal structures and emphasize principles instead of rules, constant and thorough communication, small cohesive decision-making groups, formal and informal feedback, shared memories as well as standard databases, and a shared collective identity both formal and informal. To do so may also mean 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. In the final analysis, the best foresight happens in real time, in the midst of action. The best managers develop an instinct for response, a discipline of readiness and an insight into what first steps need to be taken and then as the action unfolds, what next steps need to be taken.

One example of an organization effectively managing change from my experience was the Federal Occupation Health Agency reorganizing itself in 2008 to become more of a one-stop shop for health services rather than a provider of individual services. This agency is a non-appropriated agency within the U.S. Department of Health and Human Services that 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 do so, Operation Five-Star was created to choose, prioritize, and operationalize strategic initiatives. Among the first steps taken was to reduce the 12 initiatives to 6: 1. workforce planning, 2. acquisition management and planning, 3. establishing a project management office, 4. improving interagency agreements and statement-of-work processes, 5. integrating health and wellness programs and 6. the branding of agency products. By focusing early on two critical needs: expanding employee recognition and creating a uniform new employee orientation as well as to create quick wins by 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 the initiatives and process to the shifting nature of resources in government and to agency priorities for federal employees, U.S. Public Health Service officers and contract vendor employees. Key to the success of Operation Five Star was the creating of cross functional teams so as to obtain information and insight from more than headquarters, support from senior leadership reinforcing the message that the projects were important to the overall agency’s success, virtual meetings rather than face-to-face meetings which saved time and boosted productivity, and a business-case format for recommending initiatives that helped the executive team weigh the pros and cons of proposed initiatives objectively, enhancing the team’s decision making and ultimately accelerating implementation.

In the final analysis, future success 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.


Christine Gibbs Springer is the Director of the Executive Masters Degree in Emergency and Crisis Management at UNLV, the only program of its kind in the United States.  She has served on Congressional Panels developing performance metrics for DHS/FEMA grants, a FEMA panel to develop core competencies for college curriculum and degree programs, and on the Congressional Panel evaluating FEMA post-Katrina last year. She also serves on the Nevada Citizen Corps Board of Directors and the National Academy of Public Administration’s Board of Directors. She is also a member of InfraGard.  She is founder and CEO of a strategic management and communications firm, Red Tape Limited, incorporated in 1986 with offices in Nevada and Arizona.  To contact Springer, email [email protected].   


Images courtesy of http://fitness-health-wellness.com/ and http://www.healthter.com/media/catalog/category/health-care2-1.jpg.


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