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SatelliteHealthcare-ASociotechnicalDigitalDesign
ofaDialysisEco-system
STSRoundtableCaseStudySeptember2017
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CONTENTS
STSRoundtable–September2017 2
ContextReimaginedHome–SociotechnicalDigitalEcosystemDesignDialysisCenterTransformaEon–AdapEveWorkSystemRedesignAmbidextrousLeadershipConclusions
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CONTEXT
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DigitallyEnabledOrganizaEonsandEcosystems
STSRoundtable–September2017 4
Ourabilitytoconnectthroughdigitaltechnologyhastransformedworksystemstonewcomplexdigitallyenabledteamsand
networksthatextendbeyondtheorganizaEontotheecosystemLinearSociotechnicalDesign
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DigitallyEnabledTeamsandNetworks
[5]
Integrating Councils
Management Team Unit 1
Integrating Teams
Team Team
Executive Team
Shared Services
Integrating Teams
Team Team Team
Management Team Unit 2
Knowledge
Network
Team
Opportunity Team
CustomerTeam
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DigitallyEnabledEcosystems
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DesignSessions
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AboutSatelliteHealthcare
STSRoundtable–September2017 8
• FoundedbyNormanCoplon,MDin1973
• HeadquarteredinSanJose,CAwith80locaEonsacross6statesprovidingkidneydialysistoover7800paEents
• $200millioninrevenuewithover2000employees
• Approximately20%ofpaEentsinhomedialysis;over50%returningtoCenterswithin3months
• HomeandCenterDialysisservicelinealignmentandeventualintegraEon
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ReimaginedHome-ASociotechnicalDigital
EcosystemDesign
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GoalsforReimaginedHome
• ReducethedropoutrateofdialysispaEentsonhomecare,whileimprovingthecustomerexperienceandreducingcosts
• IncreasepaEentsaEsfacEon
• DevelopadigitalapplicaEonthatsupportsdeeperpaEentengagementandconnecEonandbe\ermanagementoftheircondiEon
• CreateanewindustrystandardfordialysishomecarethatenhancesSatelliteHealthcare’sindustryleadershipandservesasasourceofcompeEEvedifferenEaEonandincreasedmarketshare
• IncreasehomeprogramEBITDAgrowthasaresultofthenewresourcesandtools
• ReceiveaposiEveROIfromtheReimaginedHomeiniEaEvein2018andbeyond
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PaEentTouchpointsMapping
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TouchpointsSummary
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VarianceControlMatrix
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VarianceControlTablePaEentExperience“variance”name:DescripEon:
Loca<on
Whattouchpoint/step
Causes
Whatarerootcauses
Costofthevariance
Quality,quan<ty,cost,<me,experience(poten<alsavingsorimprovement)
Currentvariancecontrolsystem
Wherevarianceisdetected(awareness)
Currentac<vi<estocorrectcause
Whohasskill,resources,authorityforcorrec<veac<on
Problemswithcurrentsystem
Ideasforpreven<ng,elimina<ng,orcontrollingthevariance
Changesinrole(namerolesinecosystem)
Informa<onflowchanges
Newskillsneededand/orauthority(whodecides)
Organiza<onalchanges
DigitalTechnologysolu<ons(device,channel,etc.)
Technicalchanges
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PaEentPersonas
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PaEentPersonas
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Technology
PhysicianReferral
Dr.PatelloisreferringKaratoWBforMyChoiceassistance(formallyOp<onsTraining).Dr.PatellohandsKaraacardthathasprintedonitdirec<onsforhertomakeanappointmentwithaWBWellnessAdvocatewithherphoneanddownloadthesuppor<ngLifeOp<onsMobileapp.
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Technology
KaraConnects…
KaratypesinthemessagefromthecardandatextmessagereturnswithlinktoDr.Patello'spagedescribingtheappandalinkwithinstruc<onstodownloaditfromiTunes.
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Technology
KaraentersDr.Patello'slandingpagePatello’sgree<ngisencouragingandposi<veaboutKara'sfuturelifeandhealthoutcome.
Instruc<onsfordownloadareclearanduncomplicated…justclickthislink.
Remindertotypein'mychoice23'toassociateKara'sappwithDr.Patello.
IfPatelloreferstoseveralWBloca<onsthenumbermightbefollowedbyacharacter(‘f’forFremont)mychoice23f
Mayneedamessageindica-ngtheappisagreatwayforDr.andKaratostayconnected...asDr.wantstofollowKara'sprogresseverystepoftheway.
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Technology
KaraDownloadstheMyChoiceApp
Karaenteshercode:
mychoice23
ThiscodelinksKara’sapptoDr.PatelloandtheWBsitePatellohasreferredKarato.
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DialysisCenterTransformaEon-AnAdapEveWorkSystemRedesign
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AligningHomeandCenterDialysis
ReimagedHomeDesignLab:DigitalAppandOrganiza0on&pa0entrolesinHomeDialysisspecifica0ondevelopment
HomeDialysisSocio-TechnicalSystemPrototyped&Stabilizedin7centers(60-90)
Scale-up:AcceleratedDesignSessionsforremaining75centers(30-60-90)
Introduc:onofNewFunc:onali:esthrough:me
First3func0onali0es:(1) Nephrologist
Community;(2) Treatment
Educa0onandLifePlanning;
(3) Training
AppDevelopedItera0oninconcertwithfullprototypedevelopment
Addi0onalfunc0onali0esdeveloped:(4)Maintenance:connec0ontoclinicaldata;alertsystems.Connec0ontoSPIN,LearningModules,etc.
CenterTransforma:on
October2016:DesignAcceleratorwithCross-func0onalleaderteamsfrom5centers:
Goal,Metrics&Rewardsspecifica0ons
Check-listoffunc0onali0esSponsorleadsiden0fied
Corporate-wideFunc:onalityDevelopmentTeams: Start-upProcess
for40NewCenters
5CenterDesignAccelerator:Integra0onofhome&in-centerworksystems(30-60-90)
Scale-up:Accelerateddesignsessionsforremaining75centers
BusinessModelandExecu:veTeamStructure
“SincepaEentswillmovebetweenhomeandcenterdialysis,theopEmizedsociotechnicaldesignmustincludethesocial
andtechnicallinkagestothecenters.”
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DialysisCenterTransformaEon
Strategy
Structure
People
Metrics&Rewards
Systems&Processes
Capabili9es
Leadership
Strategy
Structure
People
Metrics&Rewards
Systems&Processes
Capabili9es
Leadership
Volume
Transi9on
Value
Today
Tradi9onalOrganiza9on Adap9ve
Organiza9on
StrategicObjec9ves Increasereten.on,reducevacancies,doublehomedialysisvolume
Capabili9es Buildadap.vedesigncapability
Structure Movefromhierarchytoagile/adap.veteams
Systems&Processes Systemofrecord,adap.veworkteamsatcenters,corporatesupportnetwork
Metrics&Rewards Redefineddialysiscentermetrics,employeeincen.vesystem
People Buildadap.veteams–informa.on,skills,decisionmaking
Leadership Facilita.veCentermanagers,empoweringcorporatefunc.onalsupport
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CenterTransformaEon-PhasesandTiming
1
1. Contextse+ng–purposeandobjec6vesofproject;keydata
2. Prototypeworksystemdesigntoaddressreten6on,recrui6ng,andperformance
3. Finalizekeymetricsandperformanceexpecta6ons
4. LearningCentersdraHini6alimprovementstrategies
5. Implementa6onanditera6on30-60-90dayitera6onplans
1. Iterateun6lCentersachieveproofofconceptonAdap6veTeamprototypeincluding:teamroles,responsibili6es,problemsolving,decisionmaking,andmetrics
2. Defineroles,responsibili6esand6mingforscalingnewmodel
3. Createfastscaleplan
Orienta6on&ReadinessAssessment
1. Purposeandobjec6vesofTHINKBIG
2. Projectworkstream,projected6meline,Centerselec6oncriteria,andDAdescrip6on
3. On-sitereadinessinterviewswithDApar6cipants,iden6fica6onofissues,barriersandopportuni6es
4. SummaryoffindingswithvariancesforDA
DecisionAccelerator
MetricDefini6onsandSystem
LearningCenterCheck-Ins
BuildAdap6veTeamPrototype
RefineandScaletoOtherCenters
2 3 4 5 6
1. Sponsorsfinalizemetricsandtargetbaselines
2. HOPOCsinplaceworkingwithCenters
3. Projectmanagementassigned
4. MonthlyMetricsScorecarddeveloped
5. LearningCenterproblemsolvingandimplementa6ontoachievemetrics
1. LearningCenterScorecardsdistributed
2. 30DayCheckInswithCenterManagersandHOPOCs
3. Staffing-Stability-Strategy(SSS)inplace;ThinkBigpartoflargerstrategy
4. EnsurealignmentbetweenleadershiptrainingandAdap6veWorkTeams
1. Adap6veTeamFunc6onality,TeamAssessment,&Ac6onPlanswithLearningCenters
2. LearningCenterPrepSessionsforJulyandAugustRetrospec6ves
3. Createitera6on/capacityplansandimpactanalysisagainstkeymetrics
4. ConductReview&Retrospec6veSessions–JulyandAugust
Sept14–16 Sept22 Oct-Dec Jan-Apr May-Aug Septforward
PhaseII PhaseIII
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AdapEveTeamEvoluEon
Tradi&onalHierarchicalleadershipLi2ledataEmployeestold
Collabora&veLeaderdependentHistoricaldataPerformanceorienta&onProblemsolvingteams
SelfManagingLeaderascoachLivedataPa&entcentricTeamsformanddisbandasneededExternalresourcesrespondtoteamneeds
SMARTLeaderasnetworksponsorandboundarymanagerPredic&vedataPa&entdrivenDigitallyenabledSMARTCareTeamswithpredic&vediagnos&csdeliverpersonalizedtreatmentplansSystem-wideresourcesfullyaligned
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“RetrospecEve”SessionOverview
Morning1. Welcome
• Introduc3ons• Purpose&Objec3ves• Today’sAgenda
2.Review-Adap3veTeamCapability
• Func3onalityChecklist• Func3onalityBacklog
3.Review-MetricScorecards
• HOPOCo SystemVacancy&
TurnoverMetrics• LearningCenters
o Vacancy&Turnoverresultso Howmetricsachieved
AOernoon4.Retrospec3ve
• Project• Process• TeamEffec3veness
5.System-wideVarianceControls• Supportandresourceneeds• Barrierstoberemoved
6.IterateFunc3onalityChecklist7.30DayItera3onPlanning
• LearningCenters• HomeOffice
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AdapEveTeamFuncEonalityChecklistFunc%onality RequirementStatement ReviewQues%ons
✓1.Mee&ngSpace
Teammee&ngspaceavailablewithwallspacetopostmetricsandteamsolu&ons.
a.Mee&ngspaceconvenientlylocatedandavailablewhenneeded.
b.Roomhasneededequipment/supplies–whiteboards,flipcharts,etc.
c.Metricsandteamprojectspostedandupdatedweekly.
2.DataAnaly&csandOpportunityIden&fica&on
DataAnaly&cs(DA)Teamformedandmeetsmonthlytoiden&fyperformancegapsinordertoiden&fyandpriori&zeopportuni&es.ProblemSolvingTeamsassignedtoaddresspriori&es.
a.Monthlymetricdataisreviewedforperformancegaps.
b.Issuesandopportuni&esareiden&fiedandpriori&zed.
c.Poten&almembersofProblemSolvingTeamsareiden&fied.Associateshavetheopportunitytovolunteertoserveonteams.
3.ProblemSolvingTeamsFormedandRegularlyMeet
ProblemSolving(PS)Teamsareformedtomakerecommenda&onsforpriorityini&a&ves.
a.DATeammember(s)launchPSTeam–callfirstmee&ng;iden&fyteamleader;sharedata,problemstatement,andanyboundaries
b.Conductfirstproblemsolvingmee&ng.
c.PSTeamsmeetweeklyforatleast60minutes.
4.DataAnaly&csandProblemSolvingProcesses
Dataanaly&csandproblemsolvingprocessesareinplaceandregularlyused.
a.DATeamhasanaly&csandpredic&vecapability.
b.PSTeamshaveaccesstoneededdataandexper&se.
c.Teammembersaretrainedindataanaly&csandproblemsolvingtoolsandprocesses.
5.Addi&onalDataandExper&se
PSTeamsareregularlygatheringnecessaryinforma&onandaccessingHomeOfficeexper&sewhenneeded.
a.Representa&vefromDATeammeetswithPSTeamtosharedata,problemstatement,andanyboundaries.
b.PSTeamgathersanyaddi&onaldataneededtodevelopsolu&on.
c.PSTeamhasaccesstoHomeOfficeexper&se.
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AdapEveTeamFuncEonalityChecklistFunc%onality RequirementStatement ReviewQues%ons
✓6.Solici)ngInput
ProblemSolvingTeamsshareproposedsolu)onforinputandfeedback.ThePSTeammayseekaddi)onalinputontherevisedproposedsolu)on.
a.PSTeamreviewsproposedsolu)onwithCenterLeadershipandAssociatesforinputandfeedback.
b.Addi)onalinputmayberequestedonrevisedsolu)on.
c.PSTeampreparesfinalrecommenda)onincludingnecessaryresourcesandimplementa)onplanforCenterleadership.
7.ApprovalandImplementa)on
Centerleadershipapprovesfinalsolu)on,resources,andiden)fiesImplementa)onTeam.
a.Centerleadershipdetermineshowdecisionwillbemadeandbywhom.
b.Centerleadershipacquiresnecessaryresourcestoimplement.
c.Implementa)onTeamisformedwithPSTeamoverlappingmembership.
8.FollowUpandLearning
Implementa)onTeamtracksprogresson30-60-90daybasisandreportsprogressatCenter’smonthlymee)ng.
a.Solu)oniscommunicatedtoallaffectedandimplementa)onbegins.
b.Implementa)onTeamensuresongoingsupportandresourcesinplace.
c.Progressofini)a)vereportedoutatMonthlyAssociatesMee)ng.
9.MonthlyUpdates
DataAnaly)csTeamconductsmonthlyupdateforallemployees:• MetricsScorecard• Performancegaps• Priori)zedopportuni)es• Problemsolvingteam
assignments
a.MonthlyupdatetakesplacesharingMetricsandteamini)a)ves.
b.AssociatesareinvitedtomeetwithProblemSolvingTeams.
c.Teamsolu)onsaresharedwithallAssociatestosolicitinputandfeedback.
10.Scheduling,Logis)csandPos)ngData
Teamschedulingandlogis)csaresetinadvanceandpostedweekly.
a.DATeammeetsmonthlytooverseeprocess.
b.PSTeamsmeetweeklyforatleast60minutes.
c.DAandPSTeamworkpostedweeklyinMee)ngRoom.
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MetricsScorecard
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TeamEffecEvenessAssessmentMeasurement Categories
Stage 1 Polite
Stage 2 Why We Are Here
Stage 3 Bid for Power
Stage 4 Constructive
Stage 5 High Performing
Goals and Objectives
Objectives are not discussed or focused on very much.
Objectives are discussed and people commit to working towards the final objectives.
There is considerable disagreement on how to reach objectives.
The team is working together to meet objectives.
Objectives are being met and there is little wasted motion.
Sharing Information
People share a lot of general information.
Most information that is shared relates to objectives and tasks.
People or cliques are primarily pushing their own ideas.
People are open to new ideas. They are asking questions to seek information and understanding.
People willingly share and listen to each other’s views and seek to understand all sides of an issue.
Cliques or Subgroups
Cliques are being formed, but have little effect on the team.
Cliques exist and are having some influence on the team.
Cliques play an important part in influencing people’s behavior and are used as a base of power.
Cliques have less effect on the team and are beginning to dissolve.
Cliques don’t exist in the team.
Hidden Agenda items
People do not share their hidden agendas.
Information is coming out that begins to point out people’s hidden agendas.
People are becoming more aware of each other’s hidden agendas.
Most hidden agendas are understood.
People have accepted each other’s hidden agendas.
Risk-Taking There is little or no sharing of people’s true feelings and thoughts.
People are beginning to open up and share some feelings and thoughts.
People are sharing their ideas and feelings in order to influence others and gain power.
People are seeking out and are open to other’s ideas.
Individuality and creativity is high. People respect each other’s views. A feeling of freedom is present.
Conflict People avoid controversial topics and say acceptable things.
There is very little conflict and open disagreements.
Conflict is very high. People are trying to get others to support their position.
People deal with disagreement as a mutual problem rather than as a win-lose battle.
People view disagreement as useful and a way of ensuring that all aspects of an issue are understood.
Participation A few people are taking part in general discussion, while others are saying very little.
Almost everyone is taking part in discussion.
Some people are trying to influence others, while others are sitting back waiting for the “smoke to clear.”
Almost everyone is contributing ideas, suggestions, and energy to meeting objectives.
People participate as much as they ever will, people seek each other’s involvement.
Total ___________ Total ___________ Total ___________ Total ___________ Total __________
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AmbidextrousLeadership
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AmbidextrousOrganizaEon
SustainingInnova-on Disrup-veInnova-on
RevenuePerformance
PerformanceNetwork
• Theparentstructureforopera/ngP&Lsonprovenbusinessmodels
• Focusonrevenueperformance• Healthmeasuredbyfinancialopera/onra/os,
resourcealloca/onhurdlesandperformancemetrics.
Transforma-onNetwork
• Wheredisrup/vebusinessmodelsgotobescaledtosize
• Towinmustcatchnextgenera/ontechnology/sciencejustasitsenteringitsmarketgrowthphase.
• Thisnetworkcanalsoredesigntheopera/ngmodeltooneormorebusinessesinthePerformanceNetworktolessentheaHackofexternaldisruptors.
Enabling
Investment
Produc-vityNetwork
• Homeofenablinginvestmentsinsharedservices,allmanagesascostcenters–IT,HR,Legal,finance,andadministra/on,etc.
• Anyfunc/onnotaccountableforrevenue.• Focusisapplyingsustainedinnova/onandcon/nuous
improvementtoproduc/vityenablingini/a/vestargetedattheperformancenetworkwiththeROIin
horizonone.
Incuba-onNetwork
• Theenablinghosttofastgrowingoffersinemergingcapabili/esandmarketsthatarenotproducingrevenue.
• Horizon3–severalyearsout.Incuba/onlab.PorPolioofinnova/ons.
• Hasitsownseparateanddis/nctopera/ngmodel.
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AdapEveAmbidextrousLeadership
CEO
DecisionNodes
PerformanceRevenueNetwork
Transforma7onNetwork
Produc7vityNetwork
Incuba7onNetwork
Strengths • Designedforsimplicityandspeedofdecisionmaking(decisionnodes),Fullexecu7veteammembershipinmee7ngs,engageimplementersindesignprocesstospeeddecisionmaking,lowerrisk,testandlearn,andfastscale.Focusonperformanceandalloca7onofresourcesinbothRevenueandInnova7on.
Weaknesses • Non-hierarchywayofworking.
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AmbidextrousNetworkEcosystems
Executive Leadership Team
Performance Revenue Network
Productivity Network
Incubation Network
Transformation Network
Networks with delegated decision-making rights Operating within the context of an Ecosystem
FastDecisionNode
FastDecisionNode
FastDecisionNode
FastDecisionNode
Rapid Design Sessions
Rapid Design Sessions
Rapid Design Sessions
Rapid Design Sessions
Executive Team Members
Decision nodes Of 2-3 Executives (RACI configuration)
Reconfigurable Networks to generate solutions fast, prototype, test in market, and scale
Stress Test Design solutions
Op0miza0on Innova0on
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Conclusions
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FromTradiEonaltoDigitalSTSDimension FromTradi.onalSTS ToNewSTS
Eraand.me IndustrialandComputer1950-2010
DigitalEra2011–current-future
Technology Mechanicalandcomputer
Digital,machineleaning/AI
Whatleadstohighperformance
SocialandtechnologyopDmizaDonandfit.AbsorpDonofuncertainty.
Social,Technical(workprocesses),technology(digitalandelectro-mechanical),andinformaDonopDmizaDonandfit.AgilityinfaceofuncertaintyandvariaDon.
Unitofanalysisfordesign Workunits
Ecosystem
Technicalsystem Internalfocus,Linear,RouDne,ProducDon/officeprocesses
Internalandexternalfocus,Non-linear,uncertain,e.g.,CustomeruserJourney
Socialsystem Workunitsandmanagement
Ecosystem/network
Worksystem WorkUnits–Jobs,roles,Teams,andworkflowregulaDon.InterpersonaldeliberaDonsanditeraDons.
OperaDngModel–CoordinaDonandintegraDonbydigitalsystemandsmartteams.
Cyberne.csystem Self-regulaDon
ArDficialintelligence,DecisionCriteriabuiltintodigitalsystem,ConDnuouslearningsystem
Approachtodesign DesignProject,ImplementaDon,AssessmentandIteraDon
Build–measure–learn.