SatelliteHealthcare-ASociotechnicalDigitalDesign

ofaDialysisEco-system

STSRoundtableCaseStudySeptember2017

CONTENTS

STSRoundtable–September2017 2

ContextReimaginedHome–SociotechnicalDigitalEcosystemDesignDialysisCenterTransformaEon–AdapEveWorkSystemRedesignAmbidextrousLeadershipConclusions

CONTEXT

DigitallyEnabledOrganizaEonsandEcosystems

STSRoundtable–September2017 4

Ourabilitytoconnectthroughdigitaltechnologyhastransformedworksystemstonewcomplexdigitallyenabledteamsand

networksthatextendbeyondtheorganizaEontotheecosystemLinearSociotechnicalDesign

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

DigitallyEnabledEcosystems

DesignSessions

AboutSatelliteHealthcare

STSRoundtable–September2017 8

•  FoundedbyNormanCoplon,MDin1973

•  HeadquarteredinSanJose,CAwith80locaEonsacross6statesprovidingkidneydialysistoover7800paEents

•  $200millioninrevenuewithover2000employees

•  Approximately20%ofpaEentsinhomedialysis;over50%returningtoCenterswithin3months

•  HomeandCenterDialysisservicelinealignmentandeventualintegraEon

ReimaginedHome-ASociotechnicalDigital

EcosystemDesign

GoalsforReimaginedHome

•  ReducethedropoutrateofdialysispaEentsonhomecare,whileimprovingthecustomerexperienceandreducingcosts

•  IncreasepaEentsaEsfacEon

•  DevelopadigitalapplicaEonthatsupportsdeeperpaEentengagementandconnecEonandbe\ermanagementoftheircondiEon

•  CreateanewindustrystandardfordialysishomecarethatenhancesSatelliteHealthcare’sindustryleadershipandservesasasourceofcompeEEvedifferenEaEonandincreasedmarketshare

•  IncreasehomeprogramEBITDAgrowthasaresultofthenewresourcesandtools

•  ReceiveaposiEveROIfromtheReimaginedHomeiniEaEvein2018andbeyond

PaEentTouchpointsMapping

TouchpointsSummary

VarianceControlMatrix

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

PaEentPersonas

PaEentPersonas

Technology

PhysicianReferral

Dr.PatelloisreferringKaratoWBforMyChoiceassistance(formallyOp<onsTraining).Dr.PatellohandsKaraacardthathasprintedonitdirec<onsforhertomakeanappointmentwithaWBWellnessAdvocatewithherphoneanddownloadthesuppor<ngLifeOp<onsMobileapp.

Technology

KaraConnects…

KaratypesinthemessagefromthecardandatextmessagereturnswithlinktoDr.Patello'spagedescribingtheappandalinkwithinstruc<onstodownloaditfromiTunes.

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.

Technology

KaraDownloadstheMyChoiceApp

Karaenteshercode:

mychoice23

ThiscodelinksKara’sapptoDr.PatelloandtheWBsitePatellohasreferredKarato.

DialysisCenterTransformaEon-AnAdapEveWorkSystemRedesign

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.”

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

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

AdapEveTeamEvoluEon

Tradi&onalHierarchicalleadershipLi2ledataEmployeestold

Collabora&veLeaderdependentHistoricaldataPerformanceorienta&onProblemsolvingteams

SelfManagingLeaderascoachLivedataPa&entcentricTeamsformanddisbandasneededExternalresourcesrespondtoteamneeds

SMARTLeaderasnetworksponsorandboundarymanagerPredic&vedataPa&entdrivenDigitallyenabledSMARTCareTeamswithpredic&vediagnos&csdeliverpersonalizedtreatmentplansSystem-wideresourcesfullyaligned

“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

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.

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.

MetricsScorecard

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 __________

AmbidextrousLeadership

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.

AdapEveAmbidextrousLeadership

CEO

DecisionNodes

PerformanceRevenueNetwork

Transforma7onNetwork

Produc7vityNetwork

Incuba7onNetwork

Strengths •  Designedforsimplicityandspeedofdecisionmaking(decisionnodes),Fullexecu7veteammembershipinmee7ngs,engageimplementersindesignprocesstospeeddecisionmaking,lowerrisk,testandlearn,andfastscale.Focusonperformanceandalloca7onofresourcesinbothRevenueandInnova7on.

Weaknesses •  Non-hierarchywayofworking.

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

Conclusions

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.