MetroHealth's Secret to Managing Change? Embrace It.

The Cleveland-based health system has set ambitious multi-year goals for making changes across its clinical, physical, and operational initiatives.

For many health systems, adapting to change is a near-term inevitability. They proceed dutifully, and with caution. You can almost hear the groans.

But for The MetroHealth System, the safety net provider for Cuyahoga County, OH, change is a welcome opportunity to adopt new strategies and abilities.

"Innovations and new environments all demand new strategies and abilities," says CFO Craig Richmond. Richmond made his remarks in August at the HealthLeaders CFO Exchange in La Jolla, California.

For the fiscal year ending Dec. 31, 2016, MetroHealth reported total revenue at $1.04 billion. In 2015, the health system posted total revenue at $941 million.

The health system's patient-population has grown from 180,000 patients in 2012 to a projected 300,000 next year. "We've had remarkable success and growth over the years," Richmond says.

Expanding its services has been a top priority. From 2012 and projected through 2018, MetroHealth will have grown in these ways:

• Inpatient facilities – from one to three
• Emergency departments – from one to four
• Outpatient facilities – from 20 to 30
• System-owned pharmacies – from three to nine

The system is investing heavily at the brick-and-mortar level, Richmond says. "We just executed on one billion dollars in financing to rebuild a majority of our main campus.

From a strategic perspective, MetroHealth is trying to harness the transformational potential of change, he says. It has adopted a three-pronged operational unit called DoIT: the Department of Integration and Transformation.

The DoIT trident features business-intelligence data, robust project-management capabilities, and a decision-acceleration model that "allows us to accomplish more at an accelerated pace," Richmond says.

1. The Department of Operations Research and Analytics (DORA):

• Analyzes specific business processes or questions;
• Manages business rules for inter-departmental data use;
• Generates forecasts, simulations, and linkages of clinical, financial, and operational data

2. Results Management Office (RMO):
Focuses on desired outcomes;

• Uses data-driven methodologies for optimizing innovation and cutting waste;
• Leverages employee knowledge to boost quality of decision-making;
• Features several project management capabilities, such as prioritizing initiatives, optimizing resource allocation, reducing risk, and increasing return on investment.

3. Center for Disruptive and Radical Experimentation (DARE):

• Fosters employee participation in decision-making, with emphasis on enabling staff to challenge the status quo.
• DARE efforts include Meeting-Free Fridays, which encourage spontaneous interactions among staff members, an Idea Lab, which serves as a dedicated space for DoIT activities, and about 40 interdepartmental "game-changers" – employees who serve as proponents of change across the organization.

"Each one of these individual divisions can have a significant impact within the organization," says Richmond. "But similar to a multifunctional tool, when all three are working together you can create better results."

For the period spanning 2012 to 2018, MetroHealth set goals for transformational change in three areas—clinical, operational, and physical:

• Clinical features – expansion of its primary-care network, IT-enabled integration of care settings, care management, and assumption of financial risk
• Physical features – distribution of anchor facilities evenly across the local market and the construction of a new main campus
• Operational features – building analytics capabilities and restructuring based on the service-line model

Creating a culture of continuous process improvement generates significant gains, Richmond says, quoting legendary basketball coach John Wooden, "If you don't have time to do it right, when will you have time to do it over?"