One of the old (but funny) jokes about consultants goes something like this: a consultant borrows your watch so that he can tell you what time it is.
There's a lot of wisdom in that saying, especially to Annette Walker, who, truth be told, is married to a consultant. It's a condescending joke, undoubtedly first told by a cynic, but it means that you essentially hire a consultant to tell you something you already know, or should know.
Walker and her colleagues at St. Joseph Health System in Orange, CA, have taken the old joke to heart.
"To some extent, every consultant relies on your internal knowledge," explained Walker, St. Joseph's senior vice president of strategic services. "And they have to repackage it and turn it around and give it back to you."
You could say that Walker and her team have "insourced" that concept. Essentially, St. Joseph's strategic services team, started two years ago from scratch, serves as a consulting group available to any clinical or administrative team in the healthcare system. But competition for their expertise is fierce, says Walker. That's the way it's supposed to be.
In part, the health system's senior executives are owed this service, because each senior executive has donated at least one member of his or her team to serve in the group.
"It was a challenge to get people to give up their right-hand person," Walker says. "The CEO had to do some convincing."
After all, it was the CEO's idea, as a way to both save money and utilize the talents and institutional knowledge of the people who already worked at St. Joseph's. The strategic services team would not report to a management silo of any kind. Instead, it would lead process improvement teams or other specialized projects identified by the senior leadership team as ideal for a consulting engagement.
Walker, who had control over who came to the team, recruited people with diverse skills in quality, marketing, IT, and clinical analytics, among others.
"Everyone was the master of some skill, and there was not a lot of overlap," she says, adding that "we didn't know what areas we wanted at first."
With so many unknowns, Walker built gradually -- looking for people who had demonstrated a track record of flexibility and success.
"It was not so scientific -- we said we want people who could live with some ambiguity and who [would be] comfortable working on a finance project today and a marketing project tomorrow," she says. "We also wanted people who would be comfortable working under a much different leadership style."
She ended up with a 16-person team that could be deployed SWAT team-style to pressing strategic issues the system was likely to face. That was two years ago.
Walker resisted the temptation to develop any type of reporting structure for a year because she wanted team members to realize that no priority—not even their former boss's wishes—was bigger than any other.
"We wanted people who could effectively float to the needs of the organization and leadership was based on the need," she says. "In healthcare, people have traditionally been comfortable with lines of authority. We wanted to change that."
The team meets for a half hour (and no longer) every Monday at 8:00 AM. They all stand so as not to get too comfortable. They use whiteboards to detail all the work currently in process. The team talks about what needs to get done this week and whether team members assigned to certain projects need to enlist help.
"Is there any dissatisfaction that I need to talk to one of the executive sponsors about?" Walker asks rhetorically, in her staccato meeting style. "Sometimes that person might be the holdup, and I might need to intervene."
The team incorporates individuals that come from both management and non-management backgrounds. It consists of one vice president of business development and the vice president of marketing. There are three associate vice presidents: one in quality, one in finance, and one in communications. It has four "generalist" directors, two project managers and four analysts.
The diversity of the work depends on the needs of the executive "sponsor." Consultants on the strategic services team dowork ranging from writing manuals, to business assessments, to business plans.
Team members wrote one business plan for wellness, and another for telemedicine. In the first nine months, Walker estimates the team saved the healthcare system $3 million for worth that would have otherwise been outsourced.
What has been difficult? Getting team members to report their productivity in the same way as in a consulting agency, "because healthcare people don't do that," Walker said.
The system hasn't abandoned the use of consultants, but it is very choosy on when to use them. For most projects, Walker says, the strategic services team already knows the background information and history of problems that could take a significant amount of time to educate an outside consultant, "which you also pay for," Walker adds.
Walker says she expected the program to succeed, but is "blown away by the results. Not only by the performance, but the level of excitement and happiness they have with their jobs. They are learning faster, and we just did an employee satisfaction survey. On every score, we got 100%. National benchmarks are 70-80%."
Walker makes sure her team acts in another way exactly like consultants. When the project is over, they're gone. "This is one-time work and then you leave it," Walker says. "Don't assume responsibility for how it is run."
Philip Betbeze is the senior leadership editor at HealthLeaders.