Putting Patient Engagement To Work, No. 3

The budding patient engagement "movement" is mainly about improving clinical and economical outcomes. It's about quality and efficiency, being more effective. D' you s'pose our leading management thinkers and practitioners might have a worthwhile thing or two to add along those lines?

I do. 

In the sub-sections below, I want to touch on one management process and another practice that I find germane to the subject. I'll describe some of the work being done around each, who's doing it, the tools and techniques they're using, etc.

Voice of the customer (VOC) (#notVolatileOrganicCompound)

The customer is king. And the "fact" -- debatable -- that he's always right (in reference to the famous Marshall Field quote) has been the case for as long as I can remember.

Recent studies are backing this up. From IBM's The Customer-activated Enterprise, for example, "Outperforming organizations are much more likely than underperforming ones to be collaborating with customers." Plus, "We found that companies that are receptive to customer input tend to have longer and more profitable relationships with their customers than companies that keep customers at arm's length."

Two companies that stand out in my mind for being ahead of the curve are Toyota (with its Toyota Way) and Procter & Gamble. Both have long "known it in their bones" that contexts matter. You simply can't do a great job of satisfying customers without partnering with them, and without absorbing and incorporating their very particular, i.e., local, knowledge. 

Now other companies, in their efforts to catch up, are looking to their own customers for feedback and insight. They're commissioning Chief Customer Officers*. And they're leaning for help on management consultancies that specialize in things like VOC.

VOC -- voice of the customer -- is a term used in business to describe the in-depth process of capturing a customer's preferences, expectations and aversions. I think of it as nearly synonymous (a near-o-nym? an almost-o-nym?) with patient engagement.

Vision Critical is one such consultancy. It specializes in building and supporting cloud-based customer intelligence platforms -- insight communities -- that provide companies with ways to deeply engage their customers. The goal in every case is to deliver meaningful insights that companies can use to make better decisions. Companies...

And other organization-types, as well. Nonprofits in the healthcare arena, for example, are using insight communities to understand and develop new patient journeys, explore and obtain feedback on new treatments, and more. Take Cleveland Clinic: it's been using one to listen to its patients. And reaping the rewards. Its "Patient Panel" has helped the Clinic improve internally in areas from marketing to operations to HR. Check out Do better for your customers: 5 business lessons from patient communities for more.

Delegation

Patient engagement = getting things done through other people = delegating

If you've been following along and clicking through my links, you know about PCORI’s, Boston Children's', and Cleveland Clinic's conceptions of the kinds of things that are delegable to patient partners. There are a lot o' things, aren't there? So many, in fact, that one might begin to wonder what's not potentially delegable. (Isn't every thing on every employee's to-do list at least a candidate? I mean, once someone commits to completing a task, he or she has three options: do it right away, do it later, or delegate it to someone else...) 

Alison Green and Jerry Hauser, authors of Managing to Change the World (2009), believe it's a nonprofit leader's duty to delegate. "If you can delegate it, you should delegate it, ” they write. Delegating should enable you to make the most of your limited** human resources and thereby maximize the effectiveness of your organization in pursuing its mission. 

Stop for a second. How many nonprofit leaders, for the sake of the mission, try to hand off every task they can? How many equate patient engagement with delegation?

When you delegate well, you put people in positions to do what they're dramatically well-suited to do. But it doesn't just happen. To the contrary, there are practices to be practiced, step-by-steps to follow. Green and Hauser offer easy-to-implement tools, for example, for determining what to delegate, assigning roles and responsibilities, and successfully guiding off-loaded work to completion. Bain and Company (one of Earth’s largest and oldest consultancies; Consultasaurus rex?) has compelling things to say about the decision making that goes into delegating. (“One key to successful delegation is to coach team members on making and executing critical decisions.” See How to be a Better Boss)

The bottom line here? 

Those who would engage patients should learn the ABCs of delegating from the ABCs -- thanks for the acronym to David K. Hurst, one of the “C”s -- of management: Academics, Business people, and Consultants.

*  *  *  *  *

Now, generalizing and summarizing:

There’s no need to completely reinvent the wheel if you’re an executive in the healthcare world who's considering a patient engagement initiative. You can look to what’s working in the business world…and apply liberally. I know in the cerebral palsy (CP) /neurological disorders arena we’re not drawing upon that knowledge nearly as much as we could. 

*Essentially, the CCO is expected to form deep personal relationships with the company’s customers to truly understand them. 

**I’ll call into question how limited those human resources really are later.

Method-in-the-Making For Engaging Constituents

My Two Cents_10

PURE INSIDERS WANTED

It's time for our nonprofits to stop seeing the millions of us inside-outsiders as walking wallets and free labor (at worst) or as passive consumers (at best). Stop. And start thinking, instead, about converting us into evangelists for your various causes.

One of the more influential books on nonprofit management of the past few years is Forces for Good. (Crutchfield and Grant, 2012) In it, the authors lay out six practices the high-performing organizations they've studied use to magnify their impact in the world. My favorite of the six suggests that -- in order to help create "an ever-expanding circle of impact" -- nonprofits should strive to turn outsiders into insiders, i.e., co-creators of organizational value. 

CO-PRODUCERS. CO-DEVELOPERS.  

What's their recipe for turning outsiders into insiders? Among other things, you have to "go beyond traditional notions of volunteerism, transcend mundane tactics, and create opportunities for people to actively participate." 

CO-WORKERS. 

When I put it that way, do you see the parallels between outsourcing work and the authors' idea of turning outsiders into co-creators? Outsourcing is an opportunity for inside-outsiders to contribute, to make a difference. It's engagement by another name.

I want to move on to Bridgespan Group's conceptions of constituent engagement, next, to help tie some of these things together.

My Two Cents_09B

I define outside-outsiders as organizations or individuals who may be willing and able to take on outsourced work from organizations in the CP arena, but who don't have any prior commitment or connection to it.

Here are three types of outside-outsiders (whose members, incidentally, will "do their thing" for either little or no pay):

• Pro bono professionals. Think legal, marketing, HR, etc. pros who donate their services to social change organizations. Example: Taproot Foundation acts as an intermediary between nonprofits and pro bono workers. 

• Freelancers. Two subcategories here: virtual assistants (organizations post tasks or projects and VAs complete them to spec; example: see MobileWorks) and gig /small service workers (workers proffer specific services that organizations buy; example: see Fiverr) 

• Students /academics. To come.

Are you utilizing this talent pool? If not, are you really maximizing the effectiveness of your organization in pursuing its mission?

*  *  *  *  *

Inside-outsiders, by contrast, are would-be workers (service providers) who have a personal stake in how well or poorly our kids fare. While they don't currently work in or for our organizations, they may be familiar with them. They're part of the neuro disorders community.

Here I'm thinking almost exclusively of parents and family members of kids with CP or other neurological disorders or conditions.

*  *  *  *   *

These two talent pools differ in significant ways. For now, I just want to touch on a few of the potential advantages to outsourcing to inside-outsiders, i.e., parents.

• For one, you get their passion. And, with it, trust-based relationships. Do these things lend themselves to creative problem solving? I'd say so. To innovation? Perhaps. 

• You also get their huge numbers. There are 14-18 million kids in the US with neurological disorders. Consider this: The average association executive probably works about 2000 hours in a year. If we could enlist a-half-of-a-percent of the parents of those kids to work just two hours per month (doing outsourced work, in service to our nonprofits) we could add over a million man-labor hours a year to help us in our fight. Who wouldn't want to try to put that to productive use? I sure would.

One other thing you get when you outsource to inside-outsiders is the increased likelihood that they will be transformed in the process...into pure insiders.

My Two Cents_09A

You as an organizational leader are going to want to delegate lower-value work to colleagues who can do it -- not necessarily as well as you, but -- well enough. Competently. The idea is to free yourself up to work on the largest, most pressing issues in your area of responsibility.

The goal of delegating is to maximize your effectiveness.

But our organizations are relatively small. There aren't large pools of potential delegatees. What, then, is the point? How much can "practicing safe delegating" really enhance an organization's overall impact?

Well, London School of Economics' Professor Julian Birkenshaw would have us understand that delegating is one of two ways to offload work. The other is outsourcing. (delegating to outsiders) I happen to believe that outsourcing -- or something like it -- may hold a key to amplifying our whole community's impact. I think it's well worth exploring. 

I'll lay out why in the next four or five posts. 

*  *  *  *  *

When I think of outsiders who may be able to do work on behalf of organizations in the CP sphere, two things jump to mind. One: I think of a vast landscape made up of a larger number of individuals and a smaller number of organizations. Two: If this were fifteen (15) years ago, most of the know-how and know-what associated with said landscape would have been next-to-impossible to access. Today’s communication technologies, however -- our new digital infrastructure -- make all that knowledge "there for the taking." 

The Net opens up a whole new world of possibilities for delegating to outsiders. Those of us in the neurological disorders community aren't even scratching the surface in terms of taking advantage of it. 

I see the outsider landscape as consisting of outside-outsiders and inside-outsiders. Those are only my distinctions, my constructions. But I think they're useful. And I'll characterize them in the next post.

My Two Cents_08

What’s your best “guesstimate” as to the amount of raw work it’s going to take for us to beat CP? Any idea how you’d even express it?

I think it’s going to take more work than most of us would imagine. Way more than our organizations as they’re currently construed could possibly handle on their own. So let’s do something about it. 

Let’s figure out how to get dramatically more work done.

Jerry Hauser and Alison Green, co-authors of Managing to Change the World, say “effective management” is about “getting work done through other people.” What work are they talking about? Ultimately, all the discrete tasks and projects organizations do (or would like to do) in trying to fulfill their missions.

Good managers are good at delegating tasks and projects. We, i.e., the leaders of our organizations whose work revolves around CP, can start here. We need to become master delegators.

“If you can delegate it, you should delegate it.” How many of us operate by that rule? How many of us know which projects or tasks we should delegate to create the greatest organizational benefits?

If we’re to have bigger impact, we’ll need to know these things. The good news is that delegation has the attention of the big-time consultancies I’ve been talking about. I recommend these brief intros to the subject: 

• this Bridgespan piece about Hauser and Green’s work (take special note of their free tools for making it easier to delegate well) 

• this roughly 3-minute video introducing some interesting work done by Julian Birkenshaw (London School of Economics) and Jordan Cohen (PA Consulting) about effectively addressing “the work that matters.”

Next: To whom should you hand your work off?