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Strategy Question: How should we approach our internal cost reduction/value enhancement efforts?

Summary: Cost reduction and process improvement techniques are everywhere. The tools all work, but how do you know which tool to use when? You can waste precious time and demotivate your teams if the wrong approach is chosen. But where to start? It is a dilemma for all of us. This chapter discusses the basics of each improvement approach. It is in no way a comprehensive treatment of each, but it is thorough enough to steer the user to the right approach. The tool provides guidance regarding proper selection among numerous methodologies and techniques currently ubiquitous in business literature. Overviews of three major cost reduction/process improvement approaches are discussed, (1) Seven Basic Quality tools, (2) Lean Manufacturing, and (3) Six Sigma. The Process Improvement Clarification Tool helps direct the user to the appropriate approach based on the user’s knowledge of the process state. Real-world examples are used to help users select the right technique for the right situation.

Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.

To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.

Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.

We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.

Strategy Question: How can we enhance our reputation with our customers in the most effective and efficient manner?

Summary: In the structure and flow of this book, various tools have already dealt with some big issues that naturally impact channel partners. Product/service performance and Price/Cost are among two of the biggest areas that have already been addressed. So, we ask ourselves what additional actions can we take to become a better channel partner. These relationships are extremely important. At this point we refer back to the material on process improvement techniques and now suggest turning these toward customer facing process issues. The Pareto Chart (the 80%/20% rule) is discussed in terms of setting a method to measure and gather data, target setting, problem solving against that target, and monitoring improvement progress. This provides guidance and suggestions to focus process improvement tools toward the customer facing part of the organization. Suggestions and approaches are discussed. In cases where the company does not have a metric for the item at issue, a simple quality tool is introduced to provide timely definition of the issue.

Purpose: The purpose of this study is to analyze the changes organizations can adopt to move beyond budgeting. We show how these changes can be understood as modes of adaptive performance management that explains the ways in which organizations move beyond budgeting to become more adaptive. The proposed modes are then used to derive propositions for future research.

Methodology/approach: We follow a conceptual approach through an analysis of the beyond budgeting principles using the management and systems literatures on radical decentralization. We theorize how organizations can enhance their adaptability to environmental uncertainty through changes to their management structure and control processes.

Findings: We show that organizations can move beyond budgeting by decentralizing within or beyond their management structure and modifying or removing their budget-based control processes. We propose that beyond budgeting can be conceptualized as four modes of adaptive performance management: better budgeting, advanced budgeting, restricted budgeting, and nonbudgeting.

Research limitations/implications: The four modes of adaptive performance management can be used in future research to consider how changes to management structures and budget-based control processes can enhance the organizational adaptability needed to manage environmental uncertainty.

Practical implications: We show that while the nonbudgeting mode may be most suited to organizations facing high levels of environmental uncertainty, organizations facing low–to-moderate levels of environmental uncertainty can achieve sufficient levels of adaptability with less extensive changes to management structure and budget-based control processes.

Originality/value: The four modes of adaptive performance management reflect different approaches for dealing with environmental uncertainty. Positioning nonbudgeting as one mode and identifying alternate modes of adaptive performance management provides a basis for comparing and understanding the changes organizations make to move beyond budgeting.

The purpose of this chapter was to describe the development of an early childhood learning network and to understand that development through the lens of complexity theory and trans-organization development. It explores the unfolding dynamics and emerging meaning that became central to facilitating the design, development, and implementation of the complex multi-stakeholder network.

The chapter identifies 12 implications from complexity theory for practitioners of trans-organization development, and then applies those implications to the process and understanding of development stages of an NP’s early childhood education network.

The use of complexity theory as a framework allowed for identifying five key observations and conclusions, in particular the significant role that meaning-making dialogue holds as a driver of common understanding and engagement among stakeholders. Additionally, the use of building responsive processes, understanding contextual shift, impact of power as an attractor pattern, and capacity of flexibility and adaptability all become essential elements of complex network leadership.

The findings of this chapter will help trans-organization development practitioners and leaders alike. Both the implications and lessons learned will assist in building the capacity of leaders and practitioners as a means of improving effectiveness in dealing with emerging dynamics and leading in unknown contexts and complex contexts environments.

Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In this chapter, we use agency theory to examine the evolution of bundled payment programs in private and public payer arrangements, and postulate future directions for bundled payment development as a key component in the provision and payment of health care services.