In the world of healthcare, a CPT® code refers to the (trademarked) acronym of the Current Procedural Terminology, a set of codes describing medical procedures received by patients.
In the world of communications, a code is a system of rules to convert information into another form. Like a Morse code, an encryption code — or a code to translate medical procedures into a single 5-digit number, as in the CPT® code.
The “code” that I’d like to discuss in this week’s Telehealth Tuesday is about the effect of Culture, Process, and Technology on progress, innovation, and improvement in a healthcare organization.
The Pressure to Innovate Is On
Virtually every leader these days agrees that without improvement, without innovation your team, your organization will cease to exist. It’s the natural law of atrophy that anything with use or care will “gradually decline in effectiveness or vigor”. Unlike people, organizations do not die of old age. They die because they fail to keep themselves relevant in an ever-changing environment.
Therefore, the pressure on healthcare organizations to improve, to innovate, and to keep up with the technical and societal progress has been strong for more than two decades. Yet just in the past years, three trends have significantly increased that pressure:
The Covid-19 health crisis making telehealth a primetime care modality that defies geographic boundaries.
To address these seismic changes, what are the three most critical ingredients? They are: a flexible culture, well-defined processes, and tailored technical solutions. C, P, and T.
Finding Your CPT Code
As creative human beings we can find a solution to virtually any problem. But first we got to know what the problem we are trying to solve. To gain clarity on what needs to be done, we first need to create awareness about the obstacles.
A shorthand for this can be to determine your team’s or your organization’s “CPT” code: how well your organization, your team would rank each of the three dimensions against the ideal state. To determine your team’s code, simply rank yourself on a scale of 1-5 against the desired level, with 5 being the highest score:
How flexible is your culture when it comes to change (1-5)?
How defined are the processes (1-5)?
How well have the technology solutions been selected to suit your unique requirements (1-5)?
I.e., a high-performing team would have a CPT code of “5-5-5” and a team not ready for effective change a code of “1-1-1”.
Let’s explore how the various combinations of Culture, Process, and Technology rankings affect each other:
Culture vs. Process
When the culture of an organization is very rigid, it is very resistant to change. A lot must happen before the people in such an organization move into the desired direction.
A flexible culture on the other hand is prepared or maybe even anticipating new changes all the time and most likely is thriving on something new.
On the process side, when the workflows and the steps and the hand-offs between people are not well-defined, we find ourselves in an “ad hoc” world, where everybody mostly does what they think is right or needed, with lots of variation across the team and maybe even from week to week.
In an ideal environment, workflows and processes are documented and defined and everybody knows their role and responsibility.
When you have a team with a flexible culture and well-defined processes, then the organization is characterized by Efficient Progress (the yellow quadrant, upper right). If on the other hand the culture is rigid with very loosely defined processes, you have a Hidden Anarchy — everybody can do what they want and everybody likes it this way, no complaints (the gray quadrant, lower left).
When workflows are not well defined, but the culture is open to change, the lack of defined processes may provide great opportunities for Adaptive Agility – changing the work to the problem or task at hand (lower right, the green quadrant). E.g., a clinical team serving the homeless population outside the clinic walls needs a lot of flexibility to deal with the variety of challenges they are sure to encounter.
On the other hand, in a highly rule-abiding, inflexible culture with clearly defined processes, the result is highly Effective Atrophy: With an unwillingness to change and a defense of the defined processes, the team loses its ability to serve its customers in new ways (upper left, the blue quadrant). This is one of the most dangerous places to be for an organization, and death is often quick and, once recognized, virtually impossible to prevent.
Technology vs. Process
On the technology dimension, the desirable state is one of using technology solutions that are a tailored fit to the unique needs and requirements. On the opposite end of the spectrum are run of the mill, bland, or readily available technologies that were selected for reasons other than their usability or performance.
When tailored solutions are used in an environment with well-defined processes, the result is very High Productivity (upper right, yellow quadrant). With documented, repeatable steps and a solution that does exactly what is needed, the team can deliver high quality services. Imagine for example an OR team with specialized surgical tools: all steps are pre-planned and each tool is picked for the unique task at hand.
On the other hand, when an organization has well-defined processes but is not provided with tailored solutions, you get Frustrating Effectiveness: yes, the processes get the job done, but it’s very frustrating because the tools are not optimized for the task at hand. E.g., think about quickly cobbled-together telehealth solutions embedded in EHRs that provided minimal functionality and a dismal user experience.
If fit-for-use technical solutions are indeed available, but little thought was put into the standardization of the processes, then the quality varies greatly depending on the conscientiousness of the individual user. Ultimately the result is an Expensive Inefficiency given the usually high cost of customized technology solutions.
In the lower-right, gray quadrant we find ourselves something that could best be described as a Sputtering Engine: there’s great variability in the processes and the technology tools are whatever is available. Work gets done, but it’s inefficient, ineffective, and probably has a great deal of quality fluctuation.
Technology vs. Culture
In the last pairing of the three elements of the CPT code, we are pairing Technology and Culture.
With a rigid culture that is unwilling to embrace change but forced to use non-optimized solutions, you find a sentiment of Faked Contentment. Unwilling to admit that change must happen, the team plows on despite the many frustrations or shortcomings of the technology.
With subpar technology but a culture that is more flexible, at least a degree of the resultant Underperformance is made known and usually efforts are quickly underway to remedy the situation through better technology solutions.
When on the other end of the matrix, the green quadrant, a rigid culture is given some custom-tailored tools, it can best most optimistically be described as a Slow Adoption, since the resistance to change will make it very hard for the team to reap the benefits of the well-suited technology.
If however a change-ready culture is handed the perfect-fit technology solutions, the team will run with it and find even better ways to adopt and adapt the technology, most likely finding new and improved ways to provide the service: Improving Productivity.
Using Your CPT Code: An Example
So, how do you use your CPT code? The main benefit of a self-assessment is simply the self-awareness about your current situation.
The objective here is to recognize the current shortcomings that stand in the way of changing into a high-performing team that delivers outstanding services.
Let’s take the example of a health center that wants to add tele dental services to its offerings. Their self-assessed CPT code is 2-1-2: a culture quite resistant to change, no defined processes (since this is a new offering) and no access to custom solutions, such as an EMR or telehealth solution optimized for dental services.
The team next decides that in order to launch the new dental service successfully, they’d like to get their CPT code up to a 4-4-4 and they identify a set of specific actions to close the gap between their 2-1-2 and the desired 4-4-4. Here are just a few examples:
Technology: Assess the current EHR features with regards to supporting dental services. Talk to other health centers using the same EMR that are offering dental.
Processes: Define the ideal/desired workflows that later on can also inform the search for custom-tailored technology solutions, once the needs are understood.
Culture: Change the team composition to add more individuals that are excited about the change. Increase the desire in “fence sitters” by explaining the benefits of this new offering and how valuable dental care is for the overall health of the community.
If you think that takes too much time and is too slow or expensive, consult the three charts above and the respective quadrants for an organization with a CPT code of 2-1-2.
C=2, P=2: Hidden Anarchy – everyone does want they want to
Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.
Contact Christian by phone or text at 657-464-3648, via email, or video chat.
Christian Milaster optimizes Telehealth Services for health systems and physician practices as the interim Telehealth Program Director. He serves as a Digital Health & Telehealth Advisor to startups and established Health IT firms.
Christian is a Master Builder of Digital Health and Telehealth Programs and the Founder and President of Ingenium Digital Health Advisors, a boutique consultancy focused on enabling the effective delivery of extraordinary care through workflow optimization and the judicious use of technology.
Born, raised, and educated as an Engineer in Germany, Christian started his career at IBM Global Services before joining the Mayo Clinic in Minnesota, where he worked for 12 years in various roles before launching Ingenium in 2012.