TheDemandPerspective

By Anna Caraveli

Wouldn’t you know it! I was struggling to figure out how I could brilliantly sum up what I learned from our interviews with Dr. Doug Henley, CEO of the American Academy of Family Physicians (AAFP);  and that is, how a fairly traditional association could unleash radical innovations that made a difference for their members and healthcare when most others are satisfied to just talk about them.  Then I happened to glance at today’s paper and my eyes fell on the horoscope column.  I read:

There is a lot of good that can be said for being on autopilot. It gets you to a destination with little effort. The problems arise when you want to go somewhere other than where you are programmed to go.”

That was it! It described in a nutshell the stalemate most associations (and no doubt organizations across sectors) are in, better than any of my “witty” metaphors could have.  

The log jam lies in the habitual assumptions and automatic mental associations and paths of action that are hard to acknowledge because they have become second nature. Every industry develops its own esoteric jargon, values and belief systems.  For example, the culture and system of meaning I call association autopilot or “association think,” values lofty mission, prestige,   reputation, articulating positions on issues, efficiency and stability over practical solutions for members, co-development, entrepreneurial exploration, risk-taking and innovation.  It also considers narrowly defined processes and committee-driven decision-making as the norm. Conversations among association insiders revolve around topics such as mission, governance, board relationships, policies and processes and reinforce the sense of their importance in their minds.  Unfortunately, these are not the things that keep their members up at night.  Innovations cannot translate into dramatic new outcomes when they take place within the existing assumptions, beliefs, norms and conversations.  In all our case studies of organizations that are thriving in today’s market, we have identified what I will call “disruptive” thinking as a common characteristic: the ability to suspend existing categories, assumptions, values and norms and start with blank slate.

Approximately ten years ago the AAFP was dealing with an unhappy membership, struggling to survive in a fragmented healthcare that was out of sync with healthcare needs; and a broken practice model that frustrated them and became increasingly unsustainable financially. So what were the unspoken cultural tenets and norms that the AAFP ”escaped” from to get different results?

• Thought big from the start, re-examining and expanding its role in healthcare. The conventional role of professional associations is to serve as gatekeeper and advocate of the profession–“advancing” its prestige and keeping entry requirements high to exclude unqualified candidates. The results of exclusionary values as the basis of strategy are usually self-centered, internally-oriented cultures that are out of sync with the changing boundaries of actual practice.  AAFP went the opposite way, expanding its role from its own discipline to the larger healthcare environment, joining forces with medical associations, business and many others so that it could improve the larger healthcare ecosystem within which its discipline existed.

• Tenets busted: narrow allegiance to the association’s benefit rather than the health of the larger professional/economic ecosystem; the “lone cowboy” organization that fills all product needs on its own and leads through command and control of its content and customers.

• Its leadership took risks and made pivotal decisions.  There were two major decisions the AAFP’s leadership made that were turning points in the course of its development:
  • Initiated the seminal Future of Family Medicine project (FFM) that culminated in recommendations for a dramatic practice re-design on the basis of the “Patient-Centered Medical Home.” 
  • Launched TransforMED as a wholly owned subsidiary that was to lead and catalyze the transformations recommended in the FFM report.

•  Tenets busted: leadership model in which chief executive is merely an operational manager implementing the board’s mandate; grow only through incremental improvements; risk aversion.

• Chose action vs. talking about action.  Instead of viewing the report as an end in itself, the AAFP embraced practice transformation as the centerpiece of its efforts at healthcare reform and its membership strategy.

• Tenets busted: talk vs. action; adopt positions about, rather than help solve, problems

• Completely reinvented planning and new product development:  Henley did not think that the same modes of assessment and planning that they always used—board committees, ineffective methodology and tools—would give him a perspective unencumbered by habitual assumptions and lead to different results. He applied this philosophy to all major initiatives the AAFP undertook in the last few years.  TransforMED, in this case, would learn by doing and co developing with members rather than retreating into a room to design the perfect plan on paper. To this end, in June 2006, TransforMED launched an innovative 24-month National Demonstration Project (NDP)  to pilot test the new model in 36 family medicine practices from all across the United States.

• Tenets busted: internal, committee-driven planning and product development; planning along existing categories, driven by prescriptive processes and layers of approval

• Burst open the options for delivering value to members outside conventional “benefit packages.” TransforMED did not have to work hard on designing and marketing new products. Participants in the National Demonstration Project experienced the success of TransforMED’s services, model and products for themselves and wanted more of the same. Co-development with customers, rather than aggressive marketing, created demand. The result was the launching of The Delta Exchange, an online collaborative network that supports “physicians, clinical staff, office staff and primary care-focused residency programs” with achieving and maintaining “Patient-Centered Medical Home (PCMH) transformation.”  Network participants with needs for more focused support, could choose among several custom, consulting services that TransforMED had developed, at additional cost.

 The AAFP as a whole appears to have made a major shift from productized benefits to strategic solutions, offering a wide spectrum of options that include:  practice management support or complete practice transformation through education, peer networks, consulting support and other resources; training and education; coalitions and think tanks that promote practice and health care transformation; experimentation through pilot and demonstration projects, etc.  The AAFP and its subsidiaries, in short, have created a demand-focused enterprise of sophisticated, multi-faceted knowledge service delivery and pilot execution in health care that utilizes new business models and engages the entire spectrum of stakeholders.

• Tenet busted:  Association creates products on its own and then convinces members of their value through marketing.  Value to members is delivered through productized packages of benefits and other defined “educational programs.”  New programs are designed on the basis of extrapolation from existing programs rather than re-thinking the

The AAFP’s executive vice president and chief executive officer, Dr. Douglas Henley, is quick to point out to us, how a number of external factors converged and several stakeholders pitched in to make these results possible. Yet change does not occur by committee.  It takes strong leadership that can discern the right moments for tough decisions and can suspend autopilot thinking and action.