Reflections from the Executive Director

Part of a Series

This Reflection is a part of the 2017 Health and Human Services Summit Report.

To see the complete report, click here.

What will it take to create the future of outcomes and impact? Is there a breakthrough on the horizon?

Scan the headlines and you will see innovative organizations answering these questions. GE is leveraging a digital ecosystem that enables airlines to pay for jet engine outcomes (uptime) rather than purchasing the engine. J&J is experimenting with ecosystems that can provide information and supplies to hospitals in order to build outcomes-based (patient wellness) models in healthcare. Ford has a vision for providing an ecosystem of “mobility” rather than just selling cars. And the State of Ohio is running analytics across an ecosystem to move to episode-based payments – an approach wherein service providers will receive payment based on patient health outcomes.

The 2017 Health and Human Services Summit posited that the future of outcomes and impact will indeed be based on building vibrant health and human services ecosystems – a network of organizations, machines, and services that coproduce new solutions to solve the root causes of individual, family, and community health and human services challenges.

Ecosystems in organizational theory certainly aren’t new – virtually every organization operates within a complex web of actors and factors. Yet now the power of artificial intelligence, machine learning, analytics, and digital platforms enable more intelligent and robust integration of organizations, people, and services. In the broader health and human services world, the movement to ecosystem-based business models means we are poised to break through the plateau of outcomes that industrial models of organizing have delivered over the past 100 years.

We need this breakthrough to happen urgently. In fact, 73 percent of Summit attendees said they are facing significant or extreme pressure to improve capacity, service delivery, and outcomes, and 89 percent said building new ecosystems is critical to success.

Yet being poised for a breakthrough and actually achieving results are two different things. To make progress, leaders will have to mobilize their stakeholders in two fundamental ways.

First, policymakers and executives in health and human services will need to harness as much as possible from private sector “outcomes-focused” business models, but realize that “impact” is measured very differently. In the market economy, broadly speaking, success for private sector ecosystems depends on growth of customers (building features that increase customer dependency on the ecosystem) and services and the resultant throughput to revenue. In the political economy of public and social sector organizations, success will be measured in outcomes that move customers to self-sufficiency (building features and services that decrease customer dependency on the ecosystem), health, and well-being. So while the underlying technological mechanisms (digital platforms, analytics, etc.) of ecosystems are quite the same, the end goal is substantially different.

Second, leaders will have to distinguish between “technical” and “adaptive” challenges in building new ecosystem-based models. Technical challenges are problems or barriers that can be diagnosed and solved, generally, by applying known solutions, such as incremental innovations to governance, structures, systems, and managerial and operating processes. Technical work requires leaders and organizations to problem solve by mobilizing, coordinating, and applying current expertise, processes, and cultural norms. Adaptive challenges, in contrast, are problems or situations in which the gap between the values people stand for and the reality they are facing creates tension and deep anxiety. Adaptive work requires leading people through a period of learning, creative problem solving, and disequilibrium while they invent and discover what “DNA” to keep and what to discard to adapt and thrive in a new environment. The movement to ecosystem-based business models will be a huge shift in health and human services, and leaders will have to grapple with the high degree of adaptive work necessary to move people forward.

The next generation of health and human services leaders has to be digitally savvy and innovative, yet grounded in the complex realities of what makes people embrace change and transformation.

Given the caliber of thinking at this year’s Summit, I think we can get there, and I hope this report will seed your ideas and journey.

Let’s get to work!

Dr. Antonio M. Oftelie
Fellow, Technology and Entrepreneurship Center at Harvard
Executive Director, Leadership for a Networked World
Harvard John A. Paulson School of Engineering and Applied Sciences
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