We are also going through a ambulatory EMR Conversion and I am very sympathetic to many of the challenges you describe.
Couple of thoughts
1. Is there a possibility to do a “wave” approach to the go live.; splitting up the go live from one big bang approach to a staggered approach that is build around specialties? This has worked well for us in making sure we (a). we invest in getting the build correct and (b). are thoughtful around change management .
2. Set reasonable expectations. We involved a lot of our physicians in the design sessions and included a lot of their input but we also were clear and intentional about communicating that not all proposed modifications would work and how decisions would be made around what was proposed.
3. Invest in training and configuration. The worst go lives are when there is confusion. You can have a great EMR but if the providers and staff are completely confused on Day 1 than it won’t matter.
I agree with the above comments around making front line teams and middle managers key contributors to the organizational decision making apparatus. The current model is not sustainable, as you mentioned in your post, and if continued will probably lead to negative impacts, the biggest being that senior leaders will be to wrapped up in operations that they will fail to due their due diligence in strategic planning and development. One initial thought is that organization might want to look at its investment in developing front line leaders. What programs has the institution created that will help shape/mold the front line leadership skills that they are looking for? This should be a key first priority for the team.
As you mentioned in your post “most hospitals are part of a system but are viewed by HSCRC independently”. Is there any opportunity to remedy that and allow aligned hospitals (believe there are many in Maryland) to band together to “share” capped revenue targets. This would potentially allow some smoothing and reduce the need to do patient ping pong between hospitals. Also interested in seeing if this could refocus the health systems on the task of reducing expense .
I imagine that this type of transformation is incredibly hard and realistically will take time and considerable effort to have it “stick”. Couple of initial thoughts:
1. Have your shared the mission/vision in clear and specific ways that are digestible to the front line team that will have an important part in the execution of this pivot. Hard to change your mindset when you are unclear of what you are really changing it to. For example in my organization, we made the switch to the service lines and many individuals found the concept too nebulous and therefore stuck to the more department based structure they knew. Progress stagnated until we found a better way to communicate the why and the how.
2. Align financial incentives. Make sure that the front line teams financial incentives (compensation, promotion ladder, ect, ect) are not aligned to the traditional transactional model but rather the model you are moving towards.
I agree with many of the above comments around alignment and structure within the organization. However, as our healthcare systems become more and more matrixed through acquisitions, growth, and the general complexity of healthcare, I think we will all have to get comfortable working within and making decisions as multidisciplinary leadership teams where hierarchy might not be clear or is lateral. This might be more pertinent to the midlevel of leadership/management where I see a lot of dyad and even triad leadership structures emerging.