Monday, 19 June 2017

Chronic Complex Patients and the Blue Ocean Strategy

The book "Blue Ocean Strategy" by W. Chan Kim and Renée Mauborgne has been celebrating 10 years, having sold more than three and a half million copies, and now, to celebrate, a revised edition has just been published. The central thesis of the book is that today's markets are characterized by oversupply and therefore, companies must compete fiercely between them and the oceans (It’s a metaphor) are stained red with the blood of the fight. For this reason, the authors propose to companies to go on the search for blue oceans, like Cirque du Soleil or Ikea, where their products or services will be incontestable because people will see them as novel and useful. The strategy of these companies is clear: their contribution must be perceived as a value innovation, and as a consequence would able to open new unexplored markets like oceans that will not go red.

Leaving aside the commercial aspects of the theory, the book left me with the (attractive) vision of a blue ocean that, inevitably, I have contrasted with the difficulties that all health systems have when it comes to implementing convincing programs of patients’ care and I thought that perhaps at this point a blue ocean strategy would be beneficial when aiming to implement new projects that would arise from overcoming current difficulties. I have to admit that applying Chan and Mauborgne's theories to complex chronic patients is a bit far fetched, but I am convinced that there are some strategic methodology proposals that could be of some use.

The three qualities to generate a blue ocean

If the aim is to generate a disruptive project of complex chronic patients’ care, that is, to create a blue ocean, it would be imperative that the most involved professionals: primary care doctors and nurses, municipal social workers and geriatricians, abandon the heavy meetings of circuit and coordination and see if they are able to define the three qualities of blue ocean generation proposed by Chan and Mauborgne: a) What is the focus of the project? b) Why are the differences between the involved actors not being negotiated? c) Can they agree on a convincing central message?

The four actions to be undertaken

Once the three qualities of the project have been defined, the promoters should focus on four actions to value what they do. They are supposed to be clear that the aim is to go beyond simple coordination. If so, I recommend implementing the following scheme: a) What actions should they create? b) What actions should be increased? c) Which ones should be reduced? d) Which ones should be eliminated? If you do this exercise, you will probably realize that, from the communicating vessels between these four groups of actions, resources that would feed the new actions could arise, starting from abandoning those actions that have already been proven not to bring any value. 

Overcoming the four barriers to innovation

The blue ocean strategies depart from the status quo, so you have to know that if you want to innovate in a disruptive project, based on current experience and knowledge, strategies should be defined to address the four barriers that are sure to be encountered on the way: a) The motivational barrier - that is why it’s necessary to know how to transmit project values ​​to team professionals; b) The cognitive barrier - being able to explain all the details of organizational changes and how they involve each one; c) The resource barrier - detecting the waste of those actions that don’t add value (remember Sutton's law?) and d) The political barrier – knowing how to harmonize political interests existing in all elements of power related to the project.

Leadership by turning point

Finally, if you’re interested in the blue ocean strategy, you must pay attention to the concept of leadership by turning point. The authors' recommendations for disruptive leaders are that they have the ability to define hot zones, where few resources can achieve high yields, in addition to the cold areas, which are the ones that are wasting large resources with poor results. Another tip is that leaders must be able to work in the field of disproportionate influences, both positive and negative, because these can change the progress of the project.
In complex chronic patient policies, the theories are well defined but, between the status quo of care levels, institutional competencies and the myopic clinical visions of many specialties, the results are still scarce. I think it’s time to embrace blue ocean strategies with the intention of developing projects with added value and with disruptive force, following the methodology of first defining the qualities of the initiatives, then taking the necessary actions, knowing how to fight the barriers and enabling leadership by point of inflection. In a nutshell: less theory and more strategy.

Jordi Varela

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