Guides
Prioritize problems
Why does this matter?
- To reinforce organizational strategy by aligning problem selection with the organization’s mission and goals. Review the paper ‘Can you say what your strategy is?’ for guidance on how to make organizational strategy explicit.
- To build robust momentum by prioritizing problems that have the highest potential for success. A good prioritization process will prevent wasting time and money upfront and can also align stakeholders early on to remove barriers as projects progress.
- To define a rigorous process that prioritizes problems at the organizational level and prevents others from stepping into the vacuum to create an ad-hoc process. Without a rigorous process:
- Vendors can pressure business unit leaders to adopt AI products that are unlikely to positively impact healthcare
- Senior leaders with decision-making power who control budgets can prioritize problems themselves, whether or not they are aligned with organizational priorities.
How to do this?
Competing priorities are inevitable. Prioritization of solicited problems may be feasible only once a year, but your organization must continuously adapt to internal and external changes.
Step 1: Gather strategic priorities to measure against
- Curate organizational strategic priorities.
- Obtain sign-off from the highest level of leadership involved in allocating resources for pursuing prioritized problems.
Step 2: Develop a structured prioritization process to run all solicited problems
- Create a structured method to collect input from diverse reviewers, business unit leaders, and other relevant stakeholders for all solicited problems.
- Use online forms to build an internal review process.
Step 3: Empower an independent team that manages the prioritization process
- Create an independent team with business, clinical, and technical expertise to help prioritize solicited problems for your organization.
- The team should report to an executive leader and operate independently and without influence from business unit leaders.
- Be prepared to overcome existing power structures and ensure that problems from across the organization are given equal weight.
Step 4: Recruit a diverse pool of reviewers that assesses problems
- The review team should reflect the diversity of individuals who helped identify problems.
- Recruit clinical and operational champions and relevant business unit leaders from across the organization to help prioritize problems.
- Capture the input of stakeholders with different perspectives to ensure a well-rounded review.
- Proactively work against bias and avoid entrenching power structures through problem prioritization. Examples of what not to do:
- Have a group of physicians de-prioritize problems submitted by nurses
- Have procedural specialists de-prioritize problems submitted by primary care physicians
Step 5: Seek input and sign-off from relevant business unit leaders
- Engage the business unit leader who controls resources where the problem is most acutely felt.
- The leader may not need to be directly involved in prioritizing the problem but must support efforts to address it.
- Addressing the problem will require significant time and effort, and the business unit leader must be willing to invest political and social capital to facilitate success.
- If the business unit leader is not aligned with senior leaders to address a problem, it is unlikely for use of AI to succeed.
Step 6: Pursue slingshots, not moon shots
- The gap between AI capabilities and the status quo is massive. Avoid the pull to invest in multi-year projects to develop transformational healthcare solutions.
- Incrementally solve problems with practical solutions that can be implemented within 12 months.
Step 7: Determine novelty
- Prioritize problems that your organization is ready to solve. To assess a problem, consider the questions and scenarios in the table below
- Focus on problems that are novel within the organization and align with risk tolerance and capabilities.
| Has the problem been solved in an external healthcare delivery organization? | |||
|---|---|---|---|
| Yes | No | ||
| Has the problem been solved within a business unit of the target healthcare delivery organization? | Yes | Solution NOT novel within organization; Solution NOT novel outside organization If the solution is not scaled across the organization, then there are diffusion challenges.1 This is not a technical problem. | Solution NOT novel within organization; Solution IS novel outside organization The organization has potentially valuable intellectual property that could be scaled to external settings. |
| No | Solution IS novel within organization; Solution NOT novel outside organization Review literature, consult peer organizations that have solved the problem, and look at solutions available in the market. Depending on resources and capabilities, an organization can build internally or procure external solutions. See how to assess the viability of buying or building AI for more. | Solution IS novel within organization; Solution IS novel outside organization The problem may or may not be tractable. Addressing the problem requires a novel solution. Only prioritize problems if the organization has tolerance for risk and is open to external partnerships or building new capabilities. | |
Step 8: Determine the opportunity type
By categorizing opportunities, you can prioritize and allocate resources effectively. Using the matrix below, determine whether addressing the problem is a core opportunity, adjacent opportunity, or transformational opportunity.2 Which type of opportunities to pursue depends on your organization’s priorities and availability of resources.
- Core opportunities are feasible to address within budget and time constraints.
- Adjacent opportunities require external partnerships or new capabilities. Budget and time depend on identifying partners or recruiting new talent.
- Transformational opportunities require the development of new intellectual property. The risk of failure is high. Budget and time depend on identifying partners or recruiting new talent.
To what extent are new products and capabilities required to address the problem? | ||||
|---|---|---|---|---|
| Products and capabilities exist within the organization | Products and capabilities exist outside the organization | Products and capabilities do not exist outside the organization | ||
| To what extent does addressing the problem expand the scope of services your organization already provides? | No expansion, addressing problem serves existing patients | CORE opportunity: optimizes existing services for existing patient populations | ADJACENT opportunity: expand from existing business model to “new to the organization” business | TRANSFORMATIONAL opportunity: develop breakthrough solutions that create new markets |
| Expansion into adjacent markets to serve new patient populations is required to address the problem | ADJACENT opportunity: expand from existing business model to “new to the organization” business | ADJACENT opportunity: expand from existing business model to “new to the organization” business | TRANSFORMATIONAL opportunity: develop breakthrough solutions that create new markets | |
| Addressing the problem requires creating a new market that does not currently exist | TRANSFORMATIONAL opportunity: develop breakthrough solutions that create new markets | TRANSFORMATIONAL opportunity: develop breakthrough solutions that create new markets | TRANSFORMATIONAL opportunity: develop breakthrough solutions that create new markets | |
“Harm, heat and heart– Harm is quantitative evidence that we’re doing something poorly… heat I think of as things which if the press would get a hold of it [there would be controversy]. Like maternal morbidity– why is it that black and underserved minority populations, mortality during childbirth is so much higher? That’s heat. That’s a problem which we need to have a stance on and be working on. And then heart is the stories that pull at the heartstrings, like this young person died and it could have been handled better [or the issue] could have been identified earlier.”
Technical Expert
Step 9: Make sure your organization captures value from solving the problem
Map out who benefits from addressing the problem and who captures that value. This requires understanding reimbursement and payments into the healthcare delivery organization. Here are some things to consider:
- Value can be created in many ways, but it’s only captured when dollars flow into the organization.
- Incentives between payers and providers are often not aligned, and value for patients is often prioritized only when payers or providers can capture value simultaneously.
- The table below describes how value is created, lost, and captured under several different patient scenarios. The payment model is also specified to illustrate the impact on value creation.
| Value assessment for different perspectives | ||||
|---|---|---|---|---|
| Scenarios | Payment model | Patient | Healthcare Delivery Organization | Health Insurer |
| Patient cancels elective surgery | Fee-for-service | Value created Value captured ($$ from cost-sharing saved) | Value lost | Value created Value captured ($$ from reduced costs) |
| Capitation (fixed amount paid for a population) | Value created | Value created Value captured ($$ from reduced costs) | Value neutral | |
| Patient successfully manages a chronic disease, prevents complications | Fee-for-service | Value created Value captured ($$ from cost-sharing saved) | Value lost | Value created Value captured ($$ from reduced costs) |
| Capitation (fixed amount paid for a population) | Value created | Value created Value captured ($$ from reduced costs) | Value neutral | |
- To learn more about capturing value when addressing problems, check out this resource on capturing more value. 3
“We have our Board of Trustees and our CEO, and our senior leadership team, who set our goals for the organization. [The goals are] to lessen the burden of disease and minimize friction across our hospital system. For people working in the healthcare system, how do they get their jobs done better, and treat patients as best as we can to improve care? Those are our strategic initiatives. Projects are prioritized in line with those strategic initiatives.”
Clinician
References
- Hansen, Morten T., and Julian Birkinshaw. “The innovation value chain.” Harvard business review 85.6 (2007): 121.
- Nagji, Bansi, and Geoff Tuff. “Managing your innovation portfolio.” Harvard Business Review 90.5 (2012): 66-74.
- Michel, Stefan. “Capture more value.” Harvard business review 92.10 (2014): 20.
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