Sustainability in Complexity

Everywhere we look we see ever growing complexity. It seems that advancement and growth are accompanied by ever more complex structures, processes, and demands. Payers, clients, and science contribute to the complex environments human service organizations are operating in. Clients are more aware of needs and are active in managing their care more than ever. Payers want accountability data as part of a move to value-based contracting. And new evidence-based practices are emerging that impact service lines and operating processes at our organizations. As we evaluate service lines, revenue streams, and human resources we are faced with complexity.

Navigating this complexity effectively can make all the difference to an organization’s sustainability and success. Being strategic – embedding the complexity within a planning process – is essential to long-term growth and viability. Organizations that thrive within complex environments have clarity around processes, interactions among processes, and accountability for results, and these are transparently linked to their mission and purpose.

Not all increases in complexity are avoidable and some are imposed upon organizations by payers or regulators. For example, states have tended to outsource the purchase of social and health services, creating multiple payer sources where there was previously a single state entity. This has significantly affected enrollment, eligibility determination, and billing/revenue cycle management processes and added complexity. Often, there are differing and greater data demands, increasing what organizations must manage. In these situations, it is often essential that organizations re-engineer key processes to address the new demands and minimize the complexity they seemingly generate.

Assessing Value to Find Solutions

A key ability in navigating complexity is the understanding that not everything that is possible adds value, while they each invariably add cost. Organizations need to evaluate options in service lines, markets, revenue streams, and technology with a clear view of their potential value (enhanced benefit to customers, to payers, to staff, to the bottom line, greater market share) against their all-in cost (investment and support cost, staff time lost). They must answer the question of whether the added complexity of a new business line or process is worth it. More is not always better, and even when it is, it still needs to be effectively and efficiently managed.

Bain & Company (2009) look at three aspects of complexity. Business complexity refers to the drivers of value, only those things that drive value should be embraced. Process complexity wherein only those complexities that support high quality at the lowest cost should be accepted.  Organization complexity is acceptable only if it significantly helps deliver the desired results.

Taming complexity and managing it efficiently is possible through the establishment of meaningful and measurable KPIs, flexibility and review of processes so that they can be re-engineered when they are not driving the desired results or have costs that exceed their value, and the judicious use of technology. Technology can, for example, reduce the time staff dedicate to clerical enrollment tasks or scheduling, which can be managed through portals that clients access directly. Automated processes for staff can reduce HR time. Compliance monitoring and audits can be partially automated, freeing staff to do value operations like training on quality rather than mere compliance. Data from numerous sources can be linked and integrated to provide actionable information throughout an organization.

In short, complexity is growing and seems easy to drown in. But careful planning and process design, clear eyed evaluation of the value and cost of service lines, clearly defined metrics that track the results the organization seeks to achieve and supports adaptability and efficient management make all the difference in sustainability. Technology can then be used to enhance processes, manage complexity, to improve both effectiveness and efficiency.