Organization development – Ron Bercume http://ronbercume.com/ Sat, 04 Dec 2021 23:05:50 +0000 en-US hourly 1 https://wordpress.org/?v=5.8 https://ronbercume.com/wp-content/uploads/2021/10/icon-23-120x120.png Organization development – Ron Bercume http://ronbercume.com/ 32 32 Nick Nurse is “completely confident” in the development of Dalano Banton as a shooter https://ronbercume.com/nick-nurse-is-completely-confident-in-the-development-of-dalano-banton-as-a-shooter/ Sat, 04 Dec 2021 23:05:50 +0000 https://ronbercume.com/nick-nurse-is-completely-confident-in-the-development-of-dalano-banton-as-a-shooter/ On paper, Scottie Barnes’ transformation into a three-point shooter seemed to happen overnight. In just 21 games, the Toronto Raptors rookie has gone from being the kind of player who would go from a wide open three-pointers to a three-point shooter, ready to let him fly from behind the arc almost without hesitation. But, behind […]]]>

On paper, Scottie Barnes’ transformation into a three-point shooter seemed to happen overnight. In just 21 games, the Toronto Raptors rookie has gone from being the kind of player who would go from a wide open three-pointers to a three-point shooter, ready to let him fly from behind the arc almost without hesitation. But, behind the scenes, work has been endless for Barnes since the Raptors first got their hands on him after the NBA Draft last July.

“We certainly encouraged him to [shoot threes] – all the coaches, the coaching staff, I give them a lot of credit, ”Raptors coach Nick Nurse said after practice on Saturday. “It always comes down to the players. They always come in in the morning, come in at night, they come in and do double or double what we ask them to do, and then it’s their switch that finally turns on, so go ahead and do it. So give him the credit for it.

From the start, the Raptors were convinced that fine-tuning Barnes’ mechanics wouldn’t be much of a problem. It was a few small things, Nurse said at the time, nothing was “broken.”

With Dalano Banton, however, Toronto knew the change wasn’t about to tip right away. His shot was going to take some time to work.

Much like Barnes, Banton was a college non-marksman. He averaged two three-point attempts per game over his two college seasons and shot 23.7% from behind the arc. The difference between the two, Nurse said, was their mechanics. Barnes’ shot was not far away. Banton was.

But Nurse and the Raptors aren’t the type to back down from a challenge. Instead, they challenged the second-round pick to keep shooting. That’s why Toronto assigned Banton to the G League on Saturday, where he played in 36 minutes with the 905 Raptors and attempted eight three-pointers. Sure, 2 for 8 isn’t very good, but it’s the fact that he takes the punches the Raptors are focused on.

“He did everything really well,” Nurse said. “He’s going to get there. Like, I’m totally confident he’s going to get there and it’s just a matter of how fast we can speed up the process.

This is why this back and forth between the 905 and the big club will continue for Banton who saw his minutes switch during his first 23 NBA games. The Raptors try to get him as many minutes, as many reps, and as many shots as he can as he tries to get a feel for the adjustments they’ve made to his shot.

Will it work?

Well, just look at Nurse’s track record, not only with Barnes, but also top to bottom in Toronto’s list. From Pascal Siakam and Fred VanVleet to former Raptors like Norman Powell who entered the league with major question marks over development. Ultimately, it was that journey between the G League and the big club, a ton of hard work and a dedicated development organization that made it all work.

So if Nurse goes out of his way to say he’s confident Banton’s shooting will develop, it’s hard not to believe him.


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Microsoft India Development Center Expands Presence in Noida https://ronbercume.com/microsoft-india-development-center-expands-presence-in-noida/ Thu, 02 Dec 2021 06:34:22 +0000 https://ronbercume.com/microsoft-india-development-center-expands-presence-in-noida/ Bangalore: Microsoft Corp has expanded its Indian Development Center (IDC) in the National Capital Region (NCR), the company said Thursday. Over the past two decades, the Microsoft The India Development Center has expanded its footprint in India to cities like Hyderabad, followed by Bengaluru and more recently its third campus in Noida which opened in […]]]>

Bangalore: Microsoft Corp has expanded its Indian Development Center (IDC) in the National Capital Region (NCR), the company said Thursday. Over the past two decades, the Microsoft The India Development Center has expanded its footprint in India to cities like Hyderabad, followed by Bengaluru and more recently its third campus in Noida which opened in January of this year.

Realizing the potential of the NCR market for technology, Microsoft India Development Center expanded its third facility in the KP towers in Noida on November 20.

The newest work site spans 150,000 square feet and is designed to drive digital innovation through expanded teams in the cloud and artificial intelligence (AI), experiences and devices group , Microsoft’s digital teams and the new games division have a growing presence in India.

“The KP Towers project reinforces Microsoft IDC’s commitment to finding global technology solutions through innovation in India. With an increased presence in NCR – the country’s emerging technology hub – the facility aims to attract a rich pool of technological talent from engineering and management institutions to better serve the needs of Microsoft customers and create a direct and indirect economic impact in the region, ”the company said in a statement.

“The expansion of the India Development Center in Noida is our continued effort to empower every person and organization on this planet to do more. We are poised to open a new frontier in innovation as we continue to expand our presence across the country. The excellent workplace facilities at KP Towers provide the right environment to shape the future of the IT industry in this part of the world, ”said Rajiv Kumar, Managing Director of Microsoft India Development Center.

Microsoft India Development Center is one of Microsoft’s largest R&D centers outside of the Redmond headquarters. Established in Hyderabad in 1998, the center drives Microsoft’s globally shared development strategy to create products and services. With a presence in Hyderabad, Bengaluru, and now NCR, IDC is home to three core technology and engineering departments, driving innovative work within Microsoft.

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Hill District development remains intact with new owners of Penguins https://ronbercume.com/hill-district-development-remains-intact-with-new-owners-of-penguins/ Tue, 30 Nov 2021 00:17:00 +0000 https://ronbercume.com/hill-district-development-remains-intact-with-new-owners-of-penguins/ THE TEAM AND THE CITY? SHELDON? >> CONSTRUCTION FOR THE LOWER HILL DEVELOPMENT HAS BEGUN AND THE MAYOR SAYS THE FUTURE OF THIS PROJECT IS SECURE WHO THE OWNER OF THE PENGUINS IS. >> THE REDEVELOPMENT OF THE MIDDLE AND UPPER HILL, THESE DIFFERENT TYPES OF AGREEMENTS WILL BE INTACT. THE ONLY DIFFERENCE WILL BE […]]]>

THE TEAM AND THE CITY? SHELDON? >> CONSTRUCTION FOR THE LOWER HILL DEVELOPMENT HAS BEGUN AND THE MAYOR SAYS THE FUTURE OF THIS PROJECT IS SECURE WHO THE OWNER OF THE PENGUINS IS. >> THE REDEVELOPMENT OF THE MIDDLE AND UPPER HILL, THESE DIFFERENT TYPES OF AGREEMENTS WILL BE INTACT. THE ONLY DIFFERENCE WILL BE WHO OWNS THE TEAM? >> THE FIRST TOWER OF THE NATIONAL BANK IS THE ANCHOR OF THIS MASSIVE INTELLIGENT PROJECT THAT STARTS IN LOWER HILANL D IT IS EXPECTED TO CONTINUE IN MIDDLE AND UPPER HLIL AS A REVITALIZATION PROJECT. THE HILL COMMUNITY DEVELOPMENT CORPORATION HAS CONCERNS ABOUT AFRO-AMERICANS BENEFITING FROM THE JOBS THAT WILL BE CREATED WITH THIS PROJECT. ESPECIALLY IN THE LOWER HILL OF THE BANK TOWER. SAY THIS, AND SCIPEFICALLY THE FENWAY SPORTS GROUP HAS BEGUN TO THINK ABOUT HOW THE PENGUINS ORGANIZATION CAN FULFILL ITS COMMITMENTS TO THE HILL DISTRICT COMMUNITY AS PART OF TRANSACTION AND ORGANIZATIONAL STRATEGY. NO MORE FROM MAYOR. >> EVERYTHING THEY FUCKED AND EVERYTHING HAS BEEN PROMISED, AND EVERYTHING FOR THE FUTURE WILL BE GUARANTEED. >> ALSO TODAY, HE T MAYOR SAYS HE WOULD BE M

Lower Hill development remains intact as new group of owners take control of Penguins

Mayor Bill Peduto said on Monday that massive development in the Lower Hill District will continue as the Pittsburgh Penguins organization is set to change ownership in the near future. development project starting in Lower Hill, with a first National Bank tower, office and commercial space, while extending into the community of Middle Hill and Upper Hill. Some of the features of the project include pledges of investments of up to $ 50 million over time in Middle Hill and Upper Hill, as well as job creation for African Americans in the businesses created in Lower Hill. where the bank tower is. However, the Hill Community Development Corp. suggests that these promises may not be as strong as those initially made by the Penguins, and encourages the Fenway Sports Group to follow through on the commitments “and in particular that the Fenway Sports Group has started to think about how the Penguins organize ation can fulfill all of its commitments to the Hill District community as part of the transaction and organizational strategy, ”Hill CDC President and CEO Marimba Milliones said in a written statement. Peduto said these commitments will be honored: “Everything they’ve fought for, and everything they’ve been promised and everything going forward will be guaranteed to them.” Fenway Sports Group, owners of the Boston Red Sox, concluded a deal with the Penguins that will give FSG a controlling stake in the hockey franchise. The deal, which would see Mario Lemieux and Ron Burkle part of the Pens ownership group, is pending approval by the NHL Board of Governors.

Mayor Bill Peduto said on Monday that massive development in the Lower Hill District will continue as the Pittsburgh Penguins organization is set to change ownership in the near future.

Watch the report from the old Civic Arena site: Click on the video player above.

This is an economic development project starting in Lower Hill, with a first National Bank tower, office and retail space, while extending into the community of Middle Hill and Upper Hill.

Some of the features of the project include pledges of investments of up to $ 50 million over time in Middle Hill and Upper Hill, as well as job creation for African Americans in businesses created in the region. Lower Hill where the bank tower is located.

However, the Hill Community Development Corp. suggests that these promises might not be as strong as initially stated by the Penguins, and encourages the Fenway Sports Group to follow through on the commitments “and in particular that the Fenway Sports Group has started to think about how the organization des Penguins can fulfill all of its commitments to the Hill District community as part of the transaction and organizational strategy, ”said Marimba Milliones, President and CEO of Hill CDC, in a statement.

Peduto said these commitments will be honored: “Everything they fought for, everything they were promised and everything going forward will be guaranteed to them.

Fenway Sports Group, owners of the Boston Red Sox, have reached a deal with the Penguins that will give FSG a controlling stake in the hockey franchise.

The deal, which would see Mario Lemieux and Ron Burkle part of the Pens ownership group, is pending approval by the NHL board of governors.


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Port Arthur Economic Development Corporation to meet with CEO finalists – Port Arthur News https://ronbercume.com/port-arthur-economic-development-corporation-to-meet-with-ceo-finalists-port-arthur-news/ Sat, 27 Nov 2021 06:38:12 +0000 https://ronbercume.com/port-arthur-economic-development-corporation-to-meet-with-ceo-finalists-port-arthur-news/ The EDC building in Port Arthur. (Mary Meaux / The News) Three finalists for the post of CEO of the Port Arthur Economic Development Corporation are expected to make presentations to the board of directors on Monday evening. The three are Biguita Hernandez-Smith, Larry Calhoun and Jessica Carpenter. The agenda for the meeting includes the […]]]>

Three finalists for the post of CEO of the Port Arthur Economic Development Corporation are expected to make presentations to the board of directors on Monday evening.

The three are Biguita Hernandez-Smith, Larry Calhoun and Jessica Carpenter.

The agenda for the meeting includes the candidates’ presentations and any questions from the candidates. The board is due to deliberate on the appointment of a CEO at the executive session, but is not expected to make a final decision on Monday.

The new CEO will replace Floyd Batiste, who resigned after 17 years at the helm of the organization. His last day was September 30.

Deputy Director George Davis has been appointed to this post on an interim basis. He did not apply for the CEO position.

Batiste’s resignation came after a staff member filed a complaint against him in February, which Batiste said he disagreed with “100%”.

EDC Port Arthur Board of Directors; however, accepted the grievance findings as reflected in the minutes of the April 29 meeting. The only vote against the reprimand was John Chirafis, who resigned from EDC’s board in July.


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Regional Arts Development Organization for the South Coast | South Coast Registry https://ronbercume.com/regional-arts-development-organization-for-the-south-coast-south-coast-registry/ Thu, 25 Nov 2021 02:00:00 +0000 https://ronbercume.com/regional-arts-development-organization-for-the-south-coast-south-coast-registry/ news, latest news, The city councils of Shoalhaven City, Shellharbour City and Kiama have welcomed an offer from the NSW government, through Create NSW, to help establish a Regional Arts Development Organization (RADO) for the South Coast. The new RADO will join the regional arts network of 14 RADOs across the regional NSW. The network, […]]]>

news, latest news,

The city councils of Shoalhaven City, Shellharbour City and Kiama have welcomed an offer from the NSW government, through Create NSW, to help establish a Regional Arts Development Organization (RADO) for the South Coast. The new RADO will join the regional arts network of 14 RADOs across the regional NSW. The network, with core funding from the NSW government and local councils, has grown over the past 30 years to inform, support and promote artistic and cultural activities at the regional and community level, including including opportunities for creative professionals and producers in different artistic fields. and cultural practice. Announcing NSW government funding in October, NSW Minister of the Arts Don Harwin said we know regional communities do best when they put on their own show. “I am happy that the new regional arts development organization for the south coast is joining forces with the existing regional arts network to highlight its artistic and cultural offering,” he added. For artists and communities hard hit by natural disasters and COVID 19, the creation of a South Coast RADO is timely. There are many pockets of creativity in our region, for which a RADO, with a bird’s-eye view of the entire South Coast, can help connect the dots, build bridges and foster networks between artists. , arts organizations, local government and communities. RADOs are at the service of artists, helping them to achieve their artistic and commercial objectives, by becoming viable in their practice. RADOs help communities develop and promote their own creative projects. RADOs connect to councils, bringing additional attention, knowledge and expertise in arts and culture to aid local government efforts in tourism, economic development, and community and cultural planning. To get the ball rolling, RADO invites regional professionals with a passion for the South Coast and with expertise in arts management, financial management, corporate governance, philanthropy, media and marketing, and artistic and cultural knowledge. First Nations, to nominate themselves for a position as a member of the board of directors (a one-year volunteer position). To inquire, please email: info@radosthcoast.onmicrosoft.com by December 10, 2021.

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How is custom app better than low code development? https://ronbercume.com/how-is-custom-app-better-than-low-code-development/ Tue, 23 Nov 2021 07:00:43 +0000 https://ronbercume.com/how-is-custom-app-better-than-low-code-development/ Almost 90% of mobile Internet consumption is through smartphone applications. In addition, the reason number one why most of the users uninstall an app is the lack of usability and usefulness. While the above stats may seem like they don’t connect and wrap up, they do imply the importance of application development and indicate how […]]]>

Almost 90% of mobile Internet consumption is through smartphone applications.

In addition, the reason number one why most of the users uninstall an app is the lack of usability and usefulness.

While the above stats may seem like they don’t connect and wrap up, they do imply the importance of application development and indicate how crucial it is to ensure the quality of the process and the results.

A smart way to do this is to choose custom app development for your business. Are you wondering why not low-code development? This article talks about it in detail.

Here are a bunch of reasons why it makes sense to prioritize custom app development over low-code application development. But first, let’s find out what we really mean by low-code and custom application development.

What is low-code development?

Low-code development is a process of mobile application development that uses low-code development platforms that include various tools that help build mobile applications through a drag-and-drop interface.

While low-code platforms help build applications in a short period of time, ease of access comes with a variety of drawbacks that need to be considered before starting a project.

What is custom application development?

Custom application development is the process of creating software for a specific set of users, functions, or organizations. The idea of ​​building custom code applications is to develop software that meets users’ needs and expectations as closely as possible.

Custom apps are usually built from scratch and offer limitless customization options.

Why choose custom application development over low-code application development?

1. Low-code can encourage inexperienced development

While not all low-code application developers are inexperienced, this is a route often preferred by people who may lack technical know-how or expertise.

Of course, a custom code developer developing your business application from scratch may demand higher pay compared to our low-code friend. But, this cost will bring the valuable experience and availability of a talented custom application development team who will take care of your business application development closely.

2. Low-Code lacks freedom of design and functionality

As low-code apps are based on pre-developed models or low-code platforms, there isn’t much room for customization.

If you’ve ever tried to develop a low-code, template-based mobile app, you might have an idea.

While these models and platforms allow users to quickly get started with the application, the end products often lack various features that can be essential for your business.

Other than that, even the most minor changes, including graphics and visual updates, can require an unusual amount of additional work. This makes low cost applications a less preferred option by businesses.

3. Low-code approach makes scaling and updating more expensive

Unlike custom code apps, reduced code apps have fewer customization options, which we just mentioned. But is this the end of the problem?

A low-code application is often susceptible to problems when it comes time to scale or update.

For example, the template you used to build the app may stop future support for that particular product line. Or, the latest model updates may not be a good fit for your purpose. Additionally, a template-based app will put limits on your business’s creativity and productivity, keeping the app locked into the same design and feature set.

4. Safety and reliability can be a concern

Over the past ten years, more than 300 data breaches have occurred, causing an overall loss of over 100,000 records.

The amount of data lost and leaked can run into tens or hundreds of thousands of dollars, inflicting severe damage on businesses across industries.

One of the main reasons that data attacks become easier is the lack of security that low-code platforms can offer.

This mainly happens for the following reasons:

  • You or your development partner did not write the code, so it cannot be trusted for its reliability.
  • Developers of low-code models can eliminate security features that may not hinder the normal functioning of the application, but can leave loopholes for a cyber attack.

However, when you hire a full-cycle application development services company, the team guarantees the delivery of a fully customized product according to your company’s preferences and security requirements.

5. Integration challenges

Another downside to using low-code platforms is their lack of integrability with other existing tools and software that your business is currently using.

Most low-code platforms have several limitations on what changes you can make to the output. In addition, to make these changes, the developer will need the know-how of the platform used.

This makes integration a challenge. Even though the integration of such a grade is possible and supported by a low-code platform, finding the way forward can be difficult because all platforms work differently.

Speaking of custom code development, it leaves enough room for seamless integration with your existing software.

6. Low-code applications can reduce efficiency

Most low-code applications are designed with several flaws, due to lack of customization. This means that several useful features may be missing from the app. Or the design preferences may not be optimal or as required.

These factors can go a long way in reducing the overall effectiveness of your team.

As your business application is not performing optimally, your employees may need to step in to guide your users, make changes, or simply manage the mess created by the low-code counterpart.

Building a custom code app on the first try will save you the hassle. In addition, a personalized application will be designed and developed according to the specific needs of your business and your target audience.

It can help your business make a connection with its prospects.

7. User lockout issues

As a low-code platform is ready by its developers, we don’t have full access to how the platform works.

In the event of data loss or vendor or user lockdown, your business may simply find itself helpless or too dependent on the developers of the platform. This can lead to mistrust or dissatisfaction, accompanied by panic among your users.

In a custom code application, your team of developers or development partner will be able to make the required changes as a priority.

Read also : Main benefits of developing custom applications

Low-Code Development vs Traditional Development

In the sections above, we’ve discussed a variety of factors that support the fact that custom code apps are a little better than their low-code counterparts. For a better understanding, a high-code vs low-code differentiation table can be useful:

Low-Code or Custom-Code? What is good for your business?

Companies with firm plans to move upmarket and expansion would generally consider creating a versatile application that can be updated easily and without limitations. Second, businesses may also need to update app design / functionality based on user feedback.

This can precisely be done in a custom code application. Although, as mentioned above, low-code apps may seem like they save time, effort, and money on the first try; a few months or weeks later, you and your users can begin to discover the long list of loopholes.

Save yourself the trouble – consult a reliable custom application development company like Appinventiv. With skilled resources and years of experience in custom development, we create applications that satisfy our clients and their customers.

Learn more about developing custom applications.

For example, for one of our clients, JobGet, we delivered an end-to-end custom application development solution that generated over $ 2 million in funding for the organization and cut job search time for blue collar workers from days to days. minutes.

For another customer, YouCOMM, we developed a customized platform of multiple request formats that reduced the wait time for patient assistance during emergencies and led to a 60% growth in real-time response time for patients. nurses.

Prateek Saxena

Prateek Saxena

DIRECTOR & CO-FOUNDER

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Get Comfortable to Learn with Live Webinars from Leadership and Organization Development | E-News https://ronbercume.com/get-comfortable-to-learn-with-live-webinars-from-leadership-and-organization-development-e-news/ https://ronbercume.com/get-comfortable-to-learn-with-live-webinars-from-leadership-and-organization-development-e-news/#respond Thu, 04 Nov 2021 12:13:00 +0000 https://ronbercume.com/get-comfortable-to-learn-with-live-webinars-from-leadership-and-organization-development-e-news/ As the cold weather approaches, this is a great time to focus on how to continue to grow and learn, supporting the drive to achieve professional goals. Leadership development and organizational talent and culture encourages WVU leaders and staff to invest in their development with upcoming courses. Learning opportunities available: Leadership development (leaders only)November 18: […]]]>

As the cold weather approaches, this is a great time to focus on how to continue to grow and learn, supporting the drive to achieve professional goals. Leadership development and organizational talent and culture encourages WVU leaders and staff to invest in their development with upcoming courses.

Learning opportunities available:

Leadership development (leaders only)
November 18: creating the first year experience: onboarding your new employees – a virtual roundtable

Professional development (all staff, including managers)
November 30: Build and maintain trust
December 2: Build a culture of appreciation among your peers

Remember that all LOD courses are available free of charge to leaders and staff at all WVU campuses.

Visit the LOD Course Registration Portal to register for courses, view transcripts, and print certificates of completion. Note: You must create a profile to access the portal.

While the Marshal’s Office hosts several faculty and leadership development offerings specifically for faculty, faculty members are also encouraged to participate in LOD’s course offerings. Professors who supervise employees are encouraged to enroll in LOD’s leadership development courses.

Visit the LOD website for quick access to this online course registration portal.

Contact the LOD team at LOD@mail.wvu.edu or 304-293-7217 for any questions.


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Education teacher will receive national award for organizational development https://ronbercume.com/education-teacher-will-receive-national-award-for-organizational-development/ https://ronbercume.com/education-teacher-will-receive-national-award-for-organizational-development/#respond Mon, 25 Oct 2021 18:21:02 +0000 https://ronbercume.com/education-teacher-will-receive-national-award-for-organizational-development/ William Brendel, Assistant Professor of Education (Organizational Development and Change) in the Department of Learning and Performance Systems, will receive the Organizational Development (OD) Award for the evolution of OD by connecting people and ideas during of a virtual ceremony on November 12. The OD network is made up of leading academics and practitioners who […]]]>

William Brendel, Assistant Professor of Education (Organizational Development and Change) in the Department of Learning and Performance Systems, will receive the Organizational Development (OD) Award for the evolution of OD by connecting people and ideas during of a virtual ceremony on November 12.

The OD network is made up of leading academics and practitioners who guide the practice of organizational development and serve as agents of change by creating a global community for meaningful connections and exchanging best practices.

“One of the most famous people in our field, Lisa Kimball, was renowned for connecting people and ideas, not just connecting people so that they could talk to each other and share ideas, but connecting them to that they can co-create ideas. It meant bringing together diverse and quite different people, and also pushing the boundaries of what we are currently doing on the ground. This (award) is in his honor. And I was very lucky to be nominated for the same reasons, ”said Brendel.

Brendel’s research examines how mindfulness theories and practices can be incorporated into organizational development to improve the conditions for strategic innovation, healthy organizational cultures, effective leadership, and a navigable workforce. in complex changes, to manage stress and to interact with others with more compassion.

“Mindfulness is built into leadership training in over 60% of Fortune 500 companies; that’s a lot, ”said Brendel. “I was there when it was very experimental. And I am cited as a pioneer in what is now called conscious leadership.

A Google search for conscious leadership will yield millions of entries, but Brendel was the first to conduct an empirical study with real business leaders, comparing a leadership development course to leaders who practiced mindfulness for 45 years. minutes per week instead of taking a leadership development course. Classes.

Brendel said the group that practiced mindfulness had an increase in creativity, resilience, and tolerance for ambiguity.

“It shows the distinction between traditional education, which focuses on putting knowledge into someone’s head, and those awareness skills of metacognition and letting go of your ego and your expertise and welcome from various perspectives. This is the way of the future, I am convinced of it, ”said Brendel.

Brendel, who has been teaching, giving workshops and conducting research for 22 years, said the genesis of his mindfulness research came when his sister died aged 30. He said he didn’t have any tools to make him feel good and think clearly after her. death.

“I felt so locked in and tightened up that I went to Google and typed ‘What are you doing to stop thinking about things … – based on stress reduction at the University of Massachusetts. It’s probably his. only the person responsible for popularizing mindfulness in the United States, “Brendel said.” I researched him, and learned from him directly and immediately saw applications in the business world, not just to reduce stress, but also for meditation – the type he uses is secular, so there is no religion in it. “

He said he focuses on innovation and inclusion. “I remember walking through a supermarket the day after my sister died, passing strangers and thinking, ‘Any of these people can suffer to the same degree as me and I wouldn’t know. never “. Brendel said. “I felt a real connection with people and thought how good that would be for businesses, schools and any organization? Isn’t that exactly what we need right now? So that’s kind of the genesis of everything I’m playing with.

Organizational development continues to evolve to meet new needs of organizations and communities, such as a growing investment in understanding and implementing Diversity, Equity and Inclusion (DCI).

Brendel cited two false positives that are currently occurring within DCI. “One is that organizations create checkbox lists. If we do ABCDEF and G, we can officially say that we are diverse, inclusive and fair, ”he said. “Although this is partly true, it is not all, because you can tick every box and you can still feel that this is the least inclusive and fair place, that there is a false sense. As human beings we understand this; we can tell when excuses are bogus there are tons of studies out there.

“The other false positive is just feeling inclusive and not doing anything about it, not actually taking action but thinking that you are inclusive. This opens a valve for good people to suffer from their own unconscious biases. ”

He said the question he’s interested in is how to integrate the two, and he thinks the answer is to establish an integrated consciousness. Behavioral science consciousness studies say that human beings experience the world through access consciousness, or by making sense of language and thought, and phenomenal consciousness, or experience. intuitive to be.

“You can’t think or feel your way to inclusion,” Brendel said. “Incorporating these two is very much possible through the practice of mindfulness. I developed the theory of conscious OD. And this approach is to stretch out where people spend most of their day – that is, in that place of reflection – and stretch it into phenomenal consciousness so that we can both think and simultaneously feeling this thing that we call inclusion. “It’s just opening our minds to what we’re feeling and what we’re feeling and integrating those two instead of favoring one or the other.”

From that work came the letters of nomination from his peers, and Brendel said it “meant everything to me” to be nominated by his peers. “And not just any peers, but really very eminent people in the field. This award has been reviewed by people I admire for decades, and to hear what the comments were like, I was like, “Oh my gosh, this is awesome,” Brendel said.

“I feel really happy and lucky to be part of this crowd, but I fell into it. It’s good; it’s encouraging to feel like someone is saying ‘Atta boy, keep going, you are on the right track.’ ”


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An Organization Development(OD) Approach to Agile Adoption https://ronbercume.com/an-organization-developmentod-approach-to-agile-adoption/ https://ronbercume.com/an-organization-developmentod-approach-to-agile-adoption/#respond Thu, 30 Sep 2021 19:38:38 +0000 https://ronbercume.com/?p=59 Key takeaways To understand Agile adoption from a systemic perspective – redesigning team and work structure, developing individuals and managing change Gain new perspectives on ‘Learning’ – how to redefine learning to enable individual growth and development, to help them adapt to complex and ambiguous environments […]]]>




Key takeaways


  • To understand Agile adoption from a systemic perspective – redesigning team and work structure, developing individuals and managing change
  • Gain new perspectives on ‘Learning’ – how to redefine learning to enable individual growth and development, to help them adapt to complex and ambiguous environments
  • Understand redesigning organization structures for better performance, through socio-technical systems design, which looks at an optimal design for both technical and social aspects of an organization
  • Acquire knowledge on research-based models and tools for designing self-organized teams
  • Learn new strategies for working with resistance to change which organizations encounter during Agile adoption  

For a new Software System, the requirements will not be completely known until after the users have used it “ –Humphrey’s Uncertainty Principle

Introduction

Though Agile is largely practised as a software development approach, today many practitioners believe that Agile is meant for and can evolve into a powerful cultural and business paradigm. If Agile is used only as a development approach for software and is limited to how a project team works, the organizations may fail to reap the full benefits of Agile.

How can Organization Development (OD) help in the successful adoption of Agile?

OD is an interdisciplinary field of research, theory and practice, dedicated to helping organizations improve their effectiveness to accomplish successful organizational change and performance. OD, having emerged out of the human relations movement in the 1930s, has evolved to help organizations adapt themselves to the changing environment, which is growing more in complexity and ambiguity – through organizational learning, managing culture and better internal alignment, to name a few.

In this post, we will look briefly at how OD can help organizations in taking a systemic approach to adopting Agile.

What OD stands for?

OD stands for the following values : respect, inclusion, collaboration, authenticity, self-awareness and empowerment. OD approaches organizations as open systems, (that is, systems that constantly interact with and adapt to their environment), and therefore works with organizations at a systemic level, and not just with some parts of the organization. OD is informed and supported by theory from various fields, such as sociology, psychology, industrial psychology and other physical sciences. Collecting data and using the data for informing appropriate OD interventions is a crucial part of OD. Action research is a method used in OD that continuously re-examines, reflects and integrates data throughout the process of change in order to achieve results. OD’s main focus is also groups and group dynamics, and how groups can become high performance teams and/or self-organizing teams

What Agile stands for?

At the heart of Agile, lies its manifesto and principles. Its core values are trust, respect, transparency, truth and commitment. Agile efforts are focused on creating working software – incremental software product versions that can be tested at the system level and demonstrated to the customer. Agile follows the empirical process control model for delivering high quality products well within the timelines – by frequent inspection, reflection and adaptation of its processes. By doing so, Agile teams become better at their internal processes – communication, decision making, problem solving, etc. Agile needs close collaboration with customer throughout the project tenure, making sure that the customer gets what he/she wants. Agile methods have built-in processes to change their plans at regular intervals based on feedback from customers. Agile methodologies are based on the knowledge that, in order to succeed, they must plan to change and adapt.

Traditional vs Agile Methods

In the traditional systems development model, a rational engineering based approach such as waterfall method has been used to develop projects. This seems to be grounded in ‘hard systems thinking’ which assumes that problems can be well-defined and processes can be optimized and results well predicted. Extensive upfront planning is done to measure and control the variations in the development life cycle. In summary, traditional software development life cycle is highly process-centric.

Based on the above understanding of systems development, organizations adopt a management style which is command-and-control, with a set hierarchy. Therefore these are predominantly mechanistic organizations geared for high-performance in a stable environment. It is also characterized by high formalization and standardization. People with different specializations are assigned roles for producing defined outcomes.

Agile System Development

Agile addresses the shortcomings of traditional software development life cycle by :

  • adopting the empirical process control model as against the ‘defined process control model’.
  • The development model changes from linear life cycle model to an evolutionary-delivery model.
  • Agile methods also need constant collaboration with customers needing their inputs and feedback at various checkpoints during each iterative cycle.

The organization design required is that of an organic management system :

  • Organic design provides for the inherent instability in the systems development projects through less formalization, decentralization and less supervision
  • In order to get the necessary flexibility and speed, the agile projects self-organize themselves into small teams, with a ‘servant leader’ who facilitates the team’s processes and goals.
  • These teams are constituted by people of diverse set of skills who often take different responsibilities as the situation arises
  • The entire team goes through repeated cycles of thought-action-reflection, with the primary goal being learning and adapting, enabling them to respond quickly to emergent situations

Challenges in Agile Adoption

Adopting Agile needs a shift in organizational and management practices that include :

  • Moving from a mechanistic organization to an organic one, or an effective mix of both
  • Relinquishing a ‘command and control’ style to a collaborative style. The project manager becomes a ‘facilitator’ who guides and coaches the team members and coordinates their collaborative efforts. The major challenge here would be to make the manager relinquish the authority he/she enjoyed
  • Reward systems need to change to promote team work and retaining people

 The challenges in re-organizing teams would include :

  • Agile practices are heavily dependent on collaborative team work. Teams have to be trained and coached to perform as self-organized teams, to learn and adapt with the environment.
  • Customer collaboration being an important aspect, requires the team to build an atmosphere of mutual trust and open communication. It would also be difficult to get some customers participate actively in many of the processes
  • Several organizations have invested heavily in CMM practices to strengthen the processes and ensure stability in their setup. Moving to agile requires them to re-look at these practices and doing away with some rigid processes that hinder teams to work in the new methods.

An OD approach to Agile Adoption

One of the myths about Agile is that people and organizations tend to believe that by practicing a set of activities, such as Daily scrum, sprint cycles, and retrospectives, they become Agile. On the contrary, organizations which want to become truly Agile need to change their mindset. This needs learning to be redefined.

The above figure shows the fundamental difference between ‘doing agile’ and ‘being agile’, at the team level and the organization level.

  1. Redefining Learning for individual and team development

Learning is the process of closing the gap between our aspirations and ability. It is important to understand the mechanics of the process of learning to improve the learning outcomes. There are two types of learning, Acquired Learning and Adaptive Learning.

Acquired learning occurs through training and experience that imparts new knowledge and skills. Acquired learning is referred to by psychologists as “horizontal development,” because it broadens our existing knowledge base and skill set and increases our ability to successfully execute tasks. To draw on a familiar metaphor, acquired learning can be compared to loading additional data and applications onto a computer, thereby extending the system’s capability.

Unlike acquired learning, adaptive learning expands the mind by helping it evolve to the next level of complexity, by examining the underlying fundamental beliefs and assumptions.

To use the same computer metaphor, when upgrading a computer’s operating system from, for example, Windows 8 to Windows 10, the new system transcends and includes the capabilities of the previous system (much of the same data and applications are retained).

But the new operating system also opens the door for additional, more expansive, capabilities that simply were impossible with the older system. This kind of learning leads to ‘vertical development of individuals, which can give new perspectives and capabilities that can fundamentally shift how and why people do what they do.

While organizations normally invest enough in horizontal development by providing the required training in building skills and knowledge, the investment required in vertical development, is either nil or far from sufficient. Vertical development efforts include those interventions that are needed for individual and team development, such as assessments, personal growth programs such as coaching, mentoring, group facilitation, team building and leadership development.

While Agile software development related training provides the horizontal development, which is needed for executing the project tasks, the vertical development efforts will provide the necessary mindset change to being Agile.

There are several tools available in the market which can be used for this purpose. One such tool is the Existential Universe Mapper (EUM), which helps individuals and organizations examine their beliefs, values, needs, wants and proclivities and make necessary shifts. For more information , see here.

For more information on horizontal and vertical development, refer here.

  1. From mechanistic to organic structures

Software engineering at its inception borrowed from the classical engineering discipline, which was based on the scientific management and a clockwork universe. The accompanying organization structure is more mechanistic, that can be geared for high performance in a stable environment, through job specialization, close supervision and hierarchical control.

As against this, Agile frameworks go for a organic structure, which is geared for the highly unstable development environments, where teams are geared for constant changes and complexity through less formalization and standardization, flatter structures and less supervision.

In reality, not all parts of an organization, can exist as purely mechanistic or organic. The choice of the kind of structure that has to be designed and chosen is based on the need of the environment, which includes the customer, technology and the kind of work the organization performs. For example, where innovation is needed, organic structure is best suited to give employees the freedom and flexibility to perform.

Socio-technical systems theory is one such concept that has been used by organizations to design teams which are organic in nature. In Agile, the development team is one such team.

Designing Agile teams using socio-technical systems theory

One of the core aspects of Scrum is self-organizing teams that deliver software in small iterations called sprints. The sprint teams are truly cross-functional teams that choose the best way to do their work without being directed by others from outside. How can we redesign the traditional teams into self-organized teams ?

Socio-technical systems theory defines work systems as having both technical and social subsystems. A technical subsystem concerns the tools and processes that are needed to create products and services. The social subsystem concerns the work structure that relates people to the technical subsystem and to each other.

The core design concepts that help in designing a self-organized team are centred around

  1. choosing the work group as the unit of design, rather than the individual, thereby breaking silos and making collaboration to happen
  2. the locus of control as the team, rather than the supervisor, placing the team closer to the source of variations and therefore control, thereby reducing risks

For more details on how socio-technical systems can be used to design Agile teams, refer here.

Hackman and Oldham’s theory of job design (Job Characteristics Model, aka., JCM) can be used as another approach to verify whether the socio-technical work design is really high on job enrichment for its group members. When work content is high on core job characteristics such as skill variety, task identity, autonomy, and feedback, outcomes such as job satisfaction and work effectiveness result. These two theories reveal that work variables can be designed to contribute to both motivation and self-regulation.

A questionnaire for evaluating the job characteristics based on JCM can be found here.

  1. Adopting a Change Strategy that Improves Success Rate

One important reason why change initiatives fail or do not yield expected results, is due to resistance from participants to the change involved. The change programs, quite often, require the employees (including the management), to change their working styles, behaviour, job titles, etc, and many times need them to re-skill themselves.

Resistance to change is an important aspect to be worked with, in making these initiatives successful in organizations. Removing or reducing resistance to change involves working with people to help them understand their underlying beliefs, assumptions and competing commitments, that stand in the way of change.

Robert Kegan and Lisa Lahey’s model and exercise , ‘Immunity to Change’, is a common technique used to unearth the reasons for immunity and helps people to move forward towards their goals.

This activity is an awareness-building exercise that works with individuals and groups to make explicit that which is currently implicit. The output of this exercise will help the participants and the group to understand the motivation or lack of it, behind their actions in moving towards their goals.

For more information on this exercise, visit.

Helping people in dealing with change, also ensures that their buy-in is got in implementing Agile practices. One of the prominent reasons change initiatives fail, is due to a lack of commitment from the participants. When participants are involved in a dialogue to understand why change programs are initiated, how the organization and its stakeholders, including employees will benefit, it increases the likelihood of success.

Appreciative Inquiry (AI) is a method of intervention that involves groups of any size (from very small to very large), in carrying out conversations to envision a future together. These conversations are strength-based, as against ‘problem-centric’, that elicit future possibilities. The process is an information gathering, or inquiry sessions that are meant to energize the participants by drawing out positive aspects and stories about themselves and the organization and use them to create a movement for potential alternate actions.

To summarize, applying OD techniques and theories can help organizations take a systemic route to Agile adoption – by getting the organization design right, by structuring teams for high performance and working with change programs successfully.

About the Author

Vijaya Devi is an IT professional-turned-OD consultant with 2 decades experience in the industry. She has a deep interest in helping organizations to improve their performance through applied behavioural sciences, management sciences and systems thinking. She consults and trains in the following 3 areas : techno-structural interventions (aligning processes, structure and technology), human resource interventions (performance management systems, goal setting, training, etc) and human process interventions (individual development, team development and leadership development). Check out her company’s website for more details.


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Private Sector Accountable Care Organization Development: A Qualitative Study https://ronbercume.com/private-sector-accountable-care-organization-development-a-qualitative-study/ https://ronbercume.com/private-sector-accountable-care-organization-development-a-qualitative-study/#respond Thu, 30 Sep 2021 11:30:59 +0000 https://ronbercume.com/?p=53 Study Design: Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. Methods: Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study […]]]>

Study Design: Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers.

Methods: Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs.

Results: We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients’ relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume.

Conclusions: These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

Am J Manag Care. 2017;23(3):151-158

Improving the understanding of factors that have been important for more mature accountable care organizations (ACOs) can help organizations that are developing and continuing to evolve as ACOs. Our study is among the first to explore private sector ACO development, and we found the following:

  • An adequate information technology infrastructure enabling timely access to meaningful data was essential for ACOs to manage and monitor quality and outcomes.
  • Consumers generally lacked knowledge of ACOs and were unaware they were part of an ACO.
  • Physician engagement and strong organizational leadership to shift culture from a volume focus to a value focus were crucial to ACO development.

The introduction of the accountable care organization (ACO) as a form of healthcare delivery and payment system reform supported by the Affordable Care Act is hoped to improve quality of care and reduce healthcare costs by aligning the incentives of physicians, hospitals, and other clinicians and healthcare organizations.1-4 Coined in 2006 by Fisher et al,5 the ACO label has been defined as “groups of providers who are willing and able to take responsibility for improving the overall health status, care efficiency, and healthcare experience for a defined population.”6

Although early adopters of the ACO model commonly operated under the CMS Medicare Shared Savings Program (MSSP) or the Pioneer ACO Program,7,8 recent market entrants have included ACOs in the private market.8 These private sector ACOs have goals similar to those of the MSSP and Pioneer models in that the contracts with payers include both cost and quality targets; however, they have more flexibility with respect to contract terms relative to Medicare ACOs.9 For example, private sector ACOs are able to develop multiple contracts with multiple payers to extend coverage across broader, commercially insured populations and those including children. In addition, private sector ACOs can have very different quality reporting requirements and financial relationships with, and incentives for, providers—within the boundaries of antitrust considerations—relative to Medicare ACOs.9-14

Early reports have suggested that provider groups decide to become ACOs for a variety of reasons, including the desire to save money and improve care,15-19 and due to a sense of inevitability about the direction of health reform.16,20,21 However, few studies to date have focused on private sector ACOs9,22—particularly those that bear downside risk—and none have asked both ACO stakeholders and consumers affiliated with these organizations about their perspectives. Because private sector ACOs are not bound by the federal regulations and reporting requirements of Medicare ACOs, they have the potential to develop quickly and for different reasons and in different environments than Medicare ACOs. We undertook this study to improve our understanding of ACO development and implementation in the private sector, which is one of the most rapidly growing sectors of the ACO market.23 Our research objective was to explore the rationale for private sector ACO development, the perspectives consumers had about these emerging ACOs, and the critical success factors interviewees associated with private sector ACO development.

METHODS

Study Design

We conducted 4 comprehensive case studies of private sector ACOs that assumed full risk from different geographic regions of the United States. Unlike most studies that focus only on the perspectives of ACO providers and leaders, we also focused on the consumer perspective. We elected to use a multiple case study design24 because of the exploratory nature of our study and our desire to learn from multiple stakeholders to improve our understanding of a relatively new organizational form.25

Site Selection

We selected ACOs for study that both operated in the private sector and assumed financial risk for substantial portions of the populations they served. Organizations had to self-identify as an ACO and, consistent with common definitions of ACOs,13,26,27 they had to involve groups or networks of providers that assume responsibility for the cost and quality of care for defined populations, including some level of downside financial risk. We also maximized the variability of our sample to include ACOs that differed along several important dimensions, including structure (ie, physician-owned vs physician-hospital organizations), size, geography, and population (ie, pediatric vs general). Summary information about our 4 ACOs is included in Table 1.

Data Collection

We collected data through site visits during the spring and summer of 2013. Across the 4 sites, we held a total of 68 in-person or telephone key informant interviews. In addition, we held 5 focus groups comprising 52 consumers (Table 2). Our data collection process included a concomitant assessment of interview and focus group transcripts and discussion of preliminary findings to permit probing for new concepts and to ensure that we reached saturation in data collection consistent with standards for rigorous qualitative research.28

Site visits and key informant interviews. During 2- to 3-day visits, we conducted semi-structured interviews with ACO stakeholders from 4 main areas: 1) organizational leaders (eg, chief executive officer [CEO], chief operations officer, chief marketing officer); 2) administrators and staff members who could provide insight about the ACO decision making and development process (eg, informants from business development, strategic planning, finance, contracting, marketing, external affairs, information systems, quality and performance improvement); 3) administrators, staff members, and clinicians involved in ACO operations (eg, ACO administrator, contracts manager, practice manager, medical director); and 4) physicians affiliated with the ACO.

Interview guides and interview process. To ensure consistency in our data collection, we used 2 standard interview guides: 1 tailored for providers and 1 for administrators and staff. The interview guides consisted of multiple-question domains, including: 1) History and Context; 2) ACO Implementation; 3) Consumer Involvement; and 4) Critical Success Factors. These interview guides were tested in a pilot study of a different ACO to improve question clarity and refine the guides prior to our study site visits. Most interviews were conducted in person and lasted 30 to 60 minutes. All interviews were recorded and transcribed verbatim.

Focus groups. Each focus group was conducted using a standard guide that included open-ended questions exploring consumers’ perspectives about ACOs and their own healthcare. A study investigator moderated each of the focus groups, with an additional investigator present as a co-moderator. One focus group was conducted at 3 of the ACO sites and 2 were conducted at the fourth site to capture consumer perspectives from both the urban and rural markets this ACO served. Each focus group comprised 7 to 16 participants who lived in the ACO market and interacted with the ACO as patients or parents of patients of ACO providers. Sessions lasted 90 minutes and participants were given a $50 gift card as a token of appreciation for their time. All sessions were recorded and transcribed verbatim.

Document collection and review. For each participating ACO, we also requested key documents related to ACO development. Examples of these documents included the ACO strategic plan, communication vehicles, ACO progress reports, board presentations, and annual reports.

Data Analysis

Our analytic approach included using both inductive and deductive methods to analyze the 1158 pages of transcripts from our interviews and focus groups in an iterative process. After each site visit, the research team first compiled a “Site Visit Summary” that included summary impressions. This initial analysis was helpful for conceptualizing findings and themes and provided insight into more focused inquiry.29

Our second analytic step involved coding the interview transcripts to break this qualitative data into smaller, meaningful segments for analysis.29 We developed an initial set of codes based on our interview guides and emergent themes from the site visit summaries; we then summarized these codes in a “coding dictionary” that included detailed definitions to ensure consistent application of the codes.29 This preliminary coding dictionary was further refined as themes and patterns emerged in the data. Three members of the research team then coded the data and, throughout the coding process, conducted cross-checks of the coded data to ensure that codes were consistently applied.28 Data were coded and managed using a qualitative software program, Atlas.ti (Scientific Software Development GmbH; Berlin, Germany).

The third step of analysis we conducted for this paper involved examining the codes of “motivations” and “critical success factors” to inform our understanding of private sector ACO development. We used an inductive approach to identify themes and patterns in the coded data, first focusing on patterns within cases (ie, study sites) and then evaluating whether these were replicated across cases, paying particular attention to any differences in the contrasting cases (eg, in pediatric ACOs vs others).25 At each stage of this coding and analysis process, we also sought and considered disconfirming evidence25,28,29 to ensure the robustness of our findings.

RESULTS

Motivation for ACO Development

When asked about their motivation for developing a private sector ACO, interviewees across the study sites noted 3 reasons, explained here and with supporting evidence presented in Table 3.

The first was to lower costs while improving care quality. As one ACO executive summarized, “We came together with a fundamental mission of improving cost of care and improving quality of care.” Second was to improve coordination of care and population health management. This motivation was acknowledged even in the face of understanding that all incentives were not aligned. As one interviewee explained, “You can’t see either the hospital or the health plan or the physician group or whoever the players are as adversaries, even though your incentives might not always be completely aligned. You’ve got to find a way, a common ground to do what’s right for the patient.” The third common motivator had to do with a sense of inevitability given the direction of health reform. One interviewee reflected, “I think if you polled hospital CEOs, 90% of them are going to say, ‘We are on the path to an accountable care organization.’ …there is now a general belief and acceptance in that this is the right thing to do in that whether you’re an insurance company, a provider, a hospital, you are moving in this direction.” Although individual interviewees at the sites noted other reasons, such as the desire to consolidate market power so that the organization could “leverage the best payments” or to be “a market leader” in this new model of care, these comments did not reflect the collective sentiment across interviewees and institutions.

Consumers’ Perspectives about ACO Development

Across the focus groups, none of the consumer participants was familiar with the terms “accountable care organization” or “ACO,” nor were any individuals aware they were part of an ACO. This became apparent during each session when no participants provided answers to the questions, “Prior to coming here [to this focus group session], did you know what an Accountable Care Organization was?” and “Did you know that [this organization] was an ACO?” As a result, participants’ answers to open-ended questions instead reflected their experience with their own physicians or a named hospital and not the ACO entity. Consumers’ lack of familiarity with the ACO model had been predicted by our sites’ key informants, who consistently indicated that their ACO outreach efforts purposely did not include branding the ACO to consumers, nor promoting the ACO as something new and different.

Critical Success Factors for Private Sector ACO Development

When asked what interviewees believed to be critical success factors for development and implementation of an ACO model in the private sector, responses could be classified into 5 main categories: 1) physician involvement, 2) strategic buy-in to the ACO vision, 3) information technology (IT) infrastructure and data, 4) experience and understanding, and 5) leadership. These factors are explained below, with additional supporting evidence provided in Table 4.

1. Physician involvement. Provider buy-in and engagement were mentioned often and across all 4 sites, and were perceived to be the key factors limiting whether the ACO model could be implemented. As one senior executive explained, “The providers actually have to buy into it…Because if they don’t, you can provide reports and have meetings and do everything that you want to, but if the providers haven’t actually bought into it, it’s an uphill battle.” Engagement and involvement of physicians in ACO governance were also important, with one interviewee summarizing this factor as “absolutely bringing physicians to every point in the table.”

2. Strategic buy-in to the ACO vision. Strategic vision and buy-in at the organizational level (ie, moving beyond provider-level buy-in) involved commitment from and across the organization rather than only individuals (providers) engaging with the ACO concept. One senior executive reflected, “I think you really need that strategic buy-in … the fact that the healthcare system needs to take some responsibility to figuring out how to provide more effective, affordable, and efficient care that still meets the needs of the patients.” Interviewees at other sites made similar comments about the importance of buy-in to help ensure support for required investments and the effort required to support cultural changes for the organization.

3. IT infrastructure and data. IT was commonly recognized as critical. As summarized by one executive, “Well, an IT infrastructure is key. You can’t control what you can’t measure. You need to define your quality and utilization parameters. … You’ve got to build the structure right. You’ve got to have adequate data from your health plans so that you can figure out what you need to figure out.” Beyond infrastructure, interviewees also recognized the need for the data that the systems supported. As one ACO director noted, “You can have physicians who are bought into it and are engaged in it, but they need to know how they’re doing, and they want to know how they’re doing, right?”

4. Experience and understanding. At all 4 sites, interviewees explicitly noted that past experience with risk was contributing to their successful implementation of the ACO model. One director commented, “What we find is that with the experience that we’ve had previously, we’re sort of anticipating what’s coming down the road. And I think that’s positioning as well, as we move forward. Otherwise, you’re spending a lot of time scrambling.” This understanding was also valued at another site, as an interviewee explained, “We felt that we could take risk for a population that we knew very well and that we could manage the health of that population within the fiscal constraints.”

5. Leadership. Comments emphasizing leadership as a success factor reflected the importance of the leadership function overall, as well as the need for leadership of the cultural changes required to implement the ACO model. One manager commented, “The cultural shift is pretty huge to move from fee-for-service. And that whole mindset and getting people to really be able to embrace that.” Leadership was noted to be especially important as the ACO model evolved. As one executive explained, “And even when everybody’s on board it’s tough, because there are winners and losers, and people’s roles are going to change, how they’re perceived to perform, their incentives will change. It’s a tough cultural change even when everybody’s on board. So if there’s any hesitation by an important part of the organization, it’s going to be tough.”

DISCUSSION

The ACO concept has spread beyond the Medicare ACO initiatives, as provider and payer organizations in the Medicaid and private markets are developing ACOs to serve these populations. Lacking clearly defined models for private sector ACOs, however, payers and providers in these spaces are left to develop their own models. Furthermore, because most research to date has focused on ACOs developed in the MSSP and Pioneer ACO programs, there is little information about how and why ACOs are developing to serve other populations. In this paper, we have begun addressing this gap by providing early insights from the development and implementation of 4 ACOs serving privately insured and Medicaid populations.

Although private markets and populations may vary from those served by the MSSP and Pioneer programs, our findings suggest that many of the motivators for developing private sector ACOs are similar. The need to control the rising costs of care while simultaneously improving the quality of care, the need to develop capabilities to manage population health, and a sense of the inevitability of healthcare reform were the primary motivations for ACO development espoused by our interviewees. In a sense, providers want to “do the right thing,” and they perceive the ACO model as providing an opportunity to do that. This mix of motivators suggests both push and pull forces at work. The sites we studied are moving away from legacy approaches to healthcare financing and delivery, including fee-for-service and fragmented, siloed care, which they feel are no longer sustainable nor desirable. At the same time, these organizations are moving toward new contractual and organizational arrangements that they perceive both as inevitable and as allowing them to improve the health of populations.27,30 In short, healthcare reform efforts to better align incentives with quality and population health goals for traditional Medicare populations appear to be affecting transformations more broadly.

Our findings that consumers lacked knowledge of ACOs and were unaware that they were part of an ACO are notable, especially given growing emphasis on the engagement of patients in their own care.31-33 Providers and payers involved in developing ACOs are investing considerable time, money, and effort to transform the healthcare system, and yet the parties with arguably the greatest stake in that transformation are neither informed of nor empowered to shape these efforts. Given the linkage between patient behaviors and many health outcomes, we expect there are numerous opportunities to involve consumers in ways that will improve the abilities of ACOs to accomplish their goals. For example, there may be opportunities to provide incentives, including financial ones, to engage patients or to provide physicians training in patient engagement.34 Other opportunities may be to include patient representatives in governance, as required in the MSSP and Pioneer ACO programs, but not required in any private sector ACO model of which we are aware.

Implications for Management and Policy

Our findings suggest the importance of having strong leadership and physician engagement as part of ACO development, thus highlighting the importance of physician engagement reported in prior studies.22 Moving beyond physician engagement, however, all of the ACOs in our study had physicians in formal leadership positions and 3 of the ACOs had strong physician representation on their governing boards. The ACOs in our study included employed and community physicians in various aspects of decision making, ranging from compensation and incentive committees to quality improvement initiatives. Our findings about the importance of physician leadership are consistent with a recent national survey of public and private ACOs, which found that more than half of all ACOs are physician-led and that physicians make up the majority of governing boards in over 75% of the ACOs surveyed.23 Strong physician leadership could also help facilitate high levels of communication across providers, thereby improving patient care.35

These findings also underscore the need for adequate IT infrastructure for ACO development. Policies, such as Meaningful Use, helped motivate providers to implement electronic health records, which is a necessary first step. However, ACOs need the ability to access timely and meaningful data to monitor and improve outcomes and efficiency. The ACOs we studied are making significant capital investments in data and reporting capabilities; meanwhile, the ACOs that are unable to make the necessary capital investments in IT infrastructure will likely lag in terms of development. The Medicare Advance Payment Model attempts to address this capital need for smaller or rural Medicare ACOs; however, there do not appear to be similar arrangements in the private sector ACO markets.36 Rather, private sector ACOs either rely on capital infusions from physician groups or health system partners or turn to the credit markets. The limited options for capital support may hinder private sector ACO development, particularly for newer and smaller private sector ACOs.

The ACOs in this study had all been in risk arrangements well ahead of the emergence of the term “ACO” and had considerable experience (and success) in managing risk. Thus, they were able to reorganize relatively quickly as ACOs and had the confidence that they could take on the associated risk and responsibility successfully. New ACOs may face more challenges ramping up and may need to enter the private sector ACO market with lower-risk arrangements, such as shared savings, as they work to gain experience with contracts and population health management.

Limitations

One important limitation of this study was the small number of organizations involved. Given the time and energy constraints of qualitative studies, there are significant barriers to large-scale studies. Future work can include the development of surveys based on this research to explore and validate our findings in large samples. However, the ACOs included in our study are relatively mature, and their experience and perspectives provide important insights for newer ACOs that are considering entering the private market and assuming downside risk. Another possible limitation is that the ACOs in our study are likely to have experienced substantial changes from the time of our initial visits, given the rapid development of the ACO market.

Future Work

The private sector ACO market is developing rapidly. Recent estimates suggest that approximately half of the 600 ACOs identified in the United States are private sector ACOs.37 Given this rapid growth, future research should include larger-scale studies to explore the structural and financial arrangements in private sector ACOs that facilitate their development. Future studies should also focus on the performance and sustainability of the ACO model in this market. To date, approximately one-third of the ACOs participating in the Medicare Pioneer ACO program have withdrawn38; however, far less is known about exits within the private sector.

CONCLUSIONS

This study is among the first to explore the development of ACOs in the private sector. We found that these ACOs developed under the belief that payment reform is inevitable and that they perceived that becoming an ACO would allow them to respond to anticipated policy changes that will impact the way healthcare is delivered and reimbursed. These ACOs were also motivated by the opportunity to increase quality of care and efficiency and to improve population health. Moreover, each organization’s prior experience with successfully managing risk was identified as a factor that prepared these ACOs to enter downside risk arrangements with confidence. Although private sector ACOs are still evolving, improving our understanding of the factors that have been important for more mature ACOs can help facilitate the development of less mature organizations that are beginning or evolving their ACO journeys.

Acknowledgments

The authors are extremely grateful to the organizations and informants who participated in this study, and to the members of our Project Advisory Team. They also thank their research team members who assisted at various stages of this project: Meredith Rosenthal, Julie Robbins, Daniel Walker, Jennifer Hefner, Daniel Gaines, Lindsey Sova, Kelsey Murray, Pamela Thompson, Pamela Beavers, Alexandra Moss, Megan Sinclair, Kendall Haas, Mary Frances Gardner, and Jessica Stewart.

Author Affiliations: Department of Family Medicine, College of Medicine (ASM), and Division of Health Services Management and Policy, College of Public Health (ASM, BH), The Ohio State University, Columbus, OH; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (PHS), Chapel Hill, NC

Source of Funding: The Robert Wood Johnson Foundation funded this research; however, the study sponsor had no involvement in the collection, analysis, or interpretation of data; in the writing of this manuscript; or in the decision to submit the manuscript for publication.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (ASM, BH, PHS); acquisition of data (ASM, BH); analysis and interpretation of data (ASM, BH, PHS); drafting of the manuscript (ASM, PHS); critical revision of the manuscript for important intellectual content (ASM, BH, PHS); statistical analysis (N/A); provision of patients or study materials (N/A); obtaining funding (ASM, BH, PSH); administrative, technical, or logistic support (ASM, PSH); and supervision (ASM).

Address Correspondence to: Ann Scheck McAlearney, ScD, MS, Department of Family Medicine, College of Medicine, The Ohio State University, 273 Northwood and High Bldg, 2231 North High St, Columbus, OH 43201. E-mail: Ann.McAlearney@osumc.edu.

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