Case Study

Top-line growth and quality patient care

How one healthcare organization equipped its leaders to deliver both


An integrated healthcare organization committed to providing affordable, high quality healthcare services wanted to develop a new, enterprise-wide leadership development program for its mid-level leaders, reaching every department. The company needed a program focused on enabling an “enterprise thinking” mindset that would give leaders a broader perspective on their business. Such a paradigm would allow leaders to better understand key trade-offs between improving operational efficiency and increasing quality of patient care, demonstrate resilience among shifting industry regulations and trends, and meet the various ongoing challenges faced by healthcare organizations, all while balancing “mission vs. margin” objectives.

To achieve broader enterprise thinking, the healthcare organization partnered with BTS to design a customized business simulation modeled after its existing business. This solution sought to provide participants with a deeper understanding of how their departments’ operational decisions affected “the big picture,” and also to help them identify the areas in which these decisions most significantly impacted bottom-line improvements, strategic alignment, and decision making. In the simulation, each leader:

  • Practiced making trade-off decisions on key investments and discovered how each decision was inter-related.
  • Gained insight into how others perceived them as a leader by increasing self-awareness of their own behaviors while running the business.
  • Learned best practices for cross-functional, high-performing teams to manage stress and build resilience.

The simulation created a risk-free, engaging, and fun way to achieve these learning objectives. Participants gained a holistic view of the organization’s value chain, which ran from attracting new health plan members to decreasing the average length of a hospital stay and system-wide medical costs.

The simulation’s unique approach to learning placed participants in challenging, realistic scenarios. By reasoning through the simulation, participants drew from both their own experiences and their peers’ to adopt new behaviors, enabling them to manage their business areas more successfully. After each year of the simulation, BTS consultants presented feedback on and analysis of each participant’s results to demonstrate outcomes of the various strategies at play.

Faced with relevant and high-impact business challenges, participating teams strove to maximize operating margins, revenue, quality of care, community wellbeing, service experience (including member satisfaction), and employee performance. Participants also assumed the position of someone on the executive team, formulating a strategy and prioritizing investments on a quest to generate the most improvement on the overall financial health of the organization.

An Experiential Learning Program

The simulation was composed of three rounds experienced over four days. Each round had a distinct theme and set of learning objectives.

The first round focused on understanding the enterprise from top to bottom:

  • Growing the top line by managing membership through a mixture of affordability, service experience, and access.
  • Sustaining financial performance and improving quality of care through controlled usage across care settings.
  • Attracting and retaining talent through opportunity for growth, education, wellness, and safety.

The second round focused on managing the system, from member to employee:

  • Capturing growth by responding to an evolving market and new partnerships.
  • Leveraging enterprise resources and excellence to drive local outcomes.
  • Investing in the workforce to drive member retention through employee engagement and consumer experience.

The third round involved creating momentum for a sustainable business:

  • Promoting whole health, which describes social determinants of health such as mental health and financial stability, and community wellbeing, thereby improving system affordability.
  • Investing to meet the patient needs of the future, while still managing total cost of care.
  • Building resilience by maintaining focus and influence across the individual’s network.
Learning by doing

Before the four-day program began, participants were asked to read a detailed case study describing a fictitious company in a fictitious market environment, both modeled after the real healthcare organization and its environment.

On the first day of the program, leaders were divided into five teams. Each team entered a strategic planning session during which they set their business decision-making strategy and planned how to preserve resilience across the three simulated years. Within each team, leaders received one of six roles: Head of Health Plan, Head of Hospital, Head of Outpatient Clinic, Head of Outpatient Pharmacy, Head of Shared Services, and CEO / Head of Community Wellness.

In the simulation, leaders made critical decisions across three areas. The first is Member Segments, which includes Groups, Individuals, and Medicare. Medicaid is also one of the member segments, but leaders don’t make direct decisions for this member group. The second is Points of Care, which includes the Health Plan, Hospital, Outpatient Clinics, and Pharmacy. The third is Shared Services, which involves enterprise decisions around core infrastructure, data analytics, mobile experience, and community involvement.

Over the three simulated years, the marketplace evolved, forcing teams to react to the needs of every member segment. For example, when the business expanded into a new geographic region, teams had to decide which products to bring to market. In another, Medicare growth and demand far exceeded expectations, and leaders had to recalibrate priorities. Periodically, teams would receive a “Wobbler,” or an unexpected event requiring that they respond in real-time. Examples include a sudden drop in patient satisfaction scores, drug shortages at pharmacies, or a staph infection within the hospital. Teams’ decisions impacted both KPIs and their market share for each market and segment.

Playing to win

Team performance was measured by four primary metrics: operating income, revenue growth, quality of care, and community wellbeing. Leaders’ choices were also benchmarked according to additional metrics that reflect relationships across the enterprise, including member satisfaction, service experience, employee engagement, and access.

Leaders also participated in “debrief” sessions to discuss the results of running the simulated business, which were integrated with observations of each individuals’ resilience, agility, and stress regulation throughout the round, particularly when facing critical moments.

While running their simulated companies, leaders experienced two “Know-How” sessions, which are mini-learning sessions to deepen their knowledge of the business and learning objectives. The first session focused on driving affordable care by deepening comprehension of income statements and building patient health-management skills, while the second featured a patient journey map that highlighted the critical moments in a patient’s healthcare journey.

After experiencing all three simulated rounds, leaders entered an “Application” session, identifying the actions and behavior shifts that would drive business results back on the job. They also created “Go-Dos,” which are goals designed to sustain lessons learned and yield meaningful change. Following the program, every participant received follow-up emails reminding them of their Go-Dos, each embedded with a secure link that allowed leaders to update and track their progress.

Participants’ Key Session Takeaways
  • “Every decision has a takeaway. While trying to solve any problem, the decisionmaker needs to consider all factors.”
  • “[I grasped] the complexity of our system and how to manage it by engaging with colleagues more broadly.”
  • “[The importance of strategic thinking, whole system consideration, and the necessity of strategic collaboration between outpatient and inpatient teams to improve affordability.”
  • “The business simulation was excellent. It demonstrated the business’s complexity and interconnectivity and also required great discourse within groups.”
  • “[I appreciated] the real-life aspect of having to make decisions quickly and resolve competing priorities. We may have the best intentions, but we need to ensure that the organization is sustainable and taking calculated risks. The simulation showed that clearly.”
Post-Program Participant Actions

As a result of the experience, participants had a better understanding of the organization’s strategy and business; specifically, about increasing operational efficiency. Each participant committed to concrete actions they would take back on the job to make an impact on the organization. A total of 135 Actions were submitted to and tracked by BTS. As of 6 months post-pilot, 30.02% of actions were completed, and 36.71% were in progress.

Highlighted below are specific outcomes resulting from participant on-the-job actions:

  • “I had my team collaborate on how to save money… while maintaining our mission of integrity. In doing so, our team has created and implemented new cost-saving initiatives for the entire service area around waste and hazardous expiring supplies.”
  • “I met with my finance team to see how I can help with my department’s budget. As a result, we were able to get payroll back on track and strategize hiring new staff within the payroll budget.”
  • “I shared my learnings from this Business Simulation with my Direct Reports, especially [about] the balancing act needed between growth, market share, maintaining quality, service experience, member/patient satisfaction, [and] revenue, as well as a focus on innovation. Through sharing my learnings consistently… I have seen more buy-in and more receptiveness in implementing changes and making process improvements related to the initiatives. This has impacted our department’s efficiency and encouraged innovative solutions to our current issues.”
  • “After participating in this experience, I have strong support for virtualization initiatives. My team is now supporting virtualization efforts in our service area through implementing Bluetooth-enabled devices in our Advanced Medical Care at Home or Hospital at Home program, which impacts our financials, but also member satisfaction and retention.”

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