2. Find opportunity in chaos
In healthcare, between the Affordable Care Act, privacy legislation and radical changes to the International Statistical Classifications of Diseases (ICD), an industry bible used to categorize virtually every diagnosis and medical procedure, "our business requirements have been utterly redefined," says Halamka, who is also a Computerworld columnist.
"Obamacare, for example, funds medical centers not on what operations they perform but on quality and wellness outcomes," he explains. "Hospitals know how to take care of people when they're sick but not how to take care of them when they're well. There's VUCA for you."
VUCA leads to opportunity because "no one in the industry has any idea how to do this right," Halamka argues.
"What an incredible opportunity for innovators and risk-takers," he says. Also a plus is the fact that "there's a whole new generation of tools and technologies, which now means we are able to do some of these business processes successfully," he adds.
Two years ago, it was unclear precisely how all of the various proposed rules and regulations would ultimately play out. So Halamka and his team made what he calls "an educated guess," and began aggregating all of the data across the sprawling Beth Israel Deaconess community into a central care management repository. Today, that repository is the foundation of the medical center's electronic health records system and information exchange.
Now, Beth Israel Deaconess is figuring out how to help physicians grapple with the more than 170,000 billing codes in the revised ICD, which takes effect in October 2014.
"Doctors will have to document entirely differently, so we're asking questions like 'Is a doctor able to remember 170,000 codes?' and 'How can we blow up the way it's done now and use things like natural language processing so the computers read what a doctor writes and suggest a code?'
"We've had to completely rethink in a natural way the approach to clinical documentation with a timeline of one year to have it go live," Halamka says.
To be successful in the escalating VUCA environment, two things are required, he says. The first is management that doesn't get frustrated by the need for agility, but instead gets empowered by it. The second is an "extremely resilient" senior team, which Halamka says he has.
"We've learned that every time a new project or new imperative comes up, you don't say, 'Woe is me, I'm a victim.' Instead, you study the possibilities and understand how it fits into the context of what you're doing. It requires almost daily reprioritization of activities."
The swift embrace of the bring-your-own-device movement at Beth Israel Deaconess is a prime example. "We support 7,000 iPhones and 2,000 iPads, and I didn't buy a single one," Halamka notes. "We've had to rapidly innovate layers of security that keep the balance between ease of use and confidentiality with regulatory compliance. That meant redoing the operating plan with extra dollars and staff focused on security issues. That wasn't in the [original] plan. That's something society inflicted on us."
3. Be a chameleon
Unable to completely control her environment, P&G's Clement-Holmes has embraced a management strategy based on what can be controlled.
"VUCA is a lot about what you don't know. What we want is for people to focus on what they do know and can control," she says. For example, rather than waiting to get 20 people together for a meeting, which could take as long as 12 months given conflicting schedules, "get the people you have now and trust those people to start working on the problem," she says.