The standard elements of collaborative value creation

Governor Mike Leavitt has a long and distinguished record of public service, serving as the executive head of state in Utah, as administrator for the Environmental Protection Agency, and as secretary of the Department of Health and Human Services (HHS). Along the way, the Governor and Rich McKeown, his chief of staff in all three of those positions, have documented a number of factors that contribute to successful collaborative alliances. Those critical elements (see sidebar) were outlined in the 2012 book, Finding Allies, Building Alliances: 8 Elements that Bring — and Keep — People Together. While not specifically called out in the list, the book provides a number of examples when the development and/or agreement on a set of standards is fundamental to the formation and operation of alliances that deliver value for multiple stakeholders, including but not limited to those involved in the alliance.

A common example of the need for standards comes from the time when President Abraham Lincoln sought to create a national rail system. At the time, there were seven different railroad gauges (the distance between the two tracks) in use in America, which meant not all rail cars could use the same tracks. To achieve standardization in this case, the federal government mandated a national railroad gauge (4 feet, 8 ½ inches) that remains the standard to this day.

There are parallels with more recent efforts to drive adoption of the use of product data standards in healthcare. While we saw some market movement when the Healthcare Transformation Group and group purchasing organizations began demanding manufacturers use GS1 standards for product identification in transactions and contracts, the real shift came when the U.S. Food and Drug Administration (FDA) mandated unique device identifiers (UDIs) for all medical devices sold in the U.S.

But there remains a question that many manufacturers point to for their initial reluctance to move to GS1 standards before the regulation: Will healthcare providers use the standard product identifiers once they are available? New federal regulations require the use of UDIs for implantable devices in certified electronic health record technology and as part of the Common Clinical Data Set, but there are no mandates beyond those devices or in those scenarios. And there is no mandate for manufacturers to use UDIs in their systems and processes beyond what it takes to label their products and populate data in the Global UDI Database. The question then becomes: Will there be adoption and use by either party (and by other stakeholders) beyond what is required?

Here’s where Governor Leavitt and McKeown’s work delivers some valuable lessons; in their opinion, not all collaboration and standardization requires a mandated solution. In regard to UDIs, I would add that the real opportunity lies not with the standard identifiers themselves but rather how they can improve visibility to what products are used in healthcare and how that translates to better clinical, financial and operational performance for the various parties involved, and ultimately to better value for patients and populations.

Take the case of the American Health Information Community (AHIC), created as a result of an executive order by then President George W. Bush and led by then HHS Secretary Leavitt to develop standards for interoperability among electronic health records (EHRs). As McKeown told me, that effort initiated the conversation, but it never really solved the problem, as evidenced by the challenges users of disparate EHR technology still face sharing data with one another. Today, he points to work by the Carin Alliance, a bi-partisan, multi-sector alliance that brings together industry leaders, in collaboration with the government, to make it easier for providers and patients to share digital data to achieve their respective goals. And once again, Governor Leavitt is serving as one of the conveners. Like the AHIC, The Carin Alliance’s work includes overcoming technical barriers to electronic data exchange, specifically through the use of a relatively new standard — FHIR. But it is the group’s work around creating trust among the parties and helping drive widespread value — in terms of better quality, outcomes, affordability and patient satisfaction —that is more difficult. As Governor Leavitt and McKeown write in the book, technology (and standards) facilitate collaboration, but the real results rest with the sociology of how people organize and work together to achieve results. Or in their words: “Good technology rarely makes up for bad sociology in a value alliance.”

Governor Leavitt has countless real life examples to demonstrate the power of the eight core elements and the factors that accelerate time to value by collaborative alliances. You have a rare opportunity to hear him first hand – and at no cost – at an upcoming lecture at Arizona State University. Governor Leavitt will deliver the 2018 Mark McKenna Foundation Lecture on Wednesday, March 14 in Tempe, Arizona. To register, see the information in the sidebar on this page.