The Spreadsheet Isn't the Strategy

Too many organizations deploy efficiency models and processes designed for manufacturing, supply chains, and even corporate finance in an attempt to improve health care delivery. The results are predictable, and predictably bad.

These models are seductive because they work, elsewhere. A supply chain genuinely does get more efficient when you strip out variation and standardize the process. A factory floor genuinely does benefit from treating every unit the same way. The math is sound. The problem is the substitution: health care delivery is not a supply chain, and the people receiving care are not units.

Data and AI can inform a decision. A cost-per-encounter model can tell you where spending is concentrated. A staffing ratio can tell you where a team is stretched thin. What none of these tools can do is replace the judgment of the people actually doing the work, or account for the person on the other side of that work — the patient, the member, the community. A plan that optimizes the spreadsheet and ignores that relationship isn't a strategy. It's a report that will not survive contact with a Tuesday morning.

The plans that actually hold up are the ones built from the perspective of the people delivering care every day — how they work with patients, with each other, with the systems around them. Understand that, and the strategy follows. Skip it, and no model will save you.

None of this is an argument against data. It's an argument against letting data replace the harder, slower work of asking the right questions of the people closest to the problem — the frontline staff, the case managers, the members themselves — until the larger picture actually comes into focus. That's a different discipline than running a model. It's also the one that produces a plan an organization can actually run, instead of a vision it can't.

Everything we do at Totten Consulting is in service to the people on both sides of that relationship: the teams delivering care, and the people they serve. The spreadsheet has a role to play. It just isn't the strategy.