The four questions to ask about your organization.

A resume comes across your desk. It declares its author to be a "team player" with "communication skills" and "organizational skills," a "self-motivated, results-oriented problem solver."

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Make you want to snap that person right up? Didn't think so. But that's the kind of cliched yawner non-specific pap that fills most resumes.

Now use those eyes to look at your strategic plan, and your "mission, vision, and values" statements. Are you more likely to survive the next five or 10 years because of them?

It may be that your organization's central plans, the documents that are supposed to provide you with a guide for these turbulent times, are powerful, specific, hard-edged and insightful.

Maybe.

Almost every one that I see--and I see a lot--are comforting pablum. They all speak of "a spirit of innovation" and "a dedication to the customer." There must be a "Dummies" book somewhere on how to write these things.

Here's what I search for, beyond the usual fund-raising and edifice-raising plans, four things that would tell me that this organization is awake, wide-eyed, smart and ready. I call them "The Four Questions."

1. Does it have some kind of Deep Future Initiative?

2. Is there a detailed and insightful Innovation Initiative?

3. Do the Information/Digitization Initiatives show specific targets and budget commitments?

4. Where is the Automation Initiative?

Deep Future Initiative

Health care is entering a period of large-scale discontinuous changes. Here are six major transformations:

* The triumph of pharmaceuticals -- new drugs drastically reducing utilization across major disease categories and dispersing much of health care away from the hospital

* Globalization -- with many functions, from the writing of contracts to reading of images to medical transcriptions, shipped overseas

* The plague century -- a series of public health shocks, springing from both bioterrorism and natural plagues, pushing health care institutions into unforeseeable new alliances and re-organizations

* The new diagnostics -- new genomic and nanodiagnostic techniques moving much diagnosis out of the hospital and into the doctor's office, the clinic, or the home

* Digitization -- techniques beyond the mere computerization of today's methods, moving health care into a new level of precision and power

* Automation -- health care adopting and adapting techniques that can greatly speed transactions and increase their accuracy, while improving the quality of service and vastly reducing the workforce needed to deliver it

Are these ideas correct? How exactly will they affect your organization? In what form, in what order? When? How would you know? What is the best course of action for your organization to take?

I don't know the answer to these questions. But in most strategic plans, in most organizational structures, I do not see any mechanism for even asking these questions, let alone answering them.

If the general idea is correct--that health care is facing a period of serious change--any institution of some size and importance needs such a mechanism. It should not be a separate department. because any insights it produces must be broadly "owned" by people of major responsibility throughout the upper levels of the organization.

Rather, it needs to be a special kind of intentional conversation among those people, organized and promoted by the chief executive, and catalyzed by one or more outsider futurists and researchers.

Innovation Initiative

Any organization needs innovation to thrive in the current business environment.

But needing innovation, actually desiring innovation, and getting innovation are three different things. You can't order it over the Internet or fill up at the local Innovation Station.

By definition, the leadership of the organization cannot know what specific innovation it needs.

Nor can the leadership order innovation to happen. That's the "Be spontaneous!" paradox. Any true innovation would go directly against Standing Order #1 of many organizations, which is "Do things the way we do them here." That lies employer-induced schizophrenia. Employees, being smart people, don't go there.

Everyone says they are for innovation, but almost no one really is, for simple, systemic reasons. In the status quo, everyone in the organization is as competent as they can be at the way things are done now.

When you institute any true innovation, everyone in the organization becomes instantly incompetent at the new way of doing things. They are beginners at the new thing. They have no seniority at it, no experience to throw around, no politics around it. It cuts across and impedes whatever informal institutional powers they have built up. It might even threaten their jobs, directly or indirectly, truly or symbolically. True innovation is always disruptive.

So nobody really likes innovation. Organizations tend to work around any innovation and seal it off, like a tree might do with a tumor. And innovation cannot be simply ordered from the top. So how do you get innovative behavior?

An executive bent on true innovation must find ways to ferret out people and groups with innovative ideas, nurture them, reward them, protect them from attack and eventually celebrate them once their seedlings have taken root and shown results.

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There are a variety of ways to do this, none of them direct. That is what I would like to see sketched out in the places in any strategic plan that mention the importance of innovation: an awareness of the difficulty of pursuing true innovation, some sense of the methods of getting around that difficulty and a budgeted commitment to nurture it.

Information and Digitization Initiatives

Digitization of health care is deeply important.

In the grand scheme of things, it is more important than building new buildings and expanding programs, because properly designed and implemented it gives the entire enterprise a lower cost base, with higher quality--in a business where poor quality doesn't mean a squeaky car door, it means people dying needlessly.

Your strategic plan should answer such questions as:

* What do you believe the desired state will be by 2010?

* What would it take to get to a fully digitized environment that delivered on the promise of computer-mediated communication?

If the document seems mushy on this point, and if the desire on the part of management is anything but clear, detailed, committed and forceful, this will not happen.

Automation Initiative

Airline passengers can get their own tickets online, choose their seats, upgrade to first class, print out their own boarding passes and even run the boarding passes through the machine at the gate themselves.

Except for security questions, they need not interact with airline staff anywhere on the trip if they don't want to. Airline ticket counters have greatly reduced staff, yet are offering better customer service than before.

UPS and FedEx can track every package, and customers can find the package's location and arrival time on the Web. By automating its book-keeping, Cisco Systems reduced the time needed for its annual close from six weeks to 16 hours.

The examples go on and on, in industry after industry. Automation is the engine of the phenomenal and continuing rise in the productivity in the U.S. workforce. Health care has shared in almost none of this.

In health care we employ legions of people to make appointments, admit patients, verify their eligibility, hassle with insurance companies, do billing, manage receivables, manage medical records, schedule operations, manage bed inventory, order supplies, manage and distribute pharmaceuticals, and thousands of other tasks. Many, if not most of these tasks could be automated--as the analogous tasks in other industries already are.

One can imagine a health care world where:

* Patients could make their own appointments

* Software could schedule surgeries, negotiating between the schedules of available operating space, the surgeon, the anesthesiologist and the nursing teams

* Labs could handle samples quickly and accurately with little or no human handling

* Databases of insurance companies and hospitals could automatically verify eligibility of patients

Any task that can be described as a set of rules can be automated. Any task that does not strictly require the presence of a human can be completely automated. The argument that health care is somehow exempt from the imperatives of automation and productivity gains is inside out.

We do not have a moral mandate to employ as many people as possible. We have a moral mandate to deliver the highest quality health care at the greatest efficiency to the greatest number of people.

No time to waste

These four questions are not peripheral. They are not questions to contemplate when you have the time and budget and nothing else is bothering you. These four questions are core to survival in this decade.

We dodged the bullet of the Balanced Budget Act of 1997. We survived the Y2K frenzy. We seem to be coming to terms with HIPAA. We're still struggling with digitization, with keeping the ER staffed, with keeping nurses, with malpractice problems, with quality problems.

This is not the time for complacency. This is not the hour to ignore the looming challenges of the future in order to wrestle with the challenges of the moment. because those challenges and possibilities of the future light the paths out of our present predicament.

This is the hour to do what must be done.

Joe Flower is an internationally recognized health care futurist. He can be reached by e-mail at [e-mail].