Finding time for organizational development can seem impossible in the busy world of Medicaid agencies, but strengthening the ability of staff to lead in an environment where they don’t always have control over strategic priorities is critical for success. In Medicaid, a steady stream of constant changes keeps things exciting, but challenging, too. Sometimes, leaders are prepared to manage the changes. Other times, it can feel like a steep learning curve to navigate unfamiliar territory. Without an organizational development plan, staff may feel frustrated about not having defined roles and scopes of work, clear implementation and decision-making processes, or opportunities to develop technical and leadership skills. Organizational development can help Medicaid teams build their capacity to be more effective and achieve goals by developing, improving, and reinforcing strategies, structures, and processes. Investing in organizational development can help to develop the next generation of leaders, build the organization’s capacity and knowledge to juggle several priorities, and most importantly, better serve enrollees.

The Center for Health Care Strategies (CHCS) partners with Medicaid agencies across the country to help create organizational development plans and provide technical assistance to implement these plans. This blog post highlights three key lessons for agencies to consider when embarking on an organizational development journey.*

Lesson 1: Make Room for Others — Develop Workgroups to Empower Staff at All Levels to Lead

Senior Medicaid leaders can feel pressure to be intimately involved in efforts to move high priority work forward, but this may result in bottlenecks due to their limited capacity. There is also a tendency to go to the same trusted high performing staff, who end up becoming overwhelmed. Both habits can limit organizations’ ability to manage complex work. Developing workgroups is an effective way to maximize the capacity of the organization while encouraging and preparing others to lead. Organizations may create workgroups for various reasons, such as to implement a policy initiative, advance diversity, equity, and inclusion goals, or improve a systems process.

Leaders exist at all levels within Medicaid agencies. Executive leaders can take a step back and empower staff — particularly staff of marginalized identities who are often overlooked for leadership opportunities — to manage projects, lead workgroups, and make decisions. Workgroups can provide an opportunity to nurture staff with untapped potential. This may require explicit conversations about coaching needs and development goals, which can take significant time — but if the alternative is relying on senior leaders who are already stretched thin, this investment may be worth it. As Thomas Lind, MD, chief medical officer at the New Jersey Division of Medical Assistance and Health Services (NJ DMAHS), said, “[Participating in organizational development work] helped me to be more intentional and thoughtful on how to effectively give constructive feedback and develop staff.” When a staff member is motivated and supported to drive a project forward, they become a champion and can build trust, momentum, and cohesion among the group to get things done.

Using workgroups as a vehicle to invest in leadership development, bring people together from different teams, and help executive leaders stay out of the weeds can help accomplish organizational goals. As Karen Enoch, chief of staff, NJ DMAHS said, “Workgroups have helped me to realize that staff have heart, they care, and have many ideas to contribute.”

Lesson 2: “We are Gathered Here Today…” — Define Project Goals and What Success Looks Like

Lack of clear vision can lead to confusion and ineffective efforts. At worst, it can lead to competing agendas that erode trust. Clear project goals ensure that everyone is working toward the same outcome. The key question “What does success look like for this project?” gives Medicaid teams an opportunity to develop a shared understanding of the objectives and co-create a vision. This also provides room to openly discuss any concerns and problem-solve foreseen challenges.

A project charter can be a useful tool to frame project goals, define roles and responsibilities, set expectations, and track milestones. Project charters provide all workgroup members with a clear picture of the project, particularly for cross-functional or cross-sector teams. Project charters also help to solidify the team’s charge and update strategic goals and timelines when changes inevitably occur. It is important to embrace an agile mindset and manage change during the organizational development process.

Lesson 3: The Sweet Spot — Identify the Right Cadence for a Feedback Loop

Delegating to a workgroup doesn’t mean simply letting go. Developing the right routines for communication and support are essential to help the workgroup succeed. Since they often remain accountable for the outcomes, executive leaders may be more comfortable to trust the process and take a step back when they receive regular updates from workgroup leaders.

One strategy to help structure a feedback loop is the use of an executive sponsor. Executive sponsors ensure that the project’s goals are aligned with the organization’s overall strategy, garner support and overcome resistance from other senior leaders, and provide ongoing direction and thought partnership to the workgroup leaders. Executive sponsors can also prevent pigeon management. As Jessica Hill, chief of staff at TennCare (Tennessee’s Medicaid program), said, “I try to avoid being a pigeon manager, a leader who stays above ground for the most part, but then flies down into the weeds out of nowhere and wants to change everything, requiring the project team to backtrack and lose momentum.” With the right level of communication, executive sponsors can help create clarity and accountability without “making a mess” and rescinding the power of the workgroup when setbacks occur.

Workgroup leaders can update executive sponsors via weekly emails, bi-weekly meetings, or monthly correspondences to share progress, report “red flags”, and navigate challenges. Even when it feels like there is nothing to report, executive leaders and workgroup leaders are encouraged to use the time to connect and strengthen their partnership in the work.

Looking Ahead

Investing in organizational development can help Medicaid agencies increase their capacity and strengthen the pipeline for internal rising leaders. Additionally, more agency priorities can be advanced when executive leaders support workgroups, leverage tools that help establish goals and drive progress, and develop a clear feedback loop. Lastly, remember to celebrate the organization’s wins. As Greg Woods, chief innovation officer at NJ DMAHS said, “We are not exactly where we want to be, but we are in a much better spot than we were two years ago.” Acknowledging progress is especially important with the unpredictable nature of Medicaid. Agencies that invest in organizational development will benefit from a skilled bench of leaders who are ready, motivated, and empowered to prioritize and advance agency priorities.

*CHCS is grateful for its most recent organizational development engagement with the New Jersey Department of Human Services, Division of Medical Assistance and Health Services (Medicaid), which helped to inform lessons in this blog post. This project was supported by the Robert Wood Johnson Foundation.

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