How To Drive Change at Big Companies: A Q&A With John Proietti

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John Proietti is an independent consultant and project manager with experience in digital product development, program management, and operational integrations. He’s been a consultant at Bain & Company, held project management roles at Uber and Expedia, and served as the COO for BlueSleep, a digital health start-up.

In our latest expert Q&A, he talks about how to drive change in an organization—and how the health and life sciences industries can capitalize on digital opportunities.

You’ve led several major business transformations in healthcare, an industry that’s not always known for its willingness to embrace change. What are some of the things you do to make those initiatives a success?

You have to take a long view. Just because you have a great idea that delivers quality healthcare in an innovative way does not mean you can turn it into a profitable service in the space of a year. You’ve got to invest in getting that idea to market in a way that works for everybody—patients, payers, regulators, and all the other stakeholders.

And from an organizational perspective?

The projects that I’ve seen go well at big companies have both top-level executive support and a lot of resources—and usually a tight timeline, as well. When teams are under-resourced, they become overworked, and then things get delayed. That makes the project look bad, and it becomes a self-fulfilling prophecy. Take a decent-sized team and put them to work, hard, for three months. Take a small team with fewer resources and give them a year, and it usually goes wrong.

The projects that I’ve seen go well at big companies have both top-level executive support and a lot of resources—and usually a tight timeline, as well.
Digital health holds a lot of promise for the industry, but it’s been hard to execute on those opportunities.

Healthcare providers and payers have been looking for ways to innovate and scale their services, but there are a lot of obstacles. Take the example of telemedicine. Healthcare payers either won’t reimburse doctors for the cost of a virtual visit, or they’ll reimburse it at around one-tenth of an in-office visit. That stifles innovation, and it’s a real challenge. Other companies are trying to go directly to consumers. But health insurance is a major cost for most people, so they don’t want to spend money outside of their plan, and it can be difficult to convince them that your product or service is worth opening their wallets for.

How can companies start to tackle some of those challenges?

You’ve got to demonstrate the benefits—to offer users actionable insights that link their behaviors with opportunities to improve their health or incentives to change their behavior. Healthcare technology and wearables often provide people with a lot of data that doesn’t do anything. After people get over the novelty of knowing how many steps they take each day, they realize it hasn’t changed how they behave, so they stop caring. A similar thing is happening with sleep monitors. Actually, in some ways, it’s preventing people from sleeping, because it’s giving people sleep anxiety. They wake up and get graded and start to worry.

Fortunately, wearable technology is getting to a point where it can, say, alert a diabetic that his or her blood sugar is getting low, or tell someone to sit down and call a doctor, because their heartbeat is irregular. Those are huge insights that can make powerful changes to people’s lives.

Yet even with telemedicine, the adoption has been much slower than one might expect.

I mean, the technology has been around for a long time, but it’s just really starting to be used at scale. Virtual visits are shorter, so doctors can see more patients. They also lower costs for patients, because you no longer have to take your whole afternoon off to see the doctor. But in addition to the reimbursement issues I brought up earlier, ensuring privacy is a challenge. You need HIPAA compliant video, and a lot of folks are worried that they’ll share some sensitive issue with their doctor and will get hacked.

There are also some things you can’t accomplish without being in the same room as a doctor.

That’s true. But some interesting innovations are happening in places like the Veterans Administration, where they’re providing robots that can take vitals so folks can get good in-home care and daily monitoring.

Are there things you wish companies would stop doing as they roll out major change initiatives?

The impulse towards scope creep is so hard to control. “While we’re building this, let’s add this other thing,” and so on. It can be difficult to push back on those suggestions or postpone them till version two, but if you don’t, your teams will never finish what they set out to do.

When you come in from a big firm, with a huge group of people, you stick out like a sore thumb, and it sends a pretty clear signal that you’re not part of the team.
Do you have any recommendations to help clients get the most out of their engagements with you and other independent consultants?

It pays to be explicit not just about objectives, but about how we’ll work together. As an independent consultant, it’s a lot easier for me to become part of the team and operate from the inside. When you come in from a big firm, with a huge group of people, you stick out like a sore thumb, and it sends a pretty clear signal that you’re not part of the team.

At most places, people are working hard, and change initiatives are like extra homework in addition to their day job. If people forget you’re a consultant, there’s a huge advantage there.

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About the Author

Leah Hoffmann

Leah Hoffmann is BTG's Content Strategist. A former journalist, Leah worked for Forbes.com and The Economist before joining BTG. She is passionate about clear thinking, sharp writing, and strong points of view.

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