Leading into the Future XIb: Holding the Center While Innovating and Opening Boundaries
I would suggest that many organizations in the health-care sector are intersects, by Boulding’s definition. They operate on behalf of the public—monitoring medical or dental costs, reviewing the performance of professionals in the field—and, as a result, often obtain not-for-profit tax status. These same companies, however, are run like for-profit businesses, and often attempt to influence federal and state legislation through lobbying efforts that typify for-profit companies. These health-oriented companies also often look more like governmental regulatory agencies than either for-profit or not-for-profit organizations. They may control costs and determine the nature of appropriate licensing for the provision of certain professional services (though withholding of payment for services by unqualified personnel).
Kaiser-Permanente was one of the first of these intersect health organizations. Founded as a combination health delivery system and health insurance program, Kaiser has blazed the trail for many of the other HMOs in the United States and is a classic “intersect.” It is both a delivery and insurance organization, and both a human service agency and private business. The Delta Dental Insurance Companies in the United State provide yet another example of the intersect organization in the health field. Most of the states have a Delta Insurance plan that covers payments for dental services. Delta Dental is a nonprofit organization that makes a profit—excess funds being placed in reserve or given as bonuses to management staff. In many ways, Delta Dental operates like a private insurance company, having an active marketing and advertising program. Yet, it also operates as a quasi-governmental regulatory agency, given that it controls the cost of dental care by only reimbursing member dentists a specific amount of money for specific dental services.
The peculiar intersect organizations are quite challenging for those seeking to lead them. The challenge begins with the way in which success in the organization is defined (a challenge we shall return to later in this essay). The bottom-line mentality to be found in the traditional for-profit sector is typically not appropriate in the intersect organization. Organizations no longer (if they ever did) exist simply to make money for their owners or stockholders. This is an inadequate statement of intention for any organization, especially one with diffuse or highly flexible boundaries. In essence, a bottom-line mentality tends to hide or distort the founding or driving purpose of the institution and leaves it directionless in a rapidly changing world. The center no longer holds.