It’s a common argument in sports management: should your team seek out and recruit players who fit your current style of play, or should you design your style of play to fit the talents of your current players?

This never gets resolved, by the way. As arguments go, it’s a hardy perennial.

There’s a corollary in healthcare management. It’s the challenge of finding the right individual to do what needs to be done.

Example: Employee X has an outstanding reputation as a therapist. Hired as clinical director for a struggling outpatient program. Does well in clinical supervision of others but clinic volumes continue to struggle and everyone is disappointed and frustrated. Employee X responds defensively and threatens to leave. ED doesn’t want her to leave because she’s really good therapist, but…

HR expert on their Board analyzes situation and recommends following: Redesign the org chart to move some duties to another position, freeing up X to do what she does best. Alter other position description to emphasize management skills: scheduling, checking documentation, doing QI on access, dealing directly with payers on UR calls. Don’t cut anybody’s salary, just give employee Z a bump in status and bucks.

Three months later, all is well again. Improved revenue more than offsets added expense.

If that sounds a bit like cutting and pasting, well, fair enough. All it requires is some objective analysis and a bit of organization flexibility.

Here’s another example. Company A operates a number of addiction rehabs in major metro areas. Once again, revenues are low and the a new CEO is brought in specifically to increase them. He’d previously succeeded in a turnaround for a similar-sized chain of outpatient surgical centers. His enthusiasm and expertise had so impressed the Board that they offered him a substantial salary and free rein over the change process. Eager to duplicate his earlier success, he brought along two of his very best marketers from the other companies.

They set out to aggressively sell Company A’s services using the same techniques that had done so well elsewhere. Here again, the results were disappointing. Why wasn’t it working?

In short, because the CEO had missed something crucial: the difference between rehab and surgery as a service. A surgical procedure is a transactional product– clearly defined, limited in scope, with an obvious endpoint and outcome. The primary care doc acts as gatekeeper. The marketers were accustomed to bringing lunch to the physician’s office in exchange for a chance to introduce their services to the staff. No particular expertise is required on the part of the sales rep; just a pleasing personality and the ability to communicate.

In mental health, however, the bulk of the rehab’s referrals came from therapists in private practice. They were looking for something quite different. They asked more questions and delved deeper into the answers. Their main concern was how their patient and family would be treated. They sought a trust relationship with the rehab– one that would continue through future referrals as well as the current one.

How this eventually shook out: The two marketers resigned to take jobs in their former field, and a new hiring process focused on recruiting licensed mental health clinicians to work closely with referral sources through frequent contacts and informal consultation. They became in effect resources for the customer, with services that extended well beyond the immediate need.

I recall one executive director who airily insisted that if you can succeed in one business, you can succeed in most any business, regardless of type.

If only that were true. But all too often, it isn’t.