I recently overheard a senior executive of a healthcare technology consulting firm say that most healthcare organizations have been "Six Sigma'd and Leaned to death" and that digital technology will be the real determining factor in transforming healthcare.
Well, not so fast. You only need to read Dr. Bob Wachter's recent blogs about digital technology in healthcare to temper that optimistic perspective. In addition, Electronic Medical Records have not yet fulfilled their promise of better, safer and more efficient care. Technology may eventually enable the transformation of healthcare but, in the end, healthcare transformation will still be driven by and for people. Understanding how to create and deploy digital technologies in healthcare safely and effectively, with the human element in mind, has been a great deal harder than many expected.
Furthermore, we have only begun the scratch the surface with management practices such as Lean Healthcare, to increase value while reducing the use of resources. Organizations such as the Institute for Healthcare Improvement and the Lean Enterprise Institute frequently comment on the slow progress being made in improving and transforming healthcare to achieve the level of quality, safety and efficiency in other industries such as airlines and manufacturing.
Yet, despite the rapid advances in technology, the shift from volume to value and the emergence of many new delivery venues, healthcare providers will still have to mind healthcare's fundamentals to remain viable and relevant. That means that they still need to continuously focus on delivering easily accessible, excellent, safe comfortable and convenient services at a price that patients, employers and payers are able and willing to pay, regardless of where and how these services are being provided.
Edwards Deming said that managers must develop Profound Knowledge of their business to be successful and competitive. But what does Profound Knowledge really mean? Profound Knowledge means developing a thorough understanding of your customers and their needs, combined with a thorough understanding of how your organization delivers services, at a detail level. This can only be developed if you regularly meet with and truly understand your customers, make problems visible and create safe environments for patients and employees. Simultaneously, you should create an environment in which all levels of management, frontline staff and physicians are enabled and empowered to continuously learn and solve problems together.
Understand patient expectations and their experience.
My wife and I spent countless days at three different hospitals over a period of five years, as our daughter survived leukemia twice, first as a toddler and ten years later as a teenager. During our two journeys, we had great, as well as very bad experiences that made for an emotional roller coaster during that time. Fortunately, many organizations are beginning to understand the importance of the patient experience but current efforts still suggest an incomplete and often fragmented approach to improving the patient experience. Some focus on a creating more comfortable facilities, while others emphasize empathy. Then there are still many who erroneously believe that improving the patient experience is just a fad and all about making patients happy, which they then consider to be an impossible goal.
An actionable framework for patient experience still appears to be missing. Yet defining value and what makes for great patient experiences is not difficult for those of us who have been at the receiving end of healthcare.
Having to go to a doctor or a hospital is, at a minimum, an inconvenience and, at worst, a very scary or sad experience for many patients. They, or their caregivers, may have jobs or care for children or elderly parents, Having to interrupt their daily responsibilities may have significant consequences for them and those who depend on them. Fundamentally, value and the patient experience – from the patient's and caregiver's point of view - is defined by the degree to which your organization establishes peace of mind and trust on the part of the patients and their caregivers. Healthcare providers can achieve peace of mind and trust by focusing simultaneously on the following.
- Best possible outcomes, based on survival and quality of life following treatment.
- Safe care, which most patients and their caregivers assume will be provided anyway.
- Physical and emotional comfort during and after treatment.
- Amenities that make the stay more comfortable for patients and their caregivers.
- Convenient locations and hours.
- Speedy and timely services to minimize the time impact on patients and caregivers.
- Affordability as deductibles and co-pays are rising rapidly.
- Treatment with courtesy, respect and empathy during all their interactions with employees and physicians, from the first phone call to the people staffing the parking garage.
- Treatment of patients and caregivers as true and active partners in decision-making.
Make problems visible.
You must first understand what constraints and problems are holding your organization back in order to truly improve. This requires honesty and transparency across all levels and teams in the organization, while focusing on the system and not on blaming individuals. Consequently, this is probably one of the most unnerving and overwhelming parts of the transformation process. It will require constant commitment, active engagement and perseverance on the part of your organization's leadership to drive previously hidden or ignored issues to the surface. Most problems fall into one or more of these three categories:
- Unevenness in patient volumes and patient flows
- Waste
- Overburdening of people and equipment
Much has been written about the importance of driving waste out of healthcare, a complex mix of operational and clinical factors, but much less attention is typically given to unevenness and overburdening. These last two factors often also have a profound impact on quality, safety, operational performance and the patient experience. Unevenness in patient volumes and overburdening frequently lead to unsafe conditions, as bottlenecks emerge and staff becomes stressed, harried and distracted. Such situations easily lead to errors and/or the use of unauthorized workarounds to overcome obstacles, which can put staff and patients at risk.
Tools from Lean and Six Sigma, such as value stream mapping, smoothing patient flows, 5S and control charts, combined with active involvement of the executive leadership, aim to make a wide variety of these problems visible quickly.
Create a safe environment for employees and patients.
Safe environments for employees and patients form the foundation for improving your organization's overall performance. The reduction of unsafe conditions also positively affects employee morale and the patient experience as it demonstrates your commitment to their wellbeing. It also makes good business sense as it reduces expenses associated with risks and liabilities. Alcoa, the airline industry, the U.S. Navy's nuclear program, ThedaCare and Virginia Mason are well-known examples of improving performance by intensely focusing on safety first.
Develop your people.
The most difficult goal to achieve is the creation of an organization in which everyone in your organization is encouraged, empowered and engaged to identify and solve problems, to work well with others across the organization and to learn together to constantly improve. Special attention must be given to unevenness in patient volumes and patient flows, waste and wasteful activities, as well as overburdening of staff and equipment..
While the vast majority of people in healthcare give their best to care for their patients, sometimes through heroic efforts, it also requires profound changes in the way all levels of the organization perform their responsibilities. People do not change easily, regardless of whether you are a board member, senior executive, physician, supervisor or frontline staff member. It is the duty of board members and senior executives to lead by example and to serve as coaches by providing clear direction and by consistently focusing everyone on their responsibilities.
Transforming healthcare by and for people is a never-ending journey toward clinical perfection, operational efficiency and great patient experiences because external conditions will continue to change constantly. This quest for the "holy grail" in turbulent conditions, i.e., better value with fewer resources, requires grit, determination, perseverance, humility and emotional intelligence on the part of everyone in order to succeed. It is, after all, about preventing or reducing the suffering of fellow human beings and their families.
Paul Schilstra is President and founder of primeASCENT, LLC, a healthcare consulting firm that focuses on helping healthcare providers pursue operational excellence. He has over 25 years of domestic and international experience in healthcare, having previously served in a number of executive positions at global companies. He feels forever indebted to the doctors and nurses who provided excellent, compassionate care during his daughter's three life-threatening episodes. They gave his daughter a chance at a successful life after surviving premature birth first and then leukemia twice. He can be reached at paul.schilstra@primeascent.com.
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