Playing in the Gray Space is Critical for Process Improvement

In an era of unexpected and disruptive forces, healthcare leaders are finding it increasingly challenging to keep the pace of change inside their organization on par with the pace of change outside. Many are already deep into reengineering/improvement methodologies, embracing technology solutions and facing the realities of rapidly declining reimbursement rates. But often — in the messiness of making change — those in leadership roles can lose the big picture and miss the best opportunities for making a lasting impact.

Today those missed opportunities are most often in the gray spaces between departments. Organizations have become intensely focused on optimization within high cost or trouble areas and haven't taken into account the handoffs that occur intramurally. Sometimes the root causes and opportunities for improvement rest in the no man's land between departments often across the hall. Fortunately, making an impact doesn't always require adopting new technologies or tools; it simply requires taking a systems view of the organization – ideally from the perspective of the customer or patient.

Case in point: In our recent work with a large payor in the West, the CEO and executive team had articulated their concern with the proliferation of options for the buyers of health plans. Cost pressures were not new but had become more acute and more important, and customers had begun to be more and more vocal about the experience of being a customer. For some time they had been using Lean and Six Sigma to improve processes; they had invested heavily in new technology and user interfaces; they had embraced cultural transformation and leadership development tools, and yet the results were uninspiring. They certainly couldn't abandon all the hard work and investment. but they also recognized something was missing.

Following a brief review of actions to date, impact and the gap between their desired state and current state, the team recognized that their approach was missing the view of the customer. While they had worked hard on improving the customer experience within departments, they had never taken a horizontal view across the departments. The ah-ha moment was when they finally followed the process as a customer would encounter it — across the silos built into their system of value delivery.

Finally they recognized what had been missing, and immediately set about de-siloing the various gaps between departments. They streamlined and consolidated customer service decision-making, which had previously occurred in multiple departments and — in some cases — geographies.

In one work stream, all departments involved in a claims determination were consolidated into a single location to create real time, face-to-face collaboration. Previously with the teams located in separate areas, customer claims were delayed, hampering their ability to make decisions on treatment and reimbursement. Employees were also trained on multiple software platforms so they could more quickly interpret and consolidate data for faster and improved decision making. The results were impressive:

•    Reduced claims volume 40 percent
•    Decreased the number of reviews 90 percent
•    Double digit improvement in productivity and responsiveness

Developing a patient value stream in a hospital has the same effect as the payor experienced above. Looking at the total hospital experience from a patient's point of view, hospital executives will find the process bottlenecks and break downs which take place in the wasteland between departments. A patient value stream provides a sensible, visual and highly effective approach for systemic diagnosis of the entire stream of actions from diagnosis through reimbursement. Combing the focus on the entire value stream or continuum of care with technology and cultural tools can have a tremendous impact on operating performance while simultaneously creating a seamless experience for the patient.

As organizations are buffeted by disruptive change and regulatory complexity of health reform, it will continue to be critical for leaders to do more with what they have. Bringing the view of the organizational leaders back to the horizon and taking a look at the landscape of their organizations from a customer-centric value delivery system vantage point will provide insights and opportunities to leverage their current competencies in new ways. The pace of today's health system won't give organizations the opportunity or time to constantly switch from one approach to another. Playing in the gray spaces between departments offers fresh opportunities to leverage the people, process and technology strengths within the organization to meet the ongoing challenges that will come in continuous squalls for decades to come.

Ron Wince is the CEO of Guidon Performance Solutions, a national hospital and health system efficiency consulting firm that has worked with world- class organizations such as Kaiser Permanente, Aetna, the American Red Cross, the Cleveland Clinic and the Mayo Clinic in addition to numerous regional hospitals to help them transform themselves to meet the tsunami of new demands, regulations and pressures to streamline and improve patient outcomes.

More Articles by Ron Wince:

6 Survival Skills for Healthcare's "Era of Disruption"

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