Standard Work for Managers

A client of ours recently completed our Managerial Quality program. We worked with them up front and connected a few times during the year. They had great results. Here’s the link to an article about their achievements from Nurse.com.

Our clients tend to get results like this, but that’s not the point of this entry.

The point of this post is that most of what we have been able to do to create sustainable improvement at the frontline is to create a systematic way for managers to learn how to lead their units. Achievement and accountability are much easier to attain when managers have simple principles and tools they can employ to become effective leaders.

This is a no-brainer, I know. But I’m continually surprised at how seldom organizations have a systematic way of creating ways for new managers to learn on the job. (I often hear dreams for big educational programs, but we’ve found that they’re both impractical and ineffective.)

Managers must, of course, use good judgement. To make best use of that judgement, though, we’ve found that simple, standard work for managers is essential.

ACOs – How to succeed

ACOs are hot. There is no doubt. What counts for an ACO is, as yet, not entirely clear. Nonetheless, it has become a significant and important discussion.

Setting aside the need for certification of “meaningful use” of an information system by a CCHIT, there are two approaches to achieving ACO status: (1) create the entire structure, essentially at once; (2) start with what we know will be required of CMS (regardless of ACO status) that can create a platform to build toward a full-blown ACO (Think: readmissions).

For large-scale organizations, with lots of patients, money and, well, employed docs, the “whole hog” approach makes sense.

On the other hand, our group has been talking to tech companies that have great tech solutions that lack but one thing: a robust capacity to get workflows to conform to the new, higher quality, less expensive ways of caring for patients. This jibes with surveys/interviews of ACO pilot participants, which consistently said, on every dimension, that “culture” was the absolutely critical element for success in higher quality and gainsharing. From our simplistic point of view, culture really amounts to the way we work. You might call it workflow; you might call it something else. But it really just means how people coordinate their work.

Furthermore, I’d like to suggest that the platform approach will happen faster and is likely to be more successful. We’ve been working with tech companies that have partial solutions to pieces of the ACO puzzle, lacking only the capacity for building durable work practices to support and sustain improved cost and quality.

In my research–in the VERY old days–at the Harvard Business School, the “toe-hold” approach (Think: Intel, Southwest Airlines, Apple, and even Kaiser) to developing large-scale transformation is successful about five-times as frequently  as the “whole hog” approach. And because healthcare is vastly more complex, this strategy makes more sense, as it allows an evolving response to an unpredictable future.

Pretty, yet Depressing Illustration of US Safety Problems

We spend a lot of energy thinking about how best to represent information when we’re implementing improvements in hospitals and I think this chart really nails it. They get a lot of information across clearly and quickly. That said, they have a clear bias and their solutions such as, “enforce good sanitation practices” are a lot easier to write than to implement.

Created by: Medical Billing and Coding

New Info Systems from the Patient’s Perspective

I’ve had two doctor visits this summer. Both were in the process of installing their new information system. At one (I was a new patient), they asked me to come in 30 minutes before my appointment time to fill out all the paperwork. While I did this, I wondered why they didn’t send me the forms to complete in advance (I had made the appointment months before). Then I also would have had all the info I needed – like my spouse’s social security number. When I was in the exam room, the delightful tech asked me many of the same general info and med history questions and she input them into the computer! When I couldn’t immediately recall the date of a prior surgery. I asked her to look on the form I just filled out. She seemed surprised that it was on the form too.

At the other, I am a patient of record and yet, I got entirely blank forms and had to enter my address, phone age, birth date, family info on each form. They also wanted my spouse’s social security number and I still didn’t have it! Why did I have to fill out an entire medical history which I know they already have?

We’re all patients too. We should run through our new implementations from a patient’s perspective, don’t you think?

Great healthcare graphs and discussion

I love a good graph. Lane Kenworthy found a new way to express just how inefficient our American healthcare system is compared to other countries. Here’s the link…