” 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients…”
“The official, Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.”

There’s other great stuff in there as well.  Here’s the link.

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.

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.

Created by: Medical Billing and Coding

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?

I keep being reminded of last Thanksgiving because I’ve been recently helping a client use the principles of LEAN to transition into a new hospital.

I’ve visited many new facilities where staff and administrators are quick to blame the design of the space for the operational shortcomings that arise once the space is being used. Experience has taught me that no design principle can offset the need to learn and adapt to a new environment.

What did my client do?

Three things:

1) Assign frontline leaders and staff to assess the new space and use LEAN problem solving to redesign workflows.
2) Simulate new work with staff and systematically experiment when “problems” arose.
3) Do those things relentlessly BEFORE they moved into the new hospital, rather than winging it like my friends and I had.

Though the transition has not been without confusion, people began settling in to new workflows, and continually adapting, within weeks of the move-rather than blaming the architects for the design of the space. I’m certain that my client is better off for it.

If you are considering allying LEAN principles to a move into hospital or addition, let us know and we will happily connect you to our client.

The easiest way to say this is planning/initiatives will always outpace the ability of an organization to change.

Here’s a graphical representation of what I mean.

On the one hand, this graph represents a predicament: the gap between expectations and execution causes increased demands on monitoring and “educating” or forcing “buy in.” These become activities that occupy much of leaders’ time. On the other hand, this predicament causes a sense of hopelessness or cynicism on the part of workers. I consistently hear healthcare professionals bemoan the fact that they feel “scattered,” that they feel like they have “a million initiatives.”

I contend that leaders must match their initiatives to the pace of change. Not because it’s morally right, but because leaders have no other option if they wish to succeed.