Author Archives: Ron Webb

Healthcare, your process is your product

Processes are how work gets done. They are a series of activities that convert an input into an output for the customer or next stage of work. Healthcare is fundamentally a service industry with processes as its product. Because efficiency has never mattered in a fee-for-service world, healthcare is overripe with opportunities to innovate.

Innovation through rigor

Most people think of innovation in terms of products:  Apple, Google, etc. We always hear about those game changing product launches that corner a market. While there are still plenty of innovations to be had for new treatment modalities and groundbreaking therapies, healthcare organizations are primed and ready to see major shifts in organizational performance by innovating their processes. What we, at APQC, refer to as innovation through rigor.

Some of the best representations of these principles come from the Toyota Production Systems (TPS), or the Toyota Way. The basic principles of TPS go to the core of what healthcare has purported for years and drive straight to the center of why many healthcare organization were created in the first place. The principles of TPS are:

  • Continuous improvement
  • Respect for people
  • A long-term philosophy
  • Belief the right process will produce the right result
  • Developing your people and your partners adds value to the organization
  • Continuously solving root problems drives organizational learning

When I read through this list, I am amazed at the parallels I see to the mission and purpose of the healthcare organizations I’ve been a part of over the last 20 years. Why, then, is there a disconnect between most healthcare organizations and the concepts of continuous process improvement.

Binary focus

It comes down to a singular, binary focus of many organizations. Healthcare organizations tend to focus all their energy serving the patient. Now, before you lambast me, let me explain.

I’m NOT promoting that the patient shouldn’t be a key focus of any healthcare organization…far from it. It should be the central focus; it is why you the organization was created. I’ve found that some healthcare organizations (and many non-healthcare organizations) take on a hero’s mentality to serve the patient at all costs, which ultimately leads to very convoluted and at times unsuccessful approaches to serving patients. The exact opposite of what they have intended.

Instead of thinking about how to treat THIS patient the right way, the organizations innovating through process are figuring out how the treat ALL patients the right way. Thus creating an organization innovating patient care through the way they work with patients, not just the technology, treatment, or modalities they apply to a single patient.

Falling short

When I look at the principles of process innovation noted above, I think healthcare respects people, does focus on long-term solutions, and focuses on developing people. I think they tend to fall short on their continuous improvement focus, focusing on how they work vs. who they work on, and stepping back to understand and solving their root process problems.

We’re already seeing examples of the use of continuous process improvement and process innovation within healthcare at organizations like Virginia Mason, ThedaCare, and others. They are able to apply these process innovation principles to impact the real outcome for all patients, showing us all that it isn’t an either/or problem. Stronger, more innovative processes will result in better patient outcomes, better financials, better HCAHPS scores, or whatever process outcome you choose to measure. The key is taking a more holistic, process approach vs. a binary vies creating tradeoffs between the care of patients and other outcomes such as financials or patient satisfaction. That is not a place any organization wants to find itself.

Translating healthcare’s Rosetta Stone

OK, my healthcare process improvement folks, I gave you a hard time a few weeks ago about always feeling you are different and I heard your responses. Now, let’s get down to business.

Healthcare Rosetta Stone

I want to build a common process framework for healthcare, but, I need guidance from both the healthcare folks out there, as well as my BPM and process framework geeks. We need to come up with a usable framework that will allow any healthcare organization, staff person, or systems to talk to each other in a meaningful way, much the way the Rosetta Stone allowed translation between multiple languages for the first time. The issue in developing this process framework is complex, but not unlike what we’ve seen in other industries (Healthcare, you are that different). The shared benefit of doing this is enormous.

Translating

The goal is to build out a process category called something like “Deliver Patient Services,” and ultimately develop meaningful, common process groups, processes, and activities within that category. Easy enough, we are a process shop and can spit out a framework with our eyes closed. In order to make this a meaningful framework, though, it has to allow any healthcare organization a guide to assembling their individual value stream and translate that to any other organization, individual, or system.

For example, one organization might assemble their process groups, processes, and activities based on disease, such as oncology, pediatrics, or cardiology. Yet another may assemble these based on access points, such as emergency department, clinics, or day surgery. And, yet another may categorize these based on the type (or age group) of the patient, such as newborns, adolescents, or adult care.

90/10 rule

I’ve also heard and read of organization using protocols to track and measure the outcomes of patient services. Many healthcare organizations report that nearly 90% of the actual services delivered (activities) fall under a small proportion (i.e., 10%) of the protocols they manage. That sounds like an area ripe for a framework. If you can identify that amount of the work under that focused of a set of categories, then you are getting close to a common language.

My internal framework guru tells me the key, right now, is to just get started. So, that is what we are doing. We’ll start with asking as many healthcare professionals what they actually do. The activities are the key. We’ll categorize those into processes, groups, and categories using the groupings that naturally evolve. The result won’t be the ideal process framework for any single healthcare organization, but it will be a starting point for every healthcare organization out there.

That is my Mission and I can’t wait to see what we come up with. Stay tuned and tell me what you think through your comments and emails.

Healthcare, you aren’t that different

The following is a guest post by Ron Webb, Executive Director, APQC

My career in healthcare started in the early 90s, and it was a crazy time for the industry. The Clinton version of healthcare reform had just hit and the industry was trying to react quickly to the change in reimbursement levels for inpatient and outpatient services. It was a great time for a consultant seeking job security, but a horrible time for a young professional who wanted to see his work actually come to fruition. I can’t tell you how many strategic and operational plans I had to update or abandon based on a change to the reimbursement rules.

Every time I tried to compare data from healthcare organizations with data or examples from other industries, I heard the same things: “We’re different…” “Yeah, but…” “They don’t have to…” Healthcare organizations did not accept a single case study, example, or data point I brought to the table as a valid point of comparison or example to learn from (even when I used examples from within the healthcare industry or other facilities within the same healthcare system). I left healthcare to work with other industries.

Guess what?

Healthcare organizations are no different than organizations in any other industry I work with. Most organizations have qualms about comparing their performance and productivity to other industries, but they tend to move past those qualms once they see other organizations successfully using cross-industry benchmarking to improve. Unfortunately, the majority of healthcare organizations still seem to resist and hold onto a “we’re different” mindset.

Yes, healthcare has to deal with patients, doctors, unions, politicians, community leaders, activists, the government, and more. But so do all organizations. Regardless of the industry, every organization contends with a different set of stakeholders. Education has students, parents, and communities. Government has the tax payers. Publicly traded corporations have shareholders, Wall Street, and unions. A multitude of factors impact businesses of all kinds, in every industry. The industries and organizations that move forward successfully simply recognize those factors and use them to drive new improvements. They don’t see stakeholders and other issues as barriers and excuses to remain stagnant; they see them as facts and sources of feedback that can help them survive.

In case study after case study, the first organizations to innovate and overcome significant market forces usually emerge as industry leaders that eventually acquire those organizations that react too slowly. No doubt, the healthcare industry is facing a huge number of challenging market forces in the coming years as it transfers to ICD-10 (and ICD-11) codes and adopts Electronic Medical Record (EMR) standards. I’m not trying to scare anyone, but being willing to look beyond the healthcare industry to improve these systems and processes could very well be the key to leading the competition instead of losing to it.

Common language

The single largest issue I have seen hamper an organization’s ability to learn and adapt is not having a common language. APQC recognized this in the mid-1990s and developed our Process Classification Framework (PCF) (www.apqc.org/pcf). The PCF is a document that outlines the exact activities that occur in major organizational processes. For example, whether you call it “IT,” “information technology,” or “whatever those guys on the 10th floor with all the laptops are doing,” the PCF calls it “7.0 Manage Information Technology.” The PCF then names and numbers every process group, process, and activity that occurs in 7.0. The PCF is intended to help organizations to understand and describe how work actually gets done—within organizational walls, beyond those walls, or even (dare I say it) outside their industries.

The original PCF is a cross-industry framework, but we have also developed industry-specific PCF documents. We fully recognize that although the basics of the payroll process are fairly consistent across industries, there will be significant differences between how a bank delivers services to their customers and how a downstream petroleum organization produces product for their customers. For that reason, when a significant transformation occurs in an industry and the leaders in that industry want to get ahead of the game, they often reach out to us, and we work with them to create these industry-specific PCFs.

Challenge

So, here is my call to action for you, healthcare industry:

Yes, you are different and unique, but so is everyone. Way too many issues have piled up, and you can’t afford to wait any longer. It’s time to grow up, put on your “big boy” pants, and buckle down, and get the work done in a logical, efficient, and effective manner. I would offer a common language (or framework) as a first logical step.

If you know of any process frameworks or other industry process standards for healthcare, please include them in a comment below. I don’t want to reinvent anything that already exists. I’m also willing to do my part. If you want to help develop a healthcare-specific version of the PCF, please let me know by commenting or by going to www.apqc.org/contactus.