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.

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Categories: Continuous Improvement, Disciplines, Healthcare, Markets, Process Management, Strategy

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6 Comments on “Healthcare, your process is your product”

  1. May 21, 2012 at 12:20 am #

    Ron Webb:

    Innovation through RIGOR…that is innovative.

    Most creativity / innovation programs oversimplify and teach brainstorming … and leave it for the learners to become creative or innovative. Often, the learners do not benefit from the method. What is worse, they discredit creative / innovative methods, skipping innovation altogether.

    Although I do not have many innovations to my credit, I have a small collection of what may be considered minor innovations. What is significant is that they are all results of long and persistent, thinking, experimentation, refinement, involvement of others, building on their suggestions, relaxing strong beliefs and commitments, tolerating rejections etc.

    In this process I have formulated “Innovation through ABSTRACTION”….not entirely new but a formalization of brainstorming principles combined with TQM and QI methods and tools.

    I would like you to evaluate it and give me feedback. Please send your email ID to kenabersys@yahoo.com

  2. May 21, 2012 at 7:11 am #

    Ron:
    I did study JIT , Jidoka and Andon as a part of TQM but it was not popular as TPS in early 90s. We did not have much scope for using it since we were into software development and services.

    To me it appears that Software Engineering and Business Process Design are “Requirements and Design” intensive. I am not sure TPS principles are applicable to this phase.
    It would be interesting to know what Toyota Way has for this phase. Please let me know.

    kenabersys@yahoo.com
    21MAY12

  3. Ron Webb
    May 21, 2012 at 8:31 am #

    Putchavn,
    I’ve sent you an email with my contact information. I’d love to look at your Innovation by Abstraction content. Sounds very interesting.

    I definitely think TPS would be applicable to developing software requirements and designing software through all phases of development. Actually, I haven’t researched it, but I’d be willing to bet there are some great examples out there of software companies (or IT organizations within larger institutions) applying TPS to software development.

    TPS, at its most basic level, simply provides a tool for the employees of the organization to engage in the improvement and betterment of the organization through improving the processes. It allows employees and management to have an open dialog and clear system for making the organization better. That will apply to any working process area or industry for the most part.

  4. May 21, 2012 at 9:44 am #

    Ron:
    Thanks. I will wait for your mail.

    I hope your research wil bring up something useful to Software Engineering. As you probably know there is no manufacturing or production of software though there are problems of distribution and version control.

    While you research how TPS may be applied to Software Engineering. Let us know how what is the Toyota Way for Requirements Engineering and Design.

    Best wishes,
    21MAY12

  5. May 21, 2012 at 9:54 am #

    “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’ve made a similar point on this very blog:

    http://successfulworkplace.com/2012/03/16/translating-healthcares-rosetta-stone/#comment-1019

    “Health IT needs to move from debate about patient-centered versus physician-centered design (“Who is the real user?”) to a more encompassing view (including explicit and executable representations) of the processes within which users (including patients) are embedded.”

    By “explicit and executable representations” of process I mean modern BPM-style workflow engines plus user-editable and systematically improvable process definitions and case management templates. However, doing so will require moving from document-based to workflow-based EHR delivery platforms. Academics call these process-aware information systems (or PAISs). While most EHRs and HIT systems automatically execute steps in processes, they do not contain, consult, or are “aware” of any explicit process models of those processes. Most current traditional EMR / EHR systems are not process aware. While EMR / EHRs gradually incorporate more-and-more sophisticated task management features, most of these capabilities are relatively frozen. Their workflow is not amenable to editorial control by EMR / EHR users or systematic optimization using BPM process optimization processes.

    There’s more in this vein here:

    http://chuckwebster.com/2011/07/clinical-intelligence/clinical-intelligence-complex-event-processing-process-mining-process-aware-emr-ehr-bpm-systems#pais

    I do see increasing mind share for this point of view. What would (and I believe will) increase awareness of need for process-awareness in healthcare is confluence of traditional process improvement techniques with business process management infrastructure and EHR functionality mandated by meaningful use.

    Cheers

    –Chuck

  6. Ron Webb
    May 21, 2012 at 10:33 am #

    Chuck,

    Thanks for the post with more information. Yes, these concepts are moving forward very fast. I think the pressures impacting this industry, along with the work of blogs like yours and this one are really moving the needle.

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