25 April 2016

The Drive for Process Improvement Part 5: Elevating Transformative Vision

Three leaders from the International Consortium for Health Outcomes Measurement (ICHOM) – a nonprofit founded by organizations known for progressive business practices and rigorous research: Harvard Business School, The Boston Consulting Group and the Karolinska Institutet – published an article in Harvard Business Review that analyzes the success some healthcare organizations have had in implementing patient outcomes measurement programs. The article lists five steps that should be applied when implementing major change or process improvement within healthcare systems. This blog post is the final in a five part series that critique and nuance each ICHOM step from a Kaizen perspective.

Be Prepared

The final imperative outlined by the ICHOM is to use early successes to scale and spread innovation. Scaling and spreading transformative improvements to hospitals can assist the healthcare system in the transition to value-based care. In this sense, communication of best practices between providers has the potential to benefit the entire healthcare system. Each organization has its own unique characteristics, therefore it is essential to make sure that scaled process improvements are rock solid and adaptable in implementation. At Sheridan, we have developed a robust system to ensure success in expanding improvements to other organizations.

We understand that in order to adapt an improvement to another setting, it is essential to form a foundation of standard work that provides those responsible for implementation with a specific understanding of how the improvement needs to function. An illustrative analogy can be found in football. For proper execution, a quarterback needs to know exactly where each of his players is going to be, when they will be there, and what responsibility each of his teammates has. Furthermore, the best way to ensure this understanding is through a precise language of illustration via X’s and O’s. To gain an understanding of how an improvement needs to look and function in a variety of different settings with different teams is an incredible challenge, standard work sheets illustrating the new process, expected timing, work content, and results must be made simple and transparent, this is the only way to effectively implement a change to its full potential.

Beyond Quantitative Goal-Setting

We invest in people as our most important resource. No matter how often a similar problem is encountered at different facilities the solution is always dependent on the factors present at a specific site, canned solutions are not viable. The greatest likelihood of sustained success if through the training and practice of the individuals actually doing the work. After participating on a kaizen individuals on the team should be able to analyze their own process going forward and solve the problems specific to their own role in the workflow. We regard every Kaizen team member as both a learner and a problem solver. Kaizen is a system that enables people to leverage their own unique perspective with effective team communication. We are confident that our events will leave each Kaizen team member more adept at solving problems through a communicative, systematic approach. In this sense, we regard Kaizen as a dual objective system. Even if the implemented process improvement does not have the desired impact, you have empowered your staff with skills necessary to re-evaluate and readjust the process. The most important outcome of the Kaizen is to enable staff to approach problem-solving logically and cooperatively through application of the scientific method.

Indeed, Sheridan has implemented a system to scale and spread its own vision of Kaizen process improvement to many organizations nationwide. In Part 2 of this series, we described how the facilitator acts as arbiter and guide for the Kaizen. Integral to the guidance of the facilitator is making people understand the skills they are quickly developing through their Kaizen experience. 50-70 percent of the time facilitators also work with trainees called facilitator technicians to train them to conduct Kaizens themselves. Facilitator technicians tag along for three to six Kaizen events before they conduct their own guided facilitation. With each event leading up to their facilitation, the technician gains additional responsibility. Technicians are invited to discuss with the facilitator how they would approach a problem. If the suggested approach is correct, the technicians are permitted to present their perspectives to the group. At Jupiter Medical Center in Florida, two facilitator technicians trained under an extensively experienced facilitator through five Kaizens. In the sixth, they were permitted to co-facilitate the event while their mentor shadowed for assistance. Through their extensive experience, the mentor’s guidance and their own collaborative effort, they effectively conducted a successful Kaizen.

Executive Guidance

After an event, the administration will review the outcome with Sheridan facilitators in order to determine where efforts need to be focused next. Additionally, Sheridan staff will engage in a walkabout to gain a visual sense of what’s working and what needs improvement. Ultimately, the review and walkabout enable targeted scaling and spreading to optimize the rate of change among our partners to ensure the implementation of best practices. If we were to constantly conduct Kaizens, we would constrain the staff and sub-optimize efficiency. The final goal of the targeting is to prevent organizations from spreading their human, technical and financial resources too thin. This strategy allows our work to amount to a controlled burn (rather than a raging wildfire) that will permit continuous, sustainable process improvement.

Finally, we want to recognize the high expectations that Sheridan’s administration has for both itself and the entire staff. President of Physician Services Robert Coward expects an outline to demonstrate a logical, clear approach to lean process improvement. These expectations constantly encourage Sheridan employees to proactively evaluate their own thinking when addressing a problem.

Final Thoughts

The imperatives developed by the ICHOM demonstrate the broad requirements of successful implementation of process improvement, but they are not complete. These imperatives must be nuanced through a Kaizen approach to allow organizations and people to internalize the changes made and to continually drive progress. We find there are two fundamental lessons in our analysis that the ICHOM misses in its presentation.

First, people are an organization’s most important resource. Without soliciting consistent input from a diverse selection of stakeholders, it will be impossible to optimize a process. Furthermore, cultivation of analytic problem-solving skills among your staff will determine the long-run prosperity of the organization. It is important to build a culture that promotes both independent thought and absolute commit to teamwork. In this sense, it is essential to constantly encourage employees.

Second, process improvement is never entirely complete. Organizations and their constituents need to constantly re-evaluate their myriad procedures in order to determine where deficiencies exist and what practices could offer solutions. You can only act as a leader in the value-based healthcare industry with consistently open communication and commitment to progress.

These lessons represent how organizations need to approach innovation to be successful in the future. Healthcare is a dynamic field and professionals must respond to its changes in order to provide the best care affordably. Only with a deep understanding of how lean processes are developed, maintained and constantly improved will healthcare providers achieve a premier standard of care.

Previous Series Installments:

Part 1: Making Champions of Believers

Part 2: Assembling Your Dream Team

Part 3: Commit to Your Vision

Part 4: Effectively Celebrating Progress