Daily Kaizen

I doubt many of you would argue that the healthcare industry is really challenged in the area of understanding customer’s demands and then delivering on them in innovative ways.  So much of healthcare is structured around perverse incentives and designed to meet the needs of internal stakeholders as opposed to customers.  I spent some time this last weekend leafing through Womack’s book Lean Solutions.  It had been a couple of years since I first read this book and it was interesting to read the notes I had left in the margins about how I was thinking about applying the concepts to the problems we were wrestling with a couple of years ago.  I remember thinking this is exactly what we need in healthcare, and at the same time thinking “boy do we have a long way to go.”   

It is now a couple years later and it is quite exciting to say that we have made real and measurable progress.  A progression that has moved at a much faster rate of improvement then I would have ever predicted possible.  This progress would have surprised me, because designing processes around customer’s specifications often requires re-focusing priorities.  This starts with being crystal clear that the customer is not some internal stakeholder (MD, Pharmacist, Manager, etc.), but instead the end user of the services.  Not an easy task by itself in healthcare.   In practice this means that the processes need to be far more nimble and flexible then in a system that is designed around the stakeholders.  For example, a process we just improved this last week in our Pharmacy will have our pharmacists providing consultation to our new members in real time as they call for their first appointment.  In the old process a message was sent after the appointment was made and we would call back the member at our convenience, which meant we often did not reach them and when we did it was bad timing.  The new process was a significant change for the team, but once they understood the customer demands they were ready to make it. 

A couple other examples to further illustrate the changes underway from some of the notes I made in the margins of Lean Solutions: One set shares my frustration with our call center that at the time was primarily focused on measuring the amount of time each representative spends on each call.  You can imagine the quality issues.  Over the last couple of weeks I got to spend time working on some improvement work within our call center and not only is this measure gone, but the center is focused on not only helping solve the customers problems the first time, no matter how much time it takes, but they are also collecting valuable data that is supporting improvement efforts throughout the organization. 

A similar set of notes vent my frustration with some complaints from members at the time having a difficult time trying to access our Primary Care system.  Since then our Primary Care teams have listened to our customers and learned that most of their demands could be answered without a face-to –face visit.  Now more services are being provided via secure message and phone then in the exam room and customers are happier, quality is improving and the care teams are more satisfied.  There are very few complaints.   I could tell other exciting stories about our Urgent Care, Specialty Services, Pharmacy, etc.   All making good progress, but to be clear we still have a long way to go. 

I thought I would end by stating that a couple of years ago I would have been surprised by the progress we have made, but looking back today I am not surprised at all.  This is because I have come to understand that nobody is more frustrated by the broken healthcare system that we have then the people that work in the system.  There is an incredible pent up demand within the care teams and supporting staff to make improvements on behalf of the patients they serve.  This demand has been slow to be tapped, because of a lack of an improvement system that helps these teams actualize the customer first principles that they all believe in.  What I can tell you from experience is once care teams get over their initial skepticism and spend time understanding the customer needs they become the biggest advocates of driving Lean Solutions.

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