Daily Kaizen

This is the first of a long overdue series on Health Plan Business Transformation, a critical improvement initiative of the organization. Sharmarie Dares, and other lean colleagues will be joining me in contributing.

Leo Tolstoy famously wrote – “All happy families resemble one another, but each unhappy family is unhappy in it’s own way” (Anna Karenina – page 1)

This to is true in business, as well as any process in which consistent, high quality outcomes are required: all successful businesses / processes resemble one another, while each unsuccessful business / process is unsuccessful in its own way.

Group Health is learning this lesson once again as we take on a process to dramatically reduce the variation that enters the production system of our health plan.

A pilot is beginning in the initial three rule areas below, to apply a standard process and scoring criteria evaluating new opportunities against a standard, based on the strategic priorities of the organization.

• New Benefits / New Plan Designs
• Provider Contracts
• Authorization Rules

Designing the process and scoring criteria has been challenging, with leaders working long and hard on a process that’s applicable across all areas of the organization. This complete, the biggest challenge ahead will be changing ingrained behaviors.

In the past, a plethora of governing bodies have made decisions on various components of our health plan production system. These groups attempt to make a decision that takes into consideration all impacts to the organization. However, each group has limited visibility to the entire value stream that their decision impacts. As a result, there are unfortunately plenty of examples of decisions made with the best intentions, but which cause significant downstream defects. As a result, we have the waste of band-aids on band-aids, as we administer to these new defects while still addressing previous ones.

Within and between many downstream functional areas, the unfortunate equation resulting from the current variation entering our system is:

Complexity + rework + extra movement =

waste in process = cost and diminished respect for people.

Rightly so, these are unhappy families.

The challenge in changing behavior comes from the fact that leaders and existing governing bodies will be required to use a process that will feel like “extra” to them, but will actually result in much less for the organization as a whole. Further, they will be required to value the input from a scoring criteria that may give an answer that’s different than what they’re used to, or what they’d like to do.

Tolstoy’s quote comes to mind, as there’s an underlying principle always at play with cross-functional process and management system change: a discipline by each individual, small team, leadership group, to stay committed to something that they know intellectually is better, but emotionally feels worse – until it becomes habit. Successful processes resemble each other through commitment to this principle.

This is true with Hoshin Kanri, where:

• Commitment to say no to many improvement ideas (including many individual’s “pet projects”) to ensure the critical few get completed successfully must occur
• The divisional rivalries must take a back seat to enterprise success
• Commitment to a single process must trump what can feel like a faster, more efficient way to get divisional improvement done

This is true with 3P.

This is true with a management system and manager standard work.

It seems the organization that keeps the key principles of lean front of mind, recognizing the realities of discipline and patience will be needed for all elements of the system, and therefore shouldn’t be run from, is the organization that makes lean thinking their own thinking, and who moves from attempting to emulate the Toyota production system, to living their own production system every minute, every hour, every day.

The leaders of Group Health have struggled in the past, but they keep trying, which is more than half the fight. I look forward to this new process for health plan production rules being the stepping stone for this discipline to be followed by more and more of our leaders, so their actions begin to resemble each other – and our processes are happier.

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One of the most basic, fundamental and challenging steps any team needs to take in the beginning the improvement process is setting a standard. While this might sound simple it is often a big step for leadership. In my experience most healthcare processes do not have standards. Thus it is impossible to judge what the plan is vs. the actual or if there is a problem. If there is no standard there is no problem nor is there a basis by which any team can improve.

So why is it so difficult to set a standard? Often leadership in a professional environment does not want to declare an expectation for what success looks like. This often has to do with the lack of evidence to show the cause and effect relationship between the process and the outcome; or the focus on perfection as opposed to improvement. Leadership is uncomfortable making anything binary since it may force an uncomfortable conversation.

I always push an aggressive approach in terms of standard setting. I steer my clients to bring science and intuition into the calculus of setting the standard, and I push to bring the voice of the business and customer into the process. Yet, if there is incomplete information I believe the right approach is to still set the standard even if it is not backed by evidence or in other word is might not turn out to be accurate. Why? By setting the standard, even if it is “wrong” it creates the basis for the “right” conversation. Teams are forced to think about what is the right way to define and then achieve the outcome. If this is done in a constructive way the team/organization can begin to put in place the processes that will allow them to be successful. This will create a venue to address variation and talk about best practices. In other words, setting the standard is the right first step, even if the standard must change once we understand more.

Popularity: 53% [?]