Today (as I write this) is Veteran’s Day. I’m a veteran. My wife is a veteran. My dad was a veteran. My father-in-law is a veteran. Most of my uncles are, or were, veterans. Some of my best friends are veterans.
There are some (including some in Congress) who feel that changing the bureaucracy is not enough. For instance, Representative Jeff Miller, Florida Republican and Chairman of the House Veterans’ Affairs Committee, said “A bureaucratic reshuffle isn’t a substitute for firing employees who were responsible for the wait lists, ignored whistleblowers, or otherwise put the department’s needs ahead of veterans.” Continue reading →
I just went to the doctor’s office for my annual physical. In my market, I have to schedule this appointment a year in advance, and there are no automatic reminders. So when a year rolls around, there is always some sort of scheduling conflict that makes me have to reschedule. This time, when I called to reschedule, the very polite front desk person said next available was seven months away! Oh boy, I had no choice but WAIT.
When the appointment finally rolled around, I sat in the waiting room for over an hour. I wished someone had let me know ahead of time that Continue reading →
When I mention healthcare payment reform these days, I get one of two, maybe three responses. One is someone’s eyes light up. They’re fired up – this is a passionate topic for some folks. They can’t wait to tell me what’s wrong with our system and what ought to be done. More of the time, however, I either get eyes glazed over, or a deer in the headlights look. Admittedly, this was me until earlier this year, when I took a role at the ThedaCare Center for Healthcare Value, where my main focus would be – and is – payment initiatives. Now I understand the importance, and it’s my mission to do my part to be a change agent. I’m one of those ‘light in the eyes’ people, and I think everyone should have a vested interest in this topic. Our current prevailing approach is wrong, and has serious consequences. If you have a current or future need for healthcare in this country, or have an interest in the US economy, then you ought to as well. Continue reading →
My mother passed away recently. As her children reminisced about her life, we recognized that one of the biggest gifts she had given us was her practical wisdom. This wisdom came in the form of countless proverbs with which she would admonish or help us, some more well-known than others, such as, “don’t saddle the horses before the cart is ready,” “the night is a bad advisor,” “better late than never,” and, “bad news travels fast.” Adding to these was the oft repeated reminder about the wisdom of the story, A Message to Garcia, when explaining why she set high expectations without giving clear instructions.
So it’s not surprising that I often find myself thinking of proverbs I learned from her in my daily life. A proverb that summarizes for me what happens when healthcare leaders don’t spend time in the gemba (Japanese for “at the site”) is, “out of sight, out of mind.” Continue reading →
This year I attended the 5th Annual Lean Healthcare Transformation Summit, and I was excited to hear James Hereford, COO at Stanford University Medical Center give his keynote presentation. He had a lot to share, and I had a lot to learn.
First, Hereford explained that lean is nothing new. Henry Ford was following lean principles when he designed flow into the early assembly lines in Highland Park. But what is new is that lean thinking has the power to fundamentally transform the way healthcare is delivered. He bases this thought on the years of experience he gained while experimenting with lean at Group Health Cooperative, the Palo Alto Medical Foundation, and now in his role at Stanford.
However, unlike applying lean thinking in manufacturing, healthcare has a much more complicated operating environment. No other industry has the amount of specialized buildings, the high priced capital equipment, such a large number of labor intensive specialties, and such a highly engaged customer base as healthcare. Continue reading →
Recently, I was skimming through travel websites in search of the most scenic route to take from my home town in northeast Wisconsin to a location in southern Indiana where our bi-annual family reunion will be held next month. We have made this trip a number of times and are ready to look out the window at something new during the nine-hour trip. As I scanned the pages, reading traveler comments, (‘Beautiful’, ‘Excellent!’, ’Don’t do it – speed-trap!’) I encountered a phase I have never heard before – at least in regard to road-tripping – ‘elephant racing’. Next thing I knew, I was six sites deep into the theory of elephant racing as a significant contributor to traffic congestion and road rage. Certainly, a little deeper than was necessary to plan our trip to the family reunion but, interestingly enough, I found some valuable relevance in the concept of elephant racing that we can use to understand and improve information flows in healthcare. Really? Yes, seriously. Let me share… Continue reading →
“It is no longer the question of why we need change in healthcare, it is how to change,” stated Helen Zak, president and COO of the ThedaCare Center for Healthcare Value in her opening remarks at the Fifth Annual Lean Healthcare Transformation Summit held June 4-5, 2014 in Los Angeles. Hosted by the ThedaCare Center for Healthcare Value and the Lean Enterprise Institute, the focus of this year’s annual event showcased how real leaders and real organizations are making substantial and sustainable change in the healthcare industry. Over 600 healthcare industry leaders representing 43 US states and five countries descended on sunny downtown Los Angeles for two exciting days of learning, sharing, and connecting. Continue reading →
The Robert Wood Johnson Foundation published an article earlier this month about the efforts in Wisconsin to move from the traditional fee-for-service model of paying for healthcare, to more innovative, cost-effective methods. Two Wisconsin healthcare organizations, ThedaCare and Bellin Health, joined forces in 2011to form a Pioneer ACO (Accountable Care Organization) under the CMS Shared Savings program. The results in 2012 were 4.6% lower cost for Medicare beneficiaries in northeast Wisconsin – the best performing Pioneer ACO nationwide based on per capita cost.
While more than 80% of the reimbursement for Medicare patients is still fee-for-service, the ACO’s efforts show that there is a better way. Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, has been a strong influence in the state as well as nationally, and has proven that better care can come at a lower cost.
This is the first in a series of blog posts where we will discuss our current thinking on each of the principles that work together as a system to guide the thinking and actions behind better healthcare. The focus of this post is to explain what we mean by “guiding principles for excellence in healthcare.” We will describe our current thinking behind these principles, and we invite you to share your thoughts as well. We published a white paper in 2011, which provides some background about our journey to understand these principles. A fuller description of guiding principles, some of the sources behind our thinking, as well as current examples of application can be found in this case study. Much of what we have learned can be attributed to our work with partner organizations like the Lean Enterprise Institute, the Shingo Institute, the Institute for Enterprise Excellence, and others. We believe we are just scratching the surface of what these principles mean for us. We try to continue to learn and share what we are learning with others.
Why focus on principles? The reason is because they are foundational to a lean transformation, and they need to be understood by senior management in any healthcare organization. Most people gravitate to the lean tools and try to copy them, but they don’t know what to copy. Some people are imitating the behaviors they see (like having huddle meetings, or using white boards, or gemba walks). These activities are not wrong, but need to be understood in light of the principles behind the behaviors. Continue reading →
Earlier this month I had the opportunity to observe and capture video of the Seattle Children’s Hospital’s surgical department’s patient flow. Beginning at the hospital’s entrance, the Surgery Center’s system is designed to lead the patient through the process step-by-step, from start to finish. A surgical nurse commented, “Because everything flows in one direction, it is very obvious if something is going the opposite direction; you know it is out of the ordinary and everyone can see that something is not following the standard work.” The patient flow system was designed so each Operating Room is served by two induction suites where the patients are cued up and ready for their procedure as soon as the room preparations are complete. Continue reading →