As lean thinkers we need to keep in mind the "enterprise wide" value stream. This means understanding every step in the customer's experience from time to when an abnormality occurs to cure. But what if there is no process to identify abnormalities? Today we have a process that is perfectly designed to deliver poor health outcomes for farmers. It goes way beyond whether we actually have the right providers and care processes designed correctly in a medical clinic. More and more our thinking has to shift to understanding the entire customer experience. This includes understanding their work, where they live, what their access to healthcare is etc. ThedaCare's Community Health Action Team found that most rural Wisconsin farmers were fearful of doctors and refused to go to the clinic. So, the team brought nurse practitioners to them piggybacking off the local agriculture extension service. The team had to build trust before it could save lives. The natural place to start was the extension.
In the adjacent article from Commonwealth the program to address the needs of farmers in rural Wisconsin is highlighted and brought to national attention. The importance of this work,however, is the difference in thinking about the health of a relatively isolated population. This thinking can be applied to any population of individuals from inner city America to the farm fields of Wisconsin. The point being that lean thinking is very applicable to population health and if it was utilized more often community health teams such as the Rural Health Initiative in Wisconsin would be the rule rather than the exception.
http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/February-March/In-Focus.aspx
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