What is IT’s role in the Lean Journey?

Julie Bartels shares her thoughts on IT's evolution and its role in the lean journey.

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The days of waiting for the users in clinical and operational areas to ‘define their requirements’ and ‘tell IT what to do’ are long gone.

I cut my teeth in Information Technology in the mid 1980’s. It was referred to as Electronic Data Processing or EDP then. We prided ourselves in being ‘systems’ oriented – uncommonly smart, thorough thinkers able to grasp technology and wield it on behalf of the organization. These were the days of computers as big as city blocks running high volume transactions (millions!) at 90% reliability with sub-second response time – a performance standard that is laughable today. It was the role of EDP to automate the business to increase capacity and standardize quality. Technical staff were routinely located in remote areas of the building – it was generally accepted that we could function just as well and maybe even better in isolation. Basements or converted out buildings with few windows and no connection to our users would suffice. Social skills were a minimal job requirement. If we had one or two people who could navigate communications with the rest of the company that was fine. The career path of an EDP professional followed the implementation of technology from one business sector to another;  manufacturing to service to finance to healthcare…okay, maybe not to healthcare. No need to understand the business or the customer to do our jobs. The total value of our work was in automating business processes so that companies could do more, faster. Our primary business was ‘technology’. It was the role of the user to define requirements -- we built exactly what they asked for, no more, no less. If they didn’t get it right the first time, well, rework was expected. That’s how it was and we liked it just fine.

Of course, not everyone felt as warm and fuzzy about this scenario as the folks in EDP. CEOs and CFOs felt hi-jacked – too much money, too much mystery, no way to guarantee ROI. Every project of any significance was at least 8 months long and 900 hours in the making. Bringing up new systems was a multiyear project with a guaranteed ‘break in period’ that could wreak havoc on the business. If you were lucky – and luck was really the deciding factor, you could retain your customer base through the transition.

Enter the Personal Computer (PC), the mobile phone and the internet. Electronic Data Processing became Information Technology (IT). Next thing you knew everyone was sharing ideas, hiring expert consultants from the outside, buying software and running their own reports.

The gig was up. Users could now understand what IT did – at least to some degree -- and to demand that IT learn the language and the value proposition of the business and MAKE A POSITIVE (read that as financial) DIFFERENCE. Go figure. Competition based on innovation that drove down cost and improved quality was the business model of the future.

Except in healthcare.

Somehow this whole technological revolution missed the healthcare industry. Sure, we saw some innovation in high profile/high dollar areas like pharmacy and robotics but not at the bedside or clinical care setting. It just wasn’t sexy enough. Inefficient paper based systems, memory based care delivery, rising costs and increasingly poor quality were hallmarks of healthcare then and remain in place today.

We have some serious catching up to do. People, process and technology issues must all be considered. The historical limitations of data access and use in healthcare settings have conditioned us to ask the same limited set of questions over and over. Today’s tools and technology offer greatly expanded options to work with data. The challenge is to inform leaders of what is possible so that they can begin to leverage data to understand and then redesign care delivery processes for higher value.

Don’t be confused – this is not a problem looking for a technology solution – no matter what the vendors say. There is a logical sequence to this effort that influences its success: first mindset, then skillset and then toolset.

Lean processes, the well-executed, data driven problem identification and solving processes used to deliver consistently higher quality, lower cost products in manufacturing and service industries are slowly making their way into healthcare with similarly spectacular results. The speed and impact of the lean journey for a healthcare system is dependent upon its ability to deliver a reliable flow of meaningful information across the enterprise to support continuous process improvement.  In fact, comparative performance reporting is essential to the value improvement of a healthcare organization and the transformation of the larger healthcare system. Scientific thinking fed by timely and reliable data must signal best practice and motivate change in provider behaviors.

A lean culture engages the entire organization in identifying waste and redesigning work flows to deliver value to their customer. Lean is not a spectator sport and IT is no exception. The analytical staff must work side by side with their clinical and operational peers to understand and solve business problems. Capacity issues are being felt across the enterprise. The eight wastes http://www.fastcap.com/estore/pc/catalog/leaninanutshell.pdf apply as aptly to IT as they do to any operational or clinical setting.

At the ThedaCare Center for Healthcare Value, we convened a group of healthcare leaders last November to talk about the potential of clinical business intelligence (CBI) in the transformation of healthcare. Leaders from 23 organizations from around the nation told us that the lack of access to meaningful, timely, accurate information about their performance was a major obstacle to performance improvement. They identified the absence of analytical capability and capacity as key factors to information flow. IT where are you?

As John Toussaint often reminds us, transformation takes a gang tackle. Get out there!