Recently we have had the chance to talk to many healthcare provider CEOs, CFOs and COOs regarding their key challenges and concerns. While there are often similar issues across organizations, right now the challenges on the mind of many seem to be very concentrated around one subject: How to integrate acquired assets, ranging across new EMRs, physician practices and hospitals into a working system that can deliver outstanding quality with economic efficiency. The subject is further amplified by many providers entering risk based agreements and needing to rethink their business models.
Systems Engineering is the field that is focused on the design and management of complex systems, and if there is a system that ever qualified for being complex, I would argue healthcare is it. So, systems engineering is a logical approach to solve for this. But, as is almost always the case, the tools alone are hardly the solution, putting the tools at play takes additional consideration.
One such consideration that is a big driver in how successful the work will be, and how quickly it will produce, is the scope of the projects themselves. To support the objective of creating a seamless system, and at the same time, create efficiencies and cost reduction, the inefficiencies created by silos must be removed, which of course is directly related to scope. The larger the scope, the more opportunity to remove inefficiencies created by silos.
Silos are simply a reality, and silos are serious barriers to building a holistic system. They create hand-off issues, and each hand-off creates risk of errors as part of the hand-off. The hand-offs create a bumpy customer experience, especially if they occur directly in the customer facing process. Hand-offs increase the timeline to completing the overall task as the work has to wait in line at the next silo. Hand-offs are productivity killers. Each person or department has to go through a ‘mental’ setup process, getting their head into the case or work, before being able to contribute. Silos contribute to a lack of comprehensive ownership and limit line of sight to customers. Measurements are another issue, silos require silo based metrics which by definition are limited and often suboptimal, driving all sorts of well-intended but undesired behaviors.
Silos are bad.
But, silos are here for a reason. They mostly date back to driving specialization and efficiencies, and they are often based in historic tasks that are no longer needed. The issue is, the world has changed with the new tools and approaches now available, while our organizational makeup, and therefore the silos, have not.
New technologies, the Cerners, Epics and “new” Meditechs of the world, have evolved to provide magnificent functionalities that should change how we organize around the work. Many tasks that had to be completed manually can now be automated, cutting hours of mundane tasks and focusing us on much more valuable work.
This has several implications. First, we can broaden the scope of work each individual completes. Second, the scope of organizational responsibility can increase, creating fewer groups in the end to end value stream. This reduces errors, increases ownership, and eliminates the labor inefficiencies of hand-offs. Finally, this has significant implications for the workforce itself, mundane repetitive tasks are replaced by those where decisions are made and customer service is created, which is where the value of the human touch is. This means we are creating a shift in what many people in the system do, and that has implications for the role of managers and associates alike.
(As an aside, some EMR implementations have created barriers in this space where the administrative, and non-value portion of work has actually increased, for example, for physicians burdened with documentation requirements, which will be the subject of another blog, and not something we will discount).
This brings us to the key question, one that has no precise answer, but a directional one: What is the right scope for the projects that integrate the pieces into a working system?
As a general rule, we have found large scopes defined as end to end processes are the most successful. Interdepartmental scopes will not produce system level gains, we have to scope across departments. Value stream thinking and the consideration of natural breakpoints are usually a good starting point. For example, for Patient Contact Centers, a ‘one call does it all’ approach will define scope across several traditional departments that can make sense. Value stream thinking will then allow for a design where teams are organized by service line with standard processes for each team servicing customer requests, and working in parallel based on request type.
It seems like the time has come to integrate health system assets and reap the benefits associated with this type of work. In one recent project, this approach has led to one organization freeing up approximately 30% of the labor to make those resources available for other critical tasks. Not bad.