Improving the Patient Experience

Recently I was on site at Chatham-Kent Health Alliance in Ontario, Canada to facilitate a 5-S project in the Surgical Services area.  The 5-S process or Sort, Straighten, Sweep, Standardize and Sustain is a tool from the Lean Six Sigma Methodology.  This video demonstrates how the 5-S process helped Chatham-Kent create three additional bays for patient care and save money by pinpointing excess supply and streamlining ordering strategies.   This is a great example of a successful implementation because of passionate staff who were involved in the process of change which starts with the support and enthusiasm from key leadership: CFO, Sarah Padfield; Program Director, Eleanor Groh; and OR Manager, Janice Wilmott.   

I am always surprised how much you can learn by mapping the work flows you manage. Over the past several weeks I have been spending time with various Healthcare Leaders mapping their processes as they prepare to introduce an electronic medical record (EMR) to their organization. For this engagement we decided to map the patient experience using swim lane maps. A swim lane map or diagram is a good tool to map a process flow and identify potential problem areas that need to be corrected.

A map of your process can be useful in several ways. First, it clarifies each team member’s role and responsibilities, including direct patient interaction and behind-the-scenes activities. This answers questions such as “Who is responsible for walking the patient back to a bed?” or “Who should call patients with their test results?”

Second, it helps reveal problem areas and targets for improvements. This is critical when you are implementing an EMR. To ensure a smooth (well smoother than expected) deployment you need to first understand your current state – warts and all, before moving to the future state. For example, this mapping approach shows visually where hand-offs occur in the process. This is where lack of coordination and communication can cause process problems. When we started documenting the lane changes, I heard, “wait that doesn’t happen during our shift. We do it differently.” Or another response heard often was, “why do you ask those questions again during discharge? We ask those questions when the patient first arrives. We have to ask again, because not all the correct information is being collected at the beginning.” Missed data, wrong data, rework and delays in the process become painfully clear when laid out in a swim lane map.

Our healthcare clients have come to truly appreciate the process of mapping the patient experience using the swim lane. The map is a great change management tool as well. It clearly illustrates that providing patient care is a team effort, thus creating a shared need and vision for change!

If you would like additional information about this approach, please drop me a note.

I recently read an article that idenitifed 5 innovative items from automotive that almost didn’t happen, e.g., seatbelts, airbags, catalytic converters, etc. These are now expected, standard items, but recent history tells us that the industry fought their introduction. What innovative idea will healthcare look back on and think why didn’t we do that sooner?! EMRs? ACOs? Lean Thinking?

As a consultant it is always good to attend conferences and workshops. They allow me the opportunity to listen and learn, as well as get a pulse on what others are doing to improve the patient experience. At the recent Michigan Medical Group Management Association (MMGMA) Spring Conference along with excellent speakers presenting on relevant and timely topics (e.g., ACO, PCMH, and BCBSM PGIP), the keynote speaker was Coach Lloyd Carr, University of Michigan Football Coach (retired).  

I’ll be honest. When I got the MMGMA email announcing that Coach Carr was the keynote speaker I had mixed emotions. While not a Michigan alum I thought he was a great coach and was excited to hear him speak in person; however, I wondered, “what does Coach Carr know about healthcare?” It turns out a lot!  During his appearance, Coach Carr talked about leadership, tradition, and the pursuit of excellence.

These are topics relevant to any industry whether you’re running a major football program, COO of a hospital or managing a high volume physician practice. Carr told a story of a champion bull rider he met while coaching a bowl game. He asked this young man how are you so successful? The bull rider said, “I remind myself everyday that the bull doesn’t give a damn about what I did yesterday.” I find this story very relevant to healthcare. Care givers need to remember that each patient is different and they could care less about what you did the day before. While the job is the same to you every day, the experience is new to that patient who is counting on your expertise.    

Coach Carr also emphasized that as leaders, you need to communicate your expectations to your team (or staff), your priorities, what you need from them and always let them know how they are doing. Great advice since healthcare workers are always busy and these core items tend to get neglected.

Prior to his talk, as he waited quietly in the back of the room, Coach Carr shook hands with several MMGMA members, me being one of them. Carr looked at my shirt, grinned and said, “Lean Fox…I could use your help to lose weight.” We both chuckled and he moved on to the next person. Maybe he sensed how nervous I was to shake his hand. He could have easily brushed me off, but he went the extra mile to make that brief moment memorable for me (and him). I truly enjoyed getting the chance to meet Lloyd Carr.

Recently I have noticed that many in the media and healthcare industry (myself included) use the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably. However, these terms describe completely different concepts, so what the heck is the difference? Off to Wikipedia we go…no not this time. Don’t worry I’m not going to go all techno geeky on you. All you need to remember is this, an EMR is a more silo’d record of a single diagnosis; while the EHR provides a more comprehensive view of the patient’s health and history by pulling information from several systems or multiple EMRs. EMRs will never reach their full potential without interoperable EHRs in place. It’s important to understand the differences, and to reduce confusion in the market.

Lean thinking can assist you in the selection, implementation, and adoption of an EMR/EHR for physician practice, service line and/or hospital.  Before selecting and deploying an EMR/EHR, you really need to assess the current process flow first to understand how your team works and uses data. Too often we introduce software solutions to get us out of a paper mess and simply end up with an electronic mess that is less flexible. Prior to selecting an EMR/EHR, we recommend that our clients:

• Map out the current state to identify the waste in the process.
• Agree on what waste needs to be first.
• Create a stop, start, continue document that outlines what the team is going to stop doing, what they are going to start doing differently and what will stay the same moving forward.

All of this helps shape the vision for change and prepares the staff, physicians and others for the deployment of an EMR/EHR. Physician practices, service lines and hospitals should only engage a software solution where it adds value. Your organization has specific characteristics and behaviors that make your business unique.  You need to fully understand them before committing to an expensive software system that won’t or can’t adapt to your organization. Here is an interesting story from Fast Co Design on an EHR deployment.

Reason for a blog:  Welcome to our first official blog posting. When we decided to add a “blog” to our website I first had to figure out exactly what the heck a blog was supposed to be. So I went to everyone’s source of truth…yes, Wikipedia. According to Wikipedia the word “blog” is the blending of the term web log and is a type of website or part of a website. So far so good.

It continues…Blogs are usually maintained by an individual (that would be me) with regular entries of commentary, descriptions of events, or other material such as graphics or video. Well that about sums up all you need to know about our blog.

Moving forward, these blogs will be educational, humorous (hopefully), as well as thought provoking. Your thoughts, feedback and comments will only make this a better blog. Enjoy!

Todd wrote the Practice Manager’s Column in the Journal of the Michigan Osteopathic Association. Download a PDF of Triad Winter 2011 to learn about the Voice of the Customer and 10 ways to transform your practice.