My career in healthcare started in the early 90s, and it was a crazy time for the industry. The Clinton version of healthcare reform had just hit and the industry was trying to react quickly to the change in reimbursement levels for inpatient and outpatient services. It was a great time for a consultant seeking job security, but a horrible time for a young professional who wanted to see his work actually come to fruition. I can’t tell you how many strategic and operational plans I had to update or abandon based on a change to the reimbursement rules.
Every time I tried to compare data from healthcare organizations with data or examples from other industries, I heard the same things: “We’re different…” “Yeah, but…” “They don’t have to…” Healthcare organizations did not accept a single case study, example, or data point I brought to the table as a valid point of comparison or example to learn from (even when I used examples from within the healthcare industry or other facilities within the same healthcare system). I left healthcare to work with other industries.
Guess what?
Healthcare organizations are no different than organizations in any other industry I work with. Most organizations have qualms about comparing their performance and productivity to other industries, but they tend to move past those qualms once they see other organizations successfully using cross-industry benchmarking to improve. Unfortunately, the majority of healthcare organizations still seem to resist and hold onto a “we’re different” mindset.
Yes, healthcare has to deal with patients, doctors, unions, politicians, community leaders, activists, the government, and more. But so do all organizations. Regardless of the industry, every organization contends with a different set of stakeholders. Education has students, parents, and communities. Government has the tax payers. Publicly traded corporations have shareholders, Wall Street, and unions. A multitude of factors impact businesses of all kinds, in every industry. The industries and organizations that move forward successfully simply recognize those factors and use them to drive new improvements. They don’t see stakeholders and other issues as barriers and excuses to remain stagnant; they see them as facts and sources of feedback that can help them survive.
In case study after case study, the first organizations to innovate and overcome significant market forces usually emerge as industry leaders that eventually acquire those organizations that react too slowly. No doubt, the healthcare industry is facing a huge number of challenging market forces in the coming years as it transfers to ICD-10 (and ICD-11) codes and adopts Electronic Medical Record (EMR) standards. I’m not trying to scare anyone, but being willing to look beyond the healthcare industry to improve these systems and processes could very well be the key to leading the competition instead of losing to it.
Common language
The single largest issue I have seen hamper an organization’s ability to learn and adapt is not having a common language. APQC recognized this in the mid-1990s and developed our Process Classification Framework (PCF) (www.apqc.org/pcf). The PCF is a document that outlines the exact activities that occur in major organizational processes. For example, whether you call it “IT,” “information technology,” or “whatever those guys on the 10th floor with all the laptops are doing,” the PCF calls it “7.0 Manage Information Technology.” The PCF then names and numbers every process group, process, and activity that occurs in 7.0. The PCF is intended to help organizations to understand and describe how work actually gets done—within organizational walls, beyond those walls, or even (dare I say it) outside their industries.
The original PCF is a cross-industry framework, but we have also developed industry-specific PCF documents. We fully recognize that although the basics of the payroll process are fairly consistent across industries, there will be significant differences between how a bank delivers services to their customers and how a downstream petroleum organization produces product for their customers. For that reason, when a significant transformation occurs in an industry and the leaders in that industry want to get ahead of the game, they often reach out to us, and we work with them to create these industry-specific PCFs.
Challenge
So, here is my call to action for you, healthcare industry:
Yes, you are different and unique, but so is everyone. Way too many issues have piled up, and you can’t afford to wait any longer. It’s time to grow up, put on your “big boy” pants, and buckle down, and get the work done in a logical, efficient, and effective manner. I would offer a common language (or framework) as a first logical step.
If you know of any process frameworks or other industry process standards for healthcare, please include them in a comment below. I don’t want to reinvent anything that already exists. I’m also willing to do my part. If you want to help develop a healthcare-specific version of the PCF, please let me know by commenting or by going to www.apqc.org/contactus.
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Ron Webb’s post resonated with me on several levels. My own work in healthcare began in 1956 as Industrial Engineering Intern at Lincoln (Nebraska) General Hospital. I was a freshly minted Bachelor of Management Engineering. At that time, Harold Smalley was doing his doctoral research at the University of Pittsburg. In correspondence with him I learned that there were probably only three of us on hospital payrolls in the entire country. Ironically, the Industrial and Systems Engineers on hospital staffs today seem to be called Management Engineers.
I still remember Lincoln General as the best, most communal workplace I ever had. But it was also completely hostile to my professional efforts. Members of the medical staff said that I was, in their words, “trying to put a value on human life,” which they saw as reprehensible. I was unsuccessful in convincing them that I was only trying, among other things, to determine the implicit value that hospital policy and their decisions put on human life. When I learned that for every dollar that I was able to help the hospital save, they lost $1.10 in reimbursement, I decided that there were better battles to fight.
Like Ron, every prospective consulting client I ever had thought that they were unique. I once had to agree with a prospective client during an initial meeting that they really did seem to be unique. However, after a day of interviews to better understand the clients issues from various perspectives within the organization, I reported to them that there were other organizations that had quite similar issues—hospitals. The organization was the New York Stock Exchange.
Ironically, the executives who thought that there organizations were unique preferred to solve problems by looking around for “best practices” and copying what someone else was doing. I think that one of the most significant barriers to progress in these organizations is this desire for baked solutions—the intellectual laziness that avoids thinking things through from some fundamental level. After that, I would agree with Ron that the absence of a shared language is perhaps the most significant.
Great comments!
Paul,
Thank you so much for your comments. One of the things that has perplexed me about healthcare is that they are SO communal and social. They interact with patients daily and really understand how important that linkage is to their successful treatment practices. For some reason, when it comes to focusing on how they work and how they can work better, they circle the wagons and shut down instead of engaging.
I think through the work you’ve done, and much of the work to come, we can convince them that focusing on processes will only help save more human lives that try and put a price on them. There is something to be said to efficiently treating more patients (with continued high outcomes of care), thus ensuring a higher level of health for a broader population.
Keep up the fight!
Thanks to Chris Taylor for pointing out this post to me.
“We’re different” can either be a challenge that leads people to be creative… or it can become a crippling excuse.
Here is a blog post that I wrote about this dynamic… it was true back in manufacturing and it’s true in healthcare. Proven ideas won’t work here…. “because we’re different.” Or will they?
http://www.leanblog.org/2009/07/lean-wont-work-here-were-different/
Great point, Mark and very interesting post. There are so many tools and techniques from other industries, including Lean, that have yet to accelerate in Healthcare. As Ron says so well, time to “put on the big boy pants” and modernize.
Mark, that is a great post, and I agree 100%. The organiations (in Healthcare as well as other industries) that “get” the fact that they are different AND that is what makes them unique are the organizations I’ve found that grab whatever learning they can and apply it. Whether that is through benchmarking, lean, six sigma, or any other process improvement (PI) tool or methodology out there.
So, this leads to a natural question: If change is so beneficial, how do we go about changing it?
First, it is hard, no doubt, but I think having some great PI folks like yourself moving into healthcare will help a great deal.
I’ve seen this happen in two ways, primarily. The first way is “big bang” change. A new leader comes in and this transition is expected. It’s still hard, but it happens quickly with an innovative new leader.
The second is incremental through the hard work of folks like yourself. Bringing the tools, concepts, methodologies, and skills to get the job done. Some very sound change management techniques, like:
* Setting a clear set of ground rules (nobody wants anyone to risk the health of patients or have poor outcomes)
* Getting some quick wins to show it will work and all the benefits that will come from a new approach.
* Gaining momentum for change.
* Showing the data (financial, patient outcome, etc. - when the CEO and CFO get that, change accelerates.)
Great post and great work. I always love reading about things that work.
Every industry’s processes are different. Within each industry processes vary for good reasons and bad. Many current EMR, EHR, and HIT systems cannot easily accommodate natural differences in clinical and administrative workflow, forcing healthcare users to into unnatural workflow. Worse, after users adapt, there is no way to systematically improve workflow, because it is implicitly (not explicitly) represented and hardcoded. Changing workflow requires expensive programmers. Thankfully, process-aware ideas and technology-such as business process management (BPM), workflow management systems, adaptive case management, and process mining-are spreading within healthcare to help address these workflow usability issues.
Regarding relevance of BPM to healthcare…
EMRs and EHRs Need to Solve “The BPM Problem”: Why Not Use BPM to Help Do So?
http://ehr.bz/lb
Also
Question: Are Healthcare Institutions Using Business Process Management Software with Fiscal and EHR/EMR Software? My Answer…
http://ehr.bz/uq
Great blog and great comments!
Chuck