Landscape
Architecture
“System” is a misnomer for many of the current health care delivery models, as the reality is we operate as silos where each unit acts to achieve its own success. A saying attributed to W. Edwards Deming is “Every system is perfectly designed to get the results it gets.” Our goal for value based patient centered care calls for a new design.
Transforming the Model of Care
Current clinical operating models, designed in the era of rotary phones and postage stamps,
met the challenges of answering machines and even introduction of the “fax” and life has gone on.
Consumer Driven
Focus upon the patient journey
Collective Idea Generation
The goal is not to improve one measurement in isolation – but to achieve better flow – Goldratt
Rapid Protyping
Measure what matters:
plan, DO, study, ADJUST
Continuous Testing
Need to establish Vector based targets – direction and speed of travel from present
If We Could Start Again
With the advent of Medicare in 1965, followed several years later by Blue Cross’ launch of expanded coverage for outpatient services and denial of inpatient claims based upon their view of medical necessity, reimbursement has driven the design of the provider landscape.
Despite perceived certainty that HMOs and capitation would take over in the 90’s and valued based incentives would replace fee for service, providers have enjoyed incrementalism’s dominance over radicalism.
Looking Ahead
The current combination of cost shifting, from payers to individuals (high deductible plans established with the primary motive of preserving profits of commercial payers and associated cascades) and accelerated technology adoption (mobile and virtual) creates the probability that the consumer will become the driver of evolution across healthcare’s’ continuum, not limited to the physician office.
In this era of consumer driven expectations and demands, high performing organizations accept that it is not enough to adapt existing workflows, processes, and systems. We need to enable a discipline of collective idea generation, rapid prototyping, and continuous testing to match people’s needs and expectations with what is technologically feasible, provides customer value, and is a viable organizational strategy.
Related Research
Memory
Memory is a weird thing. We can’t find our keys and yet obscure triggers have us recall things ofttimes better left unremembered/forgotten/lost. Attending a recent ceremony at my alma mater, I noticed the flagpole – rusted and minus the flag – and recalled standing in the back of a classroom decades earlier, as Principal Lintz looked out at the structure.
Leverage humanity: How the deepest learning is when technology is a tool, not a panacea
Upon graduating from high school, without any particular honors or distinctions, my general practitioner, Almeda Decker, DO, assured me that I did not want to make a living sweeping floors in my dad’s stores. Subsequently, she got me a job at the Chicago College of Osteopathy. Albert Kelso, PhD, my new boss, was an esteemed academic, the institution’s director of research and chair of the school’s Departments of Physiology and Pharmacology.
MUSHIN: Clinical Care Team
MUSHIN: “absence of discursive thought and judgment, so the person is totally free to act and react towards an opponent without hesitation and without disturbance from such thoughts. At this point, a person relies not on what they think should be the next move, but what is their trained natural reaction, or what is felt intuitively. It is not a state of relaxed, near-sleepfulness, however. The mind could be said to be working at a very high speed, but with no intention, plan, or direction.”
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