Kevin Shea -- Process Collaboration

Applying Systems Engineering to Healthcare

I previously wrote about my personal experience as the system integrator in two different incident related to healthcare. These observations arose from activities both in doctor’s offices and hospitals.

 

I have conducted more research and now realize that systems engineering is being viewed as a possible means to process improvement in healthcare.

 

Within any environment in which systems engineering is deployed, one must examine the specific nature of the work before defining a solution, a process change or an alternative method. But one must maintain a focus on the fundamentals of systems engineering and balance the nature of the work with these fundamentals.

 

In my work, I see that most people working in staff positions know what they have to do, have the skills to do their job and want to do their job well. We as system engineers need not focus heavily on individual task improvement, but should turn to improving the interfaces, interactions and interruptions that prevent a staff member from completing a task effectively and efficiently. We should focus on rearranging, eliminating and combining interfaces to reduce complexity, minimize errors and improve quality. We should work with, and indeed rely on staff members to help identify areas for improvement.

 

There is also a significant difference between deploying systems engineering in healthcare and in other industries --- in healthcare the product is healthy people. Healthcare facilities take in customers who have concerns or needs about their health, and hopefully, discharges healthy, productive people happy with their overall condition and the way in which service was delivered.

 

The key in applying systems engineering in healthcare is making sure that we don’t lose sight of the fact that the “product” has a characteristic never found in a manufactured product --- emotion.

 

How to achieve Effective User Adoption

According to a study done by the Sand Hill Group and Neochange, the most critical factor (70% listed as number 1) for software success and return-on-investment is effective user adoption. Software functionality came in at 1% surprisingly, with organization change at 16% and process alignment at 13%. (see Jason Rothbart at  ReadWriteWeb )

This does not come as much of a surprise to me..... Indeed, I have written on the topic of how to create effective user adoption, specifically for Enterprise2.0.

Anyone interested in a step by step outline should take a look at my paper -  Execution Strategy for Adoption of Enterprise 2.0 Technologies

Who is the integrator in Healthcare --- I am!

 

One of the failures of poorly run companies is the inability to integrate information and communicate across “silos”. The idea of “throwing it over the wall” has crippled many companies and forced those that maintained the practice out of business.

 

Two personal examples of my involvement in the healthcare business suggests that the healthcare is at risk since they do not offer or provide any real integrative services when it comes to customers, ooops, patients.

 

My mother was in and out of hospitals, rehab centers, long term care facilities prior to her passing. She was transported, relocated, and moved many times and what was depressing was that there was no communication between the service providers. There seemed to be a total lack of information being collected and amassed. It was we as caregivers who had to maintain a running history of what was going on, who was saying what, what treatments she had, etc. We received NO paperwork yet we had to provide the history of her health care. In one case, she was transferred from one building to another in the same facility and her records got screwed up.

 

I recently needed to investigate a gait related problem that seemed to me to be systemic. I could not find a orthopedic who would look at me as a whole person. I had to first see a foot doctor, (not the ankle), then a physiatrist, (nope) and then a hip guy (not your hip). None of them offered any insight into an integrated opinion about the problem. I chose to see a physical training specialist ( a quack) and she identified and solved the problem by focusing on my lateral oblique muscle. The healthcare people couldn’t identify the issues since they were isolating their view. No one took an integrated look at me. I had to force the issue. I was the integrator.

 

If you can’t act as an integrator, you may be at risk in seeking healthcare services for systemic problems.  

It's about execution!

You can strategize all you want about business but in the end, it comes down to execution. How many business strategies have failed as a result of poor execution? A lot, as noted in Hrebiniak’s Business Strategy: Execution is the Key. And I might add, that execution efficiency is the Master Key.

 

In his book, Hrebiniak cites numerous examples of failures to implement a well thought out execution plan to a new business strategy. What he doesn’t say much about, is why.

 

Why don’t companies develop, detail, and deploy well crafted execution plans? What prevents companies from successfully implementing the company plan to change? What barriers and limitations exist that prevent success or otherwise screw everything up?

 

The most obvious reasons for failure is that those who have to undertake the change are not provided with sufficient direction, or more specifically, they aren’t told “how to do it”. Often, the execution plan, if there is one at all, is not linked to the business strategy since the company set up one team for the business strategy and another for the execution. Silos. 

 

Or, the business strategy was developed, and then a request was made for a lower group of managers to come up with a plan to accomplish it. The managers may or may not comprehend the strategy, likely were not involved in the development, and are not provided with any guidelines, framework, or architecture within which they can execute. In effect, the business strategy was “thrown over the wall”

 

Lack of communication at the interface between those focusing on business strategy and those responsible for executing all that is necessary to achieve the strategy is a primary reason why important business changes fail.

Collaboration, execution efficiency, and Enterprise 2.0 in Healthcare

A lot of my work has been involved with manufacturing type firms, but a recent series of healthcare related activities has got me rather interested in the ideas of process change within healthcare. From optimizing doctor’s offices to treating people as customers, I am now joining others in an attempt to use systems engineering methods along with principles of the Toyota Way to alter standards and practices throughout the healthcare industry.

 

Healthcare finds itself operating in an environment that mostly hasn’t changed in decades. When healthcare is benchmarked against other industries and tests conducted in applying lean techniques to processes, it is discovered that most all techniques and methods used in applying systems engineering, lean execution, demand and supply side management, etc. are applicable to problem resolution in healthcare.

 

If we follow the thread that has been woven in other industries and project this into healthcare, it becomes apparent that healthcare will be leveraging the lessons learned in other fields. This path started by breaking down isolated work space, introduced integrated work activities, and then moved on to collaboration and sharing, and eventually to knowledge sharing. Activities along this path also moved the focus squarely towards the customer.  

 

Healthcare is beginning to change and one major movement is in managing patient flow following concept of industrial engineering applied within manufacturing plants. In the eyes of many the path is clear. It will basically follow fundamental changes in work methods that have occurred in many other fields. The path will ultimately lead to integration of work processes with the customer in the middle.

 

One question that arises is at what time will collaboration begin to be introduced as an execution strategy?  A few leading hospital leaders are taking advantage of Enterprise2.0, mostly blogging. But an interesting challenge that they will face will be how they may benefit from emergent collaboration.

Principles of Process Change

With the economy faltering, many businesses will be hunkering down and looking at ways to survive. Strong companies will be seeking to use this time to place even more distance between themselves and weaker competition.

 

As personnel reductions are undertaken, companies will be seeking to do more with less, or at least the same with less.

 

All in all, difficult times should spur firms and employees to action, rather than a “stick your head in the sand” reaction. It is at these times that it becomes much clearer that improvement should, and can be made, to standard business practices. Everyone should be asking the question, What can we do to assure that our business, our company, will remain competitive now and into the future?

 

The time has come to examine or re-examine how your business processes either help or hinder your companies’ success. It is time to return to basics and focus on those core activities that result in high quality product or services that customer, clients and consumer want.

 

In this difficult time, it is time to change.

 

But how?

 

Here are some principles that have proven successful:

 

1.     Establish a long term vision and philosophy

2.     Improve or redesign processes and process flows

3.     Eliminate wasteful materials and methods

4.     Level out the workload

5.     Stop to fix the problem

6.     Standardize tasks and processes

7.     Use simple devices to support work activities

8.     Deploy technology only when it serves people and processes

9.     Live the philosophy

10.  Work as a team

11.  Work with customers, partners and suppliers to help them improve

12.  Talk and listen; learn for yourself

13.   Think slowly, create a team decision and act quickly

14.    Undertake continuous improvements.