On March 30, 2008, the ThedaCare Center for Healthcare Value started writing blog posts highlighting successful transformations of healthcare systems. Over the course of the past eight years, the depth and scope of the Center Point Blog has widened to include the entire spectrum of payment, delivery and transparency. And as the landscape for improving healthcare has changed, we have changed with it, to supply the needed information to help guide our readers with objective and trusted viewpoints. Continue reading →
The holidays at the end of the year are a time of reflection. During this time we pause to look back and take stock of significant events in our lives during the previous 11 months. This year I would like to offer some of my personal reflections from my collaboration with many committed, visionary, and courageous industry leaders and coaches. Here they are, in no particular order: Continue reading →
Would healthcare be better if everyone understood and applied the five lean principles described in the book Lean Thinking? As part of our team development at the ThedaCare Center for Healthcare Value, several of us have embarked on the process of taking the Lean Bronze Certification examination. To prepare, we are studying the various books that are required reading. As I was reading Lean Thinking I was struck by how much of our current healthcare system goes against these five simple principles. Continue reading →
Jim Marks, the Chief of Staff and Chief of Anesthesia at San Francisco General Hospital (SFGH), in this open letter to his colleagues, details the importance of teaching the principles and thinking behind lean management, the work ahead of his organization, and what they’ve accomplished so far. The shift in thinking required to switch to a lean management system is difficult work, but as he explains below, it’s well worth the effort.Continue reading →
I come across many healthcare organizations that struggle with performance management. What I hear and see are intelligent, dedicated people all trying to help their organization improve. Most EMR implementations do not include a clinical business intelligence strategy. Vendors have come in and convinced the organization’s leaders that their software can somehow automatically improve performance. The software is so easy to use it will be self-service. The vendor will demonstrate the ad-hoc data discovery capabilities that anyone can do. All the organization has to do is submit their data and the improvements will begin. Oh there’s also a large expense of at least $250,000 just to start. Many organizations that have spent much more than that and are not seeing any significant improvement. Why?
There is more to performance management than just tools and technology. The ThedaCare Center for Healthcare Value has formed a peer-to-peer learning network called the Clinical Business Intelligence Network, or CBIN for short. Our shared learning has led us to a deployment sequence in performance management of Mindset, Skillset, and Toolset. While technology is very important, the deployment of technology without the proper organizational mindset and skillset will not be successful. The analytics must be supporting an improvement methodology like lean. The organization must be skilled in producing, consuming, and using data to take actions on insight.
Our network has developed a formal assessment process to help an organization build an actual strategy and roadmap. We also have designed a skills matrix development process to help accelerate an organization’s analytical journey. The focus is on developing and maturing the mindset and skillsets needed to be successful in actual performance improvement. While we certainly discuss technology, the main emphasis of our learning, sharing and connecting, is on people and processes.
There are several symptoms of a performance management system in need of help: Is your organization improving at the desired pace? Are you spending a lot of money on tools and not satisfied with the actual results? Do you have a strategy and roadmap for organizational performance management? Is your analytical maturity focused on latent performance measures? There is help available. Start by reading Management on the Mend by John Toussaint, MD. This book describes the model, step by step, through people in 11 organizations who are transforming into high performance healthcare organizations. Please join the Clinical Business Intelligence Network and our other peer-to-peer learning network, the Healthcare Value Network to learn, share, and connect with others who are also on this transformation journey.
Brian Veara, Program Director
ThedaCare Center for Healthcare Value
I’ve visited a number of organizations and one of the recurring problems I’ve seen is lack of an effective prioritization process. I think this is paramount. In this world of competing priorities and regulation we must have a way to focus on the “vital few,” demonstrate and stabilize the improvement, and move on to the next “vital few.” We will accomplish more sustainable solutions with added focus.
As I visit healthcare organizations around North America, people come forward sharing concerns that they are hitting a wall, even within the management system. Often what I hear is that they have implemented stat sheets and huddles, but not all of them have implemented a performance review process. The management system is just that—a system! The goal is to develop people to solve problems and improve performance. How do you know if your problem solving is driving improvement if you are not measuring it? Continue reading →
If you encourage staff to identify defects, you better have a process to solve them. Often the first step is to bring those defects forward to a huddle. In the book Beyond Heroes, we recommend that this conversation occurs at a huddle board (visual management) with your staff. During this huddle, you identify and discuss defects which have been brought forward from various sources—status sheets, staff, ancillary areas, or physician. A system to prioritize these opportunities is essential.
One of the first components needed in a management system is a way to look at your day. We call that our status sheet. It’s a daily check-in. It could be a huddle, it could be a conversation, whatever it is that you are doing, but it is at the front line and focused on identifying what is happening in the business today. How can you proactively think about your business in a way that solves problems before they occur?
This will be my last blog post as an employee of the ThedaCare Center For Healthcare Value. I am very grateful to have the opportunity to work with some terrific people who are trying to make a difference. I’ll be moving on to other work where I’ll be contributing to the “gang tackle” of healthcare transformation in other capacities. If you are curious about what I’ll be doing, you can follow my exploits at gembawalkabout.com.
A few years ago I had the good fortune to tour a company that is a supplier for Toyota, Honda and other companies. The gentleman that was showing me around would occasionally talk about advice that he was given from his sensei from when he worked at Toyota. Apparently, this Japanese gentleman would try to emphasize important points by making this statement, “this is truth”. I was thinking about this as I was asked to offer some reflections on my time at the Center over the past six years. So, here’s my “top 10” list: Continue reading →