Why Processes Matter Most in HC, Part I

Posted on March 27, 2014


Among the many cultural paradigm shifts under way in healthcare, arguably the most important is the understanding that, simply put:  processes rule.

Paraphrasing Harvard Business School professor, author, and innovation expert Clayton Christensen, a business organizes three ingredients for long-term success:  priorities, resources and processes.  First, an entity identifies priorities to deliver a product or service.  Second, it acquires and aligns resources to accomplish the priorities.  Third, it develops repeatable processes using those resources to address the priorities.  This development must happen in this order, and if the priorities change, the resources and processes must change.

When a correct process is put in place, a business can be efficiently managed for maximum production with minimal effort.  This is the definition of the proverbial ‘well-oiled machine’.  For most established companies, developing and protecting processes is the most difficult and important part of success.  It is a business’s holy grail.  Hospitals have dozens of departments where this is essential.

It is important to note, processes are not designed to change.  Let me repeat:  they are specifically developed to not change.  In fact, the theory behind Lean and Six Sigma is all about process improvement:  eliminating waste (Lean) and ensuring process repeatability (Six Sigma).  Processes rule.

With that floating in my head, I listened intently to a healthcare CEO round table discussion at a conference.  The CEOs were discussing the high cost of operating facilities and the need to be more efficient.  One CEO said there was a lack of standardization behind the design, use and operations of his facilities.  Cue simulation.

Perhaps more noteworthy was another CEO’s piggy-back comment that there was “toleration of each person’s idiosyncrasies” and there needed to be standardization, specifically among nurses and in the OR.

This is the antithesis of the process discussion above.  In this case, and probably most departments in most hospitals in most systems in most cities (because I hear it quite a bit), the resources are unfortunately dictating the process.

Resources are always role players, components within the process, subordinate to, at the service of a process.

 [Continue on to Part II]