Why Processes Matter Most in HC, Part II

Posted on March 28, 2014


[Click for “Why Processes Matter Most in HC, Part I”]

This concept is made very clear in sports. When a key guard and defensive specialist gets hurt in a basketball game, the coach says, ‘next man up’. The coach does not switch from man-to-man to zone defense (process) because one of his star players (resource) is unavailable.

If a process changed every time a resource changed, a business / team / entity would go nowhere because there would be constant change and no chance to perfect skills that make a process and system work (i.e. make money).

This is why Lean and Six Sigma are good investments. To paraphrase another great conference speaker, Dr. James Bennyan, a professor of Engineering at Northeastern University: forcing function through design will ideally disallow mistakes or waste, instead of relying on human memory. In other words, processes will not allow failure. That’s why they exist—to ensure the same thing gets done the same way each time. This fact is the singular best selling point for simulation modeling, which helps study and perfect internal clinical processes.

Constant process change is self-sabotage. Yet this is exactly what healthcare does to itself. It happens all over the place.

For instance, in most hospital systems when the Director of Facilities leaves, the incoming Director is always given the freedom to procure design and construction teams as he or she sees fit. This could mean such radical changes as adopting a different project delivery model unfamiliar to the healthcare institution—CM instead of Design-Bid-Build, or Integrated Teaming instead of CM-at-Risk.  This one decision could change the way projects have been run for decades. That is a lot of process power!

Or, after a project is 14  months along and well into design development, the Chief Nursing Officer or another C-level administrator changes and the newbie insists on redesigning the project, scrapping hundreds of thousands of dollars of man hours already spent simply because he or she was not there in the beginning. One person hitting ‘reset’ on an entire process.  These are two very common examples of resources directing processes—the opposite of what should be happening.

Instead, when a new Facilities Director is hired, the C-level boss could say, “we’ve studied delivery models and have been doing design-build for eighteen years. It works well for us. Everyone here knows it. If you are not familiar with it, we will train you and send you to whatever seminars or conferences you need to feel competent, and get any certifications you need. We periodically evaluate those decisions, but that’s how our processes are set up now. If you want this job, you will need to be comfortable with doing design-build.”

These types of discussions are starting to happen as hospitals and physicians work under new relationships as employer-employee; the industry calls this “alignment”, and this can happen elsewhere, too.

The future of healthcare will require more standardization. Processes will be essential in this quest, and should be paramount to any resource a hospital has—including surgeons. Culture is the most challenging part of an organization to change, but it is also the most important part for long-term success.