Perfecting Patient Journeys, Improving Patient Safety, Quality, and Satisfaction While Building Problem-solving Skills, by Judy Worth, Tom Shuker, Beau Keyte, Karl Ohaus, Jim Luckman, David Verble, Kirk Paluska, Todd Nichel, Lean Enterprise Institute 2012
The 17% factor
If you are a healthcare executive in the US today, it’s hard to know where to begin. At 17% of the US GDP the industry offers too many opportunities and big challenges. Where to start?
Perfecting Patient Journeys offers a simple approach that includes tools, illustrated examples from groups that have already “gone there,” and most important, a starting place. Business leaders want to attack profitability and customer service challenges, and they have proven tools at their fingertips, as well as personnel trained in all the various approaches to profits, but in healthcare the “products” are human and the providers are, for the most part, also human. Customer service in healthcare extends far beyond and through the delivery of great products on time. The healthcare industry is tasked with not only delivering a great product, but it must design a great and compassionate experience.
This book presents a method for healthcare providers to:
· Identify and agree on a problem
· Collaboratively develop a set of potential solutions to the problem
· Experiment in order to find the best solution to address the problem
· Communicate, share and learn from the results.
The book had the support and vision of Dr. John Toussaint, creator of Thedacare in Wisconsin, one of the very first medical collaborative to translate Toyota Production System, lean, and other classic industrial engineering methods, into human deliverables.
Key tools industry pros will recognize from their own work: value stream mapping, observation, timing and analysis, going in gemba, team formation, project reporting and tracking. But Chapter 1, a trip to St. Luke’s Emergency Department says it all. Patients sit, they walk, they wait, they yell, they are examined – or not – and then they sit again. It’s controlled chaos, a mix of harried healthcare workers, EMT’s, patient families, computers and clipboards, and a flow that peaks and subsides, peaks and subsides with the unmanaged rhythm of an unpredicted ocean storm. Weaving through and layered over the bursts of human outcry and chaos are critical information flows – that lab work the doctors need to evaluate a fevered patient, a clipboard filled with and-written patient history that appears over and over again as the sick and injured lurch from one operation to the next.
The St. Luke’s team observed and discussed their Emergency Department situation and settled on wait time as a critical indicator of this area’s performance. The problem statement established the goal of “reducing patient LOS (length of stay) that would raise their satisfaction level, keep them safer, make work more satisfying for staffers (and reduce turnover), and make it less likely that patients will abandon our hospital to seek care from our competitors.” Although it may be difficult for patients to obtain Consumer Reports type ratings on the comparative wait times of their local emergency rooms, the St. Luke’s example illustrates how promising a “door do doc” time of 30 minutes and a total visit time of 2.5 for most patient is a competitive, attractive offering. Word gets around.
Readers will learn how to identify and select a problem, define project scope, and create a shared understanding of what's occurring in the value stream. Readers will also learn to develop a shared vision of an improved future, and how to work together to make that vision a reality. All of these are learning experiences that team members struggle through and share as they attempt their first project. Project after project the learning continues, but as more and new team members are introduced to their very revealing and powerful problem-solving techniques, its good to have a guidebook like Perfecting Patient Journeys to refer to.
Healthcare projects are projected to have the same stunning results that early industry kaizen projects first uncovered. The authors quote average length of stay reductions of 30%; number of patients who left without being seen (LWOBS) dropped by 60^; customer (patient) satisfaction increased by 73%; operating room changeover time reduced, which increased the number of surgical procedures performed by 20%.
The Mill Girl’s one critique of this book? There is no Index, no way to look up key graphics or examples from various stages of the process. Although the Glossary is helpful, team members need an Index.
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