The healthcare industry is has one of the most complex infrastructures compared to other global industries. Consider all the moving parts and transfer of data (as well as patient care) across health systems starting with individual practices and prehospital care, through hospitals and onto palliative care facilities. When healthcare process management works well, it’s a finely tuned machine that lends to the treatment and recovery of patients and provides faster of services to families through social and administrative services.
The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one.Mark Twain
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Outside of the patients, properly tuned processes give healthcare providers and workers the information, connections, and resources they need to do their jobs.
But how often do those processes work? And how often do they work efficiently and as intended?
You could draw parallels to the automotive industry in complexity; a system in which complex processes absolutely must function or the entire process gets behind and is often shut down until the flow is restored.
Decades ago, William Deming established guiding principles that helped shape process management and changed the automotive industry forever. Many of those same principles could be applied here and help drive substantial change and improvement in healthcare process management.
1. Focused Quality Improvement – Fix Critical Processes First
When you step back and look at the larger picture of patient care, there are hundreds of people, directly and indirectly, involved at some point during treatment, recovery, and post-recovery. This includes clerical workers, prehospital staff, physicians and nurses, nurse aids, administrative and billing, social services, physical therapists, mental health workers and more.
The more people you add, and the more data changes hands, the more complex and convoluted the process becomes. This results in much slower processes and approvals. Much of the work is created as a result of failing or inefficient processes.
Healthcare is made up of thousands of processes, and if you focus on the ones that are most critical you can make a significant improvement. Rather than try to change everything, or create quick fixes that add to the workload, look at it by the Pareto principle; 80% of your results come from just 20% of the work.
Rather than patch the process, find the critical points and bottlenecks in the critical processes that will have the most impact. Optimize them and focus on quality improvement at the source of the issue.
2. Better healthcare process management starts with data
“In God we Trust, all others must bring data”
No matter what kind of healthcare process you’re trying to improve, it should be tackled by the numbers. That’s how you evaluate and find the areas that need the most attention.
- Where is the most time being lost
- What causes the most delays in billing
- Where are the gaps in communication
- How is information moved between facilities
- What are staff response times for emergent and non-emergent issues
- What are patient satisfaction rates, how do they relate to processes
When you’re dealing with a complex health system, process changes have to go up the chain, sometimes through multiple levels of leadership and even to a board. The most effective way to enact change is to present the data.
This should include the data showcasing the current issues in workflow and efficiency, while also showing some measure of data on the results (even if forecasted) that would come from improved process management.
Use the numbers to sell the need for improvement, as the data can provide tremendous insight into how more efficient processes will impact the bottom line, patient care, and communication among staff.
3. Process management should focus on the process, not staff
“Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis…”
Improving process management in healthcare is about managing the process of care. Many facilities in the industry took the wrong approach in recent years, and still do, by trying to manage the physicians, nurses and other workers.
It’s naive to think that improving processes starts and ends with cracking a whip on your facility staff, at any level.
Too many facilities get caught up in the audits, inspections, and performance of care staff and physicians, and attempt to manage them. What really needs to be audited, managed, and improved are the current processes.
The teams within the healthcare system at every level should be tapped to achieve this. Because they work with those processes around the clock, they can provide the most accurate insight into how those processes should be improved.
4. Adoption of the new processes is critical
“Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change”
According to Harvard Business Review, hospital administrators typically work from the information that is most readily available to and trusted by them—namely, the line-item expense categories on their P&L statements. Those categories, such as personnel, space, equipment, and supplies, are attractive targets: Reducing spending on them appears to generate immediate results. But the reductions are usually made without considering the best mix of resources needed to deliver excellent patient outcomes in an efficient manner.
The administration also pushes physicians to spend less time with patients in order to improve workflow efficiency and improve patient care in hopes of dealing with the rising costs of providing care. But this is a backward approach.
Not only does leadership need to shift their focus to improving process management, which can reduce treatment and administrative costs, they also need to lead their teams with better training and updated employee onboarding when new processes are deployed.
The only way more effective process management can occur is when communication and training happen from the top down, not laterally.
This approach eliminates the need for constant retraining, inspections, and audits of the workflow by building quality and effective deployment into the process from the beginning. Rather than having to cut line item costs or rushing treatment, the savings come through more efficient practices throughout the entire system.
5. Constantly improve processes
“ Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.”
Simply put, healthcare process management is ongoing. It doesn’t stop. There are always opportunities to refine and improve the way various departments communicate, share information, and move the workload through the system.
Rather than auditing workflows only during bottlenecks, or only auditing performance of the healthcare staff to see what’s broken so the order can be restored, a new approach is necessary. Healthcare leadership, at every level, must empower staff with the ability to find ways to improve the process.
A proactive approach like this will consistently reveal issues with process management and provide opportunities to continually decrease operational costs while improving efficiency.
6. Eliminate fear for improved deployment
“Drive out fear, so that everyone may work effectively for the company”
People naturally “fear” change. It makes us uncomfortable and it’s a barrier to improving processes. Our gut reaction to fear and change is to reject it immediately and maintain the status quo. This is one of the biggest challenges with implementing new and more efficient processes. It’s especially true when you have older health care workers with tenure that are used to “the old way of doing things.”
Part of improving healthcare process management needs to be improved training and onboarding. Whether it’s an improved method of obtaining and processing labs or a more complex process that involves new technology deployment (like EHR integrated tablets), leadership needs to have a plan to eliminate the fear of change and make it easy for all staff to adapt.
Even with an automated process, strategic training and onboarding are critical to the effective deployment of new processes.
7. Break down barriers in healthcare process management
“Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service”
A complaint often heard among prehospital workers (Paramedics and EMTs) are hospital staff that won’t provide a face sheet containing a patient’s personal information. This is despite the fact there is a transfer of care taking place. That small interaction can waste several minutes or more, acting as a barrier to progressing patient care and slowing down other processes that would involve that same personnel.
Even in a unified healthcare system, there are barriers between departments and divisions that can result from personal, cultural, technological and even geographic differences. People in research, design, sales, and marketing, and down to clerical and direct patient care must work as a team.
When leadership can get their individual teams working together with others, communication improves. They’ll also be able to identify problems (and potential problems) in processes that will ultimately lead to improvements being made.
“Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job.”
8. Stop seeking perfection
“Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belongs to the system and thus lies beyond the power of the workforce.”
It is unreasonable to expect perfection from any employee, regardless of the industry. This expectation creates disconnect where the staff is no longer seen as humans, and instead machines that must be fine-tuned to perfection. If perfection isn’t achieved then they are defective.
This viewpoint punishes healthcare workers for poor performance when in many cases the performance is tied directly to inefficient processes and workflows. That response impacts their performance and only inhibits growth, further diminishing productivity in a still-broken string of processes.
An organization’s bottom line is certainly going to take a hit, but it’s the patient that suffers the most when care isn’t provided and managed effectively.
Healthcare providers are ready for change
Improving healthcare process management doesn’t necessarily require a major overhaul. Focused, targeted changes in the most critical processes will create the largest results. From there it will become far easier to begin making additional process improvements among departments and facilities.
Physicians are ready to take the plunge and support these types of process improvement. According to a study from McKinsey, a majority of physicians express a strong willingness to change and remove waste from the health system. This includes:
- Utilization and flow of emergency departments (58%)
- Improvement of inpatient procedures (60%)
- Improvement of admission processes (61%)
- Eliminating variability in orders (61%)
- Clinical decision variability (61%)
- Diagnostic processes (62%)
- Ineffective discharge practices (63%)
Now is the best time to leverage staff, draw on their knowledge, and work together to improve healthcare process management to provide better-managed care and operational efficiency.
