Cancer Center Sterilization

This prominent Los Angeles-area cancer hospital was one of my first exposures to healthcare delivery as a consultant. By the time I got there, my firm had thoroughly indoctrinated me on Lean principles. Of course, I had spent a career in innovating solutions. I now had a portfolio of experience that included both the operations and design worlds. Previously, I had worked at a medical device company, and now I was where the nurses, doctors, and surgeons were doing their job. Ready, set, go!

Our operations consulting delivery model was to place a consultant at a client with a team, in a conference room for an entire week. I shared in the Navy A.D.D. moment that the first three days can be quite difficult, typically because we uncover a significant amount of procedural waste. Despite the fact that employees can feel the pain, some leaders have trouble admitting their existing process needs to change and that they weren’t leading the team in the optimal direction.

The task here seemed simple: redesign the area and the process used to sterilize the surgical equipment. Things did not go smoothly. The amount of push back we received from the new department manager and the “sterilization expert” was so high that they tried to cancel the engagement after just one day. As consultants, this experience isn’t out of the ordinary. We have to have an escalation path. In this case, it was the Chief Nursing Officer. Magically the new manager and team aligned with our method and findings.

As we were digging into the details of what was currently occurring with sterilization, the main problem became readily apparent. Each surgeon had their own set of requirements, based on what procedure they were doing. However, the department providing the surgical instruments wanted to have a standard kit for all surgeons. As you can imagine, we were re-sterilizing many instruments that surgery didn’t use. In fact, about 70,000 a year that were never used were re-sterilized. Each had been exposed to the atmosphere of the surgical suite, thus contaminating them.

We defined the challenge as “putting the correct instrument in the surgeon’s hand when asked for during the procedure.” From there, we were able to come up with a process to do just that. As a result, we drastically reduced the number of instruments in a kit as each surgeon got their own custom kit. It required a bit more coordination on the sterilization department, but it saved the hospital a lot of money. Annually, tens of thousands of instruments avoided the destructive process of repeated sterilization-without-use. There were savings in both the process and purchase budget. That savings could fund treatment for the patient instead of repeat sterilization of an unused instrument.

VA Cardiology Suite Redesign

The task seemed relatively easy to me: design a new cardiology, surgery suite that can provide world-class care while simultaneously keeping up with future demand for our veterans. This project was at a major, regional VA hospital. I had done similar work before, but not for a government agency. Apparently, it was a big deal. The local press was at the kick-off event for the work. I was partnered with a high-powered, architectural firm. Our goal was to develop and finalize the design to build.

We established a team of stakeholders and subject matter experts. They conducted interviews with patients, surgeons, nurses, and staff. We began the process and analyzed existed demand, procedures and available technology as well as budget. We discovered great information. The government building-requirements binder was as thick as I had ever seen but despite the significant number of rules and regulations and requirements for cardiac surgical suites, we made them work for us.

The team created an optimized layout for the entire department, with specific attention to where clinicians delivered the medical care, the surgical suite. We used a Lean tool known as Process Preparation (2P). For this, we made small-scale, “paper doll” cutouts for everything that might go into a surgical suite. Then we moved things around on an architectural blueprint until we found a good solution for the suite itself and the entire floor. Eventually, we mocked-up an actual suite with surgical tables, full-scale cardboard cutouts, and auxiliary equipment until we finalized a solution that would work for everyone at each stage of use: before, during and after surgery.

We had created the goal. From there, it was figuring out how to make it happen. A team took our work and delivered it. It was a great plan with great teamwork that yielded great results. Our veterans are receiving better care, at a lower cost, because of it.

Nearsightedness Kills Innovation

This system became famous in its industry for its original implementation of lean in the early 2000’s. Following their heyday, the CEO went on to be quite famous and started a consulting firm helping implement lean in other healthcare organizations. However, they were still not achieving the breakthrough level of performance improvement they needed or wanted. They called me in when they were looking to redesign their care model for their high-risk patient population. By definition, we included the top five percent of these patients. It would require a new way of thinking about things.

Per my typical requirement, they named a leader and set-up a cross-functional team to successfully execute this massive project. We established stretch goals and began work. The team developed an in-house, risk stratification method to define the patient population for the new care model. This patient population was then studied to determine their barriers to care and better health. The insights were staggering. One patient traveled over 5,000 local miles annually to get to all of their appointments. Another patient had 66 physician interactions in one year; more than one per week!
Patients were interviewed, observed at home and brought into focus groups.

We studied their engagement with the healthcare system. Their needs and pain points became evident, and the brainstorming of solutions began. Soon, a new model of care began to coalesce. It was different than anything this healthcare network had done before. Every patient would have an interaction with a patient care team that acted as an extension of the primary care provider. The team included all critical elements determined during research: a pharmacist, a social worker coordinator, a behavioral health counselor and a triage nurse. The experiments began. The team saw multiple successes in medicinal accuracy, blood pressure control, blood sugar reduction, physical activity and patient engagement.

My involvement stopped when they were expanding the patient cohort. It was then the Operational Excellence team swooped in and almost destroyed the efforts. This company struggled the entire length of the project despite years of Lean implementation and associated subject matter expertise. Eventually, the COO disbanded the effort, even though the health outcomes were outperforming even the best physicians in their network. This organization struggled with many of the Becoming Endurance principles outlined in this book and the results have become obvious.

If you talk to the former CEO of this organization, he will say he wonders why they only came up with two “new” things during his tenure. My analysis and involvement made it clear that they were expecting the operational excellence tool kit to innovate. It is unable to do this; you need innovation techniques. Teams can’t innovate when you’re staring at the bottom line every month. Executives have to be 100 percent committed to the project once they decide to do it. The project should keep going until it’s time to stop it altogether. Why? Because nearsightedness kills innovation.

Population Health and What it Really Means

State of the Union

It’s hard to discuss population health or the topic of healthcare in the United States and not hear about how expensive it is. In the United States, we spend about $10,000 per person per year on healthcare. That amount is approaching 20% of our country’s gross domestic product. The Peterson Foundation tells us, that second place for highest per capita healthcare spending is Switzerland, at about $7000. Sweden and Germany spend about $5000. France is at $4500, while the UK, Australia, and Japan spend about $4000.1

Despite the high spend, both media and healthcare reform advocates point to the fact that the United States is behind many industrialized nations in quality of care. The current WHO ranking for the U.S. healthcare system is 37th.2 Many wonder how we spend so much and seem to have the best at everything, yet still have such a low health score. If you are an American, white male who is wealthy and educated, you have access to the best healthcare in the world, period. Change any of those variables, and your access to that “best healthcare“ is diminished. Period.

The factor of wealth alone lead to a thirteen-year difference in age of death.3 Some would say your zip code is the primary indicator of longevity. In greater Philadelphia there is a twenty-year difference in lifespan between the best and worst zip codes. Spend varies wildly too. In America, 20% of our population accounts for 90% of our spend.

There are multiple factors to our ranking but the biggest impact is the discrepancy between the people with the worst health in the U.S. and those with the best. It depends how you define health or what factors you consider lead to a healthy environment whether your country is ranked high or low. In fact, there were 100 indicators in use by WHO in 2015.4 For example, our alcohol usage, sexuality, suicide and obesity negatively impact our numbers compared to other nations although we rarely deal with other issues like tuberculosis or amount of spending on healthcare.

Population Health Panacea

Most medical literature today mentions population health. Healthcare systems are promoting it across the country. Universities are beginning to offer certification and advanced degrees in it. Hospitals and health systems are hiring executives to run it. A countless host of medical vendors are offering solutions that deliver it. What is it?

In 2003, Dr. David Kindig, Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin-Madison, proposed that population health was “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”5 Three terms should jump out: outcomes, group and distribution.

Outcomes

The World Health Organization defines an outcome as a “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” It is the resulting change in health after a specific effort. WHO includes things like malaria and access to clean water in its world health ratings. We simply don’t worry much about those in the U.S. However, our culture of sexual freedom does care about the incidence of HIV and access to family planning, two other outcomes used by the WHO.

The problem with outcomes is the variation. They could be macro-measurements like national infant mortality rate or expected lifespan; or they could be very targeted measures such as uncontrolled diabetes in rural areas or hypertension of people living in economically depressed regions.

You have to determine what outcomes you are trying to move. They must be defined and measured. They must be tracked. It could be the percent of women over 50 with a biennial, breast cancer screening. It could be the blood pressure for all adults in a county. The combinations of outcomes are infinite. You must decide which are important and which aren’t. Once known, an action plan can be created and deployed. Outcomes should improve over time. This will define whether your interventions are working or not. You can’t use the same outcomes for different groups. Each group must use their own customized outcomes.

Group

There is the “population” part of population health. Kindig calls it a “group of individuals.” What defines a group? Like outcomes, there are an infinite number of ways to define a group. Using the previous example, the group could be all women over 50. It could be the entire state of Ohio. Health systems, however, like to define populations by disease state or condition.

Several tech firms offer software to “identify all individuals” with a high-risk condition that will eventually lead to an exacerbation and hospitalization if left untreated. Popular ones include all patients with a blood pressure greater than 140 over 90 (hypertension) or all patients with a hemoglobin A1c over 7.0 (uncontrolled Type 2 diabetes).

For this reason, many healthcare systems have been forced by insurance companies to hire nursing care coordinators (CCs). These CCs specifically target rising-risk and high-risk patients to lower the cost of future care. Therefore, they define populations as the ones “on these lists.”

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. There population includes anyone approved for participation in the program.6

Medicaid is a state program (funded jointly by states and the federal government) that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.7  There are fifty different populations for Medicaid.

Depending on your interest, the population varies. Often people are overlooked until there is a known problem. There is very little interest in healthy or low-utilization groups of individuals.

Distribution

The term “health inequities” is used when negatively defining distribution. The WHO defines health inequalities as “differences in health status or in the distribution of health determinants between different population groups.” 8 For instance, what are the individual BMIs for a group of people and why do they vary. Is it due to lack of access to healthy food or regular exercise or is it something else?

Some believe the distribution of outcomes should be equitable across the entire population. Zero variance is best. There shouldn’t be spikes, dips and huge variances. Your view on how equitable variation should be likely determines your political alignment and what the government should be doing for poor performers. Regardless, everyone is placed in the healthcare system. It is complex.

Healthcare Players

Healthcare providers, federal and state government, employers, and insurers are the major institutions in healthcare. Supporting these are a host of other entities such as medical device makers, pharmaceuticals, IT firms and more.

Healthcare Systems

According to Becker’s Hospital Review, just over 20% of United States hospitals are run as a for-profit business. That leaves almost 80% that are either not for profit or government funded. Provided they achieve annual profitability to continue operating, their primary focus is providing care.9 Healthcare systems provide the actual care for the patient in outpatient, inpatient or virtual settings. They own the physicians, clinical staff and administrators that run hospitals and clinics. They bill a third party for your services. This is the government or your insurance agency.

Government

The government creates policy that impacts all players in the healthcare arena, including all of the aforementioned entities. It is their responsibility to look after the health of its citizens. Historically, government’s view on health changes based on which party controls it.

The U.S. government pays for about half of all medical expenses today. Medicare and Medicaid make up nearly forty percent of spend and other government programs are an additional twelve percent. (Private insurance is over forty percent and the balance of the total spend is out-of-pocket.) The government became a significant player in the healthcare market when most insurance was running through employers, leaving out the elderly and poor. The Medicare bill that included Medicaid was signed in 1965. This led to the formation of Centers for Medicare and Medicaid Services (CMS).10

Although there are nuances, the federal or state government sets the amount they are willing to pay healthcare providers for services provided to Medicare or Medicaid patients. Some suggest that the healthcare reform CMS is pushing is pop health. Initiatives like Accountable Care Organization (ACOs), Merit-based Incentive Payment System (MIPS) and other APMs (alternative payment methods) are mentioned in these discussions. I would call this hint-of-pop-health-flavored healthcare. It’s the government’s way of controlling costs and telling healthcare what they will and won’t pay for. It’s not population health.

Healthcare providers are stuck in between the patient and those paying for it, trying to figure out outcomes and populations and interventions. Eager, publicly-traded mega-corporations stand on the sideline, ready to fill the performance gap with solutions. The government defines the reimbursed amount clearly. The healthcare systems have to comply. The amount owed by non-CMS patients varies wildly. Primarily, insurance companies negotiate with health systems on behalf of employers’ health plans.

Insurance Companies

There is no altruism among healthcare insurance companies. They simply want profit. They want a greater share of the insurance dollar. Your health only helps their revenue. The more they collect (from you or your employer) and the less they pay out (for your visits and meds) the more money they make. Costs are controlled by increasing premiums and deductibles. Rates are negotiated with employers on an annual basis. They won’t lose money. That is why many are not on the healthcare.gov exchange in many states.

Less than a century ago, there were no health insurance companies. Health insurance started when a Baptist hospital was looking to keep the bills paid. The hospital worked with a group of public school teachers in Texas. For fifty cents per teacher per month, the hospital would pick up any medical expenses for the teachers. This employer-based plan gained popularity during the Great Depression and eventually got a name: Blue Cross.11  When funneled through the employer, the benefit was tax-free. Eventually, if you were employed, your employer would cover a large portion of your health insurance. The unemployed had to find insurance elsewhere.

Employers

For the foreseeable future, employers continue to foot the bulk of the medical insurance spend. Most will send you a statement of benefits showing what you used the prior year. This is useful to decide during “open enrollment” for the following year. Costs are going up the cost of care increases and as the health of our nation decreases. At some point, we must fix the direction of both. This is accomplished by addressing health determinants.

Determinants of Health

You health is determined by five areas. These areas are called the determinants of health. They are biology and genetics, socio-economical, individual behavior, clinical care, and the environment. Each contribute to your overall health. Although 88% of our spend is on clinical care, only 14% of our health is impacted by it. The vast majority of our individual health (79%) is determined by our genetics (30%), socio-economics (28%) and behavior (21%). The remaining 7% is due to our environment.

These determinants impact our health. They create health inequities. They impact the distribution of health across a population. They determine who will get sick, from what, and why. Some we can control. Some we can’t. Some are easy. Some are difficult. Everyday, we make a voluntary or involuntary deposit to our future health. At some point, we will have to pay for a lack of health. 

It is the area of socio-economics that most pop health thought leaders want to target, hoping to improve the lives of those suffering from health inequalities. However, this means a greater invasion into our lives.

Healthcare’s Blurry Lines

Based on a 2015 research study with a client in eastern Massachusetts, a vast majority of patients do not want more interaction with healthcare, they want less. Healthcare is intrusive to their life, not complementary.

They consider health as the ability to do life. There chronic conditions and acute incidents are annoyances in the way of doing life. Their last resort is to enter the healthcare system with all of its cost, complexities, and inconveniences.

Population health advocates want more involvement in the lives of people. They want to push healthcare up the value chain and be even more proactive in people’s lives. They want it to include community meetings, school involvement and rigorous legislation. They want to expand it beyond clinical care. Maybe you agree. Maybe you don’t.

When there is a breakdown in our health, we want it fixed. There are two sides to fixing it: providing healthcare and paying for it. Anyone can find a doctor. Who should pay for it? Does age matter? Race? Level of wealth? There is currently no one responsible for the health of an individual over their entire life. Therefore, population health is a glimpse at a group of people’s health at a specific point in time, either good or bad. It is a snapshot that tells part of the story.

Our determinants impact our need for healthcare and thus our spend. Fairness means we should each pay for our personal predispositions and lifestyle choices along the full continuum of our life. If we are more prone to certain diseases, use tobacco products, eat poorly, fail to exercise or are sexually promiscuous, we should pay more for health. People must be personally responsible for their impact to lifetime healthcare costs.

Conclusion

In my humble opinion, we need a party that is vested in an individual’s full-longitudinal lifespan of health across the entire population. This could be solved with a universal insurer. Our base healthcare would be covered by this insurer and our premium would be accounted for by our top three determinants. Extras such as non-elective procedures would require an additional premium. We would have a full lifetime view and responsibility.

Is population health the future? Some say yes. Others disagree. Truly doing population health would require a massive overhaul that would make the Affordable Care Act seem insignificant. Is it right? Probably. I wrote another article that shares how we can fix health care without waiting for the government. As for me, I’ll keep working on my own health and its contribution to our country’s health.

#StopEatingFries #Exercise #NoTobacco

References:

1 https://www.pgpf.org/chart-archive/0006_health-care-oecd

2 https://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html

3 http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

4http://www.who.int/healthinfo/indicators/2015/100CoreHealthIndicators_2015_infographic.pdf?ua=1

5http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.3.380

6https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html

7 https://www.medicaid.gov/medicaid/index.html

8http://www.who.int/hia/about/glos/en/index1.html

9https://www.cms.gov/About-CMS/Agency-information/History/

10https://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry-2017.html

11http://www.npr.org/templates/story/story.php?storyId=114045132

Healthcare Fix Despite Government-Media Vitriol

Healthcare Targeted

Like our nation at large, I live in a politically divided state. We are equally Republicans and Democrats. This was demonstrated in the ‘16 election and evident by our two Senators being in separate parties. Everyone is hotly debating healthcare. In the lead up to the BRCA vote after the AHCA passed the House, I emailed both of them. Eventually, I received carefully crafted responses, likely sent by a staffer. Neither were focused on the real issues, instead they were filled with the same partisan lines we’ve seen in the news.

The healthcare debate is dividing our nation for no reason.
I thank my senators for their responses but neither had a true grasp on the real problems occurring within healthcare. We should not have acted like either
ACA or BRCA is better for the country. There are pros and cons to each bill. It would behoove lawmakers and citizens alike to investigate the facts before offering a canned assessment of healthcare. However, I believe we can unite and fix healthcare despite the circus in Washington.

I See Something Different

Virtually every week of my life I am helping healthcare organizations transform themselves through the IHI Triple Aim–better outcomes, lower cost and patient satisfaction through innovation practices. I have helped many of these organizations make enormous progress toward this goal, despite regulatory constraints. We could easily improve Triple Aim metrics by a factor of two through the adoption of a fraction of the best practices I have seen. With or without ACA, if we don’t act, insurance premiums will continue to increase. The trend is staggering. Premiums will not begin to match inflation until four things are done:

Healthcare providers must: streamline their operations, maximize licensure usage, apply the most effective technology,  and focus on treating the person, not the disease.

Addressing the Four

Operations

Healthcare operations are among the most clunky of any industry. Streamlining through the use of operational excellence principles is critical. Every person in America could be meaningfully insured and treated without a government mandate or a single payer system; however, we have to lower the cost to deliver care. It’s actually easier than the industry would like you to believe. I have audited thousands of appointments across multiple healthcare systems: many do not require an actual office/hospital visit, a large percentage do not require a physician, and many are not required by evidence based practices. These appointments fill the schedules, restricting access for higher acuity patients.

In addition, there is excessive waste in clinical and administrative processes. These add zero value yet are repeated constantly. I have seen major waste removed time and time again by expert practitioners working with health systems to modernize their operations to these best practices.

Licensure

Staffing in healthcare is not unlimited. It takes half a generation to train many of them. We need to take advantage of every level of licensure. For example, in many states Advanced Practice Clinicians (APCs – Physician Assistants and Nurse Practitioners) can see many of the cases that currently go to a physician. In primary care, there needs to be an about face. High acuity, complex patients are the ones who should be using physician’s time the most. There is a perception that the patient only wants to see their doctor.

In the thousands of patients I have surveyed and interviewed, I have found this to be the case only about one third of the time when the patient is facing an appointment delay. Doctors need to see only the patients and cases that other clinicians cannot handle. APCs, RNs, LPNs and others can all focus more of their daily activity to match what their state allows them to do.

Technology

Next is technology. I’ve seen repeated installations of technology for technology’s sake. Only a handful of healthcare delivery organizations have the capability to determine the needs for a technology from both the clinician and patient viewpoint, research options and make purchase decisions. What I typically see is a radiography department leader being courted by an imaging firm or an EMR vendor singing praises of the latest module to a CIO. You can’t fix a broken process with a shiny new object.

This recipe is simple: fix the process and then add technology to advance the process toward the Triple Aim. Don’t let the medical device companies push what they think is best for clinicians and the patient. They’re not close enough to really know. The best innovations are ones created in the hospital or clinic, not the R&D center of a multinational conglomerate.

Treating The Patient

Finally, we have to treat the person. Unfortunately, many people who need care are not entering the system until it’s too late for an optimal outcome. A variety of social determinants impact a person’s health and their ability to get appropriate care. Areas that desperately need attention are behavioral health and patient education. The break-fix treatment model doesn’t work anymore. We can’t afford it so it’s time to be proactive. There aren’t enough physicians entering the workforce or enough dollars allocated to treat the future issues as we are now. We have to address poor health choices sooner in life.

Take Type 2 Diabetes Mellitus (DM) as an example. Diabetes plagues almost 10% of our population. This condition skews toward impoverished, minority communities. It is the 7th leading cause of death yet understanding and adherence to best practice care by patients remains elusive.2 Untreated, DM leads to vascular damage which then leads to more serious issues like nerve damage, amputations, blindness and eventually death, significantly raising the cost of care for that patient while simultaneously having a profound negative impact on their life. Patients following a proper treatment protocol significantly reduce or eliminate those expensive, life-altering exacerbations. This is true many conditions including congestive heart failure, hypertension or asthma.

Escape the Noise

I attended multiple, so-called healthcare innovation conferences last year. I listened to dozens of speakers. There were zero presentations on reducing cost. Instead, every organization, whether it was a payer, a medical device maker, software provider or provider, was looking to get a bigger chunk of the existing insurance premium dollar from another company for their own organization. This doesn’t save money, it merely shifts it around.

If lawmakers truly cared about health, we would ban smoking, the number one contributor to health issues and costs. Close to smoking is obesity. We have allowed our restaurants and grocery shelves to be full of low-cost, high-sugar and high-fat foods, practically begging for obesity. A myriad of health issues arise later in life due to obesity. These issues are expensive to treat, significantly more than the healthier, lean population.

Focusing on the number of insured won’t fix healthcare nor will it break it. Patients are empowered to cooperate when we focus on getting the proper treatment to them using a method they prefer. Reimbursements must reward outcomes achieved, not actions taken. Healthcare providers that continue to force patients to high-cost facilities (hospitals) by overqualified medical staff (MD/DOs) with a protocol that doesn’t follow the latest evidence based medicine (EBM) can no longer be tolerated. Patient behavior must be guided by insurers, including Medicaid, by pushing EBM practices. Allowing these things to continue is kicking the proverbial can down the road until we hit a healthcare version of the 2008 subprime market collapse.

Leading the Charge

Institutions like Jefferson Health, UPMC and Kaiser Permanente are leading the way in true healthcare reform with thought leadership practices like population health, innovation centers and vertical integration.

We cannot allow partisan politics continue to slow true transformation of our healthcare system for those it impacts most, patients. We don’t need regulations to deliver the right care. I’ve seen it. However, I’ve more frequently seen the opposite.

Worse, the division, angst and spectacle Congress has created and the media has fueled has paralyzed and misled those inside and outside healthcare. Regardless of government direction, hospital administration must take the reigns. We need strong leadership cooperating and developing a real solution; our country’s and citizens’ health depend on it.

Adam Ward is an Innovation Consultant for Simpler, an IBM Company. Initially trained as an engineer, he designed cars for 12 years before switching to improving processes, products and services in healthcare, where he has worked as a consultant for several large healthcare systems, public and private in the 10 years since. His passion is radical performance improvement while delighting the customer–patients and clinicians. He started his personal health transformation in 2009 and has finished multiple Ironman triathlons.

 

Adam’s Writes His HIMSS Part 2 Report

 

On the first day of HIMSS 2017 I stayed in our booth, so Day Two was my day to venture out. Where do I even start? The HIMSS community has literally taken over the area around the Orange County Convention Center. There are product launches, awards ceremonies, and press interviews galore. The twitter-verse is overflowing with #HIMSS17 and other associated tweets. I’m particularly amazed how every hotel, restaurant, Wi-Fi hotspot, pedi-cab, and Uber is crawling with formal and impromptu meetings between attendees and exhibitors.

I decided to take advantage of the hoopla and joined the #HCLDR meetup in the Hall D lobby. It was there I was approached by Nick Adkins, a kilt-wearing, healthcare MBA who welcomed me into the #pinksocks tribe by presenting me with a mustached-pair of pink socks.

The socks are intended to be a conversation starter. “It’s easy for us to get caught up with technology and get stuck behind a screen,” Nick said. “Sometimes we need to be reminded to talk face-to-face and show empathy looking into the actual eyes of another human.”

For me, that was the theme I pulled away on Day Two. The HIMSS show floor is filled with vendors that all claim to be “doing” population health, value based care, and data security. On the surface, there is little to no differentiation between vendors.

As a developer who believes deeply in ethnographically-based solutions, I have to ask, “Where is the human value of the product or service?” While my design engineering background gets excited about technical solutions and my business background relishes in financial implication, it’s my humanness that begs there be more than technology and net margin.

One attendee told me, “What I want [from AI] is the ability to talk with the patient and have AI listening to the conversation and [cognitively] pop up suggestions based on what we’re talking about.” That could be a game changer for doctors, but what about the nursing staff, care coordinators, coders, IT staff, and other front line staff?

Healthcare organizations need to be strategic about their technology investments. They can’t assume that purchasing one more software packages or devices will result in successful implementation and achievement of the IHI Triple Aim – improved quality outcomes, improved patient experience, and an overall reduction in the cost of care.

Too often, organizations inject new technologies before understanding the overall impact on the continuum of care. So, how can organizations successfully implement new technologies?

They can’t count on a vendor to know all of this information. At Simpler®, we believe healthcare systems need to orchestrate clear plans that take into consideration all systems that contribute to quality patient care. These plans are rooted in deep customer insights and bounded by properly set operational constraints. To develop and implement a new solution, healthcare systems need to determine what is important to their patients, what would help them run the business better, and what would position them for the competitive edge.

This brings me back to the #pinksocks. Every healthcare system feels compelled to differentiate themselves in this competitive market. While outfitting a healthcare system in pink socks won’t do the trick, a customer-first, development technique like Simpler’s can distinguish organizations from the sea of others. By optimizing work flows around the patient, clinicians, information, equipment, and quality, organizations can introduce winning, new services that set themselves apart. Thank you HIMSS.

You can find out more on how Simpler® is successfully guiding Lean transformation in the healthcare sector here: http://www.simpler.com/p/healthcare

This blog was also published on www.simpler.com.

 

Adam’s Composes His HIMSS Part 1 Report

I’ve arrived in beautiful Orlando, Florida for the largest healthcare IT conference, HIMSS 2017. As an innovator, technology enthusiast and veteran of healthcare tradeshows, I was excited to finally get the opportunity to see and hear first-hand from some of the best and brightest thought leaders and innovators in our industry on how technology will impact healthcare in the year to come.

As eager as I was to meet some of the 40,000+ health IT professionals, executives and vendors exhibiting at the show, I was particularly excited to attend the inaugural keynote session.

This year’s opening keynote address for HIMSS was delivered by Ginni Rometty, Chairman, President and CEO of Simpler’s parent company, IBM. Rometty kicked off the conference by delivering a well-received speech on healthcare and the cognitive era. She discussed how cognitive technologies, such as artificial intelligence, are poised to profoundly impact medicine and value-based care, emphasizing that the healthcare industry needs to embrace and guide new technologies into the world in an ethical and enduring way.

Rometty also shared her concern over the fact that many healthcare organizations and leaders struggle to imagine the future. This point hit close to home as I’ve found that many of my clients aren’t putting enough thought into the future. Rometty’s remarks support my firm belief that healthcare delivery firms need to get serious about internal innovation to further support and bolster the outcome of patient care. They also must produce new and improved models of care for both patients and the healthcare system employees in preparation of the future, and that it is done in a strategic manner.

After a brilliant HIMSS keynote session, it was time to hit the exhibition hall floor. I was assigned to work the corporate booth for the bulk of the day to share Simpler’s vast array of offerings and discuss how Simpler, Truven, and Phytel & Explorys are contributing to the IBM Watson brand. It was great to meet so many fascinating people with interesting problems in their healthcare system.

As day one of the conference wound down, I found myself reflecting on the day’s events. Here are my takeaways:

  • We have to address innovations that reduce physician administrative burden, not increase it. Simpler Senior Advisor, Dr. Paul DeChant, gave a talk on his new book, “Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, A Handbook for Physicians and Health Care Leaders,” which specifically addresses this topic. DeChant shared how new innovations, processes and fixes should reduce the barriers and frustrations care givers encounter every day.
  • With so much uncertainty, healthcare organizations need to be even more flexible. To be effective for any period of time, healthcare organizations need to create adaptable environments that value continuous improvement, and don’t flinch at the notion of change. The Lean management model hardwires that adaptability. The ability to rapidly adapt to a changing environment is a critically important strategic advantage in this era of rapid and unpredictable change.

I’m looking forward to digging a little deeper in my next post.