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.