Real Health Care Service Changes Are Up to You

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With ObamaCare scheduled to start taking effect this fall, as I prepared from my classes in business strategy, I decided to read Jim Champy and Harry Greenspun’s  Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery.

In case you don’t know, Reengineering is a management change methodology that received lots of attention globally several years ago. By focusing on work processes and restructuring them its goal is to produce dramatic improvement in the performance of work.

For instance, when an insurance company tried to speed up the process of settling claims, it realized that a typical claim that took over seven days to resolve, actually spent only 10 minutes being touched by decision-makers; the rest of the time was moving the paperwork back and forth between people and departments.

For health care, the goal is a radical improvement of health care delivery process so as to enhance quality and dramatically lower costs, while also greatly expanding patient accessibility and improving care.  The book wonderfully goes through a number of examples many of which were spearheaded by a physician who planned to be a cardiologist but got sidetracked addressing the organizational psychology of the situations in which he worked and through his efforts “reengineered†dramatic improvements. I many cases, his solutions were not technology changes, but truly understanding people’s perspectives, and then restructuring processes to meet them.

It brought to mind an effort I spearheaded for a health care clinic system serving 90,000 people over 20 years ago. Paying attention to comments written in on the few “patient feedback†cards we did receive, it was clear that everyone was annoyed by the long-waiting times. Visiting the clinics to understand how service actually took place, I discovered that many patients spent as long as three hours in a clinic for a medical services that lasted about 15-20 minutes.

Why? All “patients†were told to come in at certain times of the day, including 30 minutes before doctors were even scheduled to attend, To use the waiting times “constructively†the clinics instituted 20 minute education programs before seeing the doctor, even though in many cases the clients were so nervous about getting results from the doctors, that they weren’t paying attention! Indeed, their inability to pay attention produced subsequent visits to the clinics.

Our solution was to view the system through the eyes of “consumers†who wanted to meet with practitioners and then when they understood their medical condition could then get the additional education needed to engage in good health practices.  The New Clinic Health Model focused on better scheduling to meet the needs of system (all done without computers!). By creating subgroups of clients whose different medical, educational and information needs imposed different time needs on the practitioners, and staggering everyone’s schedule to focus on providing medical services, we were able to reduce the average visit time to between 30 to 90 minutes, depending on the amount of services needed. Our consumer/client evaluation system captured the increased efficiency, learning and satisfaction with services. It actually led me to eventually develop a theory for the role of medical service providers in the “service†network of each person – and became the impetus for my Ph.D. thesis and state grant to collect data to support this health care approach.

The Affordable Care Act law mostly addresses availability of coverage and payment mechanisms. It’s up to us, the consumers, to get health care organizations to truly meet our needs for quality, personal attention, support and follow-up. Remember, you are a “consumer†of services, and not just a “patient†dependent on a provider.  Speak up and share your insights. As the practitioners saw in our new model – everyone wins when waiting time is reduced!  What’s your experience in this area? Share them with us.