Don't Overlook Opportunities for Structural Transformation

Philip Betbeze, for HealthLeaders Media , December 28, 2012

Ron Paulus, MD, who has been CEO of Mission Health in Asheville, NC, for a little more than a year, has focused on eliminating waste because he believes he can drive more volume to his hospital if he can make the visit less wasteful, both in time and other resources.

If that were the only reason to attack inefficiency, it would be enough. Really, the initiative—as well as verifiable tracking of results—adds to the mosaic Paulus can present at contract negotiation time. It also prepares Mission Health to participate in other value-based purchasing initiatives.

What's the most important way to integrate such change? Paulus thinks it first comes from the frontline staff, ironically, some of the lowest-paid employees.

He employs a dedicated team of facilitators to help frontline staff on their value stream mapping—a lean manufacturing technique used to analyze and design the flow of materials and information required to, in this case, provide a variety of healthcare services.

"We have dedicated facilitators, but we believe that you have to get the front line staff directly involved," he says. "So what we have done is provide backfill staff so that we're not decimating the front line when we're asking them to pull out to get into the value stream mapping world."

This exercise ensures that a lot of high-cost steps get analyzed and retuned, but it's only part of the equation of re-engineering processes so that they are more efficient. With the help of the facilitators, Mission Health employees and facilitators also do an experience map at the same time, which requires following patients and caregivers through their entire encounter with the health system, and takes measurements of what patients and caregivers are feeling about the value of certain tasks.

That's where the "shadow" comes in: shadowing patient and caregiver experiences in such a painstaking manner is necessary for effective re-engineering.

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