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VALUE
IMPROVEMENT
LEADERS
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1,000 words + 2 activities
| 30 minutes (4 to read, 3 to watch video, 23 to map patient's value stream)
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PRINCIPLE
Considering the patient’s value stream reveals a holistic perspective.
TOOL
Value stream map.
APPLICATION
1. Watch the value stream video.
2. Map value stream from your patient’s perspective and note where your project fits in.
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The Immediate Macro Threat
It’s not hyperbole to call our health care system, at 17.8% of GDP (2015), a national security issue, but it’s a mistake to call it a burning platform. Burning implies immediacy but nationally we’re not behaving with immediacy. How shall we alter the metaphor? Invisible flames ringing our platform? People on the platform unaware of the dangers of fire?
I’m sitting in a Starbucks in West Valley at 7:30 AM, Saturday morning in December. It’s cold outside yet it’s packed in here. Everyone is either at work or on their way to work. This town, with a median family income of $54,803 and unemployment rate of 4.20% (2015 figures), is at work this morning. I asked two sharply dressed 25-year-old guys to guess what we spent in the US per capita on health care in 2015.
“A lot. Two to three grand.”
“Hmmm, around five thousand.”
“$9,990,” I tell them.
“Wow,” they say.
Because I’m writing about this gloomy topic, I can barely see my fellow customers’ faces as they come and go. Instead I see $9,990 just above each collar. If you feed and shelter your family on $55K, and you know that $9,990 per person is gushing out from some national checkbook, then yes, you might see threatening flames.
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Defining Value
The public knows what they value in health care delivery. We’ve asked. You get varied replies because value is always personal and situational. What you’re willing to pay for a cold 12 oz drink is different than what I am. And what you’d pay for a cold drink is different on an October evening in your kitchen than on a July day at the baseball park.
To avoid complicated conversations about whom values what and get on with the hard work of increasing value, we generalized the definition of value with the value equation. It’s universal and offers a consistent principle to launch any value improvement effort.
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Foremost, the big V always belongs to the patient. Increase quality while holding cost steady and you increase patient value. If you improve service without added cost you grow value. Decrease cost in a manner that is either neutral or beneficial to the patient’s quality and service, you increase value.
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Whose Money Are We Saving?
As you’ve read, conversations about value are often clarified by the voice of the customer. Nonetheless it is often implied that reducing cost means the hospital’s costs. But no, we are fundamentally agnostic about to whom the financial benefits accrue. It’s the macroeconomic measurement approach. Often the payers benefit. When we boast of seven figures of positive financial impact resulting from a clinical redesign effort, a significant portion are for services never rendered and revenue never collected. Our operational leadership understands this. We track and boast nonetheless.
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The Bumper Sticker is Right
We’re agnostic about who benefits because we all benefit. We’re thinking globally while acting locally. (But when I write ‘globally’ please actually think ‘nationally.’) While health care professionals meet the challenge of varied yet inflexible characteristics of value, they also need to meet the challenge posed by $9,990.
“Wait a second. Isn’t this article about the value stream?” you might rightly be asking at this point. I’m getting there. Whether we’re discussing macroeconomics or one-on-one patient interactions, it’s the same issue and it’s ours to fix.
Now two rhetorical questions:
- What’s the alternative? Look to the very politicians and policymakers who got us here? Fooey.
- What other choice do you and I have but to act locally?
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Acting Locally Means Improving the Patient’s Value Stream
$9,990 per person per year is the national big picture but our patient’s big picture is his or her COPD, CABG, or appendicitis. It’s his or her value stream.
Recall that a value stream is each and every step of health care delivery from the very first to the very last as experienced by the patient. When we say every step, we mean every step: scheduling a clinic appointment, the appointment lag, the drive to the hospital, the insurance calls, the inpatient dinners… Sometimes the value stream includes unplanned steps: unnecessary labs, a delayed surgery, or a fall and the subsequent steps required to recover from it. Every step.
The elective surgery patient’s value stream begins the first time she attempts to make contact with a health care system regarding her symptoms. It ends with her return to normal function or some other condition of stasis. (Even when we execute perfectly, health care value streams don’t always have happy endings.) The stroke patient’s value stream begins with the 911 call and ends with his version of stasis. Pregnancy, chronic conditions, traumas, well patients… each category has its own value stream.
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Seeing the Value Stream
The value stream is real but only visible when it’s mapped. A patient’s value stream includes every step from beginning to end but a value stream map is most effective when it’s low-detail. The value stream map is the playbook to help the team see the patient’s big picture across silos. We suggest a handful of boxes representing the major stages of an episode of care. Later, as needed, any box on a value stream map can be expanded into a detailed process map, representing the specific actions of individual players.
Process mapping is addressed in another article. For the how-to on value stream mapping, check out this video:
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ACTIVITIES
2. Map value stream from your patient’s perspective and note where your project fits in.
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LINKS
Quickly locate all course videos, slides, and previous emails
here
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