The best measure
we have found for determining BEST VALUE is THE VALUE EQUATION shown in
figure 1 (function/cost = value). It has been our clients’ experience,
utilizing THE VALUE EQUATION as their “best value test”, that any
and all processes can be reduced by 30% to 40% in complexity. And 10%
of what is being done can be eliminated entirely, because it has been
found to have NO VALUE.
To bring this
point across to you succinctly, a client of ours that had been
utilizing our “process” value analysis methodology found that they could
shave off 10 minutes on their mammogram diagnostic tests by: (i) having
their patients fill out the required documentation themselves, (ii) not
having their patients wait to see if they required a retake, since only
one in three hundred patients required retakes and (iii) adding more
change lockers for patients to quickly disrobe and dress without
bottlenecks. This enabled our client to do eight more mammograms a day,
which increased their revenue seven fold.
Louis J. DeRose
said it best when he described value as,” Value means satisfying
customer requirements reliably and consistently. It means satisfying
them cost-effectively” and based on their acknowledged perceptions,
NOT OURS. It is therefore our job as value practitioners to root out all
waste and inefficiency in our processes’ value chains if we want to
truly serve our internal and external customers, reliably, consistently
and cost-effectively.
TRADITION Is Our Biggest Enemy In Our
Search For Value
TRADITION (or we
have always done it that way) plays a crucial role in why we do what we
do and is the #1 reason that is holding back needed process changes.
Tradition, in the classic sense, means handing down from generation
to generation beliefs, customs, doctrines, and methods and practices
that worked for a long time, but might not be of value today.
You might have
heard of the story about a young child observing her mother cooking a
roast beef dinner who asked her why she cut off both ends of the roast
before cooking it, only to find out that’s what grand mom did too. When
the young girl asked her grand mom why she cut both ends of a roast beef
off when she cooked it, she told her, “my dear it was because my pan was
too small to fit the roast beef in, so to make it fit in the pot I cut
both ends off and it fit every time without fail.”
This is the fatal
flaw with traditional practices, whether at home or in a healthcare
organization –- we keep doing what we have always done even though the
original reason for doing so isn’t needed or relevant or of value any
longer.
FIVE TACTICS TO BREAK THROUGH THE
TRADITION BARRIER
No substantial process change can
happen at healthcare organizations without first breaking through the
TRADITION barrier. Here are five tactics to accomplish this aim:
1.
Educate Your Management
Team That Change Is Good
With few exceptions, management teams
are averse to change because they fear that change is tantamount to
risks. However, it is your job to persuade your management team that
“change is good”. Nothing positive has ever happen without CHANGE –
electricity, telephone, railroads, steamships, automobile, internet,
e-mail, etc. – and with some upheaval and discomfort. All change
agents will agree that the results of the change were worth the
temporary uneasiness that change brought about.
2.
Understand The History
of the Traditions
Always discuss with process owners the
history or past events that lead to the formation of the processes
(methods and practices) that they are utilizing today. This will give
you insights into why they always did it this way and raise the process
owner’s consciences that maybe it is time to end what began well 10, 15,
20 or 100 years ago.
3.
Test All Underlying
Assumptions
Many traditions had their genesis in
rules and regulations that have outlived their usefulness or relevancy
in today’s world. If the process owner tells you that they are doing
something because it is mandated by rules or regulations check out the
rules or regulations original source documents to make sure that they
are still pertinent, material and applicable to the situation at hand.
80% of the time you will find that they are not! You can then
easily make changes with the process owner’s agreement based on fact,
not tradition.
4.
Involve Process Owners
and Non-Process Owners In The Change
Common sense will tell you that it is
critical that you involve process owners in any change you are
proposing, but it is just as crucial that you involve non-process owners
too. The reason being, process owners, with few exceptions, will ALWAYS
fight any change that you alone propose, but with their peers looking
over their shoulder, process owners tend to be more objective in their
decisions, especially when their peers have an opportunity to challenge
their assumptions or the rationale for their decisions.
5. Perform Functional Analysis Tests
Traditional thinking can’t be
sustained very long by process owners once functional
analysis tests have been performed on their processes. This is because
primary, secondary and aesthetic functions are either absolutely,
positively required or they are not. Even tradition
won’t hide this basic fact. These five tactics are the linchpin in
beginning the change at your healthcare organization from TRADITION to
fact and beyond.
TRADITION Means To End What Began Well
“Tradition simply means
that we need to end what began well and continue what is worth (or of
value) continuing (today)”. This advice given by Jose’ Bergamin in the
1800s is still good advice today. Don’t let tradition (or we always
have done it that way) to stop you from reinventing your processes.
When you realize and internalize that most traditions are built on
myths, legends, fables and half-truths that won’t stand up under the
light of day, you will be on your way to creating new processes that
will satisfy your customers reliably, consistently and cost-effectively
too.
Rework And Information Gaps Should Be
Targets Of Opportunity Too!
Recent studies in healthcare
organizations have shown that REWORK (revising, correcting, changing or
handling a task more than once) can be as high as 35%. And INFORMATION
GAPS (information not being available, accurate and timely when needed)
can be as high as 68% at your healthcare organization. With these
statistics in mind a full court press should be make on all or your
processes to determine if you
by
Robert T. Yokl, President