The Healthcare Manager's Playbook

At first pass, the definition of value in systems management appears straightforward. However, as this post will discuss, identifying and adding value is not always easy, particularly in healthcare. Jim Womack, author of Lean Thinking, explains that value should be defined from the perspective of the customer. Specifically, value is what the customer wants and what they are willing to pay for.

Womack uses air travel to illustrate the concept of value. As customers, we want to get from point A to point B, and we are willing to pay an airline such as Southwest to get us there. From our perspective, value is arriving at our destination safely, with minimal hassle, and at a reasonable price.

In healthcare, the patient is the customer. From a patient’s perspective, value often centers on feeling better. For example, an individual with a cold seeks medical care and treatment. The value is relief from symptoms such as congestion and discomfort.

More broadly, value in healthcare is restoring health as efficiently as possible while minimizing hassle and frustration. As a director of therapy, our definition of value included interventions that helped a patient recover in the shortest amount of time and with the least amount of difficulty. Exercises, educational efforts, manual techniques, and training sessions that helped a patient achieve their goals efficiently were considered value added tasks.

Examples of value added tasks in rehabilitation include:

• Strengthening muscles at the correct intensity to improve a patient’s ability to stand
• Teaching a patient how to effectively use a sock aid so they can dress independently
• Reducing stiffness and pain with manual therapy to improve mobility
• Training a patient to safely use a walker on a curb so they can return home with confidence

Over time, we made it a priority to find better ways to support value added tasks while also reducing or eliminating tasks that did not contribute to patient outcomes. Activities that directly supported patient needs were prioritized, and systems were improved to allow this work to occur with as little friction as possible. A fundamental goal of systems management is to continuously improve value added work so that patients receive the greatest possible benefit while also helping to control or reduce costs.

Examples of efforts to increase value added work include:

• Reducing the time it takes to schedule patients
• Organizing storage closets and work areas to reduce time spent searching for items
• Standardizing the flow of information so clinicians have key patient details when needed
• Reducing new admission paperwork to decrease hassle and frustration

Focusing on improving value added tasks helps patients receive better care, and it also improves the clinician experience. When time and energy are directed toward meaningful work instead of unnecessary tasks, frustration is reduced and outcomes improve for everyone involved.

Unfortunately, value in healthcare has historically been defined from the perspective of the hospital or health system. The focus is often on using facilities, clinicians, and equipment in the most cost efficient manner for the organization rather than for the patient. This approach has contributed to systems that are difficult to navigate, confusing insurance coverage, high costs, and significant frustration and waiting for patients.

Healthcare is complex, and trying to make improvements can feel intimidating. A practical place to start is by learning to see value. View processes from the patient perspective. Follow a patient through your facility from admission to discharge and observe each step. Take note of which activities add value and which do not. Focus on strengthening and supporting value added work, and work to reduce or eliminate tasks that do not contribute to patient outcomes.

There is no perfect time to begin improving value. I would encourage you not to delay, patients are already waiting.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.

References:

Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (Revised and updated ed.). Free Press.

Rother, M., & Shook, J. (2003). Learning to see: Value stream mapping to add value and eliminate muda (Version 1.4). Lean Enterprise Institute.