Maximize Value Through Process Transformation
1. Maximize Value Through Process Transformation
Are you leaving healthcare value on the table? New series shows how enabling healthcare service transformation with a technology platform can maximize the potential value of care.
Published on
January 11, 2019
“If you don’t know where you’re going, any road will get you there” – Lewis Carroll (1)

“We’ve built a successful business as a healthcare service provider. How can we break out of the growth stagnation, wasted time and money, and employee dissatisfaction imposed by manual data capture, tasks, and work hand-offs?

Welcome to the blog, Real-World Healthcare Insights. Our second series, Maximize Value Through Process Transformation, begins here. You can read the first series, Recruiting for Your Pragmatic Clinical Study, HERE.

Our opening question illustrates a problem faced by organizations that deliver healthcare services: Improving outcomes (clinical, economic and satisfaction) while lowering cost. Healthcare organizations must deliver and seek to increase value, defined as outcomes per dollar.

Cut to the punchline: Everybody wants value—bang for the buck. Healthcare’s bang includes clinical and quality-of-life outcomes and satisfying experiences. A technology platform can maximize those outcomes while minimizing cost by eliminating costly errors, saving precious time, and reducing friction.

Maximizing the value of healthcare

For this series, we’ll focus on organizations providing healthcare services that are ancillary to those provided directly by clinicians—for example, labs, imaging, procedure scheduling or clinical trials management. We’ll look at how these organizations deliver value in healthcare, by enabling healthcare to achieve its results (2).

As we’ll explain in the next episode, achieving the most value of healthcare depends on organizing healthcare services so that they occur on time, accurately (as specified), and efficiently with minimal operational friction. These diagrams illustrate this principle: a clinical service as ordered has the potential to deliver 100 ‘value units,’ but inaccuracies, inefficiencies, or suboptimal timing in its performance take away value units along the way, so that less than 100 units are actually delivered.

Value of healthcare delivery from beginning to end of delivery process. Inefficiencies in the process undermine potential value, whereas an automated and robust process enables near-complete retention of potential value.

The lost units may be of clinical outcomes (reduced effect of treatment or prevention) or cost (more resources expended to achieve the result). To borrow a term from economics, these inefficiencies and loss in value constitute a “deadweight loss,” one which could have been avoided. For illustration purposes, we assume ideal clinical competency and that no other factors impinge on translation of clinical competency in the (messy!) real world.

Knowing what to do, when, and how (clinical competency) are absolute prerequisites to creating value in healthcare, but to achieve the intended (maximum) value requires that the components of the process or clinical service are delivered on time, as specified and coordinated with minimal friction. When efficiency and task coordination is embedded in a technology platform, a transformation to reaping the full value of the healthcare service can occur.

In this series, we offer insights into the key role and value of process transformation and technology platform in maximizing the value of healthcare services. A technology platform acquires and manipulates data, assigns, hands off and documents tasks, manages workflow and reports on operations’ status and trends. A platform may also report on outcomes and cost (in terms of time, resources, or money).

Let’s talk about value. In healthcare, that’s outcomes per unit of cost. Generally, it is results per unit of cost. Outcomes include clinical, functional, and quality-of-life results. Products and services come with a value proposition: a (hopefully) clear statement of the kinds of results or outcomes they provide, along with a “how we do it.” So a value proposition is a what and a how. The value proposition metrics allow us to evaluate whether the product or service did what we paid for it to do, but the value proposition by itself address the cost of outcomes.

Generically, estimating value involves:

  • Define your key outcomes or results
  • Define your costs
  • Calculate cost per key outcome

Determining the value of clinical interventions is a deep and complex subject but fortunately, our task here is more straightforward: it’s mostly about the cost of achieving a result or outcome. Improving how healthcare services are enabled can also improve clinical outcomes (for example by reducing errors or improving the patient’s experience) but for now, our focus is on how implementing a technology platform to transform healthcare services can get the desired result more quickly, smoothly, with greater ease and at a lower cost.

Are we getting the value we’re paying for? Statins are well-known to reduce the risk of heart attack, stroke, and revascularization in people with cardiovascular disease or diabetes (3). But achieving their full benefit requires consistent adherence (taking at least 80% of prescribed doses) over a long period. Full statin value, then, requires this level of adherence. Less adherence (or good adherence for too short a time) reduces the benefit (health outcome) more than it does the cost—a case of paying for more value than one actually gets.

A study published in 2005 on adherence to diabetes medication shows this nicely. (4) As adherence increased, hospitalizations decreased, and the drop in medical costs more than offsetting the increased cost of medication. Many factors figure into a patient’s adherence to treatment, but we would hope that a system that ‘knows’ how to track these factors with minimal effort would be likelier to improve adherence (and thereby increase the value of the associated healthcare) than one that relies on manual actions recorded (if at all) across several paper or electronic documentation and tracking silos.

Now apply our value question to healthcare overall: 18% of GDP in 2017 in the U.S. Did we get what we paid for? How would we know? Could we have paid less to get the same (or even better) health outcomes? We’ll tackle that in the next episode’s deeper dive into value, but for now, we can confidently say that we’re leaving money (and outcomes) on the table in large measure because of the way we think about (strategize) and implement healthcare processes.

To see this, consider this depiction of a typical healthcare process; such as ordering, performing, reporting and billing for an x-ray or lab test; scheduling operating rooms in a hospital or outpatient surgery; or recruiting patients into a clinical trial.

A generic flow chart for an average process involving manual paperwork and feedback steps that rely on human interaction

This process feels fragmented, as many processes in healthcare are. The links among the parts cobbled together from largely manual data entry, task assignment/hand-offs, and documentation. The system’s organization exists at a conceptual level, but it isn’t thoroughly automated with built-in efficiencies, error-checking, workflow tracking, or actionable metrics. Duplication of work and errors are inevitable. So is employee frustration.

The same process with less steps because manual data entry and unnecessary communications and waiting for answers have been eliminated

In contrast, how does the transformed process, which achieves the same desired results, feel? It’s cleaner and uncluttered because it’s the product of an end-to-end redesign thoroughly supported by an enabling technology platform, customized to specific needs.

For healthcare to deliver its intended value, it must ensure that its service processes are carried out accurately, reliably (right person, right time, right circumstances), safely, without duplication or waste, and securely. Accomplishing this relies on thoughtfully (5) redesigning processes and enabling them with an integrated operations technology.

The operational friction imposed by manual or disjointed processes results in:

  • A ceiling on growth: current systems struggle to keep up with demand because they are built on arcane processes and technology. This prevents healthcare businesses and caregivers from reaching more patients
  • Impaired employee experience and morale: productivity loss, poor health, decreased efficiency, and attrition
  • Errors and missed deadlines: due to human-touch steps and use of paper with attendant information-capture and document access, errors could mean at best, inconvenience and at worst, business or patient catastrophe

What’s in store in this series?

We’ll focus mainly on the cost part (denominator) of the value equation, and how an extensible, scalable services technology platform can help maximize the value in healthcare services by strategically leveraging electronic data capture; algorithmic decision support; task and transaction assignment, documentation, hand-offs and audit trails; workflow management; and data security to:

  • Detect and wring out inefficiencies
  • Reduce task duplication and waste
  • Improve clinical quality and outcomes (error reduction, incorporating patient-reported outcomes and accelerating knowledge acquisition in clinical trials, and ensure timely patient care)

We’ll show you by building a use case example around each of three themes:

  • Process: Identifying and eliminating efficiency-robbing factors such as manual work, duplicated tasks, and bottlenecks.
  • Strategy: Execution that systematizes achieving your objectives, applying process with minimum friction in the right direction
  • Security:  A continuously-improving framework that protects data from bad actors and catastrophic events while appropriately exposing it for use by authorized healthcare personnel

Next up: How can process transformation maximize value in healthcare?

We invite your participation! Join the conversation below or contact us if you want to know more.


  1. This is the way Carroll is often quoted, but he never wrote that. The quote originated from an exchange in Alice in Wonderland between Alice and the Cheshire Cat: “Would you tell me, please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “I don’t much care where--” said Alice. “Then it doesn’t matter which way you go,” said the Cat. “--so long as I get SOMEWHERE,” Alice added as an explanation. “Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.” Of course, we could have quoted the immortal philosopher Yogi Berra’s “If you don’t know where you are going, you might end up someplace else,” and we’d have at least some chance of quoting what he actually said, since Yogi definitely said “I really didn’t say everything I said,” implying that he really did say some of the things he said. See and
  2. Outcomes are a category of results. An outcome is the result of some health or healthcare intervention such as an exercise program, surgical procedure, drug, or a disease management program.
  3. The largest of many statin clinical trials, the Heart Protection Study, found that taking 40 mg/day of simvastatin significantly reduced the rate of fatal or first heart attack, fatal or nonfatal stroke, and coronary or other revascularization in individuals age 40-80 with coronary or other occlusive vascular disease or diabetes. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial. Lancet 2002;69(9326):7-22.
  4. Sokol MC et al. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care 2005;43:521-530. There are several ways in which medication adherence is measured; most published studies use a relatively objective method based on pharmacy claims, which include date and the number of days’ supply dispensed, adjusting for overlapping dispensing events (refilling a prescription before the number of days’ supply from the previous dispense expire). Importantly, these metrics include only individuals who actually filled their prescription at least once (often twice), thus excluding from measurement people who were prescribed the drug who didn’t fill it (or in some cases, didn’t refill it once).
  5. This is not to suggest that you’ll have to completely redesign everything! Some or many parts of an existing way of doing things work well, and just need to be incorporated into the overall transformed set of processes. Others may need to be eliminated or done very differently--as found during the initial discovery phase.

Maximize Value Through Process Transformation