Maximize Value Through Process Transformation
3. Identify Process Vulnerabilities that Can Cost You Value
An efficient process allows you to convert as much potential value into actual value as possible. An inefficient process leads to leaving value on the table. How can we identify vulnerabilities in your process that are costing you?
Series 
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Episode 
3
Published on
January 11, 2019
“The significant problems we have cannot be solved at the same level of thinking with which we created them.” — Albert Einstein (1)

“We’re a lab. How can we most efficiently take in physicians’ orders, collect samples all over the community and get them to the lab so patients can quickly get the right care?”

“Can we scale our services without adding more people?”

‍Welcome back to TeloChain’s Real-World Healthcare Insights! This is the third episode in a series on how secure technology-enabled process transformation and strategy redesign can help you harvest the full value of healthcare services.

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Cut to the punchline: Realizing the full value of healthcare depends on how well (appropriately, accurately and efficiently) it is delivered—i.e. on operations. We illustrate closing the ‘value gap’ with a before/ after state example involving a thorough redesign of key processes in a community lab setting.

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Last episode, we looked at value in healthcare and how its component processes can support or detract from achieving the full value of a competent clinical ‘intervention.’ (2) This reveals the importance of transforming inefficient, uncoordinated, and error-prone processes (which may have, like barnacles, accreted over time) into a coordinated whole, enabled by an operations technology platform. The result: maximized outcomes or results at minimized cost, effort, error, and employee frustration.

Technology-enabled process redesign allows organizations to scale and grow their business, delivering more outcomes at lower per-outcome cost. This means realizing greater value rather than just throwing more people or resources at the problem.


How to identify process vulnerabilities

We’ve talked a lot about how inefficient processes can lead to lost opportunity and value. Here are some things to look out for in a process that could be holding you back.

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1. Papers everywhere

Paper is the number one obstacle to a well-oiled machine. Think of all of the operations you can do to a digital document or database that you cannot do with a sheet of paper. How do you call up a specific form from 5 years ago? Paper takes up physical space, can be misplaced, and does not communicate with anything else.

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2. Human handoffs and confirmation

Handwriting is intensely personal. Not all handwriting is very legible. Anytime one person has to interpret another person’s handwriting, there is an opportunity for error. This is true of checking boxes, filling forms, or any other type of pen-to-paper data. Even with non-paper handoffs (e.g. sending an email, calling on the phone), if there is a person handing off information to another person, there is room for error or, at least, delay.

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3. Uncommunicative systems

Even handoffs or communications between digital systems can pose problems. Systems from different vendors or even different products by the same vendor may suffer from a lack of interoperability: an extremely important concept when it comes to system design. Basically, even though two systems within a process are fully digital, a person may be required to feed data or results from one system to the other. This rework takes up time that could be spent in value enhancing work, which has the added benefit of being more rewarding for your employees.

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4. Manual QC

Quality control should be integrated throughout a process. By making QC a single step at the end, where a problem could have occurred in any of the n number of steps in the chain, much of the process has to be reworked when an error is identified. In most data type settings, human QC can be problematic. A rules-based automated QC process with human oversight cuts down on time spent on finding errors and reduces the likelihood of missing errors.

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5. High turnover

High turnover is often a symptom of the workplace environment. Automating administrative tasks, frees your supervisors to invest in the training and development of your people.  When your team is focused on putting out the fires of errors and inefficient systems, people do not feel that their time is respected and prioritized.  By creating rule-based automated systems for administrative tasks, such as scheduling and reporting, there is more time to create a supportive, collaborative environment focused on adding value for your organization.


TeloChain's customized digital platform eliminates waste and minimizes labor so you can fully leverage the systems and people vital to your organization, allowing them to work more effectively. If you think your organization might be leaving value on the table, reach out to us.

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Harvesting full value of healthcare: A use case example

The fidelity of translating clinical intent to action depends on how well its component processes handle accuracy and timing. But the value of the translation also depends on the cost of execution. As illustrated in Episode 1, achieving the intent with perfect fidelity can be done with a wide range of effort. The goal is perfect fidelity—no gap. Let’s see how that works in a specific case: fulfilling physicians’ orders for lab tests on their patients in private or nursing homes.

We call this use case community lab services to distinguish it from the more familiar centralized lab service where patients take their doctors’ requisitions to a lab.

The lab’s value proposition: Inform and facilitate decisions about patient care by transforming physicians’ requests for tests to accurate measurements (test results). (4)

The diagram below shows what the lab must do to deliver value. While these basic operations and workflow may be performed with varying degrees of accuracy and efficiency, the transformed system must preserve them.  

Physicians order tests (directly or via standing orders) on patients at home or nursing care facilities. Orders are transmitted to the lab, and entered into the lab’s information system (LIS). Each day, a dispatcher prepares draw (specimen collection) lists, using the LIS as input, for its traveling phlebotomists, who collect specimens from patients on their list, and complete the order form. Specimens are returned to the lab, run, and results reported. Stat orders are handled by regular or specially-assigned phlebotomists. Claims are prepared, initiating a series of steps ending in payment. Many steps work with the LIS by providing data, being managed or in documentation or reporting.

Now let’s illustrate the transformed processes enabled by an integrated services technology platform based on one of TeloChain’s clients. The current state processes are somewhat generalized to reveal key points.

The lab’s basic functions (requisition, fulfillment, claims) do not change. The items listed in the inputs and outputs are still required (e.g. a lab will always need test orders and patients), but their physical form may change (e.g. a paper draw list can be replaced by an app). The process of getting from input to output can be transformed altogether.

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The current (‘before’) state, has numerous manual steps—data entry, form completion and data reconciliation—resulting in unnecessary delays in translating orders, task duplication, hunting down previous reports and other documents. Besides rework and errors, manual work can impede getting the results on time and raises the lab’s costs (but not what they can collect from the payers).

Understanding the current state is critical to identifying and prioritizing the work that needs to be done. This is why TeloChain took time to listen to the people doing the work, to examine current tools and processes, and to go on ride-alongs with phlebotomists. Identifying key obstacles for each role at our client location, enabled TeloChain to build solutions that allow the team to focus on the value added work of improving patient care through timely accurate test results.

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Getting to the transformed (“after”) state required:

  • A deep dive into the lab’s status quo: learning about their current systems and understanding all of the different stakeholders, their discrete tasks, and their pain points
  • Agreeing on scope of the transformed state: how much of the incumbent process and systems were going to be rebuilt
  • Iteratively mapping the transformed state, ensuring that a transformed solution maintains required inputs and outputs, while curiously questioning whether each input and output needs to exist exactly in its current form
  • Bringing the transformed state to life in a technology-based platform (secure cloud-connected apps) to enter and display data and manage work; archive files and other artifacts in real time; and communicate with the LIS
  • QC testing simulations and in the field, while ensuring a easy learning curve
  • Ensuring that all applicable regulatory and security specifications were met (more on this in Episode 5 on security and blockchain)

Below: the “after” (transformed) state. The major functions, inputs and outputs are addressed, but in a streamlined way that greatly reduces manual data entry, workflow and handoffs. By design, TeloChain's lab platform eliminates duplication, rework, and error; and promotes smooth and efficient workflow. Phlebotomist scheduling, routing, and electronic distribution of specimen collection forms is managed by a Command Center app; a tablet-based Phlebotomist app (that displays and captures data from and to a secure cloud-based server) facilitates phlebotomist tasks, automatically validates samples, and tracks reimbursable mileage. The app sends data to the Command Center about the phlebotomist’s location to help distribute workload, including managing stat orders.

If you don’t measure it, you can’t manage it. Nor can you prove it.

The right set of actionable metrics helps monitor—and improve—the transformed processes’ performance. Importantly, we need metrics to prove the system was worth investing in; proof metrics aren’t always innately manageable, but reveal whether the investment was worth the money, taking us back to the value equation: Are we getting more outcomes (results) per dollar?

The exact nature of the performance and value metrics depends on what problems are addressed, and what the customer considers to be of value, but some are shown below.

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Harder to monetize—but relevant in a decision on whether to rethink and transform healthcare processes—is the human experience. Does revising, improving or transforming processes result in a lower-stress, higher satisfaction experience? This might translate into measurable economic results, e.g. reduced employee turnover, absenteeism and productivity (5), as well as more engaged employees.

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Next up: Use case: Accelerating accrual for clinical trials.


What does your process look like? What steps has your organization taken to be more efficient? Join the conversation below or contact us if you want to know more.

NOTES

  1. This is sometimes quoted as “The significant problems we face cannot be solved by the level of thinking we were at when we created them.” The distinction between ‘the same level of thinking with which…’ and ‘the level of thinking we were at…’ is profound. The first formulation suggests that unintended (in this case, undesired) consequences of a solution that was adopted might have been avoided if only we’d used a level of thinking that was available to us at the time. That is, we chose the wrong thinking tool from a concurrently-available selection. The second implies that we once solved a problem with what we thought was the best available thinking available at the time; the solution created unintended consequences down the line that were unavoidable given the selection of thinking levels available. This formulation invites us to redesign our thinking—our strategy—for solving the new problems arising from the particular way in which we solved the old. When the solution becomes a problem, applying more of the old thinking won’t solve the problem, and could make it worse. The episodes before you are about applying a new way (level) of thinking.
  2. We use the term intervention to cover a set of healthcare tasks organized to achieve a health-related goal. Interventions include vaccination, measuring biometric markers, performing a surgical procedure, taking a medication—or, in our context, doing a clinical trial to assess the effect and safety of a treatment. Interventions are at least somewhat complex—require specifying and coordinating several component parts (tasks), moving information around, capturing, storing and analyzing new information, etc.
  3. Not that processes can’t sometimes become too efficient, losing their human (interpersonal) touch, powering a growing market for human travel agents: https://www.nbcnews.com/business/travel/online-booking-so-90s-humble-travel-agent-making-comeback-n692056.
  4. While laboratories may handle both body tissues (such as biopsies) and fluids, community lab services in this use case collect and process body fluids such as blood, urine and sputum.
  5. Part of which can be measured as presenteeism, reduced productivity at work compared to a person’s usual or expected performance, was famously introduced to the business world in the October 2004 issue of Harvard Business Review (https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it). An expected level of good performance may be assigned a presenteeism score of 100 (with sustained performance above this level assigned scores greater than 100). Presenteeism is usually associated with performance impaired illness, medications, substance abuse, or the effects of anxiety or depression. However, it may also be associated with impaired morale due to working conditions or processes. While the concept of presenteeism is generally accepted, there are several controversies about how to measure and apply it in diverse industries or job roles. Beyond individual-level presenteeism lies company performance, which may be measured by its stock value compared to the overall market over a period of several years. Morale is, of course, but one of several contributors to “wellness” but for what it’s worth, recent studies have demonstrated a consistent relationship between employee wellness and stock performance: http://performph.com/workplace-wellness-stock-performance-impact/.

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