In my last posting I told
you I would take a look at some
other performance metrics and see how they impact our improvement efforts. I’m going to delay that posting because I
want to share an experience I had with one of my healthcare client’s teams. Although I won’t go into the details of the
experience, I will tell you that they had proposed a change in the way a
specific process is being run.
It has been said many times that the natural tendency of people is to
resist change and in many ways I believe this premise. Assuming this resistance is real, why is it
that people resist change? If you ask
most people this question, you’ll probably get a response like, “it’s outside
the comfort zone of the people being asked to change.” I know from my experiences that this is one
of the most often heard responses to this question. There is an almost art to get people to
change, but I’m here to tell you that it doesn’t have to be as difficult as
some people make it.
When confronted with an opportunity to implement an improvement, many times
we take the easy way out when we face this resistance by developing a
compromise. A compromise is letting go of
part of what we want and giving more of what the “changers” want. If we haven’t learned but one thing from the
late Eli Goldratt it is that we should never compromise! A compromise is essentially a win-lose
scenario when in fact we should only want to come away with a win-win one.
This team I mentioned earlier had a great idea about how to reduce the
financial impact of missed billings.
They had studied lost billings due to immunizations, but quickly
realized that their solution would apply to other areas such as various medical
tests and especially the more expensive tests like EKG’s, Point of Care
Testing, etc.. In fact the amount of
money lost due to immunization billing errors paled in comparison to these other
tests.
So knowing that we have an excellent solution, the question becomes how do
we present it without a compromise? From
experience I know that as long as we think that the only way to handle a
conflict is by compromising,, such as trying to change a process, we won’t be
successful in making the change. What
needs to happen is that we must surface the assumptions on why we believe there
will be resistance to the process change we are going to propose. And if we never
think about the underlying assumptions and know how to remove at least one of them,
we’ll never find the way to eliminate the conflict and “sell” our breakthrough
solution. In fact, we’ll just simply
lower our expectations and continue with business as usual.
The first and most profound
obstacle to change is that people believe that reality is complex and sophisticated. And because we believe this, we have a
tendency to believe that complex problems require complicated solutions. Goldratt introduced us to the concept of
Inherent Simplicity which clearly states that complex problems require simple
solutions. In other words, the more
complicated the situation seems to be, the simpler the solution must be.
Earlier I mentioned that we
need to develop a win-win solution, so how do we do this? The first place to start is by constructing a
solution by seeking the other party’s win, but not the win that is in
conflict. If we want our win to be
bigger, we have to ensure that the other sides win will be bigger. In other words, we must demonstrate how by
applying our solution, the side we are asking to change must see immediately
that there is a win in the solution for them.
A good solution deals with
the core conflict in that it changes an underlying assumption and therefore
significantly changes the situation for the better. When you present your solution effectively,
you immediately face a reality that is very different from the reality you’re
currently in. We must first transfer
ourselves into the future to realize the situation that will exist after the solution
is implemented and then communicate that reality effectively. So back to our GB project.
The figure below in a
simplified current reality tree that summarizes the most prominent Undesirable
Effects (UDE’s) encountered by the team.
In order to solve the billing error problem, the team had to identify a
core problem that, if eliminated, would reduce the impact of many of these UDE’s.
The team concluded that by the
MD’s not entering their immunization orders and instead gave verbal orders that
the Medical Assistants (MA’s) made errors due to trying to translate what the
MD had said. And if there were
translation errors, then the charges would be incorrect. And when the front desk scanned the incorrect
documents to the billing company, then the revenue from billing would be
missing. The team then concluded that if
the MD’s would simply enter their own orders (bottom entry on simplified CRT),
then most of the UDE’s would disappear.
The other problem stemmed from the problem that the billing documents
were sometimes unreadable, so the team recommended that the billing document be
redesigned to correct this problem.
So how could this simple
solution (i.e. MD’s entering their own orders into the database) be a
win-win. Quite simply, because of this
simple change, there were other forms of paperwork that the MD would no longer
have to fill out as they would now be completed by the MA’s. The result was,
the MD could now see more patients. The
MA’s liked this solution because they would know exactly what the MD’s orders
were and they could prepare the immunizations, paperwork, etc. while the MD was
still seeing the patient. The patients
would like this, because their wait time would be reduced significantly. Just as soon as the MD opened the exam room door,
the MA, having all that was needed to give the immunization, would simply walk
in and administer the vaccine and the patient would leave. The organization would win by significantly
reducing the lost revenue. So the team
created a win-win-win solution which will be very simple to sell.
Bob Sproull
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