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Healthcare ‘management by process’

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This HealthAffairs blog entry  by John Toussaint discusses  the ThedaCare Center for Healthcare Value‘s framework for transforming healthcare delivery through improvement-management techniques similar to the “management by process” espoused by Edwards Deming in the 1980s.

The framework has many  principles from  such big manufacturers as Toyota— now being applied to healthcare— using the “concepts of Plan-Do-Study-Act (PDSA) thinking, developing model cell areas to test new concepts, spreading new processes, and building new sets of standards for leadership and daily management.”

A “model cell” is a place, “usually a clinic or a department, where care is completely redesigned. The process change leads to new roles and responsibilities for everyone involved.”

An example: “At the Palo Alto Medical Foundation, in California, there was a need to deliver a better patient service experience while reducing cost.

“A well-known health maintenance organization (HMO) was aggressively competing with Palo Alto with better quality at a lower cost, so the organization’s leaders began model cell work in one clinic in Fremont, Calif. They eliminated doctors’ private offices, developed dyads between doctors and medical assistants, started two-minute morning huddles to understand demand for the day, and in one year, completely redesigned the entire outpatient experience. ”

Mr. Toussaint also looked at MemorialCare, in Long Beach, Calif., where a group of “specially trained facilitators teach the management team how to be successful ‘lean’ managers. This is not training in a classroom with PowerPoint slides. Instead, it is applying principles and tools to the real work; where value is created for the patient at the bedside.

“Facilitators train leaders in ‘visual management,’ which involves setting up visual management boards, identifying and posting key metrics that relate to performance of the department, and encouraging staff to post ideas for improvement. Managers are also trained to teach frontline staff to identify and solve problems, and how to map processes of care to understand which steps in the process are non-value-added to the patient.”





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