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Paralysis by Vague Announcement

I was once speaking with an engineering professor who was working on breakthrough Fuel Cell technology.  He told me something interesting…

“Fuels cells are probably about 10 years out from being broadly viable and widely used … but 10 years is what everybody says when they really have no idea how long it will take.”

The same year I went to an annual health conference and attended the eHealth panel.  they put a slide up on the screen that said:

“Ontario will have a province-wide Electronic Health Record (EHR) in 10 years.”

That was 10 years ago – and we have neither widely available fuel cells nor a provincial electronic health record.

We have heard many similar announcements over the years. There will be a new system X, a new project Y, and new process Z.  After seeing this enough times, you can get a good sense for when something will actually happen, and when it is just … an announcement.

Fuzzy promises, vague features and broad targets are usually bad sign (e.g., an EHR by 2013).  Specific actions and decisions are a good sign.

It is worth noting the impact of these fuzzy announcements. They can kill innovation and stop positive action from occurring.

If a person/organization/region has a great idea to solve a problem, but “Vague Project X” is looming that might solve the same problem, why bother trying?  This happens when in fact, project X has been threatening on the horizon for 5 years, but continues to circulate in committee purgatory and won’t ever see the clear light of day.

An organizational bias for action outperforms abstract planning and its related pronouncements every time.  Disciplined trial and error also leads to making better products, keeping the best employees and attracting more customers.  The reality is, most larger scale projects that succeed are building on small local success stories, where somebody dared to make a bold change, which is later adapted on a broader scale.

Blasting through paralysis by vague announcement can be done with a bias for simple concepts, plain language, and by using action to teach us what works best for clients.


Computers, databases, printers and forms.  One thing they have in common is that they make it really easy to collect information.

But the ease of collecting information makes us management types get greedy, and we ask for everything under the sun.  Just because you can collect information doesn’t mean you should. We call this disease “Overcollectionitis”.

Overcollectionitis comes with a cost.  It makes everything more complicated (especially for the patient and direct professional caregiver).  People have to fill out more information, the information takes longer to process, and becomes more difficult to retrieve and process.

In the end, information is collected and handled with less care and ultimately less useful.

An unfortunate aspect of this that we have observed in health care – is that a lot of information rarely gets used for making good decisions. Worse yet, it could do harm.

Most nurses doing an intake admission and assessment know what the outcome will be within a few minutes of speaking to a client. However, they are often made to go through a 60-90 minute+ documentation exercise. Too many questions can make patients feel hassled.  Worse, clinicians can lose track of the key patient problems when extra and irrelevant questions become a distraction.

Here are a few helpful guidelines to help you decide what to collect:

  • Know what you are going to do with each piece of data you collect.  Otherwise, don’t collect it.  Resist the urge to collect “just in case”.  When that “case” comes, then start collecting.
  • If its going to be collected again later, don’t collect it now (health care is notorious for this).
  • Make data collection “conditional”.  For example, if your client is in for a orthopaedic sports knee injury, you probably don’t need to ask about continence (yes, we’ve seen this).
  • Try to collect only data that is needed for patient-related decision making. Often extra information is collected for other purposes such as accounting, research or health-system-level statistics. Find ways to use the patient-related data only to meet the needs of these other constituents.
  • For every piece of data you collect ask, “Would my decision making come to a different conclusion if I didn’t collect this?”  If the answer is no, don’t collect it.

In the end, everybody will be better for it.

Where have you seen overcollectionitis?

Healthcare Referrals are Broken

Imagine that you are sitting with a travel agency trying to arrange a visit to see relatives in Europe.  After much discussion, they recommend the best airline and hotel combinations.  After filling out all the requisite paper work, the travel agent tells you:

I am going to fax this to the airline. The airline will then call you back as soon as they can. They will inform you then of the date and time of your trip.  You can probably expect your flight to leave somewhere between 6 to 12 weeks from now, but if they deem your trip to be very important you might be able to go within 7 days.

This would be crazy in the travel industry of course (or almost any other industry … except perhaps phone and cable companies). Sadly, this is what many referrals in health care looks like. Surgical services, home health care, children’s services, mental health, you name it.

When referring patients, we usually can’t tell them: 1) when the next step is; 2) when they’ll find out when the next step is; and, 3) what the availability of the next step is. We sure can’t say what 1, 2,& 3 are for all organizations.

Everybody is so used to this approach to referrals in healthcare, but we think it doesn’t need to be this way.

The network of Community Support Services in Waterloo Wellington agrees, and have decided to do something innovative about it.  They’ve created a process where a client always knows exactly what and when the next steps are, before the referral is even complete.  More than a year into their journey and they have served over 2000 people so far. You can learn more about it here.

Beautiful health care processes.

Fyodor Dostoevsky, the Russian writer, once said: “Beauty Will Save the World!”. This is a provocative statement. With health care in what seems perpetual crisis, it might be worth asking – can beauty can save health care? This is not about being pretty. If beauty saved health care it would be about artful service design. Service design that brings joy to health care providers and patients.

Processes are the things that weaves people, tools and information together in health care. Health care process design is, to a manager, what a paint brush is to an artist.

What are you doing when you are changing your health care processes? Are you improving them? Maybe you’re streamlining them, making them more efficient or more value adding?

Or do you try to make them beautiful?

Other ways of thinking about processes can fall short:

  • Making processes efficient: Efficiency is a dirty word in some circles, and can be used to justify all kinds of nasty things. Some invoke efficiency in the name of firing staff, cutting budgets or making something better for one person at the expense of another. A single minded focus on efficiency is cold. In health care, most processes are about the flow and experiences of people rather than movement and assembly of parts without waste. People deserve something more than an efficient process. A beautiful process is probably efficient, but much much more.
  • Process Improvement: Improvement is a better term, it teases at the idea of building on past success, and that we should be continuously getting better at what we do. The saying “Improvement is a journey, not a destination” is the strongest element of the “improvement” concept. However, the term “improvement” is often incorrectly used in place of the word “change”, which may or may not yield any improvement at all. Furthermore, a process can be improved … but remain a poor experience for patients and contain tremendous amounts of waste. Aiming for an “improved” process often isn’t enough.
  • Making the process lean: This term is great with people and organizations that have embraced and understand the concept. The reality is, the typical staff member doesn’t immediately know anything more about lean than a penguin knows about pineapples. Lean contains vital ideas for the quality improvement practitioner like making value flow at the pull of the customer, reducing waste, etc. People can be taught, and integrating this type of knowledge is the essence of management, but it takes time.

Your customers/client/patients interact with you through your processes. Your staff spend most of their working lives in your processes. Is it possible to make a process fun, a pleasure to be a part of, an experience to look forward to, joyful, to make it … beautiful?

I don’t think we strive to this level of achievement with processes, but we should.

No health care process is too mundane to beautify. Phone calls can be a pleasure, forms can be satisfying and communication can be enriching. Making a health care process beautiful respects the impact that it has on people and their lives. A beautiful process would deliver what people need, is not wasteful, and would be uplifting to experience.

Isn’t beauty – the experience of pleasure and satisfaction often in the presence of another – what makes life worth living? Save some room for considering beauty when designing a health care process.

Capturing the voice of the patient

Doleweerd Consulting completed an engagement that provides important information about the experiences of people transitioning from hospital to long-term care, or back home with the addition of home care, in Ontario.

The project focused on understanding what clients value, and then determining if the health care delivery process is capable of delivering that value.
The project was funded by Change Foundation, and supported by Ontario Association of Community Care Access Centres.

So what did patients going from Hospital to long-term care tell us that they value? i.e., what was the voice of the client?

“I want help getting accurate information that I can understand at the right time and place, including viable options, so my family and I can make the right decision for us. I want to feel confident that people care and to be treated with fairness and respect.”

The reports show that this notion of value is not fully understood and acted upon in a concerted way by the many agencies providing service. Agencies do not consistently optimize the end-to-end process, as felt by patients.  This translates into unnecessary hospitalization, needless admission to long term care and confusion for families and clients. Further, it is waste the health system can ill-afford.

This project employed Doleweerd Consulting’s methods of Patient Value Analysis and Digital Current State Mapping. Clear information was created to build an understanding of what patients value and how capable the care delivery process is in delivering this. This is more than measuring patient satisfaction. This is interacting with a program’s patients, capturing themes and insightful expressions, and observing the process end-to-end, even if it spans several organizations. It not only provides remarkably clear information, it is highly engaging of staff and is a way of getting patients into the health care program ‘design room’.

When an improvement-oriented leadership team pays attention to its patients, the results are unmistakeable and remarkable. One case in point is the Home First program being deployed all across Toronto in 2009 by the Community Care Access Centre. There are many others listed in the report, and still many more opportunities for fundamental process changes. Take some time to check out the reports or, fill out our ‘got a question‘ web form if you want to learn more about transforming the care experience for your patients.