5 Steps to Changing the Healthcare Perspective

- April 12, 2010 by Beverly Ingle

Healthcare reform isn't easy, but it is feasible from a small scale, bottom-up approach.  Here are 5 steps to help you and your organization innovate, along with how Tenzing Health was able to do it. If you like, you can download this whitepaper as a pdf.

Introduction

While the idea of healthcare reform is commendable, it isn’t actionable in its recently approved, government‐backed incarnation. Why? Because it attempts to achieve reform in what is fundamentally the same business and cultural environment in which healthcare existed prior to March 22, 2010.

Granted, our new legislation commits to extending insurance coverage and improving access to care to a wide, under‐served population, and, in theory, improving overall health and wellbeing. Whether you love or hate the bill that passed, this type of reform only addresses healthcare at the moment of need – essentially “sick” care.

This reform does not:

• Engage consumers further upstream, where education and coordinated care can affect outcome.
• Redefine the business model of a broken industry.
• Address the behavior change that is needed – taking personal responsibility for your state of health – to affect positive, healthy outcomes longitudinally.

An opportunity exists to reset thinking, redefine the environment and realize innovations in healthcare that have hope of making a difference in our citizenry’s health over the long term. You can grab that opportunity in 5 steps.

The 5 Steps

1. Suspend Your SOP
It sounds painful and next‐to‐impossible, but it’s necessary. Fundamentally, you cannot pursue something innovative and game‐changing if you’re still following the same old processes and procedures. Further, don’t even attempt suspending your SOP in a corporate culture that cannot tolerate ambiguity, complexity, the unknown and failure. For a truly innovative idea to have a modicum of a chance, it needs to be unfettered enough to evolve and be given the corporate support to let it happen organically.

2. Put the Individual Consumer in the Center
Like it or not, healthcare is evolving into a consumer‐driving industry. But is the consumer in the center of our current healthcare system? Only occasionally. Look for opportunities to change the status quo and link these to your business strategy. Then, look at your innovation from the consumer’s perspective. Does it create a better experience? Will it meet the latent and/or emerging needs of the consumer? Will it result in better outcomes and improved health?

3. Expect to Change Expectations
To innovate in healthcare, change is inevitable. Consider this your modified version of the Seinfeld episode in which the character George decides to do the opposite of what his instincts are, because his instincts are always wrong. So if he does the opposite, he’ll be right. For example, if your office has always required patients to complete forms upon arrival, change the process to allow those forms to be completed and submitted online in advance of the appointment… or better yet, electronically pull the needed information from your patient’s online personal health record via the access your patient has allowed you, making it hassle‐free for the patient and convenient for your staff. The result? Both you and your patient come to expect quick and easy transfer of information and more of the appointment spent delivering care, rather than paperwork.

4. Build a Straw Man
Few innovations ever turn out exactly as they were envisioned. Testing the premise, process and expected outcomes is critical. But how do you test something that doesn’t really exist yet? You build a “straw man,” a purposefully temporary functioning example of the innovation that’s substantial enough to effectively test, but without so much invested in it that you can’t tear it apart and start over. Quite plainly, create a rough prototype of your innovation, allocate appropriate resources to sustain the test, determine a reasonable timeframe for the test, and try it out.

5. Review, Refine, Repeat
Data is gold, and testing that is conducted and recorded effectively yields tons of it. Identify only a small universe in which to test your innovation so the environment is flexible and the data set is manageable. Set benchmarks for reviewing the data and scrutinize it closely and critically. Analyze it from all possible angles. Then use the learnings to refine the innovation. Are the processes creating barriers and slowing progress? Change the workflow, modify the procedures and try again. It’s a circular process of reviewing data, refining the innovation, and repeating the testing with the intent of ultimately arriving at a refined innovation in which you feel confident and are ready to scale.

Example: Tenzing Health

Background
Senior leadership at Vanguard Health Systems, a healthcare and hospital operations company based in Nashville, Tennessee, enjoys a unique perspective on healthcare: not only does the company play a role in the reform debate as a provider, but also the company experiences the effects of rising healthcare costs as a self‐insured employer. Further, as a healthcare provider, it is incumbent upon Vanguard Health Systems to be a leading example of health and wellbeing within its own organization… “to walk the talk.” Vanguard saw the opportunity to explore changes in how healthcare could be delivered, how the experience could be improved, and how consumers could truly be at the center of the healthcare system.

1. Suspend Your SOP
Committed to developing a game‐changing approach to health and healthcare, Vanguard’s senior leadership knew it needed an independent environment in which their innovation would be shielded from the harsh realities of daily operations. Vanguard and GDC agreed that this test environment would give the innovation the independence and flexibility it needed. Vanguard gathered a team of
thought leaders from within their own organization, GDC, and other partner companies, all of whom were known for their unconventional thinking, and set them to task with minimal ground rules and no existing operational framework. The field was wide open.

2. Put the Individual Consumer in the Center
The team set out to create a healthcare reform program that puts the consumer at the center of the healthcare system, with greater control of his healthcare choices and greater personal responsibility for his own health. Adopting the consumer’s point of view, the team identified needs and wants, brainstormed services that could fulfill them, articulated expected consumer behavior, anticipated
outcomes and more.

3. Expect to Change Expectations
Vanguard’s innovation was designed to change the way people manage their health by providing them with the tools, education and emotional support to make appropriate choices and decisions that would lead to improved health. The changes made were immediate, but the changes in expectations evolved. Consumer #12 embodied the change in expectations best. Paraphrasing her words: once she changed the way she sought healthcare and experienced how it was delivered, she came to expect the improved experience, and felt respected and confident enough to articulate those expectations.

4. Build a Straw Man
Now, the team was ready to build its prototype and trial it. The team expanded to include specialists in human resources, physician recruitment, workplace wellness and benefits design, all of whom would be instrumental in creating the prototype. Leadership identified a project manager, defined goals, established timelines and agreed on benchmarks. Processes were followed, appropriate approvals sought and next steps defined. The team was ready to test.

5. Review, Refine, Repeat
One hundred Vanguard employees were asked to participate in the test, and more than two dozen primary care physicians were recruited to provide healthcare within the context of the innovation concept. Both groups were asked to provide direct, honest feedback and insights on their experiences. The concept of consumer‐directed care and individual responsibility in healthcare proved to be a huge paradigm shift for both groups, leading to some confusion. The team gathered the data, adjusted the innovation’s components, and retooled communications and messaging. With what they considered “straw man 2.0,” the team resumed testing.

Conclusion

Though the title of this whitepaper references 5 steps, we all know how complicated healthcare can be, and how intricate it can be to affect real change. So where do you start? Identify a single issue that you and your institution would like to tackle. Then, implement the 5 steps.

Remember: it’s often a little switch that has a big effect. Focusing on small changes one at a time is how innovators like the Cleveland Clinic and M.D. Anderson have done it. And it’s not just the big players who can innovate; even little guys like Tenzing Health have the power to greatly improve patient care.

Now get out there and create some change.