by Lee Fried, on 07 Sep 2006 08:03 am
The Journey
Who is the customer?
In Healthcare the question is often asked, who is the customer? Is the customer the patient? Is the customer the member of the health plan? Is the customer the employer or agency paying the bill? Is the customer the physician?
I can’t tell you how many times I have been in the midst of this debate during LEAN events when we are specifying value and requirements from the customer perspective. The answer is always the same: it is the patient, and it is the member. No matter how far removed they may be. Some may claim that this makes the process confusing, especially in areas that don’t have contact with the end user. I believe if harnessed it is one of the most powerful tools that we have at our disposable. Working is healthcare is a higher calling. The work literally changes people’s lives. By connecting everything to the end customer, no mater whether it is nursing work or claims processing we have a rallying point for change and improvement. If people are able to see how their work has an impact on patient care or member service they are much more willing to give something up to help someone out. This is why LEAN is such a powerful way of thinking for an industry that desperately needs it.
on 07 Sep 2006 at 7:02 pm 1.Jon Miller said …
Great point Lee. On the few occasions I’ve had to help define the customer during Lean projects at hospitals I was surprised to learn that the patient, the physician, and in some cases even the payer was the customer. It was a bit mind boggling at first but I think I’ve made the mental adjustment.
on 08 Sep 2006 at 8:47 am 2.Mark Graban said …
How successful have you been in changing the mindset that it isn’t always about the doctors? I’ve been in many hospitals where there was maybe effort made to make doctors happy and to retain them (to keep patients and revenue coming in). How many processes are suboptimized around the doctor, such as waking patients at 3 AM to draw blood and forcing the laboratory to take on a HUGE demand spike from 4 am to 6 am, so we can get the results on all doctor charts by 7 am or some given doctor-convenient time? I don’t mean to beat up on the doctors, but there are many things NOT focused on the patient, unfortunately, and there’s a big challenge/opportunity there. Thoughts?
on 09 Sep 2006 at 7:44 am 3.Ted Eytan said …
Is there a different mindset between patients and doctors? Think about the ideas that:
1. Medicine is a calling - a career this challenging has to be
2. I have never met a physician uninterested in providing great care for their patients. Have you?
Maybe there’s a deeper question: What does a health care system/process look like when it is set up to allow a doctor to focus on caring for patients rather than on caring for “the system.”?
If I don’t respect their calling and get confused by actions shaped by a system that distorts compassionate intent, I think it’s my mindset that needs to be changed - is it really physicians who are not focusing on the patient?
Earlier this year I addressed a physician group when we started implementing LEAN processes. I said, “We’ll be looking at things from the patient perspective, always. It will be hard for us to do work from the doctor or nurse perspective. You may see me get cranky if we start doing that.” After the session was over, a colleague came to me who was sitting in the back of the room. He wanted to share some commentary mumbled by a physician that he overheard. He told me,”You know what Dr. Y said when you talked about the patient perspective?” At this point I didn’t have a choice but to ask.
The commentary was “It’s about time.”