At the same time, I enjoy the ability to focus on the unique aspects of a person because other aspects of the care experience are delivered through standard work. This includes the way they are introduced to the experience, the way we reduce uncertainty through testing, and the way we provide compassionate treatment and reassurance when needed.

If I (or a patient) can’t predict how a care experience is going to happen and need to adjust these parts - one way when working with one person, one way when working with another -, then we don’t get to spend the time we want to focusing on the special parts.

This is great advice from all of you. I appreciate your willingness to share your thinking.

Best,

Lee

After defining the “what to do” at the system level, then use Standard Work, “how to do it”, at the center level.

Defining process at the system level should reduce variability across the system.

Defining Standard Work at the center level should reduce variability within the center.

For example, if one of the specialties offered is Orthopedic Physical Therapy (PT), then:
The process: validate prescription, validate insurance, perform evaluation, develop treatment plan, schedule first treatment within 3 days of evaluation, perform treatment, perform 30 day re-evaluation, etc. should be the same process used across the system.

If we take the perform evaluation and perform treatment components, from a standard work perspective, there may be different locations for the equipment or different equipment used to perform those processes because of the difference in center layout. The basic process is not changed but the how to perform it would be.

The second item that I consider incomplete is a lack of focus on patient care / customer focus. Whether it’s the process or the supporting metrics the patients will be the ones affected along with the employees.

There is a different dynamic compared to that of designing standard work in a manufacturing environment. In this case, the patients are the objects work that have their own variability (injury, feelings, disposition, stress, etc.) as opposed to inanimate parts and assemblies. Assemblies won’t gripe when you don’t certify their insurance correctly and you hand them a $300 bill!

Spreading improvements sounds like telling people what to do. I think what you want is more of an attractive model where an improvement by one group is voluntarily adopted and adapted by other groups.

I will try to explain my point using an example.

The current problem for Group Health (GH) is high operational cost. The underlying reason to reduce variation is to reduce cost. If we draw a value stream for the whole of GH relative to the consumers’ premium, then we can identifying the cost of operation in each division (each box in the VSM) that is involved in the value stream. This analogy is similar to the work that is done at the lower levels at GH the difference being that the planning and coordination needs to happen at the top. We need to use the same metrics for each division. The metrics that can be used for the individual divisions are, for example, ‘operational cost’ and ‘revenue’. This is not Management By Objectives (MBO) if the senior leaders are involved in this process. There is bound to be one box that is the bottleneck adding to the cost. To reduce operational cost, we need to have cost transparency within GH. The employees need to know the budget allocation for their group and how it is managed every quarter. We need to have ‘Cost’ report outs just like the ‘Lean’ report outs. Then we will know what and how individual division is doing to reduce variation and hence reduce cost.

In short, in my opinion, if the work done by different groups can be measured using the same metrics then it is easier to spread standard work.