Lean for Service Operations: Improving Healthcare

A day spent on the phone with tech support or in line at the DMV is enough to illustrate the inefficiency and waste in fragmented systems. But when we’re talking about health care, fragmentation is tragic. Recent legislation in the U.S. has attempted to bridge some of the system’s most jarring gaps, but health-care companies still tend to focus on individual components of the patient journey, maximizing immediate efficiencies but losing sight of the total experience. Consequently, patients are shuttled from generalist to specialist to surgery to clinic to pharmacy, passing though dozens of different rooms and record systems along the way. Each of these transitions presents a pain point to the patient and an opportunity for error to the provider. It doesn’t take a designer to see what a difficult journey this is, rife with redundancy, wasted effort, and potentially catastrophic mistakes.

But design can help. What design thinking can offer is a practiced eye for integration opportunities: connecting adjacent but unconnected pieces of the patient experience to create small, incremental improvements. The integration process begins with a question””What’s right for the patient?””and proceeds to a deep examination of the patient journey, resulting in a holistically designed experience that benefits all.

A New Home Ventilator

Respiratory support, for example, has historically been divided into two quite different types. In the hospital and clinic, patients can be hooked up to a number of different mechanical ventilators”expensive, complicated pieces of machinery that allow clinicians to control breathing support precisely. At home, PAP ventilators are used, smaller, simpler, noninvasive devices that home caregivers can operate. Philips Home Healthcare, one of the world’s largest manufacturers of these devices, recognized an opportunity to bridge the two categories. Working with them, we developed the Trilogy100, which combines much of the function of a hospital-grade ventilator with a dual-mode interface, meaning clinicians get the control and information they want, and home users get an unscary device with an intuitive control panel. This means fewer costly trips back to the clinic and less paperwork for administrators, while the unit’s portability allows chronic patients to integrate therapy into their daily activities, affording them greater independence. It’s a small step toward integration, but for patients with respiratory problems, a potentially life-saving and life-enhancing one. Philips estimates it’ll have won 20 percent of the home ventilation market within the first 18 months of the product’s release.

Kaiser Permanente’s “Total Health” initiative emphasizes preventative over acute care. In December 2009, Allison Arieff wrote a story in The New York Times about the health-care giant’s attempts to rethink and redesign every aspect of its operations, “from medical records to medication administration, color palettes to carpet,” all in an effort to create more integrated patient experiences. Kaiser identified 22 key steps in a patient’s journey, including check-in, visiting the pharmacy, even walking along a corridor. Changing the design of the patient bed’s headboard saved Kaiser $2,369 per room. The real beauty of this initiative? Kaiser is a highly visible player in the industry, and other providers are watching them closely for signs of success.

Integrating Records and Communications

A more ambitious take on creating an integrated health-care system is being piloted in “medical homes” across the country. Already supported by such insurers as Aetna and UnitedHealthcare, medical homes rely heavily on self-administered home tests and frequent communication between patients and their primary care physicians. Services include “round-the-clock access, electronic health records, use of e-mail and phone communication, patient feedback, and fee for service and fee for performance,” according to a CNN Money report. The aim is to connect purchasers, payers, and providers to improve care and lower costs.

Initial results are promising: the article cites the Geisinger Medical Home Initiative in Pennsylvania, which tested a pilot in 2006 and found a reduction of nearly eight percent in hospital admissions among its Medicare patients and a four percent reduction in medical costs. Members with access to a virtual health-care provider were less likely to be admitted to a hospital, while in the case of chronic kidney disease patients, “improved performance measures resulted in drug cost savings of $3,800 per patient per year,” according to a Health Policy Monitor report.

That integration improves the user experience and reduces costs should come as no surprise. Apple’s (AAPL) sustained growth over the past decade is largely attributable to its integrated hardware, software, media, and retail experiences, and even classic American business successes such as Ford (F) in the 1920s and McDonald’s (MCD) in the 1950s are primarily stories of integration. Health care, like any other consumer-facing industry, has much to gain by bridging gaps and linking adjacent offerings. And with 32 million new users promised by the passage of recent legislation, they’ll have no shortage of opportunity. ↩