Redesigning Clinical Workflows to Return Joy to Patient Care
Are You Driving a Ferrari or a Porsche?

I recently was asked to work with a health system that is struggling with physician engagement in their Lean program. Nothing new about that. Doctors are so busy trying to take care of higher volumes of increasingly complex patients that they can’t afford the time to fix the dysfunctional workflows that stand in the way of them working effectively. Burnout and cynicism are rampant.

What was striking was the consistency with which everyone complained about the system leadership setting a target of 75th to 90th percentile performance while only funding for support equivalent to the 10th to 25th percentile. Most people on the front lines had simply resigned themselves to the struggle.

I tried to explain that they could achieve high levels of performance with low levels of resources, if they fully committed to Lean redesign and management.

During my two days there it was clear that some people were committed to Lean, many were ambivalent, and few really understood the significance, especially at the highest levels of the system. Top system leadership was focused on acquisitions, not operations.

As I was flying home I watched two episodes of Comedians in Cars Getting Coffee with Jerry Seinfeld that put this dilemma into perspective. If you are not familiar with this series, I encourage you, right after reading this post, to Google “Comedians in Cars Getting Coffee” and check out a few episodes. In each episode, Jerry picks out a cool car, then picks up a comedian friend to go get coffee and talk. Careful, they are so much fun that you may lose a few hours binge-watching these great conversations.

In the first episode I watched that night, Jerry picked out a four cylinder 1959 Porsche RSK Spyder to pick up Kevin Hart. “If you just want to go for a drive for the pure joy of it, I think it’s the best there is,” Seinfeld says of the 718 RSK Spyder, which was designed to prove to the big race cars with big engines that it’s possible to get better results with smaller designs. In fact, back in
1959, Volkswagen pulled together a team of top engineers who took every bit of waste out of the design. The car is impressively fast and exciting.

In the next episode, Jerry hosted Amy Schumer. Seinfeld chose a Yellow 1971 V12 Ferrari Daytona 360-GTB/4 for the occasion because Schumer “has some horse power.” This machine did not lack for resources. It also did not lack for problems. Shortly after picking Amy up at her apartment the Ferrari began to sputter, and not long after broke down altogether, leaving the comedians stranded in the Bronx, far from their original destination. Being professionals, they improvised and made due with another coffee shop where they carried on their conversation.

In the darkness at 34,000 feet somewhere over Nebraska it struck me – these two shows were the perfect analogy for what is happening in health care these days.

The Ferrari was loaded with expensive and plentiful resources, but was so poorly engineered and maintained that it could not even handle simple tasks without the operators having to figure out significant workarounds. This is the typical health system that pays more attention to growth and acquisition than to operations.

The Porsche is the epitome of Lean, using the talents of the team to get the most out of minimal resources, wasting nothing in the process. It not only got the operators where they were going, but they had a great time getting there!

This is the promise of Lean Done Right. We can achieve the Quadruple Aim – high quality, low cost, great patient experience, and return joy to patient care – if we embrace Lean and empower the people who do the work to harness their good ideas to make the workplace better.

Are you ready to ditch the Ferrari and hop in the Porsche?

What’s holding you back?

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