It is a time of upheaval once again in healthcare as we try to anticipate changes based on a new administration, promises to repeal and replace or repair the Affordable Care Act, prescription drug pricing and a host of other contentious issues which impact reimbursement, regulatory requirements and quality incentives.  Don’t worry, I won’t use this blog to share my own political views.  But in this time of change, I seem to be spending time thinking about what we do next in providing the best quality of services at the lowest cost and the highest experience.

There is an analogy from hockey that is often used in determining our planning, which is, “To skate to the puck”.  The inference is that we need to move towards where the puck will be, not skate to where the puck is now and not just stand still and wait for the puck to come our way.  The latter two actions will always leave us behind and unable to successfully react, while the former anticipates the direction the puck will take to put us in position to move forward to achieving our goals.

As I have had conversations with healthcare executives, it has struck me that those who are calm have a disciplined adherence to three activities to driving their organization’s planning.

  1. Focus on the goal by staying connected and understanding what the voice of the customer is telling you. Moving back and forth between what we think might happen to healthcare reimbursement and regulation is wasted motion and excess processing.   The customer is the puck, when we align our work to their needs we spend our time increasing value.
  1. Understand the current value stream for meeting your customer’s needs. While external assessment is important in your organization’s planning process, internal assessments are just as valuable in informing where improvements are needed.   The hockey player not only knows where the puck is, but is also aware of where their teammates are and what the plays are to get the puck to the goal.  Plays (or the value stream) can be modified to adapt to the situation the player finds themselves in.
  1. Continually drive out waste in your value streams to increase the value provided to customers. Driving out waste allows one to be agile when reimbursement and regulations change, as resources are freed up to provide more value. In driving out waste, determine the biggest problem between how we currently provide value and what the customer values.  Using Pareto thinking will help you allocate your time effectively.  For example, even if bundled payments stay as a quality incentive, focusing on heart failure when this population is small in your community is not aligning your resources.  Focusing on heart failure when this population is a large portion of the patients you see is always the right thing to do.  Hockey players may not look as graceful as figure skaters, but they are able to turn on a dime when the puck changes direction.  Eliminating waste in your organization gives you the agility to change directions when external changes are known instead of just hypothesized.

Focusing on the long term vision is a key to successfully navigating the changing times and reimbursement.  For Lean Healthcare organizations, “true north,” or the long term vision, generally stays the same despite the winds of change in our environment.  Our plans can adapt if we know our customers, what they value and we continually strive to drive out waste, improving the value we deliver to our customers.


Maureen Sullivan, Senior Manager for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Maureen Sullivan, RN, senior consulting director at HPP.

Maureen has 30 years of healthcare experience in clinical nursing, management and quality leadership.  As a registered nurse, Maureen’s clinical experience is in medical-surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels.

Maureen has a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from the National Association for Healthcare Quality as a certified professional in healthcare quality (CPHQ).

Image by Freepik

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