An interesting recent article published in the New England Journal of Medicine, authored by Michael Porter, M.D., has been circulating amongst my colleagues. The article, “What Is Value in Health Care?,” offers a number of interesting points that are worth considering in the context of our commitment to Lean Healthcare improvement.

Let me offer the readers of this blog a synopsis of Porter’s major points:

  • Porter proposes that achieving highest level of value for patients must become the overarching goal of all healthcare delivery. He suggests that increasing patient perceived value should define the framework for performance improvement in healthcare.
  • With recognition that value should always be defined around the customer, Porter suggests that value in healthcare can be considered as the ratio of successful patient outcomes achieved to the total cost of care for the patient’s medical condition. Porter allows that the current fragmented nature of healthcare in the United States sometimes makes it difficult to measure (and deliver) value.
  • Despite this difficulty, Porter suggests that measuring, reporting and comparing outcomes is perhaps the most important step toward improving patient service and making good decisions about reducing healthcare costs.
  • So what outcomes are important to healthcare customers (patients)? Porter points out that there is actually a hierarchy of outcomes for patients which all need to be considered in any value stream improvement effort. In this hierarchy, Tier 1 is patient survival and/or the degree of recovery. Tier 2 is the time required to recover the patient and return them to normal activities. Tier 3 represents the ‘sustainability’ of the treatment (i.e., limiting the reoccurrence of the patient’s original disease). To maximize value, all of these outcomes must be considered!

What does this mean for our Lean Healthcare activities? When we decide to improve a specific value stream by applying Lean concepts and tools, are we looking to improve the patient outcomes in all three of the ‘Tiers?’ For example, will our efforts be limited to getting the patient to the point of service quicker (removing delays and providing needed care sooner)? Can we also apply our efforts to facilitate a shorter, more successful recovery process (by removing barriers/bottlenecks)? Can we build standard work into our service processes that includes all of the care elements necessary to minimize reoccurrences?

As healthcare organizations continue to systematically apply Lean Healthcare concepts and tools to their patient value streams, we will need to keep in mind the potential impact of our work on every expectation and outcome of the patient’s visit. Improvements that don’t consider the complete “Voice of the Customer” are likely to miss the mark!

This week’s blog was written by David Krebs, a Director at Healthcare Performance Partners. Dave is a licensed Engineer who brought over twenty-six years of Lean experience in the Lean intensive automotive industry to the healthcare industry, and has worked with hospitals of all sizes during the past decade. Dave has successfully overseen the implementation both for profit and nonprofit health systems. David has held positions such as President, Plant Manager, Director of Product Planning and Program Management, Product Manager, Senior Engineer, Project Engineer, and Senior Staff Engineer. David has worked with companies such as BJKC-Americas Corporation, AlliedSignal/Bosch and AlliedSignal (a leader in the Six Sigma initiative throughout the world). Dave has worked with a number of HPP healthcare clients throughout the USA, as well as numerous other successful Lean Healthcare client engagements. Dave received his BS in Engineering from the University of Detroit, and received his MBA from Notre Dame.

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