Patient Experience Meets Roemer’s Laws of Evolution

There are people who believe that to improve the effectiveness of a business you must belong to one of two camps; the business process camp where you get the same result every time—a structure for predictability, or the creative process camp where you get a different result every time—a structure for possibility.

Let’s look at the here-and-now.

Most businesses, including hospitals, have, according to Roemer’s Laws of Evolution—think Darwin without the bit about fish walking from the sea—processes in place that have evolved over time.  Individual processes have evolved from multiple ways of performing a task to a single way of doing a task.  Inefficient ways were eliminated, and we settled on one efficient—fast—way of executing a process. If we still do not like the process, we hire and expensive firm and squeeze out a few more seconds by using some form of twelve-sigma approach.

When we are done, what we have left is a process that is as fast as we know how to make it, a process by which we get the same result every time. We have created a structure of predictability.

The process may not even be necessary, and the results from the process may not be correct—think effective, but we have figured out how to make that ineffective process very fast. And after all, fast is good. Right?

Having arrived at this point in the process evolution process, we have arrived at a point of stagnation.  There is very little left to tweak, and the last person who uttered the words ‘change’ or ‘innovate’ in a meeting is now working as a barista at Starbucks.

That is why patient experience improvement efforts have stagnated. What inertia there was to improve it has become the inertia of passivity.

I am not arguing that having patient experience processes and patient access processes that yield the same result every time is a bad thing. In fact, I believe that result to be the goal; processes that do the same thing every time.  However, what would happen if a priori to this singular way of doing things we added a structure for possibility?  What if we allowed creativity into the mix?

For example, what if?

What if instead of asking how do we improve the process people experience when they call the hospital we asked—what if people did not have to call the hospital? Do you know why people call the hospital? They call because they have no other alternative to meeting their needs.  What if—and I know this borders on the edge of credulity—people did not need to call? What would that entail? What would the business look like?

What if instead of asking how do we improve the process people experience when they are admitted to the hospital we asked—what if people did not have to be admitted?  But what would we do with the waiting area, the admissions desks, and all of those outdated copies of Highlights Magazine, you ask. 

There is not rule that requires you to keep a process just because the process is efficient.

Eliminating a process yields the ultimate in efficiency.

Instead of shaving thirty-two seconds off of the time it takes to admit someone, why no eliminate admissions? What would that look like?

One of my consulting clients had seventeen call centers.  They asked me to help them create a call center strategy. At the kickoff meeting I announced we were going to operate under the assumption that we were going to close all of the call centers. One executives argued, “You cannot close all of the call centers because we receive over four-hundred-thousand calls each month about our bills.”

I replied, “At thirty dollars a call, you are spending $144,000,000 a year, each year, talking to your customers about your bills. Can’t you fix your bills for less than $144,000,000, or eliminate your bills?”

Once you get that process fixed make it repeatable, make it yield the same result every time.

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