Belief #1: As long as we have an expert involved, we can ensure a successful outcome. Belief #2: Financial analysis identify opportunities for improvement.

Belief #3: The only way to structure an organization is in a hierarchy.

Wikipedia

2016 Aviation Error

300 people died worldwide in commercial aviation incidents out of 3.5 Billion passengers

Wikipedia

2016 Medical Error

• 3rd leading cause of death in the U.S.

• 250,000 preventable deaths annually

• Under-recognized cause of death

John Hopkins patient safety study 2016

Process Engineering

The design of business processes to achieve dramatic improvements in productivity and quality by focusing on delivering better value to the customer.

Patient focus, process driven improvements

5X faster care in Emergency Rooms Expert-focused: 7.5 hours Patient-focused: 1.5 hours

Post-surgery staph infections reduced by 50%

Hospital acquired infections cause 99,000 deaths each year

Source: Centers of Disease Control

Experts only perform as well as the processes they follow.

- Dawn Holly Johnson

Without good process, each expert will respond differently to an issue

No accountability for other departments solve issues and get back to Customer Service in a timely manner

What causes the issues in the first place?

I have a sore throat… 1. Schedule and appointment 2. Wait 2 days 3. Travel to Doctor 4. Wait to check in 5. Fill out paperwork 6. Wait in waiting room 15 minutes 7. Nurse takes vitals, documents for Doctor 8. Walk to Exam Room 9. Wait for Doctor 10 minutes 10. Doctor examines me 11. Doctor prescribes medication 12. Pay for visit 13. Travel to Pharmacy 14. Wait to give Rx to Pharmaceutical Assistant 15. Wait 30 minutes 16. Receive Rx 17. Pay for Rx 18. Drive Home

Valuable to Patient

Valuable to Patient

Valuable to Patient

I have injured my shoulder… 1. Schedule an appointment 2. Wait 7 days 3. Travel to Specialist 4. Wait for Paperwork 5. Fill out Paperwork 6. Wait in waiting room 15 minutes 7. Nurse takes vitals, records for Doctor 8. Walk to Exam Room 9. Wait for Doctor 10 minutes 10. Doctor examines me 11. Doctor prescribes MRI 12. Drive Home 13. Make appointment for MRI 14. Wait 5 days

15. Travel to Testing Facility 16. Wait for Paperwork 17. Fill out Paperwork 18. Wait in waiting room 15 minutes 19. Walk to Exam Room, change 20. Wait for Technician 10 minutes 21. Perform MRI 22. Drive home 23. MRA results analyzed 24. Wait for Results 5 days 25. Schedule appointment with Specialist 26. Wait 8 days 27. Wait in waiting room 15 min 28. Taken to exam room 29. Receive Diagnosis 30. Sent to Physical Therapy

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Traditional Focus is waiting for various experts to be available to serve you

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Value Stream Focus Delivers Full Value to the Patient

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Executive 1: Common Ailments Healthy

Executive 2: Joint Injury Value Stream Improved Mobility

Multiple Value Streams can exist in one organization

General Practitioner

Various Specialists

Common Belief Actual Truth Focus on Expertise Experts only perform as well as

the processes they follow Budget Analysis used to identify opportunity

Process Analysis reveals hidden opportunities

Organize Resources by Function in a Hierarchy

Align Resources to Value Streams

Medical Error 3rd leading cause of death Medical Error rates dramatically reduced

It is not enough to do your best; you must know what to do, and then do your best.

– W. Edwards Deming