True Value in Healthcare

In the year and a half that I've been working in healthcare, I've heard some really good arguments from some really smart folks regarding what makes an activity value-added.  Based on what I've heard, read, studied, and observed, the prevailing approach to defining value in healthcare is the following:

The Standard Definition of Value in Healthcare

Under this definition, for an activity to be considered value-added, it must satisfy three requirements:

1. The activity must be something the patient wants/needs
2. The activity must be done correctly
3. The activity must change the form/fit/function of the patient

If it does not satisfy all three of these requirements, an activity is considered non-value-added under this approach.  

This is a pretty strict approach, especially considering that it does not recognize the value of activities that contribute to the correct diagnosis of illness, something which I believe is of tremendous value to the patient.  Until recently, I've tended to favor a slightly more lax definition of value.  

But the more and more I read about Population Health and ACO, the more and more I've begun to question the the standard definition of value in healthcare.  I've started to subscribe to a more systemic and holistic definition of value, which I refer to as True Value.

My Definition of True Value in Healthcare

The following two guidelines define my current, half-baked view of "true" value in healthcare:

1. If an activity is related to providing care for a preventable illness, it is waste.
2. If an activity is related to providing care for an unpreventable illness, and satisfies the three requirements of The Standard Definition of Value in Healthcare as shown above, it is value-added

Thoughts?  

FYI, I prefer comments on LinkedIn or Twitter, so I've shut off comments on this blog.

Thank you for sponsoring my Little League team.  Those mesh hats were sweet.

10 Complexities in Hospitals

Having worked in a hospital as a Lean Coach for about a year now, I've grown accustomed to dealing with a wide range of complexity related to healthcare, and hospitals in particular.  Here's a list of some of the types of complexity I've seen in the hospital (it's not an exhaustive list by any means, and is in no particular order)...

1. We often have no ability to control/level the volume going into the system, especially in an ER setting
2. We have seasonal, weekly, and daily volume fluctuations
3. We often have a wide range of acuity levels, which are high-mix, low-volume in nature
4. Clinical workflows are often controlled by complex computer systems, which makes some processes more inflexible that we'd prefer
5. The most highly-trained and often most powerful people in a hospital are the physicians, who are also the "touch labor" for our front-line processes
6. We have 24/7/365 business hours, making cross-shift collaboration a challenge sometimes
7. In pediatric hospitals, we have to design processes that accommodate the needs of both the patient and their family
8. In academic hospitals, we often have to design processes with educational needs in mind
9. The customer and the payer (insurance companies, Medicare, etc.) are often not the same entity
10. In places like Texas, we have huge language barriers that our processes have to accomodate

Every industry has its own sources of complexity.  Healthcare, and hospitals in particular, bring special types of complexity that are pretty challenging.  I personally love the challenge, but I also realize that I have a long way to go if I want to be a Lean Coach who is capable of overcoming the complexity found in hospital systems.