As you read this, the next global pandemic may be “now stirring to life inside a bat cave in a little-known region of the world.”
Authors Kim Barnas and John Toussaint, MD, make that ominous observation at the start of “Reinvention,” the last chapter in their recent book Becoming the Change. And while we don’t know what deadly pathogen will come next, we do know that the fee-for-service model does not reward health systems for being prepared for a pandemic, so most were not ready for COVID-19. To be sure, there were cases of outstanding response by health systems around the country, but they amounted to islands of excellence.
In the final chapter, the authors, renowned healthcare transformation experts, examine what it will take to reinvent healthcare models through innovation. And while they don’t claim to have answers, they do propose a new process for finding them. An excerpt, edited for length, follows.
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Think of all the problems you and your organization encounter, and you can visualize all those problems falling into one of four buckets: simple, complicated, complex, and chaotic.*
- Simple problems have a root cause that is easily identifiable and usually have just one good solution.
- Complicated problems have a root cause—sometimes more than one—and have multiple good solutions. Think about addressing the issue of wrong-site surgery, for instance. A team will need to include some technical expertise to address a complicated problem, but repeatable solutions that work every time are still possible in this category.
- A complex problem has multiple variables with no predictable cause-and-effect relationship. This is where we use small-scale probing, prototyping, and experimentation to allow unique solutions to emerge from the system. Think of a complex problem such as moving a health system’s economy from fee-for-service to population health. If a team pondered all of the unknowables while searching for root cause before taking action, it would not be presenting solutions in this decade or, maybe, ever. If a team implemented sweeping changes all at once, on the other hand, it would introduce enormous risk for total system failure. So, teams are encouraged to nail a small boat together, so to speak, and see if it floats.
- The final problem type, chaotic, has many roots and courses of action and is usually fast-moving. It is unpredictable. Think about a tsunami heading for a nuclear power plant or a new coronavirus sweeping across the globe unchecked by immune resistance, and you have a chaos problem.
Health systems using lean thinking or Toyota Production System methods have often turned to 3P—production preparation process—to unleash creative solutions. And there is much to applaud in that model. While we were at ThedaCare, teams used these ideas and tools to completely remake the patient care path on hospital units in something we called Collaborative Care. It was breakthrough work that John highlighted in his first book, On the Mend. And Seattle Children’s mastered 3P while recreating the flow of outpatient surgery in its Bellevue Clinic.**
Some work, however, involves deeper questions than how to better coordinate and streamline patient care within a current environment. For complex problems, we need to question every assumption about our current state. This is the work we will investigate here.
New Care Model Development
New Care Model Development is a multistep, team-based exploration into a complex problem and its possible solutions. Care models, specifically, are systems designed within regulatory boundaries that deliver value to a population, group, or patient cohort. Successful care models must also provide a good place to work for providers and staff and deliver sustainable business results. They are designed through the coordination of six elements: people, processes, equipment, locations, methods, and information.
New Care Model Development is time-intensive at the opening stage, often referred to as research or discovery. This is where the team needs to throw out everything they think they know and go out in search of answers to critical questions. What are the patient needs? What are the clinical requirements? What are the payment contracts? What is the current journey? What are competitors doing? What is the current state, really?
In this research phase, we value divergent thinking. We want the team to remain open to all possibilities. So we broaden the questions even more. What is happening on planet Earth? What are the political, economic, social, technological, and environmental factors that influence our organization and our patients, now or in the future? What legal developments are changing the landscape? The team’s attention should be open to all factors.
Diversity of experience among team members and respectful communication are requirements here. Team members will be conducting deep interviews with stakeholders, compiling results, and diving down some pretty deep research rabbit holes to do the job. Frank and freewheeling discussions inside the team are expected but are only useful if they are respectful and driven by new facts unearthed in diligent investigations.
So far, given the complex nature of care models, three months has been a manageable lower limit for this initial phase. Beware of strict deadlines, however. The team needs breathing space to let their minds depart from today. After all, we are looking for ways to win in a radically new way.
This leads to the phase in which the team develops solution concepts based on what they learned in their exploratory research, pulling together ideas for radical leaps into the future. After the push to diversify knowledge and thinking, this phase is where the team converges on a compelling vision for the future. (The team should expect to diverge and converge thinking in just about every phase.)
Developing concepts will often overlap with the prototype phase, where ideas are given physical form. Perfection is the enemy of bold experimentation here, and teams are encouraged to fail fast, fail cheap before investing large swaths of resources. This is where a team gets basic proof-of-concept for whether their vision of the future care model is desirable, technically feasible, financially viable, and has the clinical impact they envision. We have used ideas and tools from Design Thinking, agile, and Lean Startup3—all popular in the technology sector—to encourage people to sprint toward real working prototypes.
This is the only place, we believe, in a continuous improvement environment where people are encouraged to jump to solutions. That does not mean we want bosses blurting answers. But we do want people thinking about workable concepts throughout this process.
Once a team has proven their concepts through prototyping, members must build and test the care model, run it in a clinical environment, and evolve based on real needs and limitations. The team—which has also evolved by this point to include new members with new specialties—remains actively involved, collecting and analyzing data to gauge whether the new care model is meeting its targets.
At the end of building and testing, the care model should be evaluated for scaling. Go-to-market concepts should be incorporated into the enterprise strategic plan to engage broader operational planning and resources for the diffusion of the new model across the enterprise or new market.
The future of healthcare, we believe, rests on the creation of development value streams. Covid-19 exposed major weaknesses and opportunities for us as caregivers. We have needed new care models for years. But now, the lives of our grandchildren depend on our ability to innovate.
We can push ourselves past immediate fixes, go further than a cool new app. If we can think and act differently, if we can build a repeatable process to foster creativity as outlined here, we can get there.
To Do:
- Read case studies of how New Care Model Development works in Becoming the Change, which provides a blueprint for a revolution in how healthcare executives behave, lead, and innovate. Get your copy here.
- Listen to a webinar with the authors who cite examples and describe a blueprint for how leaders can embrace behaviors that create positive and lasting organizational change. Go to the webinar.
- Read the recently released white paper that details New Care Model Development.
* With thanks to Dave Snowden and his Cynefin framework. For more information: www.cognitive-edge.com
** See Management on the Mend (ThedaCare Center for Healthcare Value, 2015), pages 42–47.
