The Coming Transformation of Healthcare... Ready or Not!

Healthcare, as a system, is very stressed and getting more so. The reason healthcare should be looked at in a systematic way is quite simple, if little understood. Fact: Approximately 94% of the outcomes we experience in healthcare, good or bad, are a function of the systems in which healthcare is delivered, not the efforts of care providers. Care providers can do no better than the systems allow them to do.

For decades healthcare has been trying desperately to improve outcomes with little success. The big issues of the past remain the big issues of the day, only in most cases worse. Chronic issues such as quality of care, patient satisfaction, care provider morale and safety have gone down while care provider stress/burnout, staffing issues, and, of course, ridiculously high costs have continued to rise. Despite spending $billions on well-intentioned systems-based improvement programs such as six sigma, lean, Baldrige and others, these efforts have proved ineffective and, in many cases, made things worse rather than better. Healthcare keeps doing the same things over and over expecting a different result.

As with any problem, the first thing we want to do is understand the problem from a systems standpoint and identify the root cause of the problem. Healthcare has never done this as it relates to identifying the ever-growing stresses on the frontline care delivery systems. If it had, it might have discovered the Nobel Prize winning Law of Dissipative Structures, which describes how systems that resist change in a changing environment become stressed. As systems become more stressed over time, quality, productivity and safety go down while costs go up. That’s exactly what we’ve seen in healthcare. But it doesn't stop there.

Stresses in systems are passed on to the care providers who must work in those systems and patients affected by those systems. Now we have stressed systems producing poor outcomes, stressed care providers not functioning at optimum levels and stressed patients, which slows healing and craters patient experience. It should be noted that this transfer of systems stress on to care providers is the biggest contributor to care provider un-wellness and burnout.

Whether it’s burnout or quality of care or safety or cost reduction, problems that have plagued healthcare seemingly forever, the source of the problems is in the systems. The most impactful thing we can do to right now to address these problems is to fix, or better yet, transform the frontline systems where care is actually delivered.

Let’s start with what has to change in our approach to transformation of frontline care delivery systems. We have to shift from:

·     Top/down driven to bottom/up driven/implementation

·     A “push” implementation strategy to a “pull” implementation strategy

·     Programs requiring experts to easy train-the-trainer frontline driven facilitation

·     Complex SPC based tools to simple tools based upon the Law of Dissipative Structures

·     Scales through edict to scales organically with inputs from the frontlines and Admin

·     Buy-in to the program to ownership of the transformation process

·     Need for strong, ongoing top management support to need for less top management support

·     Doing only systems work to transforming both systems and growing people

·     Producing little ROI to producing significant ROI

I have been using this model in transforming healthcare systems for about 15 years. For frontline care delivery systems, it works quite well. But it’s more than that. The process of implementing this model in healthcare transforms lives, too. People grow. In particular, they become good or even great leaders, managers and problems solvers, even if they don’t have the title. Everyone wins, including care providers, patients, and healthcare organizations.

Will this model become more mainstream for the transformation of healthcare? We hope so. A large medical center/university is about two years into creating a case study for the transformation of the US healthcare system using this model, which will likely be published late in 2021. I’m guessing this paper will open some gates to mainstream healthcare, both in the US and globally. We’ll see.

In the meanwhile, I’ve created an online Train-the-Trainer Certification Program for early adapters who want to be catalysts and facilitators in the coming transformation of healthcare. There is also a lot of downloadable information on the model on our recently upgraded website: www.thenewagreements.com.

Ready or not, transformation is coming to healthcare. The Noble Prize winning Law of Dissipative Structures guarantees it. However, we can and should be proactive in transforming the frontline care delivery systems and avoiding what will likely be a meltdown of healthcare as we have known it. I believe a far better option is a bottom/up, frontline driven, transformation of systems where care is actually delivered. We can do this!