To achieve a state of habitual excellence, an organization needs to have three key systems in place:
- Work system
- Improvement system
- Management system
To explain these three systems, we share an excerpt from a white paper about improving primary care at Sutter Health.
The primary care patient-visit workflow requires synchronization among employees (i.e., doctors and medical assistants). Without this coordination of work, at times, doctors are late seeing patients, some patient visits are rushed to catch up, and a significant overburden is put on everybody in the clinic. During the exam process, each system has a role to maintain the patient-visit workflow, improve this workflow, and sustain improvements.
Work system — the designed flow and sequence of activities, connections, and tasks that need to occur to properly and efficiently conduct a patient exam: “How do we make sure that the doctors and medical assistants have the knowledge, the tools, the supplies, and the capability to do this work as a well-coordinated team?” asks Value Capture's Didier Rabino. “How do we make sure that this team will always be successful to do the work, and ensure that we give them everything that is necessary to meet the safety, quality, and time requirements?”
Improvement system — identification of both the problems and the opportunities in maintaining flow between successive patient visits: An example would be the exam of new patients, which requires more time. “The new-patient visit cycle time was one of the problems preventing us from maintaining a reliable flow of patient visits,” says Rabino, “and the improvement system was there to capture this problem in real time and engage the team to solve it. When the system visually elevated this problem, the pilot team asked themselves what part of the new patient visit could be done outside of the physical exam. A registered nurse is now proactively doing some of this work by phone, therefore eliminating the cycle-time variation problem.”
Management system — elements to ensure employees are successful in doing and improving their work, and maintain flow: “When the patient visit takes longer than planned, as was the case with new patient visits, the medical assistant sends an electronic signal to elevate the problem in real time,” says Rabino. “At this precise time, the management system kicks in with the overflow process. An ‘overflow' medical assistant starts rooming the next patient to keep the flow going, and the problem is documented for the team to solve.”
Want to hear more about how Sutter Health used the three systems, and more, to drive measurable and sustained improvement? Get the full white paper today.
Hear More From Didier Rabino
Mark Graban is a Senior Advisor for Value Capture and has served healthcare clients for over 15 years. Mark is internationally recognized as a leading author and speaker on Lean healthcare. He is the author of books including Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, and Measures of Success: React Less, Lead Better, Improve More. He is also host of our “Habitual Excellence” podcast. Mark's full bio