Clinical Process Improvement – Augmented Reality
Healthcare is an industry that affects everyone, but one that has historically had a reputation for less-than-positive customer experiences. However, customer experience is now becoming a focus of many healthcare companies and clinics. This is aided by new approaches and technology that have the power to transform healthcare. Here are five top trends for healthcare customer experience for 2019 and beyond.
Augmented Reality Training For Healthcare
Augmented reality is a trend across all industries, but it is especially powerful in the healthcare field. One of the strongest applications is in medical training. Using AR, healthcare providers can see diagnoses and procedures right in front of them to learn new skills and expand their knowledge. Augmented reality also makes it possible to train more providers at once, which could fight the shortage of trained professionals around the world. Imagine a doctor being able to have treatment options pop up on a screen as he looks at different conditions or have growth charts appear around a child during a checkup. Instead of doctors having to spend more time reading studies to refine their skills, the information they need can simply appear in front of them as they seamlessly treat patients.
Leveraging Data For Healthcare
Healthcare has always used data, but new types of data and ways of collecting it will impact customer experience. Automated systems can comb through huge amounts of data in real time to provide the best patient experience. Healthcare data comes in many forms, from post-visit feedback surveys to numbers of what days and times are the busiest so clinics can properly staff their offices. Data can predict when a patient will get sick so that preventative action can be taken, create personalized healthcare plans, and potentially limit the spread of diseases before they grow out of control. It also allows providers to have a more complete view of each patient, which can potentially remove the pre-visit intake questionnaires, which customers say is the most frustrating aspect of healthcare.
Customers today don’t have time to be sick, and they don’t want to wait around for services they don’t need. With the growth of data comes the ability to personalize the healthcare experience. Starting today and growing in the future, healthcare offices will be able to create a completely personalized experience for each customer. Instead of everyone being treated the same, clinics will be able to use data to see what doctors a patient prefers, if they like being seen in person or remotely, their health history, and any potential health issues. That means that instead of having to navigate through a complicated web of healthcare representatives, a patient’s information will be easily accessible so the right treatment options, preventative care, and recommendations can be made.
Using Wearable Devices In Healthcare
Wearable devices are powerful tools to keep patients involved and invested in their personal health. The most frequent users of wearable devices are people who are less healthy than average and more likely to need to be hospitalized. Devices like activity trackers help customers stay more active and healthier on their own, which can decrease their need to see a doctor, while more advanced devices can monitor patient health metrics such as blood pressure, heart rate, and diet on the go. Instead of having to go to a clinic for monitoring, patients can do it at home and always be connected to a doctor. If a monitored patient’s blood pressure spikes, the doctor can receive a notification and take action. Wearable devices are a less invasive way to still get great care.
Hospitals Using Smart Technology
Advances in technology have created a new wave of products to improve patient comfort and care. Using connectivity and automation, these tools alleviate some of the pressure on healthcare providers and once again put customers in control. An overwhelming 94% of healthcare executives said in a recent survey that they plan to implement smart technology in their organizations. Smart technology comes in a variety of forms to increase comfort and efficiency and decrease risks. Hospitals around the country have started using smart beds that self-adjust to the correct pressure and support for each patient’s preferences and condition. Other clinics are using robots that can monitor a patient without a human provider being in the room. Smart devices and applications will continue to grow and spread throughout the healthcare field.
Blake Morgan is a customer experience keynote speaker, author of More is More and futurist.
Clinical Process Improvement – The Innovator’s Prescription
The Innovator’s Prescription (published by McGraw-Hill) argues that disruptive innovation is required to make health care affordable. In this excerpt, the authors look into the ways disruption can help hospitals, which in our current health care system are tasked with the impossible job of doing everything well and keeping costs down at the same time.
In order to understand how to “fix” hospitals, first it’s important to understand the value proposition of hospitals. Hospitals have become the workshops within which physicians could be trained and practice their intuitive craft, clinical laboratories where complex medical cases could be solved and unanticipated emergencies and complications could be resolved with as much certainty as possible. This value proposition has been a great fit for solving poorly understood problems of the past, such as tuberculosis in the early 1900s, poliomyelitis in the 1950s and AIDS in the 1980s. When these diseases were first encountered, they had to be addressed in hospitals. However, in terms of the complexity of diagnosing and treating disease, for a century hospitals have been on a relentless upmarket march on the trajectory of sustaining innovation.
An administrator in one of the major Boston-area teaching hospitals estimated for us that 70% of the patients in his hospital today would have been in the intensive care unit 30 years ago, and that 70% of the patients in his intensive care unit today would likely have been dead 30 years ago. His hospital has become extraordinarily capable of dealing with very complicated problems. But in the process of adding all of that capability and its attendant costs, the hospital has overshot what patients with straightforward disorders can utilize when they are admitted. An important lesson from our studies of disruptive innovation is that the hospitals providing much of today’s health care cannot, and therefore ought not, be relied upon to transform the cost and accessibility of health care. Instead, hospitals need to be disrupted. We need them to cede market share to disruptive business models, patient by patient, disease by disease starting at the simplest end of the spectrum of disorders that they now serve.
The Business Model of Hospitals
Why are hospitals so costly? The answer lies in an examination of their business model. Every viable business model starts with a value proposition–a product or service that helps customers do more effectively, affordably and conveniently a job that they’ve been trying to do. “We will do everything for everybody” has never been a viable value proposition for any successful business model that we know of–and yet that’s the value proposition managers and directors of general hospitals feel they are obligated to put forth. A company might want to be all things to all people, but this isn’t what customers need. There are few patients who are searching to “hire” a health care provider that can do everything for everyone else. Rather, customers of health care delivery generally find themselves needing one of two jobs done. The first might be summarized as, “I need to know what the problem is, what is causing it and what I can do to correct it.” The second job would be, “Now that I know what needs to be done to fix my problem, I need it to be done effectively, affordably and conveniently.” Delivering a value proposition to do the first job requires a solution-shop business model organized around intuitive diagnostic activities; the second job requires a value-adding process business model organized around the efficient delivery of specific procedures.
We know of no business that has successfully housed two fundamentally different business models within the same operating unit. Were it not for today’s tangled web of subsidies, administered prices and regulations that constrain competition, today’s general hospitals would not be economically or competitively viable.
Problems Created by Commingling Business Models
When the same hospital seeks to fulfill these two very different value propositions, the consequent mandate for two types of business models creates extraordinary internal incoherence. The resources and the essential nature of the processes inherent in the two business models are different. Their profit formulas are different as well. Solution shops need to get paid on a fee-for-service basis. Their fees cannot be based on outcomes, because many factors beyond the accuracy of diagnosis affect the results. In contrast, value-adding process businesses can routinely sell their outputs for a fixed price, and they can guarantee their results. Many market-oriented students of our health care systems bewail the fact that hospitals and physicians don’t readily disclose the prices of what they do, or the outcomes they achieve. The value of the services being offered therefore isn’t measured–and as a result, the normal market mechanisms that drive performance, efficiency and customer-centeredness don’t exist in our health care systems. What these critics have not yet understood, however, is that the value actually cannot be measured, because the metrics of value in the two different business models are so different.
The value of products and services can only be calculated by comparing their prices and expected outcomes, relative to the job to be done, but the jobs for which the solution shops and value-adding process services of hospitals are “hired” to do are very different. Meanwhile, reimbursement formulas typically price both types of hospital services on a fee-for-service basis, with overhead costs spread across them in highly distorted ways. The result is that the value of what general hospitals do simply cannot be measured–let alone compared.
Recommendations for Hospitals
Our first recommendation is that hospitals need to deconstruct their activities operationally into the two different business models: solution shops and value-adding process activities. This can be done by creating hospitals-within-a-hospital, or by building distinct facilities. In either case, the work done within each business model must be organized differently, and their cost accounting and pricing systems must be separated and structured in ways appropriate to each. Our biggest and best medical centers will be able to bifurcate themselves. Smaller hospitals, however, will need to focus on becoming solution shops or value-adding process hospitals, or simply expect to be liquidated through disruption. The reason why this division is such a crucial first step is because of the two different jobs-to-be done for general hospitals. Only when an organization’s resources, processes and profit model are focused around a job-to-be-done can they be integrated in a correct and optimized way that does the job as perfectly as possible. Dividing hospitals into solution shop hospitals and value-adding process hospitals ensures that each type of hospital can be integrated in a way that gets its particular job done most effectively.
Solution Shop Hospitals
The typical general hospital’s solution shop is set up to tackle any disorder in any part or system within the body. To deliver on this promise, a good general hospital must have one of every type of diagnostic equipment and at least one physician from every sub-specialty on staff. The capability to address such problems cannot reside in standardized processes. Rather, it is largely resident in the hospital’s resources–the intuition, training and experience of the people who practice there and the equipment at their disposal. Indeed, these individual pieces of equipment and the individual specialist physicians must be kept separate, not tightly linked by processes, in order to have the flexibility to do anything for anybody. A friend of ours has suffered from asthma for much of his life. Each specialist he saw seemed to have another possible remedy. It got to the point that he was taking multiple medications with multiple side effects, whose combined cost at one point exceeded $1,000 per month–yet he was still not well. Then he visited the National Jewish Medical and Research Center in Denver. National Jewish is a solution shop focused on pulmonary disease, particularly asthma. National Jewish is integrated in an optimal way to diagnose the root cause and prescribe the best possible course of therapy, for disorders of the respiratory system. When our friend arrived, they administered a unique battery of tests, then assembled an allergist, a pulmonologist and an otolaryngologist–also known as an ear, nose and throat, or ENT, specialist–to meet with him. They integrated their perspectives on his long medical history together with the test results, told him what was causing his symptoms and prescribed a straightforward course of therapy that finally solved his problem.
In the general hospital systems in which our friend previously sought solutions, each of these specialists existed. But they weren’t integrated in the right way. He had seen each of them individually and was passed from one individual specialist to the next. Indeed, the individuals he saw were typically trying to participate in both the solution shop and value-adding process business models in their hospitals. What these disjointed general hospital solution shops had been unable to do, a coherently integrated solution shop could readily do. Why? A key reason diseases remain in the realm of intuitive medicine is that they arise at the interdependent intersection of two or more systems of the body. Studying the disease from the perspective of only one of those systems, therefore, can’t develop an integrated solution consonant with the integrated nature of the disease. The Texas Heart Institute is a focused solution shop for cardiovascular disease. The Cleveland Clinic has created “institutes” within the clinic that are focused solution shops. One is a heart and vascular institute. Another is a neurological institute populated by neurosurgeons, neurologists, psychiatrists, and others whose work processes are integrated together in a way that optimizes diagnosis and therapeutic recommendations.
The Mayo Clinic is similarly organized. Patients there are processed through solution shops whose specialists, equipment, and procedures are knitted together across each of the potentially relevant organ system specialties, in order to provide the best possible diagnosis as fast and at as low a cost as possible. Once the diagnosis and recommendations have been made, they tell their patients, in essence (and using our language), “Now this is what needs to be done. You can go over there to our value-adding process organization to have it done, where we’ll charge you on a fee-for-outcome basis. Or you can return to your hometown and have it done there. Your choice.” Isn’t it too expensive for the average patient to travel to these distant solution shops? No. It’s cheap. Two thousand dollars for our friend to travel to Denver was a pittance to the system, compared to thousands of dollars spent on the wrong prescription drugs and devices that were the result of inaccurate, incomplete diagnoses by a stream of individually operating specialists. An accurate diagnosis ensures that you don’t waste money and lives solving the wrong problem.
We believe that, ultimately, focused solution shops will be able to bill fee-for-service rates that cover not just the full cost of their services, but also begin to reflect the value of their work. Current reimbursement formulas constrain and distort this at present. Are value-adding process clinics good or bad for health care? The “specialty vs. general” categorization scheme is a faulty distinction that leads to serious misunderstanding and miss-measurement. Some specialty hospitals such as National Jewish, noted earlier, are coherent solution shops. Their focus allows them to put processes into place that integrate the work of multiple specialists in a way that optimizes delivery of the value proposition. Because the care is still the realm of intuitive medicine, and because feedback from treatment decisions is essential to the learning that takes place, diagnosis and therapy in these institutions must be one and the same. The organizational structure of coherent solution shops like National Jewish makes it possible for the patient to be in the care of a true team. On the other hand, the organizational structure of the typical general hospital, with its separate departments of specialty care, typically leaves patients in the care of individuals–often several individuals passing the patient from one to another–since the current structure makes working together and coordinating care cumbersome.
Other specialty hospitals are value-adding process hospitals. These include surgery centers, both inpatient and ambulatory. Some of these do many types of surgery, while others specialize in a specific type. For example, the Shouldice Hospital, north of Toronto, repairs only external abdominal wall hernias. The Aravind Hospitals in India do eye surgery, and the Coxa Hospital in Finland focuses on hip and knee replacement surgery. Meanwhile, the Cancer Treatment Centers of America offer treatment for dozens of cancer types, even integrating complementary and alternative treatments not typically offered at traditional hospitals but all in a value-adding process model aimed at following the diagnosis of cancer made elsewhere. Just as solution shops focused on a job can integrate in ways that optimize their effectiveness, VAP hospitals, because they focus on a job, can integrate in optimal ways as well. Because they can optimally integrate the entire process–from pre-admission preparation to the surgery process to rehabilitation to discharge–value-add