Rethinking Value Streams In Healthcare
Value stream maps are a great way to see your processes in a way that a customer or patient will see your processes. A typical value stream for a hospital might be a diabetic patient who is over the age of 70 and is coming in for chest pains. Another example might be a heart surgery patient. The granularity of what constitutes a value stream is variable and by improving one value stream you will improve others that touch those same departments. For example if you improve the flow for a breast cancer patient you will help improve the process for other cancer patients because you will help improve areas like chemotherapy, x-rays, and lab testing.
Traditionally that is how Value streams are done in Healthcare. We take existing processes and find how they align to patients. I would propose a new way of looking at patients. I recently had the a chance to hear Dr. Atul Gawande, author of The Checklist Manifesto: How To Get Things Right, and he mentioned a staggering fact. About 5% of the medical patients make up 60% of medical costs and the facilities that provide the best care are not the highest cost structure. If you can deliver better care to the 5% of the most expensive care patients it should improve the care to the other 95%. The 5% that make up most of the costs are also the more complex cases who typically visit hospitals for their care.
Instead of look at a value stream by hospital and patient type I propose looking at a value stream by prevention and management of diseases instead of treatments. With that you have to look at several more factors like how do you prevent more diseases as well as effectively manage current ailments so there doesn’t need to be emergency treatment. The value streams becomes more of a value chain linking public health, in home care, primary physicians, and hospitals all playing a crucial role. Currently if you have a diabetic patient with heart disease most of the care they receive is through the hospital that would be able to handle their complex case. In this new model the patient is intercepted before coming to the hospital and focuses more on preventative care through in home care via an in home care person or program as well as a primary physician. If the patient has an emergency or needs some more specialization then they can come to the hospitals. Distribute the care away from hospitals and more at the source of the problems is the idea behind the healthcare value chain. Catch problems early and often.
A downside to this is that hospitals would see less revenue if they continue with the current model but patients would receive much better care. Not to mention it would bring down healthcare costs to treat patients since the rate of major (and more expensive) incidences would go down with proper management.