For all of us associated with healthcare, it should be apparent that our world is on the cusp of a significant change. I am not talking about the usual incremental shifts or isolated disruptions. I am referring to real and disruptive sea change that will continue for a decade or more. In fact, we are facing a perfect storm in global healthcare, and one that will impact clinicians, insurers, and industry… and ultimately the patients we all work to serve. The factors creating this storm are well recognized:
Ironically, we now have far more capability to prevent or attack disease than ever before, but we will have far fewer resources per capita to employ those technologies or to develop others. It will not be possible to survive this storm by simply working harder or trying to do more with less. Those approaches are doomed to fail. Already we can see the stress cracks forming, as government-provided resources are slashed, as centralized planning and control methods falter under their own weight, as the impending shortage of trained clinicians becomes apparent, and as patient needs and demands escalate.
Fortunately, there are methods for dealing with such crises; approaches that have evolved across organizations facing tectonic shifts of their own. These methods, labeled “business process engineering” or simply “re-engineering”, focus first on defining the desired outcomes while recognizing and accepting the external realities and constraints. Their aim is not to reduce costs or cut headcount (that wonderfully benign phrase for terminating real people’s employment). The focus is on taking positive action rather than allowing natural forces to dictate outcomes. One proponent, Minder Chen, has described re-engineering as “The fundamental rethinking and radical redesign of core processes to achieve dramatic improvements in critical performance measures such as quality, cost and cycle time.” The key elements of re-engineering are to:
- Organize around outcomes
- Engage the people doing the work to identify key processes and priorities
- Integrate information processing work into the real work
- Treat dispersed resources as though they were centralized
- Link parallel activities
- Put decision points where the work is performed
- Capture information once and at the source
This approach is ideally suited to the challenges faced across healthcare. I previously initiated the complete re-engineering of a 100 year old company with legacy processes and IT systems, proud and skilled employees, and in a highly regulated field associated with life support technologies. The prospects for disruptive change seemed somewhere between impossible and delusional, but there was no alternative. Three years later, the goals had all been substantially exceeded by teams of employees who started first with skepticism; morphed into caution and hope; and eventually became passionate owners of the new reality that they themselves had created. The process works, and there is simply no other approach to successfully react when the ground we have long stood upon has rapidly shifted under our feet; and with new realities that are no longer consistent with the “ways we have always done things.” We face harsh realities and what might appear to be insurmountable obstacles in the years ahead, but this is the perfect opportunity for meaningful and disruptive change, with improved patient outcomes as our unifying cause. How do we get there? To quote St Francis of Assisi, we must “Start by doing what is necessary, then what is possible, and suddenly you are doing the impossible.” Jim Taylor is CEO of Oraya Therapeutics, Newark, CA, USA.
