Behavioral healthcare is fresh to the process improvement party - at least so far as methodologies such as Lean and Six Sigma go. And that’s probably a good thing for lots of organizations in the field. Many of them are new or young, struggling to scale to meet the huge unmet demand for services, and busy navigating changing regulatory, M&A, and reimbursement landscapes.
But we’re seeing something of a maturation in the industry and its time to make sure the business operations side is up to date. (To be clear, the clinical side is way outside of my domain!)
Behavioral health won’t have to pioneer process improvement - that’s been done by manufacturers and more recently, service firms. Even hospitals chains and government have paid some of the early adopter price tag. Behavioral healthcare folks can see what’s worked, what’s worked with high ROI’s, and what’s worked quickly.
That said, there’s only so much to see.
In fact, a 2010 Wall Street Journal article reported: “Recent studies, for example, suggest that nearly 60% of all corporate Six Sigma initiatives fail to yield the desired results.”
And when the University of Colorado Hospital replanned their ED for a new facility in 2013, they didn’t use Lean Six Sigma. As they said, “LEAN or 6-sigma would have taken at least 3 years to execute all of the modules and processes.” Instead, they came up with something homegrown that met their unique needs.
I’ve seen the same thing in my work and now suggest at least some uniqueness in process improvement approach for my clients in any industry. Process improvement just isn’t a “one size fits all” thing. While many process improvement professionals and consultants have a tool set in which they’re certified and have used many times, we can’t let them turn every process or organization into their favorite nail.
Next week I’m speaking at a retreat for behavioral healthcare executives on the topic of process improvement. They may or may not have experience in this area, and that’s great. My job isn’t to take them through the weeds where hundreds of acronyms live. It’s to give them an immediately useful way of launching and accessing process improvement at their unique organization for maximum bottom line results.
So I’ll tell them about the ABC’s of process improvement - the simplicity on the other side of the most needlessly complex field I’ve seen. And I say that with love; most of process improvement was formalized either by industrial engineers or my fellow physicists.
To improve a process you must first recognize which specific challenge you’re facing:
A - When something that could or should be happening isn’t
B - When something that shouldn’t be happening is
C- When you’re not sure what’s happening
Solutions to A’s are about improving flow, the ability of the process to achieve more of the goal of the organization (profitability, number or share of clients served, something tied to referring entities, etc.) If the internal process isn’t having a flow issue, then it’s time to look at the external or marketing process.
Solutions to B’s are about reducing the waste generated by the process. This could be clinician or client time, materials, bed utilization, resources, information, etc.
And C’s are where we deal with variations in the process that make it unreliable or unpredictable.
Left to their own, most organizations will ignore A challenges and focus on B’s or C’s as they look like they’ll produce cost savings. The problem is those savings are often local and may not contribute to the overall achievement of the organizations' goals. Or worse, they experience the squeezing the balloon effect where savings in one area create an expensive new problem somewhere else.
B and C results cap out in the 1-10% range for cost cutting and 5-20% for productivity improvements. And while those are fantastic, A results are nearly unlimited allowing the organization to expand and extend services, achieving more of whatever the organization was actually created to do.
And, as it turns out, solving an A challenge almost always helps with B and C challenges as a bonus.
I’ll also tell those executives about the 123’s that go along with the ABC’s. Those are the first three steps they can take to generate the fastest return for the organization as a whole. I’ll talk about those in my next post.