Frontiers of Health Services Management最新文献

As hospitals and health systems struggle to maintain operations and financial solvency in a changing external environment, many find that new approaches to innovation are crucial to survival and strategic success. This article reviews the history of Agile, provides a high-level overview of the process, compares Agile to other innovation approaches, and shares how Agile can help reduce clinician burnout.

As industry consolidation leads to a growing number of large new healthcare delivery networks, patients and their clinicians are losing the important human-centric and relationship-based nature of medical care. The leadership of Hackensack Meridian Health (HMH), a New Jersey-based network of hospitals, research center, and medical school, made an organizational commitment to reverse such loss and restore the social nature of medicine. To attain that goal, HMH engaged both clinicians and administrators to confirm the demand for change, foster a collaborative culture design, and address the unique nature of the individual components in the HMH network. Efforts to transform the HMH care delivery model illustrate the effectiveness of Agile science and its problem-solving methods.

Healthcare can benefit immensely from implementing an Agile mindset. Specifically, Agile principles of value-driven delivery, adaptive planning, and continuous improvement can exert a positive impact on projects-especially amid the constant changes in laws, evidence-based practices, and technology in healthcare. The best way to apply Agile is to combine the discipline and structure of a traditional linear model with the adaptability of iterative development. That mix allows for certain controls but with the flexibility for stakeholders to provide input and call for adjustments at different stages. To start, an organization must build teams of multidisciplinary personnel with diverse perspectives. Delivering value should be addressed as soon as possible by considering stakeholder priorities, using tools for continuous project planning, and employing retrospectives to provide feedback and identify root causes. When leaders embrace value-driven delivery, adaptive planning, and continuous improvement, healthcare projects can lead to positive results and ultimately improve patient care.

People often equate "Lean" with the tools that are used to create efficiencies and standardize processes. However, implementing tools represents at most 20 percent of the effort in Lean transformations. The other 80 percent is expended on changing leaders' practices and behaviors, and ultimately their mindset. Senior management has an essential role in establishing conditions that enable 80 percent of the effort to succeed. Their involvement includes establishing governance arrangements that cross divisional boundaries, supporting a thorough, long-term vision of the organization's value-producing processes, and holding everyone accountable for meeting Lean commitments. This is accomplished through regular, direct involvement. When upper management sets the example, durable Lean success and an increasingly Lean leadership mindset follow.

All leaders of healthcare organizations, individually and collectively, must make critically important decisions every day. But how are those decisions made? What factors must leaders take into account? And how has the way they make those decisions changed over the years? In today's fast-moving world, healthcare leaders face increasing pressures to make far-reaching decisions not only accurately, but also more quickly than ever. Especially for a small critical access hospital, there is little room for error or delay. At Nemaha County Hospital, we have found that clinical and business decisions drawn from more reliable data are much better than those based on anecdotal information.

Healthcare organizations are facing exponential growth in change-not just to compete, but to survive. Amid the widening gap between expenses and reimbursements, hospitals must manage the adoption of expensive advanced technologies, continuous synthesis of emerging clinical knowledge, intensive regulatory readiness, and public ranking of quality outcomes. And they must handle all this as patient expectations grow. At Methodist Le Bonheur Healthcare (MLH), we have approached these challenges by nurturing an organizational mindset of transformational innovation. The ability to harness the collective brainpower of 12,000 MLH associates to find cost reductions, operational efficiencies, and better ways to provide patient care has proven invaluable when facing the demands to do more with less. Achieving this degree of engagement began with full transparency of the challenges we face as an organization, clearly articulating the need to change, and providing a structured approach to capture and respond to suggestions from the workforce. The Power of One Idea program, a platform for listening and learning, has enabled the workforce to answer that call and make an impressive impact: $17 million in cost savings and previously untapped revenues. In return, the forward-thinking associates submitting those ideas have shared in those savings and realized more than $1.5 million in extra income. The Performance Excellence Award, a program to seek out best practices in safety, efficiency, or effectiveness, also has enriched the business with at least 100 proven approaches to advance care delivery.

Healthcare leaders have two especially profound responsibilities. In addition to ensuring quality, they must also drive sustainable practices that benefit their organizations, communities, and the planet. Environmental, social, and governance (ESG) principles-along with sustainability and corporate social responsibility (CSR) concepts-have gained significant prominence in recent years, and an understanding of their nuances within healthcare and in the general business context is essential for effective governance and implementation. To fully integrate ESG principles into their operations, healthcare leaders should understand the essential role of governance in ESG and the differences among ESG, sustainability, and CSR. The concrete examples provided here will illustrate the relevance of ESG reporting frameworks to healthcare operations.

The simple fact is that hospitals that do not innovate today may not be solvent tomorrow. Although not every hospital has a budget for a million-dollar innovation laboratory, a pop-up innovation lab can be set up for less than $1,000 with materials available at a local superstore. In 2014, Drs. Ibata and Olver visited leading innovation labs to identify best practices for curricula and materials. The site visits were funded by a grant to support the development of a rapid-cycle innovation training program. The lessons learned are shared here with sample agendas and material lists to set up a low-cost innovation lab. This article also describes half-day and full-day rapid-cycle innovation workshops. These workshops combine design thinking and the rapid-cycle plan-do-check-act improvement method with improvisational theater games to arrive at outside-the-box solutions to intractable healthcare delivery problems.