Transformation: asking the right questions

Transformation starts with asking the right questions. My favorite first question is, “what problem are we trying to solve?” Followed by “why?” If you’re in the service industry and the problem you’re trying to solve is a financial one, that’s not transformational, it’s operational. If the problem isn’t about those you’re serving, then it’s the wrong problem. Loss of focus on true north goals often sends problem solvers down the wrong path; be sure staff define the right problem and stick to it.  And don’t let operational problems get in the way of solving the real big ones.

Common customer oriented problems are cost, convenience and experience. When considering these, it’s important to not forget the most important problem, “Why they’re coming to you or want to come to you in the first place.” – forget that fundamental, and you’ll go out of business.  Perhaps one question for transformation could be, “How can we solve patients’ problems quicker, cheaper and where they are?”

Transformation also starts with realizing what we shouldn’t tolerate, and generating paradigm shifts.  The  patient safety movement is an example of transformation. It started 20 years ago with Dr. Leape using data, and asking the right question, “why are we tolerating this?” We look back now and we can’t believe the things we tolerated. Another example is the patient- and family-centered care approach to delivering care, and designing that delivery. This movement brought about a paradigm shift in how people think about healthcare.

Perhaps another question to ask, “Is what we’re doing and how we’re doing it the best way when you consider the value it brings to the consumer assuming they have to pay every cent of the cost plus a margin?” People are willing to pay a lot to get their cancer cured. They aren’t willing to pay a lot to get a sore throat looked at and cared for.  To think about this try the “miss work” or “miss school” test (e.g. if a family that values their child’s education is willing to take their child out of class to go to the doctor, that service is of value. If it’s not then they will either not go, or they’ll go somewhere after school that is quick and convenient– i.e. CVS minute clinic).

We think patients and families value all healthcare equally, but their behavior suggests they don’t.  We need to provide value starting with thinking a little differently about what value means to those we serve: “if the patient had to pay every cent of the cost of their healthcare, how would we do it differently?”

In some cases we may need to be explicit about the value.  For example if a family takes their child to the doctor primarily to get vaccines, what would happen if they were to become solely responsible for the cost?   They would start going to CVS to get them.  Just walk in, get the shot and leave whenever at a cheap cost, no doctor involved (and by the way stop at the do-it-yourself height and weight station on your way out). Yet, there is value in going to and paying for the doctor visit that may not be entirely understood.