Like many of you, we at Beth Israel Deaconess Medical Center started our lean learning with small incremental improvements, not particularly focused on strategic goals nor coordinated as a conscious body of improvement work. The objective was to make needed improvements but, more importantly, to learn from these small experiments and leverage that new knowledge to tackle even larger problems.

These point improvements were indisputably valuable and helped individual departments see their work through new eyes. Many wonderful ideas came from this approach, which is still valid for local teams aiming to continuously improve the flow of their own work.

As our thinking evolves – a result of seeing through the eyes of our patients and families, and hearing firsthand what we could do to improve their care experience – we expanded our view peripherally beyond the walls of department-focused improvements to learning to see the patient experience regardless of our internal organisational structure and hierarchy. After all, our patients and families experience the “whole” and not a series of independent unsynchronised processes. We wonder how healthcare came to be such a random set of handoffs mostly without anyone either navigating or coordinating the needed care activities for our patients.  How much value creation is there with such an approach? I am sure you can guess the answer.

We know there has to be a better way but this transition to seeing the whole is not an easy one. In the April issue of LMJ, I shared a case story of work in progress in our Digestive Disease Center. The ultimate goal is to have everything in that care unit flow to the needs of the patients: the staff, the physicians, the equipment, even the procedure rooms. As important as this work is, this unit is but one small part of our large and complex organisation and impacts a subset of our patients.

This exercise needs to be repeated many times in many more patient care areas within the medical center as well as outside our walls if we are to transform the experience for all of our patients. Even more daunting is seeing end-to-end beyond our organisation, since patients flow to us from elsewhere and we flow patients outward to other care providing organisations, like rehabilitation centres, nursing homes and outpatient clinics.  Having perfect handoffs of information, perfect care without defects with no delays is why we go to work every day. Unfortunately, our current set of infrastructures may create barriers to progress. We ask ourselves:

  • What do our patients experience before and after we care for them?
  • Do our information systems “talk” to each other?
  • Do our facilities support the perfect workflow?
  • Are we hiring the people with the needed improvement mindset as well as developing those already present?
  • Have we partnered with critical suppliers to our systems (e.g. universities, supply chain businesses, insurance companies, other healthcare organisations up/downstream)?
  • Does a management system exist to support the crucial work needed to make substantial progress?
  • Are we organised in the best way possible to support the best flow for our patients?