How to Solve a Healthcare Problem

Understand Workflow

Healthcare is delivered by a complex system. Understanding the way it is delivered, accessed, and paid for, is crucial to understand the root cause of a problem. Ethnography / Medical Anthropology - what a lot of people call design thinking - is an excellent way of achieving this. Combining this approach with process mapping is beneficial from the perspective of understanding constraints in the system. More importantly, it is crucial to understand the flow of information and resources between stakeholders. Understanding information flow answers the question of how and why are certain decisions made.

A detailed process map lends crucial insight. Evidence based medicine is about understanding a model of patho-physiology and applying the most suitable intervention. Understanding the determinants of those outcomes becomes a basic building block of a learning system that will continuously improve over time.

House of Quality

While House of Cards is all the rage on Netflix, it is with great personal satisfaction, that I admit, I get very excited about the House of Quality. Not because I’m into Quality Assurance, but because I’m totally into communicating my product requirements with my team. There are several good resources on how to use and create a HoQ matrix; several of which are on Youtube and worth checking out. I've attached a good read below. Simply put, product requirements are linked to technical requirements in a near-deterministic way. One could also create a HoQ linking product features to market requirements (think patho-physiology) so that one can truly iterate towards the leanest solution; a solution positioned well in the marketplace.

What is a problem?

You must be wondering if I’m on chemicals now .. “Seriously, he’s going to tell us what a ‘problem’ is!!” Let’s be clear. Problems are about perspective and perspectives are the most important activity to a stakeholder. Stakeholders, by default, aren’t on the same page with each other. Hence, there is no consensus (think perspective) about what the problem actually is. A problem from the perspective of one stakeholder may not be a problem from another perspective (read business model). However, our task is to create a product that is positioned well within the system. Being ‘patient centered’ is a great framing reference to understand problems in healthcare; problems that stakeholders can reluctantly acknowledge.

Without additional mud chucking on my own fraternity, and the system within which we operate, it is sufficient to say that a ‘problem’ for a physician may not necessarily be a ‘problem’ for an insurance company or a ‘problem’ for the patient, for that matter. A good way to identify a common problem (and even to qualify it) is to task a multidisciplinary team to conduct the ‘Understanding Workflow’ portion identified above.

Experts often fight fires and are adept at managing situations as they arise. But why do they arise in the first place?

Root Cause Analysis

Clever, clever .. you’re thinking to yourself. Introduce a concept in the first paragraph to prime a cognitive bridge later on in the article. Does that make you more or less intrigued about RCAs, I wonder?

Root Cause Analyses (RCAs) are difficult endeavors. They are prone to bias and poorly constructed if not well designed and applied appropriately. Fish and Bone diagrams are a good way of lessening the intellectual churn with a traditional 5-Why approach and can be linked easily to in-house subject matter experts. Engineers with engineering expertise may only want to focus on ascertaining if the problem is truly caused by an engineering issue, hence an appropriate area of investment towards the solution.

Alternatively, one can also use the Fish and Bone diagram to understand the cross-functional requirements of the team that will solve the problem. The applications of these tools are many, but the bottom line is, when done correctly, an inquiry into understanding the Root cause, using Fish and Bone or the ‘5 Why Technique’, is invaluable for the innovator.

Anecdotal observations have led me to believe that the further we go down the rabbit hole the closer we get to a basic science solution. One could possibly try matching the different levels of the 5-Whys to Technology Readiness Levels (TRLs) and even the Investment Readiness Levels.

You too can solve problems now!

There you have it. The basic tool box for solving clinical (or even non-clinical) problems. The Approach is as follows:

1. Observe an activity through the perspective of different stakeholders to identify problems / or a problem.
2. Map out activities, flow of resources and information to ascertain determinants of decision making and understand the root cause.
3. Brain storm solutions that alleviate constraints in your process map.
4. Link ideal product requirements to technical capabilities or existing technologies (why not apply what already exists?)
5. Create a cross functional team with a charismatic leader and execute!

Sounds simple does it not ?

:)

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#healthcare #patientcentered #innovation #processmapping #ethnography

Additional reading:

Health monitoring requirements elicited via House of Quality - Link

Sentinel events, Serious reportable events, and Root Cause Analysis - Link

How to use the Fish-bone tool for Root Cause Analysis - Link

Technology Readiness Levels - Link

Investment Readiness Levels - Link