Pushing the “Envelope”

When attempting to redesign a process individuals and groups are often “prisoners” of their previous experiences and learning. I have found that if the group tries to go directly from the “As Is” design to the desirable but “Doable” design they always seem to fall short of what is actually possible. This was particularly obvious during process redesign sessions to take advantage of a new ERP or CRM system.

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The groups would assume that the new system was more limited than it actually was. I have found that if they first brainstorm the “ideal” process assuming unlimited technology and resources they would typically go beyond what was actually possible. Then it was fairly easy to refine that design to a doable design that was much better than the doable design that was created directly from the As Is design.  

To help the group break out of their prisons I use an exercise based on a hypothetical ideal hospital experience.

Unleashing the Imagination

To get the design group out of their own “prisons” I often use an exercise based on the Ideal Hospital Experience described below. I first have the group brain storm what they think would be a desirable but doable hospital experience enhanced by technology. Then I have them read the description below and compare it with their own vision. 

Creating the “Ideal” Hospital Experience with Technology

The hospital of the future will be an ever-improving patient focused experience.  After making an appointment with the central appointment desk, the patient will enter the facility with a bar coded identification card which, when scanned, will automatically in-process the patient into the hospital and set up an account for direct billing to the preprogrammed insurance provider. To prevent fraud, the patient will sign one time on a computer screen to verify the authorized use of the scanned identification card.  After scanning in, he or she will be directed to the location where the scheduled appointment will begin.  After arriving at the location, the patient will be seen by an appropriate healthcare provider who will call up on the computer terminal monitor the entire patient history both text (physician inputs, test results, etc.) and images (CRT, MRI, X-ray, etc.).  After examining both patient and records, the physician will access the expert knowledge data base and review the most recent on-line findings and “text book” diagnostics for the malady at hand.  After collecting all the information, the physician then provides a diagnosis. 

The healthcare relationship has evolved into a collaborative effort between patient and doctor and so the patient considers the doctor’s recommendation along with the on-line patient education data base and then discusses with the physician the plan of attack.  The doctor will record the results of the discussion in the computer and the computer will automatically schedule any support services needed by the patient such as physical therapy, pharmaceuticals, surgery, etc. When the patient arrives for surgery their ID card is scanned once more checking them in the hospital along with CRT display directions to the appropriate location.  The computer signals the nurse that the patient has checked in and is on the way.  The orderly or housekeeping personnel have prepared the pre/post operation room anticipating the patient’s preferences such as additional foam pillows which the computer learned last time the patient was in the hospital. No more lengthy bedside interviews, the information system anticipated the patient's needs.  At most they may ask for confirmation of the needs listed in their computer via the bedside terminal where the nurse enters the history of stay and orders the services needed during the stay such as medicines, physical therapy, meals, etc. 

At the end of the stay the patient rates the services provided by answering an on-line customer satisfaction survey.  All follow-up appointments will be automatically scheduled and confirmed prior to departure.  When the patient leaves the facility their identification card is scanned again checking them out of the facility.  After reviewing a printout of the services provided and the charges, a copy is given to the patient.   Upon leaving, the patient simply signs out, automatically authorizing the bill to the insurance provider.  The End.

Source:

Latham, J. R. (Oct 1995). Healthcare Information Systems for the Future: The Leadership Challenge. in the Quality Air Force Symposium Proceedings and Presentation.