Posted by: Knightbird | September 8, 2010

“We Are Spending More Money on You”

Patient hand offs are fraught with danger and delay. We experience this when we send patients from our Tribal Villages to the specialty services offered in Anchorage, both for primary, secondary and tertiary care, including hospitalization. First we spend countless hours getting approvals for appointments, travel, and lodging. Then our patients travel. Many times, there is no record of their appointment when they arrive. When they have a number of visits to make to different labs, specialists, pharmacy, Physical Therapy and whatever, their journey is not planned for customer flow, but for provider convenience. Sometimes travel is doubled due to lack of coordination. When they come back home, we don’t get the information we need for their aftercare.

I made a proposal in 2007 to conduct a Kaizen on coordination of care. Chugachmiut contributed a substantial amount of money to the project, and what we ended up with was a complete waste of time. The progression of work started with pre-planning committees, then a 70+ person meeting, follow-up projects ad nauseum and at the end, no results. I mean—NO RESULTS. Our patients continued with their problems and difficulties. A position and budget was created for this special project, with a clear message of “We are spending more money on you.” I felt like a failure. We wasted our contribution. Well, its happening again. I continue to push this organization for better coordination of care, and here is their response to our “demand” for a coordination of care initiative. Mind you, our initiative has been ordered by this organization’s board of directors. And it was initiated by representatives of the Rural Anchorage Service Unit (RASU).

Here is the pertinent paragraph from the Chief Executive Officer’s letter to the head of the RASU.

“The [Organization Name] is committed to increasing our customer satisfaction and reducing access errors. We are making plans to add additional staff in the FY11 budget in order to accomplish these goals.”

What we asked for does not require additional staff. We have 3 staff who already work for the RASU. And we have an abundance of Executives who, if they could stop fighting fires regarding these issues, would have plenty of time to spend on this project. But the traditional Executive mindset, as I wrote in an earlier blog, is to plead for more staff.

My recommendation has been to conduct a one week patient journey Kaizen. Map each patient trying to gain access to the Anchorage medical campus for that week. Put 10 or so employees from the value stream into a room. We would create a future state, design experiments to implement it, and have a workable solution in a week. ONE WEEK. Instead, we have to wait for the next budget year (2011 which starts on October 1). Then we need to wait for recruiting for the positions budgeted. Then the staff will need to learn their jobs, design a project, coordinate with numerous other parties, report to other executives and meet myriad other responsibilities. In 12 – 24 months we will still have another unworkable solution because the employees in the value stream are not engaged in the process and have no “skin in the game.” What  joy.

Do I sound pessimistic? I am. I have been through this, and it’s now 3 years later with hundreds of thousands of dollars expended on improvements that never happened, and more millions in “waste” on our organizations part, on our patients part and on the part of employees in the Anchorage medical campus. Been there, done that. Why can’t our Executives learn after one failure.


  1. That’s not too surprisingly, I guess. We still have a lot of work left to do educating healthcare leaders that “more money, more people, more space” isn’t the answer to everything. That “more, more, more” solution often doesn’t work and, if it does, it’s the most expensive way to drive improvements. Lean provides an alternative… we have to keep trying to educate and convince people… especially when the alternative is organizations slashing services and laying off people to “cut costs” instead of your situation of being offering more help, I guess.

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