Column | Productivity and Process Improvement

The patient's role in innovation

Column | Productivity and Process Improvement

The patient's role in innovation

So many ideas we have on how to improve healthcare come from our running into issues that we see a need to address — things like staffing, technology, supply chain. No doubt that some of the best ideas have started in a “why don’t we do . . .” context to improve our processes. Regina Herzlinger, a leading healthcare management researcher with the Harvard Business School, posed a six-factor framework for evaluating how innovation really addresses challenges we see in the industry. Many of the ideas in Herzlinger's research touch on things that immediately come to mind: How do we get paid? How do we work innovation through our accountability structure? How do we leverage technology? Herzlinger mentions one more stakeholder we don’t often consider in innovation — the patient. Maybe it is time to examine the patient’s role with innovation.

Choosing technology over humanity

Many innovations in healthcare seem to start with some technology idea. The electronic health record (EHR) is an easy example of that idea. We make great investments in technologies to refine documentation of care, and increase reimbursement, order tests more efficiently, optimize care options and hopefully improve care. 

But what is the patient’s view of such investments? Often, they are left looking at the top of a clinician’s head as data is typed into a computer. The face-to-face interaction between the patient and caregiver gets lost in the pursuit of a technical improvement in care.  

I’m not here to suggest we dispose of those technologies. The improved quality and quantity of data we gather will definitely inform ways we can make better clinical decisions. But from the patient’s perspective, have we improved care?  

As a caregiver for elderly parents, I see many patient interactions that really don’t show much care, at the expense of using technology. I’ve seen us lose that personal contact with a provider who was focused on a computer screen (it seems like they often try to hide behind that screen). We’ve had many office visits where we tap on some screen with no idea why. Yeah, I have an unfair advantage working in the industry, but why should my parents rely on me to explain (especially when the provider does not know that I speak “healthcare”)? What can we do to make innovation a valuable thing in the eyes of our patients?

Herzlinger’s article asks the question: “How does the consumer perceive the value of innovation?” Well, I’m hard pressed to see sometimes how our patients see innovation as another step to improve the process of care. Have we ever asked the patient how we could do things better? 

Sure, we ask questions pertaining to things like those HCAHPS scores because our value-based purchasing payments hinge on such feedback. Obviously, there are boundaries on how much the industry can change certain things as infection control, medication administration and insurance procedures still provide the checklist for good care. Perhaps we can find better ways to integrate that checklist into the care process and, while we’re at it, determine what’s in it for the patient. If you ask me, that’s an innovation right there.

We have to start with an idea of the patient experience. Are there steps in a process or things we ask the patient to do that seem right to us but at the same time detract from the patient’s experience? Probably so. Requiring multiple signatures on multiple forms that patients likely have repeatedly filled out with the same information seems a necessity in the revenue cycle. Perhaps there’s a way to make that process less of a burden for the patient and possibly for the patient access team as well. 

Ask the patient

HFMA's Value Project Report, Building Value-Driving Capabilities: Performance Improvement, calls for us to evaluate processes and seek out ways to improve patient engagement.

While much of the discussion focuses on getting the patient engaged in their care, there is also encouragement to convene a patient council to get input on patient perceptions of care and processes of care. Why not extend that discussion a little further to ask the question, “What do we do that annoys you?” It works well in healthy interpersonal relationships, so why not in healthy provider-patient relationships? 

While that HFMA Value Project work is a few years old now, it still rings true to me today. Let’s think about how we get the patient involved in innovation.

Many of the best process improvements I have seen as a senior executive have come from thoughtful suggestions of the front-line staff serving our patients. Reaching across the counter, the exam table or the bedrail and asking our patients for input is another good way to improve processes. 

Although we can’t fix everything, perhaps we can do a better job of explaining to patients about processes or streamlining the processes to make them easier on everyone. Process improvement innovations are not just the mechanical adjustment to an assembly-line series of steps. They are also getting the best from our people and giving the best to our patients.  

Our teams give us great innovations. It is time now to expand our innovation team by one more position and bring the patient into the team. Let them help us not only find the next great innovation, but also help us define the value for the patient in that next innovation. 

About the Author

Jeff Helton, PHD, FHFMA, CMA, CFE,

is a lecturer in the MBA-Health Care Administration Program at the University of Colorado Denver and a member of HFMA’s Southern California Chapter.

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