Team-Based, Value-Stream-Driven Organization for Health Care

A while back, my mother in law took ill.  She has a list of maladies and presents as a very complex patient, regardless of the situation.  As such, she requires the attention of no less than four specialists.

After days of disjointed messages from the specialists, spotty order writing, contradicting directions to the nursing team, my wife, a registered nurse took the "bull by the horns" and called a meeting of the specialists to get them all on the same page.

Naturally, the nursing staff was reticent about calling the meeting.  On one hand, they were elated that a patient family member had the guts to call these docs to task.  On the other hand, they were afraid of the responses they'd get either from the docs themselves or their minions guarding their time.

The meeting occurred.  It was rocky at first.  All parties were hesitant to dive in, especially in front of each other. (Note: they were quick to make orders and give direction in isolation.).  My wife had called me in to "facilitate" (read: keep the peace).  I did so and after getting folks talking and thinking together the TEAM made a great plan for getting my mother in law back on her feet.

This was NOT the normal process.

The three of the five doctors involved were visibly disturbed by the process.

One of the physicians, seeing the risk exposure, finally took the lead and began to coordinate orders and care.

If it wasn't for the concern of my wife, the guts she has, her familiarity with the broken health care system and good Providence, the outcome may have been terrible.

This is team-based care, where the DOCS are the team.  I love it, but it will require a major change to the way we train up physicians.  I advocate giving them lean / operational excellence basics including operations management and human leadership.  They need to understand that teamwork WORKS.

I few years back I had suggested to a hospital CEO in our region that part of the change would require converting the whole organization into a team-based structure, using obvious value streams to align around.  He nearly choked on his coffee.

If we want real change, we have to change both the operational side of the equation AND the human side.

If you have any good stories about team-based care, give us a shout.  Also, check out this HBR article on the concept by Stephen C. Schimpff.