Today at the Northshore Medical Center the Front Line Improvement (FLI) team set about discussing the sticky issue of change. They have been doing small team-based improvements for a couple months now and having a lot of fun! Not surprisingly this has brought up conversation around change because every experiment they run represents some level of change in the teams. Change–even when it’s an improvement–is not always easy.  Sometimes it can even lead to resistance. So they asked their leaders to provide them with some education to understand how to deal with this themselves and how to better understand and support their colleagues as they experience the changes that the FLI team experiments are generating.

Before the meeting the team all read through some helpful materials from our HR department regarding the path that people may go through as they transition through change. Alicia Eng, Administrative Director, and Steve Hockheiser, Medical Center Chief, led the team through a discussion and exercise to better understand the four phases on the transition path; Denial, Resistance, Exploration and Commitment. They discussed what it means to be in the various phases and what a person might need to help move them through the transition path from denial to commitment.

They talked about their own role versus that of management and were honest with each other about their personal experience of transition that has resulted from being part of the FLI team.

On the floor of their meeting room was a large cross made of blue painter’s tape representing the four quadrants on the transition path. They each got up from their chairs and stood in the quadrant they felt represented their current experience related to the FLI process. Although you cannot tell from the photo which square corresponds to which phase each team member was in one of these three places: Commitment (as seen in the left of the photo), on the line between Commitment and Exploration, or in Exploration (the right side of the photo).

Congratulations to our teams at both Northshore and Redmond who have braved the world of front line improvement and all the change it represents for themselves and their clinics. And thanks to the rest of the clinic staff who have been willing to run the experiments designed by the FLI team and give them honest feedback to help ensure that their experiments result in improvement, not just change. To quote a famous British pop icon they have been willing to “turn and face the strain” on the path toward continuous improvement at Group Health.

Feet In Transition

Let me tell you a story. On Wednesday, when we started this workshop I received an email from one of our Primary Care leaders about a new medicare patient complaint regarding–you guessed it–their experience of being paneled with the wrong Doctor at the wrongclinic. The situation for the patient was a confusing mess. In a nutshell, her experience went something like this: Patient enrolls in Group Health on February 1. The address we had on record was for a power of attorney somewhere near Factoria. She was paneled within 10 business days to a Doctor in Factoria. The letter was generated and left sitting in a batch in one of our systems, somewhere. It did not get sent to the patient until March 9. In the meantime the patient went to see the doctor. Not in Factoria, where she had been paneled but in Olympia where she lived.  When the letter arrived almost 6 weeks after her enrollment and three weeks after her appointment in Olympia telling her, contrary to her experience and wishes,  that she had actually been paneled in Factoria, you can imagine the result. Confusion. Frustration.

I can happily report that our team spent yesterday improving the process for how these patients are assigned and how the letters are generated and sent. We had front line staff from customer service and the clinics working out the process details. They had gotten far and reduced waste. But then they decided to call in their technical resource rep from ISD.  He took one look at the new process and immediately identified an opportunity to reduce process steps and ensure that the letter generation part of the process happened within days, not weeks, of a patient being assigned a new provider.  The team and managers involved were quickly able to incorporate the new information and adjust the process. The work request was submitted and we are on our way to having an improved process that will directly improve our patient experience and help avoid situations like the one in the story.

This is just one small example of the improvements that this team has been working on these last few days. This afternoon the Management Guidance Team is coming in person to hear about all the great work of the team. More to come!

The team is hard at work. This morning the Lean facilitators used the Hoopla to actually train some concepts on standard work. They team had completed visioning yesterday and quickly moved into project work to hammer out all the details of the new standard work and processes to support the vision. They have been working really well together, having engaged discussion, gaining alignment and documenting new standard work. In fact, they are ahead of schedule and already moving into testing some of the new processes.

For example, one of our team members drove over to the Renton clinic this afternoon to test part of the new clinic tracking process with the Admin staff there. These particular Admin were not in the workshop and had no knowledge of what we were creating. Our team member took the process and tools and walked it through with them to make sure that it really works for people who will be doing the job. He came back with their feedback and the team incorporated it into the final documentation.

The Medical Center Chiefs and Primary Care leaders have had engaged discussions about the implications of the new panel open/closed standards and what processes are needed to make status and problems visible in a more timely manner, support Medical Home principles, and most importantly, meet patient needs.

Right now the team is mocking up and testing the revisions to the Physician Selection Index on InContext. We have PCRs and Customer Service Reps who are checking the changes and making sure the tools support the new standard process.

There is more work to do but they are on track to achieving the vision created on Wednesday. Great Work team!