John S. Toussaint M.D. Chief Executive ThedaCare Centre for Healthcare Value
The health care industry is one of the least reliable industries in the world.
A recent British Medical Journal paper claimed medical error is now the 3rd leading cause of death in the U.S. and of similar magnitude in most western countries. This creates a burning platform for change. Most of that change is going to come through the leaders of healthcare delivery organisations making that change happen. This is going to require an intense learning process that includes awareness of different ways to solve existing problems and individual coaching to learn new skills.
It also requires association with a group of peers that are trying to make similar changes – the focus for this blog.
Adult learning occurs best between peers. At the ThedaCare Centre for Healthcare Value, we have had a lot of experience facilitating adult learning. Sitting in a hotel conference room in front of power points doesn’t get the job done. Neither does sending out hundred page playbooks with supposedly all the answers. Adults learn from adults that are trying to do the same thing. In North America this is what we are trying to do through the Healthcare Value Network (HVN). Established in 2009, HVN was designed by Canadian and U.S. healthcare executives to provide peer to peer learning experiences with leaders trying to apply the Toyota Production System principles in their organisations. We studied how Toyota suppliers had been organised in Canada and developed a learning process that includes a number of key components.
“Going to see” is the most important. Today there are 80 members of HVN. Every 2-3 years each member hosts a two day visit that allows the leaders in the other organisations to see how the principles are being applied at the network member that is hosting. Most of the two days is spent visiting the place where the value is created for the patient. That means, the ICU, the Emergency room etc. There are up to 16 visits per year with 35-50 attendees. This allows for the development of relationships that continue well beyond the two days. In one case leaders invited peers to present to their senior executive team regarding a process called 3P (production preparation process).
The team from the site visit site actually worked with the other hospital team to teach this process and cut down the cost to build a new cancer center by 40% as well as saving over 9 months in time to completion.
"On a scale of 1-5 where 5 is highest when asked 'was the visit of value to your organisation' the average score is a 4.8 for these visits."
Collaborative learning doesn’t just happen. Our team that facilitates the visits go to the site of the organisation that is being visited well ahead of the visit. We determine where the best places are to go and see. Where the most sophisticated work is occurring and who can speak best to the work. On a scale of 1-5 where 5 is highest when asked “was the visit of value to your organisation” the average score is a 4.8 for these visits.
Specific learning objectives are developed for each visit. For example an upcoming visit that Johns Hopkins Medicine is hosting is focused on building patient safety into everyday work processes. Recently the Cleveland clinic site visit focused on radical care redesign in a model clinic. The focus helps to get the right people from the network organisations to the right site visit.
Recently we have learned that with cuts in travel budgets regional meetings are more popular. The regions are developed with the thought that leaders can drive to the site visit or have one direct flight thereby only having to be away one night. Other ideas such as virtual site visits etc. are being considered. Not every organisation can join HVN. If the organisation is just starting on their lean journey and have nothing to teach we ask that they wait for a year or more. The purpose of the network is to learn, share and connect. But if you haven’t started yet it’s hard for anyone to learn. The rigor of determining which organisations are serious about change has led to network visits having the reputation of being a high quality experience. It also isn’t cheap. Each organisation must pay a fee of U.S. $20,000 per year to belong. This is another motivator for leaders to get their money worth out of network participation.
Peer to peer learning really works. To be successful the collaboration must be focused, constantly adding value to all members, and building a community of dedicated learners. If you’d like to know more, we have published a detailed description of the HVN based on interviews of Chief Executives from across the network.