Healthcare Mindset

Haven't you felt in recent years the sensation of being overtaken by events?

You probably blamed a lack of resources, equipment, or personnel. But have you ever thought that you needed to change the way you look at reality? Change paradigm, or mindset? Not that he is outdated in his profession, because the same happens to many colleagues throughout the hospital sector, due to the time it takes to adapt to new realities.

By observing the world of the Healthcare sector from the outside, with more than five decades of professional and business experience, I am able to identify patterns and offer valuable insights. This article seeks to highlight some of these insights, promoting a new mindset to face the challenges that lie ahead.

It doesn't matter if today you are well, and have no problems. Reality will come for everyone.

Let's look at the following table:

You are walking the blue line, with incremental thinking, while complexity and reality advance along the exponential curve. When you are on top of the curve you don't notice the problem, until after a breaking point), You will not be able to reach reality and you will not have everything resolved. Take the example of global warming.

However, every year you see a number of new illusions, new technologies that promise to solve problems completely. Now it's artificial intelligence (AI), previously it was telemedicine, IoT, Blockchain and I don't know what 5.0. And in reality all of this can help, but it doesn't solve it.

So, let's delve deeper into the root causes that you can use and preferably without investment.

O "mindset" that is: A way of thinking, or seeing things, an attitude.

The proposed solutions are not organized by priority, as each hospital has a different problem, given the diversity of cases.

Mindset 1. Growth is not the solution, changing the model is.  You have a misshapen monster. Increasing it does not solve its essence, it remains formless. You have to change monsters. We live in an increasingly complex society and we continue to have superficial responses.

As Taiichi Ohno, creator of the system, says Lean ou Lean Toyota: “common sense is usually wrong”. What he means is that we shouldn't be so superficial, we should apply the rule of 5 whys to each topic and not stick with the first why.

Experience is overestimated and those who decide which solution to take are those in power and not the experts, who are close to the problems. The problems are systemic and need to be addressed by multicultural groups from different sectors, inside and outside the institution. If you want to be creative, be careful with experts, as they have many rigid answers.

Mindset 2. Where are you going?  There is a story about a man who was riding at full gallop and when he came across a monk, who, surprised, asked: “and where are you going?” he replies: “I don’t know, the horse knows”.

At the end of each year, when we analyze what happened, we see that many of our actions were reactions to everyday events, external to us, and not the result of a strategy with a desired purpose. We have to define a clear strategy, with a powerful idea that is easy to excite many people. We have to ask: “where am I, where do I want to go and how do I achieve this”. Every day we are running from one incident or emergency to another. What is called incidental strategy. We prefer to re-study the scenario with a structural vision, based on a cultural change within the organization.

Mindset 3. Before implementing a strategy, you have to establish the Culture.

“Leaders need to understand mechanics and plumbing, but they also need to love poetry, to be able to light the hearts and minds of those led” Tsedal Neely.

Culture needs an objective, with a certain level of abstraction that can reach all groups of people, with a higher and more abstract category. It can also be a utopia or idealized solution, which attracts and then allows us to materialize actions to implement the utopia.

I often tell a story about 4 friends who go fishing every weekend. While everyone carefully prepares their hooks, one of them always arrives unprepared and asks the others for help. Until one day, one of the friends says: “This Saturday, don’t invite Zeca, because I don’t feel comfortable”. Moral of the story: whoever does not add value to the surroundings will be rejected. A good culture could be: We are to add value to others!

In this “surroundings” I include the Health Ecosystem. No solution will be valuable if it does not integrate others, inside and outside the institution. Strategic thinking, supported by a fresh culture that can cheer up the hearts of many, with a vision for the ecosystem, begins to shape what I call an appropriate mindset.

The solution can only be resolved with a more holistic vision, seeing the common good. The time when we could solve our problems by taking them from someone else is over. We have to be creative and make the cake bigger.

Mindset 4. A culture of power will have little chance of becoming the appropriate mindset. I'm not talking about just avoiding a culture of fear, which would be terrible. I'm going beyond that. A modern, future-oriented institution should have a more horizontal hierarchical environment, based on clear standards that everyone can comply with, within a fair system. The authority gradient is a terminus that defines the difference in authority between a boss and his subordinate. In the aeronautics industry there was a problem that the aircraft's deputy commanders did not dare to say that the aircraft was too low for landing. Going beyond this example, we have to understand different gradients of authority within the institution, as a problem of exaggeration of power that must be avoided, starting at the top level.

Mindset 5. Transparency is the Ethics of the XNUMXst century.  We will not be able to implement mindset 4 if we are not transparent and open. We have to let the criticism rise to the next level.

When a plane crashes, all its parts are collected and analyzed in a hangar for several months by people from another organization. When a person dies, victim of an adverse event, we do not act in the same way. The lack of transparency is based on the feeling of fear. Despite the legal complaints, we would gain more, having a superior culture that hides the problems forever. It has been demonstrated that more than 95% of cases of adverse events are the responsibility of the hospital system, that is, more of procedures and training than of people. It would be a good policy to release all professionals from blame, to help declare errors, except those of a repeated and criminal nature. Protecting those who make reports is also necessary if the person responsible has not self-reported.

Mindset 6. Balance between internal sectors is necessary. The two large cultural groups in a hospital are: the clinical sector and the management sector. When there is no harmony and deep sharing of the objectives and values ​​of these two sectors, then we end up with a system, where one sector dominates the other, with important consequences. The integration of these two sectors towards a higher objective involves an attitude of transparency and commitment, within an environment with hierarchies that respect each other equally. Just as the clinical sector wants the best for its patients, the management sector wants to consolidate and increase its profits. Both objectives are legitimate, but antagonistic and need to be resolved with a minimum of tension, with comparable powers and respect between the parties. Many operations at the hospital are similar to any other company. While the priority is to address clinical issues, in other companies the efficiency of each process is measured much more. In an industry, everyone has a stopwatch in their hand. A fair and adequate balance between both antagonistic positions must be achieved, as in the end the Hospital is a company that requires economic results, whether for profit or for its subsistence.

Mindset 7. Change in the business model.  Every business in the world is moving towards a subscription system. Soon you will no longer buy cars, you will take out a subscription to have the car of your choice. The same with many products and services. The hospital sector has no better deal than billing for a service it does not need to provide. At least in proportion. Health insurance coverage allows you to train, educate and prepare your patients to avoid getting sick. And with that, reduce your costs and increase your profit. Healthcare companies that invest in prevention spend up to 30% less than others. When a hospital works for a region, it may even be interested in improving the water and sanitation system, to avoid subsequent expenses. There are already health insurance plans that subsidize gym memberships. Obviously, billing for eliminating or mitigating diseases is completely different from a model for keeping the patient healthy. The beneficiary of this change would be the patient himself. Today, when an adverse event occurs, the same hospital continues to bill for more services, which is still an absurdity of the system.

Mindset 8. Customer orientation. “Customer centric approach" It is a methodology, centered on the client, here the patient. It is an orientation to study and prioritize everything that the customer has in terms of satisfaction, widely used by many companies. In this regard, in addition to curing diseases, institutions are concerned with hotels, food and even the vehicle parking system. Customer satisfaction or User Experience (UX) is a whole topic, as it involves measuring to provide patient satisfaction. Intertwined with the themes of Value-Based Medicine, this theme involves measuring patient satisfaction, including when leaving the hospital and in the recovery period.

The system Lean Healthcare, with a direct impact on Quality and the economy (lean system), tells us that everything that does not add value to the customer must be eliminated. With hospital waste (waste), close to 30%, reducing this number would even double the current results. Although the process is not automatic and takes a few years to change the culture, and until many know how to see what does not add value to the customer, it is very important and necessary, as demonstrated by the results of many hospitals around the world. We have too much inventory left, too many avoidable indoor walks, and too much space to make up. More information can be found in the book “Lean Healthcare” written by me, which is available for free download on the platform Opuspac University (www.opuspac-university.com).

The application of standards Lean Healthcare, (not to be confused with Lean 6 Sigma), is another way to improve Mindset, oriented towards what really offers usefulness to the client of the following process or to the patient who is the end client.

Mindset 9. Improving Quality is also good business. A study of the most profitable hospitals in the United States reveals that they place a lot of emphasis on Quality – Quality Assurance (QA). This last concept covers everything from quality to patient safety – Patient Safety. A QA management, or Lean, Quality and Safety (LQS), with a hierarchy of direct dealings with the hospital director, will certainly improve results.

Here we can observe how a hospital that is to the left of the minimum point, when increasing quality, moves to the right, reducing its total costs, while increasing its investments in quality. The few hospitals to the right of the minimum point are those that place quality as a primary factor in their commercial strategy and can profit more as a result. These solutions are purposely utopian and the reason for expressing this here is to provoke new ideals and visions, different from everyday ones. You may not be able to apply all of them, but a mindset is not a sequence of procedures, it is a vision, an ideal to strive for. For exceptional times, exceptional solutions are required.

Note: This article was motivated after the presentation by Dr. Fernando Torelly and Dr. Paulo Chapchap, where they mentioned that the situation in hospitals today is critical and that the time has come to change and seek solutions outside hospital institutions.