Wednesday, July 8, 2015

Very Cool Company: healthfinch

I almost titled this blog, "The Efficiency of Delegation: What US Healthcare Can Learn From The US Military."

For those who read my blog, it will come as no surprise that I often mention the incredible lessons learned and experience gained during my Air Force career. I wouldn't trade those years for anything, in no small part because my military service was the best training for a business career to come. In the Service, the guiding principles of honor, respect, teamwork, discipline and persistence are critical when building highly competent teams who can take on any mission, big or small. One of the reasons that the troops in the US military function so very well is the cultural strategy that places enormous emphasis on effective delegation of authority to the lowest levels possible to achieve a desired mission, and likewise, a culture that recognizes the need for rapid upward escalation when a situation requires it.

Recently I learned of a company called healthfinch, which makes Care Redesign applications that bolt on to EMRs (they are best integrated with Epic, but also working with Allscripts and will soon have products for Cerner) to automate, delegate, and simplify clinical workflow tasks. Currently, managing these clinical tasks, like prescription refill requests and laboratory results, most often falls on physicians who end up spending 2-4 hours per day sifting through hundreds of inbox messages. The sheer volume of these non-reimbursable, routine and repetitive tasks has become toxic to physicians, and is oft cited as a chief reason that nearly 88% of physicians are burnt out. Ironically, as reported recently by Bain, physicians who work in physician-led organizations are even less satisfied than their counterparts. We are at risk of losing one of healthcare’s most valuable resources.

As great organizations and the US military know well and healthfinch has figured out, delegation of tasks to the most efficient venue of completion is the most efficient way to run an organization. In the military, each person has training and a rank that comes with a defined scope of authority and they are expected to execute based on their role. Commanders set the strategy and delegate the planning to their top brass. The top brass creates a detailed plan and then they delegate tactical execution to the junior ranks, and so on. This workflow, in which all parties have well defined roles based on their authority (read: credentials), creates order, efficiency and, one could argue, ensures the safety of everyone on the team. Would it make any sense for the highest-ranking commander to get “into the weeds” and call in strike coordinates or type up a memo? No, and during the Vietnam War our US military learned that the hard way.

We must think in these terms in healthcare too, specifically regarding clinical workflow.  We need to respect the authority and training of each healthcare professional in the “chain of command” and make sure that they are working to the absolute top of their license—yet not above it or below it. Physicians are healthcare’s general officers-- our chief strategists if you will-- and should be available for managing the most complicated and high risk patients. They must be empowered to delegate routine patient care and clinical tasks to their staff, like physicians’ assistants and nurses. And then, those individuals must be able to delegate further to medical assistants and health coaches. If a physician is spending 2-4 hours per day on managing routine clinical tasks, the delegation system is broken, resulting in huge inefficiency and uncertainly in roles, staff unhappiness, escalated costs, and poor patient care. I’ve spent a fair amount of time in international healthcare settings the past few years, where clinical outcomes are higher and per capital healthcare costs are much lower. One of the common traits in these other countries is delegation of decision making and patient care to the most efficient venue. They empower nurses, PAs, and pharmacists, in particular, to care for patients and make clinical decisions that the US system constantly escalates unnecessarily to physicians. Part of the problem in the US system is the fee-for-service economic model that encourages this escalation. As soon as we become a margin and quality-driven economic model—and we are getting there-- I’m sure that delegation of tasks will be more widely accepted as the norm. Over 80% of physicians now “agree” or “strongly agree” that controlling costs is part of their clinical responsibility; we need to give them the systems and technology to enable that.

healthfinch gets it. They see the undeniable value and inevitable trend towards delegation and automation of tasks in healthcare. They get a “Very Cool” endorsement from me because they are taking delegation and top-of-license performance very seriously. Their flagship application, Swoop™, an app that automates the prescription refill process, has transformed workflows in many client sites. Physician inbox tasks for refills have been reduced by 70%, freeing them up for more direct patient care. They delegate more to nurses, who are now empowered to handle on-protocol requests in a matter of seconds, not minutes. And patients are receiving responses to their refill requests in less than 24 hours instead of 72 or more in a traditional manual approval model.

healthfinch is able to accomplish these efficiencies through automation, but only because their clients: (1) Recognize that their staff must be given the authority needed to do the job, and (2) Safely delegating the right tasks to the right people makes sense.

If your organization is seriously thinking about redesigning care delivery, I suggest you talk to the folks at healthfinch. They’ve got the right idea, and the right product, at a time when healthcare needs it most. I think you will be impressed. Physicians will be really impressed and relieved to see the emergence of this type of company and product.

I receive no reward or compensation of any kind for endorsing-- or criticizing-- companies or their products, including healthfinch.


Saturday, July 4, 2015

"Dale, what do you believe?"

This post is definitely personal-- very personal-- intended entirely for our little girl, Anna, when she reaches the point in her life when she asks herself the same-- "What do I believe?"

An old friend, Chuck Johnson, whom I've known since the third grade, asked me on Facebook, "Dale, I was curious-- are you a Christian? If not, what do you believe?"

Below is my response... it took me the better part of a day, thinking and contemplating, before I could put it down in writing.

"I was raised Christian-- Methodist-- and I consider myself a Christian, but I'm not a Christian to the exclusion and judgement of other religions. I learn, borrow from and appreciate other religions, too. I believe that there is a pervasive energy and intelligence that we call God which is the source of the Universe and all Creation. I believe that the notion of human evolution and the notion of human creation as orchestrated by God are entirely compatible. As stated in the First Law of Thermodynamics, energy is neither created nor destroyed, so the physicist in me believes that the spiritual energy of a human being is eternal. In one form or another, our spiritual energy has always existed and will always exist, even after the death of our physical body, but I have no clue if that implies the existence of heaven or reincarnation. I believe that God is an energy and power beyond our human ability to completely understand, which envelopes all of us with love and is the origin of all goodness in the Universe. I believe the flaws of humankind, especially ego and greed, are the source of all evil, as we know it. God created only love and goodness and beauty; humankind created evil as an external excuse for our own bad behavior and humankind can eliminate evil from our own behavior, if we choose to do so. I do not believe that we have to be Christian to hold a close relationship and connection to God. The Christ and God that I believe in could care less what particular religion we practice or whether we practice any religion at all... or whether we believe in them as God and Christ. What matters more is being good to fellow human beings; treating God's creation, Mother Earth, and her creatures, with the respect that Her beauty deserves; and maximizing your blessings and time on Earth in service to both. The means and beliefs we follow to achieve those ends do not matter.

Thanks for asking, Chuck. That's what I believe right now; it could change and evolve."

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