Collaboration Paradigm

I am a big fan of Fox’s TV show HOUSE.  As I was watching, I couldn’t help but think the medical team was participating in a kaizen event.  The concept that struck me was watching the doctors collaborate in the diagnosis of a patient and how this is just like breaking down the functional silos in a business environment.

Reaching across functional silos and collaborating has become more prevalent in today’s manufacturing world.  Manufacturing must collaborate with procurement and transportation in order to create a better total cost system that delivers value to the customer.  It has not been easy and it has not been the norm in the past, but there is still an abundance of examples to point to showing the benefits.

Why don’t more doctors work in collaborative teams?  The team on House all have different backgrounds and specialties.  This gives them all different perspectives on the situation (like transportation, procurement, and manufacturing) with one common goal……..save the patient (deliver a quality product to the customer when they want it).  At some point, if you put different doctors in one room and have them discuss the issue with you, it would seem that you would get to a true root cause quicker and I would suspect the cost would be lower instead of doctors working in their specialty silos.

Have you ever gone to the doctor when something is wrong and they sent you to a different doctor that is a specialist?  Then Specialist A runs all his test and claims nothing is wrong, so he sends you to Specialist B.  Specialist B runs his test and says your are fine and this goes on for what seems like an eternity.  Finally some doctor tries something and it maybe it works and maybe it doesn’t.  Is it just helping the symptom or is it the root cause?

Having doctors work in collaborative teams would seem to have the patients best interest in mind and create a stronger health care system.  I know we wouldn’t want to set up the  health care system to do this for every problem.  We could develop standardized work that would state when to call together a team of doctors and when to have doctors work individually.

We have torn down a part of the collaboration wall in manufacturing.  Can we start to tear down that wall with doctors?

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Posted on May 20, 2010, in Health Care, Learning and tagged , , , , . Bookmark the permalink. 7 Comments.

  1. Two big barriers…one is medical tort reform. Many doctors, when surveyed confidentially, admit to practicing ‘defensive medicine’ – ordering tests and procedures that aren’t needed to protect a doctor from the remote possibility of a lawsuit.

    The other barrier, in my mind, is the perception of value from patients and hospital ‘customers’. Work in this area of lean healthcare is very interesting. A big ‘paradigm’ most everyone shares when receiving medical help is; the more time invested by nurses & doctors and the more tests & procedures undertaken…the higher the value. We need to find creative solutions to this issue.

    I’m hoping to see more efforts from the lean healthcare folks in this area. Ideas like collaborative teams of doctors working within a system that doesn’t require constant protection against lawsuits have great potential.

  2. I am a big House fan as well. In the last episode you see a crisis situation in which everyone works togehter as you say in a team. This is often the case no matter the environment. I wonder though do you always need a crisis. Can you create just as much teamwork without it? Obviously, the goal in Lean is to create a environment or culutre where this occurs regularly. How do you get there? Do you need a crisis?

    Tim

  3. Many Doctors do consider what they practice as ‘collaborative’ medicine. As with most individuals, when you present your “opinion” (in this case think medical opinion) with some data and another comes along and presents their opinion (at times contrary to yours) a certain amount of tension naturally arises. Most of the Doctor’s I have worked with do not like the fact they may be wrong, aside from the blow to the ego, it may also end up in litigation some time later.

    A hypothesis as to why Medical Professionals (i.e. dr’s and rn’s) act the way they do (this is my hypothesis) can typically be traced back to two sources (in my opinion). 1st Medical School they were initially taught & 2nd Residency Hospital they finished up at. I observed my hypothesis played out at a few ‘teaching’ hospitals.

    I would like to source the crowd on this one….how many who frequent this blog have a story related to my hypothesis?

    Thanks,
    Justin Tomac

    • You bring up a great point about being afraid of litigation if they are wrong. So is it not only a mentality shift by doctors but also by patients. Patients have to understand that doctors are problem solvers and sometimes they are wrong. If the doctors are wrong then as patients lets work with the doctors to continue to dig for the root cause and a solution.

      Great observation. Litigation doesn’t cross my mind with I work with a doctor. Gives me a different perspective.

  4. I think maybe some of the lack of collaboration comes from, as Dr. Brent James describes, the 1895 split between clinical and administrative work that Johns Hopkins initiated?

    I write about that here:

    http://www.leanblog.org/2010/05/notes-from-dr-brent-james-at-the-shingo-prize-part-1/

  5. On the other side, ThedaCare, a lean health system in Wisconsin, has a wonderful model called “Collaborative Care” where the MD, RN, and Pharmacist all work together as a team. That process is described in the upcoming book about ThedaCare from LEI called “On the Mend” – http://www.onthemendbook.com

    http://www.google.com/search?q=thedacare+collaborative+care&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

  6. Mark,
    Great link and thanks for the additional insight regarding the 1895 split. The differentiation was probably needed at the time. What interests me is how to manage the differentiation so it doesn’t inhibit the patient care. Hopefully more Healthcare/Hospitals are taking the Thedacare/Viginia Mason approach.
    JWDT

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