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“If I had asked people what they wanted, they would have said faster horses.”

–Attributed to Henry Ford

In the last blog, I wrote about the patient interviews, and how the design team chose them.  In this one, I delve deeper into the thinking process the team used to create meaning from the information they gathered to inform the design elements of the care model.

Why bother with reaching for stars?  Because we are entering a completely new model of healthcare delivery and reimbursement.  Fee-for-service  is centered on the fact that only documented actions by the provider generate revenue.  Over the last 60 years, any innovation we have had (EHRs, new imaging, new treatments, new medication, new roles, etc.) have had to fit, at some point, at the tip of a provider’s pen.  What is feasible gets overwhelmingly defined by that fact.  Capitation completely upends this assumption.  The question is no longer “How many visits can you generate?” but “How much value can you generate?”, with value blending both clinical quality, patient satisfaction and financial sustainability.  It’s a big question, and it will require big answers, chosen amongst options that we can barely imagine.

How then, did our Ideal Care Model design team members, make best use of their observations at the gemba and the information gathering during patient and staff interviews?  What process did they use to avoid shutting down creative options?  Of the areas that a value-based model emphasizes more explicitly than traditional healthcare, the most intriguing to me is patient convenience.  As an example, our number one patient complaint is lack of parking.  A logical solution would be to provide more parking spots.  Yet, that solution would preclude other options potentially more appealing to patients: dramatically reducing total encounter times, making remote visits both richer through remote physiologic monitoring and easier to use, answering texts/emails within 10 minutes, online scheduling, guaranteeing a call back within an hour, etc..

Psychologists divide up problem-solving into two complementary but distinct entities: convergent and divergent thinking.  As Americans, we are societally geared to thinking that any problem is amenable to the overlooked solution.  Especially within healthcare’s generally rigid systems with complicated regulatory overlay, we tend to address problems as they present, in as quick a way as possible given the resources available: a good definition of convergent thinking.  That is, a process of taking a limited amount of information and, in the context of stated goals, formulating and then choosing amongst options.  In clinical medicine, anchoring bias in choosing a diagnosis is an example of convergent thinking: some relevant fact dominates the presenting picture, potentially leading the clinician astray.  Conversely, divergent thinking is not about coming up with the right idea, it’s about generating the broadest range of possibilities, moving back up the question, and seeking as many why’s as possible.  Let’s return to the parking example used above.  What underlies the statement that parking is the worst problem our patient’s face: long appointments?  Unpredictable waiting times?  Paying for parking?  Unpredictable parking tickets?  If they could get a quick answer, would they prefer that to coming in?  What about an asynchronous email that is guaranteed answered within four hours?  What if they had a weekly care team home visit already scheduled based on one or more of their conditions?

Through use of divergent and convergent thinking, the LCHC Ideal Care Model design team soared high above our daily work.  Working to form insights from patients and staff interviews and observations, the design team created a spectrum of potential care model possibilities.  These ideas then allow us to identify the principles that are most crucial to our patients’ journey as we work to design an ideal healthcare model.

We are all patients at some point in our lives. As a patient, what do you value in your care? What do you believe is possible in the future of healthcare, what can you imagine that does not exist?

Dr Kiame Mahaniah
Kiame Mahaniah


About Kiame

Inspired by a childhood divided between a war-affected third world country – the Congo – and a high performing first world one (Switzerland), as well as parents intimately involved in rural development NGOs, Dr. Kiame Mahaniah brings a deep passion for social justice and the fight against inequities to his work as CEO at the Lynn Community Health Center in Lynn, Massachusetts.

More About Kiame

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