Case Study Bird's Eye View, Macro Level: Ontario Cancer Care in a "Centre of Excellence"
"Voice of the Customer" Matrix
Who is the "customer" in a cancer research or teaching hospital facility that is a "Centre of Excellence"?
For example, one could identify the following:
Cancer patients (receiving healthcare)
Government (funding body for operations; expects quality, patient-centred service / outcomes)
Research funders (providing research resources in exchange for results)
Researchers (requiring resources to produce results)
Fellowship students (developing their expertise as the "next generation" of specialists)
Who should the healthcare / research facility focus on as primary customer? In Ontario, the patient does not directly pay for healthcare, yet the hospital exists to serve this constituency and is funded by the government for this purpose. Let's focus on the public's primary use of the hospital, namely for cancer care.
Some general questions:
Is healthcare delivered to meet the goal of "patient-centred" care?
How do we define quality healthcare? Is a patient to be treated like a widget on an assembly line?
Assembly line processing feeds into the "consistency"feature of process improvement, but appears not to dovetail with quality patient-centred care, especially in the case of anomalies, which seem to be more frequent with certain types of cancer patients.
How many touchpoints does the patient have with the organization? i.e. reception, nurse, oncologist, blood lab, imaging, staff in elevator, patient relations department, "special" services such as Patient Navigator, and so on.
Does or should the centre have an intake process for streaming referrals from other centres, i.e. to provide second opinion? Delays put the patient's life at risk, a most undesirable result of an inefficient or absent process.
Why are long waits considered to be the norm (and acceptable to the care institution), such as for clinic appointments or chemo? Does the cancer centre have wait time standards and feedback loop/controls that put it in the "excellent" category?
To start the analysis, we can develop a matrix to match the hospital's expected capabilities with the concerns of the cancer patient (Voice of the Customer).
This chart simply identifies how we can intersect hospital capabilities with patient care expectations. Patient trust in best possible outcomes determines the organization's reputation.
Further analysis would map process workflows between departments and how they affect the patient (i.e. time to completion for bloodwork vs patient waiting to see oncologist). Effective processes reduce cycle time, provide better outcomes and reduce costs. Reducing cycle time can improve outcomes; reducing costs can create resourcing opportunities.
Seven questions to consider (notwithstanding the organization's Balanced Scorecard and Strategy Map):
What does it mean to have an international reputation as a global leader?
How does hospital leadership reliably assess that it continues to merit that reputation?
How do we define "customer"?
Are patient surveys periodically done to identify what is important to the customer; to identify how the hospital is doing in meeting what is important to the patient?
What does it mean to the organization to provide excellent service? What metrics are used?
How is a patient's situation better handled at a "Centre of Excellence" than at their regional cancer centre?
Or...What is the value-add to the patient of going to a "Centre of Excellence"? Is the diagnosis or treatment different? Better? How? Can this be quantified?
Funding constraints are at times cited as the reason when sub-optimal performance happens.
In publicly supported systems, this can be the default reason for a failure to deliver, when what is really required is to address systemic process deficiencies.
Removing such deficiencies gives individuals greater opportunity to provide customer service excellence in healthcare with existing funding.
Here's a tickler for all Ontario healthcare organizations to review their processes to take them to Excellent.
Already done? Are you sure you got it right? How do you know?
