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Thursday, June 4, 2015

"Standard work establishes a baseline for innovation." #HCsummit15 day two

The headline quote for this post comes from the answer to an attendee question raised during the Learning Session "PAMF's Ambulatory Surgery Center Value Stream Approach to Improvement." Co-presenter M. Osman Akhtar didn't miss a beat in response to being asked to reconcile the seemingly adversarial concepts of "standard work" versus "innovation."

It was a deft reply. How can you know you're "innovating" if you don't even know the salient characteristics of the incumbent "best practice"?

To me, the idea tangentially conjurs up my venerable Deming 101, specifically his admonition with respect to "tampering" -- i.e., you first have to confirm that a candidate process is understood and empirically "stable" (emitting only non-assignable cause, random variation). Attempting to "improve" an unstable process is "tampering" and invariably makes things worse. Attempting to "improve" an unknown process is a contradiction in terms.

"Standard work" ("SW") is standard because it's been vetted in some rational fashion as the current best practice. Even the ancien SW antecedents of my before-indoor-plumbing salad days known as SOPs (Standard Operating Procedures) became "standard" predominantly (though not exclusively) via an interative consensus analytic process conducted by SMEs (Subject Matter Experts) prior to being placed into production.

Nowadays, we write verbose manuals full of "P&Ps" (Policies and Procedures), typically with the "Procedures" sections weighted down with redundant and irrelevant verbal diarrhea "Policy" statements, authors gleefully oblivious to the fact that "procedures" pertain only to how, who, and when (the "how" including requisite documentation methods). They are properly action statements, not "what (scope)" and "why" dicta appropriate to the Policy sections.

If I had a dollar for every time I've encountered these bloated, incoherent P&Ps, I'd be on permanent vacation in Hawaii, not pecking away at this blog in my PJs at the DFW La Quinta. I guess the good news is that no one ever reads these things anyway. Wait a minute! That's "waste," ja?

But, I digress...

How about some photos from Day Two for now? (There aren't many; the somnolescent Happy Hour Mode stage lighting still sucked.) I'm fixin' to watch Game 1 of the NBA Final shortly, and my brain is tired. I'll be finishing up this post on my way home to The Peoples' Republic tomorrow.

Keynoter Doug McKeever, CalPERs
The CEO Panel
CEO Panel Moderator Mark Graban
LEI Founder Jim Womack, now of Planet Lean

An inspiring two days. Fun being the dumbest guy in the room.


My Vegas pals' band and their new high-tech project. Talk about "innovation"!

This promo will run on TV's onboard the new Royal Caribbean Quantum cruise liners. It's a behind the scenes, sneak peek of our new virtual concert. Thanks to The Imagination House for creating it.
Posted by Santa Fe and The Fat City Horns on Friday, June 5, 2015

Honored that they used some of my stills in this video. I blogged them for years when I lived in Las Vegas. If you want to hear some of the best of the best "20 Feet From Stardom" performers comprising what I call the "extended Santa Fe tribe" and that I am blessed to call my friends, check out my Santa Fe and Friends mp3 audio podcasts.


Margalit Gur-Arie always rocks!

How to Use CPT 99490 for Healing the Sick

The Medscape Physician Compensation Report puts primary care physicians at the bottom of the heap, with a median earning of less than $200,000 per year in 2014. What if the largest insurer of older Americans took those numbers to heart and decided to give primary care a pay raise of 25%, in recognition of and better support for the hard work involved in caring for the very old and the very sick? This is the general idea behind the brand new Chronic Care Management (CCM) fee introduced by Medicare on January 1st 2015. Three cheers for Medicare!...
Unfortunately, Medicare structured its fees based on the now prevailing assumption that all doctors are charlatans, and hence every penny paid to them must be justified by at least one thousand pages of legal size, single spaced, dated and notarized documentation, or the electronic equivalent thereof. Furthermore, as is customary in our nation’s capital, every law or regulation that may be beneficial to the public, comes adorned with a wealth of gifts for special interests, which often render the original intent null and void for all practical purposes. The CCM is no different.

Medicare could have settled on a simple capitation fee for chronic care to provide payment for currently uncompensated care management and to expand such services to patients who can benefit from additional attention. By piling on reams of preconditions and micro-specifications, Medicare all but ensured that none of the money it plans to spend on CCM will actually benefit chronically ill patients...

More to come...

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