Saturday, September 14, 2013

Process improvement in a healthcare setting: The VA- TAMMCS model

This summer, I was fortunate enough to intern with the Department of Veterans Affairs. While I was there, I was exposed to the very kinds of Lean Thinking and Six Sigma concepts that we are exploring this week in relation to supply chain management. As a result, Julie Weed's New York Times article about process improvement within hospitals was not at all surprising - I had the chance to see these sorts of methods in practice first hand.

Specifically, I would like to introduce yet another method (as if the comparison of Six Sigma, Lean, and TOC wasn't enough to make the reader's head spin!): VA's system of Systems Redesign, including their model called VA TAMMCS.

VA TAMMCS stands for: Vision/Analyze, Team/Aim, Map, Measure, Change, Sustain. To the reader acquainted with the concepts of Lean Thinking and Six Sigma, common elements will become apparent. [1][2]

The use of the VA-TAMMCS model achieves three major goals.

  1. It creates a clear and common vision of process improvement throughout the VA. 
  2. It is not "branded" with any specific title such as Six Sigma, which can sometimes serve to cloud understanding (Imagine an organization with distinct camps representing Lean, Six Sigma, and TOC. Imagine that representatives of each camp had invested time and money in their training and study.)
  3. It synthesizes the best elements of other models and, critically, is designed specifically for the VA.
While a full explication of the VA-TAMMCS model is beyond the scope of a blog post, it is possible to briefly explain each step.
  • Team: Ensure that you've formed a team of front-line staff who are direct stakeholders in the particular process being examined. This is reminiscent of the Toyota Production System's empowerment of all staff in the organization.
  • Aim: Generate one or two clear sentences that define the specific goal of a given process improvement. This is typically framed in the context of the patient's experience, another nod to the TPS urge to root everything in the end beneficiary (customers in Toyota's case, patients in the VA's case). An important note is that good aim statements are generally numerical in nature and based on measurable data. "Reduce the wait times of patients in clinic X by Y minutes before the end of Q2 20ZZ" would be better than "improve clinic X." 
  • Map: Create a picture of the current process. Use flow-mapping tools to gain an understanding of the process "as it really exists" - not the idealized version.
  • Measure: Gather data to ensure that improvement processes are actually creating a change in the status quo, especially in the service of the previously defined aim. We see shades of both Six Sigma and TPS in the commitment to quantitative metrics for improvement. This is the step that should make MISM-BIDA and MSPPM-PolA students sit up and take notice!
  • Change: Create buy-in among the team and the other front-line staff to implement the changes determined in the preceding steps. Implement changes in recursive "plan-do-study-act" cycles. This commitment to consistently testing and revising changes can be seen as another nod to TPS.
  • Sustain: Continue to maintain data and measurement, create policy changes or implement training policies, and determine new incentive structures.

[Above adapted from [2] ]

The VA-TAMMCS example holds a plethora of insights for our study of SCM. First, it gives a concrete example of how the methods that revolutionized manufacturing in industries like cars and computers can help improve the quality of care in a healthcare environment. Additionally, it gives those students who are inclined toward public policy an example from their own domain. Finally, it shows that certain industries or specific organizations can (and, perhaps, should) mix and match the best parts of existing frameworks and methodologies to their own purposes.

It is this final point that yields a question for further consideration. For those of us who are headed to careers outside of cars and computers, should we be prepared to adopt an improvement framework wholesale or should we be sensitive to the most applicable elements of each?
Are there industries or areas that are ripe for a process improvement model but do not currently employ such tactics? Kaizen at the IRS? How about the DMV?
Does a special, custom model engender more support within an organization than a "branded" model, especially one brought in by consultants from outside?

These questions provide the kind of thinking that can be applied not just to this week's material but to the entire course and, in my opinion, serve as a kind of shorthand for why Supply Chain Management is so popular among Public Policy students.

[1]Simons, Shirley. "Continuous Improvement."
[2]Davies, Mike. "VHA Systems Redesign."

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