Kurt Knoth, VP of Performance Improvement at Spectrum Health on Embedding Patient Centricity into Performance Improvement

Kurt Knoth
Contributor: Kurt Knoth
Posted: 10/20/2016


The PEX Nextwork's 5th Annual Business Process Excellence Summit provides the USA’s ultimate guide to innovating across the enterprise and reinventing business models to achieve true performance excellence. The event kicked off with a   dedicated healthcare focus day on how to improve quality, patient safety and efficiencies. The PEX Network caught up with key speaker Kurt Knoth, Vice President of Performance Improvement, Spectrum Health to discuss the challenges and opportunities of moving from a cost-centric to a patient-centric performance improvement and quality measurement strategy.

What’s your PEX story? 

I started off in the automotive industry, right out of college and early on I was an engineer. Our company was going through a lean transformation and some consultants came in from Toyota to teach us how to do process improvement. I was interested and made a decision early in my career that I wanted to focus on process improvement as a career choice. I have had the opportunity to do improvement work in a wide variety of different industries, beginning with manufacturing and transitioning to aerospace manufacturing. I spent a good deal of time working with the US Department of Defense, a little bit with the Royal Navy and got to apply process improvement in an entirely different environment.  About seven years ago got involved with healthcare, firstly through the Air Force Surgeon General, then with more commercial healthcare entities. I later decided that I was going to spend the rest of my career working on process improvement in healthcare because there is such a great need in our industry to make things better. 

What can we expect from the next generation of operational excellence?

More people will get exposed to the power of this way of thinking, especially our younger leaders as they start to move into more leadership positions. Having leaders, especially executive leaders that truly understand how to deploy improvement will really take it to the next level. You won’t necessarily have to have a small cadre of black belts or experts who know how to do this. It starts to become engrained in the fabric of how we do things.  I think also linking that with new technology and being able to get real time data if we’re making things better, especially in healthcare that continues to be a challenge for us. 

Spectrum Health has moved from a cost-centric to a patient-centric performance improvement and quality measurement strategy, how would you now describe ‘good’ operational excellence in healthcare?

Good to me, looks like having our customers involved in the conversation and that means engaging our patients in the improvement that we are proposing.  If you think about healthcare at least in the US and it’s probably universal it’s still very much centred on how we would like to deliver medicine. You don’t have to go any further than looking at how we schedule surgeries and requiring patients to show up at 5am for a 9am surgery just because we don’t want the surgeon to have to wait, so we expose all of our waste and scheduling to our patients, and it’s really more about what we want not what the patient wants. I would be remiss to state that we are not fully patient centred, we’re still working on it, there’s areas where we’ve done a really good job and we’re continuing to get better, but we still have a long way to go to get to the point where we’re truly a patient centred organisation. 

What key hurdles have you encountered moving to a customer-centric point of view?

I don’t think it’s any different than any other improvement.  The journey includes the whole change management piece and convincing, particularly physicians that have been doing things the same way for many years that now they have to do things differently. The way we schedule, the way we bill and even the way that we compensate our physicians, those are things that we’re working to change because our current system and when I say system it’s US healthcare system encourages physicians to see as many patients as they can. That’s starting to change with some of the reforms that have gone through and getting more of a quality and safety focus and experience focus, but it really is that change management and convincing folks that have been doing something the same way for many years that there’s a better way and here’s the reason why.  A lot of times having the patients involved in that conversation helped because a lot of times our healthcare providers don’t necessarily understand the impact that they have on patients’ lives until they actually hear it from them straight away.  

Could you outline some of the steps that you have taken to ensure that the voice of the patient is heard?

We have a couple of different mechanisms. We have what we call our patient family advisory councils or PFACS. We have 16/17 of these councils and they’re centred on different hospitals, but then also services that we provide like cancer care and heart care. We have regular meetings with those patients who volunteer their time to come in and talk about different topics that are on their mind, or things that our leadership team will bring up.

They have regular access to our leadership team and then we also have an executive council that meets regularly with our executive team to give us feedback. We also have directly tied to our process improvement that whenever we have an improvement project, or what we call rapid improvement events and there’s topic that relates to our patients we always have a patient on the team and then they give their input and tell us what they feel is value added and what’s not value added, so we’re not trying to guess.

What would be your advice for overcoming resistance to change when dealing with multiple stakeholders?

I think just involving those folks in the conversation is the most valuable thing that you can do. People naturally will resist change when it feels like it’s dictated to them, so bringing them in to the conversation. We use A3 thinking, so taking a scientific approach to improvement and building a business case for change and then involving them in the solutions, I think is the best way to get past that resistance.

This is an ongoing journey, but what are your highlights to date?

There’s quite a few to choose from and I can’t take credit for them, a team supports me. One of the success stories that I would like to share is from our emergency department in our flagship hospital, which is one of the busiest ERs in the nation.

We have moved from a point where we were taking care of patients in the hallways, because we didn’t have enough space. We were thinking that we were going to need to spend $50 or 60 million on an expanded emergency department. Three years later after making some minor adjustments to improve the facilities, we have spent maybe $2 million versus $60 million, but we have also eliminated wait time for patients and eliminated the waiting room. We got rid of the waiting room in the emergency room, because we were able to streamline that process so much that the patients didn’t have to wait any more. I think hearing the feedback from not only the patients but the people at work in that area has been very rewarding for me personally. 

You recently spoke at the Healthcare Focus Day, part of the Business Process Excellence Summit, why did you feel it was important to share your story with other professionals?

I got some feedback from the folks in the audience, and I think it’s a true perception that in US healthcare we still think of the patient as an afterthought. Really talking about the importance of including our most important customers, our patients in the conversation when it comes to improvement is something that we need to spread to other organisations.  I think the trends are heading in the right direction, we’re starting to have a lot of folks come and benchmark us on our patient family advisor councils and our approach to improvement, but if nothing else if I was able to spark a thought or an idea to a colleague that was there I’d feel like I’d accomplished my goal.  

Kurt Knoth
Contributor: Kurt Knoth
Posted: 10/20/2016


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