By Roger Coleman
Coleman Associates

In the March 27, 2007 issue of the New York Times, Denise Caruso penned an article titled “Knowledge is Power Only If You Know How to Use It”. She explored research on “why can we—people or society—do some of the things we set out to accomplish and not others”. She noted that researchers distinguished between “knowledge” and “know-how”, the latter being “putting knowledge to work in the real world.” We would call this “methodology”.

“When the know-how is robust, it has a quality that [the researchers] have called the ‘Go’—or, a core of reliable action”. What this means is that results are fairly predictable and consistent. Turning knowledge into know-how is what Coleman Associates does around creating patient-centered, efficient environments. We provide a “go” for our constituencies.

“But the ‘Go’ enables more than just the right tool for the job. It can provide a vital convergence point for stakeholders with very diverse agendas. Once they find common cause in a reliable solution, they have something to rally around so that all their interests can be advanced.” We quote Caruso’s article at length because this is precisely what Coleman Associates does and why our methodology works.

Our methodology brings several benefits. First, patients respond very positively and vocally to patient-focused processes and organizations. Second, this demonstrative and positive response results in higher levels of satisfaction among all those who provide services to patients. And third, patient-focused processes always increase clinic efficiency.

As a concrete example of “Go”, take the Coleman Associates Patient Visit Redesign™ collaborative (sponsored by the California Safety Net Institute and Funded by the California Healthcare Foundation) which is just starting its fifth week. Redesign teams have developed new models of seeing patients in their clinics and are conducting “Rapid Redesign Tests” (RRTs), to test the efficiency and effectiveness of their models.

Eleven teams from public health systems in California have decreased cycle time (calculated from the time the patient enters the facility to the time they depart) by 49% and increased productivity (number of patients seen per hour per provider) by a whopping 63% over baseline. These organizations had pre-redesign cycle times averaging 92 minutes and productivity averaging 1.9 patients/provider/hour and after just a few weeks, the average cycle time is now 47 minutes and productivity is 3.1 patients/provider/hour. Simply astonishing! And patients, unsurprisingly, are unstinting in expressing their delight in the new way of doing things.

How have they accomplished these results? Well, at a Coleman Associates Patient Visit Redesign™ Learning Session in San Francisco in October, teams gained knowledge about how to redesign the patient visit process. They developed new visit models, then set up schedules for testing their redesign ideas. Knowledge is turning into know-how as the teams run iterative test clinics call Rapid Redesign Tests, or RRTs—the results of which were mentioned above. Know-how comes about by virtue of testing new ideas, reviewing the results (cycle time and productivity), making changes in their designs, and then testing again the newest version of their models.

After their models have been tested and refined over a period of eight weeks, the teams will run a final series of three all-day tests. The “Go” results when each team performs a financial analysis of the impact of these tests and the top decision-makers in their organizations give them the mandate to implement the redesigned model throughout their clinics. Teams will have proven the reliability of their model and shown how effective and economical it is before it is ever implemented clinic-wide.

Knowledge; Know-How; Go. It’s beautiful to see this concept put into play.