Much of his re-engineering work involves culture change, which on the surface is simple, but unquestionably is ephemeral. Mission starts with the premise of getting each patient to the desired outcome, without harm, without waste, and with an exceptional experience.
To do that better, he's employed facilitators to go through processes with patients step-by-step, so that no opportunity to eliminate waste is missed. And that includes movement. I'll explain: Mission's ED workers might walk 4 or 5 miles a day in the course of doing their jobs.
Maybe 3.5 miles of that is wasted effort. By constructing detailed value stream maps around what workers—from frontline check-in folks to surgeons—are actually doing during the day, they can consider changes to work habits that produce real cost savings. Mission backfills labor needs during the evaluations so that frontline staff can fully participate.
These value stream maps are created from both the patient's and the clinicians' perspective. Sometimes that means following patients from beginning to end as they make their way through dozens of visits.
The process sounds time-consuming and expensive, Paulus concedes, but when you consider the power of changing a practice that may be multiplied thousands of times over the course of a year, you start talking about real savings when those habits are broken—habits that don't add value in the first place.