by Kristi Biltz, CMRP
Consulting Director, Clinical Advisory Solutions

The use of a value analysis process in the health care setting isn’t new. In fact, it’s become a strategic imperative for health care organizations as they work to provide the highest-quality, most cost-effective care for their patients. However, in my experience the one complaint I hear most often is, “Why does it take so long to put through an initiative? Where is the speed to value?”

The reality is that Lean methodologies can be very valuable in streamlining your value analysis process and creating speed to value because it addresses the most common barriers: resource allocation, conversions, scheduling conflicts and long trials, to name a few.

To apply Lean methodologies to your value analysis process, start by mapping your process into four phases: 

  • Triage – starts with the receipt of a request and ends with assigning the initiative to a value analysis team
  • Assessment – begins with the team starting their discovery and ends with either an evaluation or a decision to go to conversion
  • Evaluation – begins with the decision to evaluate and the creation of evaluation criteria and ends once the evaluation has concluded and survey results are tallied
  • Conversion – begins with the decision to convert and ends after the product has been converted and final materials functions are complete

Detail the steps in each phase to measure the amount of time being spent to complete the phase. As you are performing this process-mapping exercise, common inefficient practices that impede speed to value will begin to surface. I have identified five typical roadblocks associated with these phases, along with recommendations on how to bypass these ineffective habits and realize SPEED to value.

Steer clear of having multiple touch points for the same function in all phases.

Consider this scenario: In the triage phase, an initial contract review is conducted by a contracting staff member. When the value analysis team decides to move the initiative forward, a service line-specific contract analyst is assigned to the initiative and they perform a review.

What began as a triage activity by the contracting team was identified as causing additional work in the long run. To avoid re-work in reviewing the initiative, the service line contract analyst should be utilized from the beginning.

When you discover these multiple or duplicative touch points, adjust your mapping into a swim-lane style so that the hand-offs are more obvious. This will highlight the multiple touch points throughout the process and allow you to evaluate where steps could be rearranged or combined to prevent confusion and improve efficiency.

Put a stop to any assessment phase work without budget owner approval.

Oftentimes I see instances where the value analysis team has received a request without a department-level signature yet they proceed to the assessment phase. Later they find out the department director refused to sign it because of budget reasons. Had the value analysis team refused the request until it had the necessary signature, the team would not have wasted valuable time on a request that was ultimately denied. 

When you notice that you are doing assessment phase work ahead of getting the appropriate budget approval, the impact can be lost time and a negative impact on your relationship with the budget owner.   

Ensure meeting time is used for appropriate evaluation phase discussions.

Another common barrier on the speed-to-value journey can be the inappropriate use of meeting time. The value analysis team meeting often has numerous initiatives, so the team spends the hour giving an overview of where things stand. The meeting starts to focus more on updates, which creates the perfect set-up for delays.

Instead of using meeting time for tactical updates, focus on critical conversations around products, evaluation criteria development, evidence discussion, voting, and the determination of categories to investigate for savings or improved outcomes. Summary information can be sent ahead of the meeting in an overview and can also be a part of the minutes. Maximizing the time of this valuable audience is fundamental to managing an exceptional value analysis process and in preventing delays.  

Execute action items, such as voting, outside of regularly scheduled meetings.

It’s a fact of life that everyone is busy and coordinating schedules can sometimes feel like an initiative on its own. For example, there will be instances where the timing of a value analysis meeting doesn’t neatly coincide with the survey results from a trial. When teams wait until the next meeting to vote, implementation is delayed, possibly adding up to four weeks to a conversion. Instead, consider using online survey tools to cast votes on initiatives.

Determine which items require third-party validation in the conversion phase.

Due to required third-party validation, there have been instances of new item builds taking up to eight weeks.

Identify those items that commonly require third-party validations and determine if an update to your policy could be made to address these. You might consider setting limits such as sending only chargeable items to a third party for vetting purposes. Another option to consider would be to send the items to the third party during the assessment phase so that the vetting is further along in the process before you get to conversion.

I invite value analysis teams to take a time out and review their processes for inefficiencies that can cause delays. Using a Lean methodology to streamline where possible will help your organization on their SPEED-to-value journey.

About the author. In her role as consulting director on the clinical advisory team at Vizient, Kristi Biltz uses her more than 25 years of experience in the health care industry to assist acute care hospitals consistently integrate clinical benchmarking data with supply chain data in a clinical value analysis setting. She helps hospitals improve practice and product variation through a standardized decision-making process supported by evidence and best practice within a culture of continuous process improvement. Prior to joining Vizient, Biltz held various roles in the hospital setting including O.R. business manager, supply chain manager and value analysis co-chair. She was instrumental in the management of central sterile supply and its supply warehouse as she drove down variation in the O.R. In addition to her extensive supply chain, contracting and purchasing experience, she possesses a keen understanding of value analysis and how the implementation of an effective value analysis program can significantly improve an organization’s clinical, financial and operational performance. Biltz is a member of the Association of Healthcare Value Analysis Professionals (AHVAP) and the Association for Health Care Resource & Materials Management (AHRMM); and holds CMRP and Six Sigma Green Belt certifications.

Published: April 16, 2019