Cathy, a former medical administrator at a Mid West research hospital, recalled:
“A diabetic patient felt numbness in his foot and decided to have it checked out. He drove to the medical center without wearing a shoe on the affected foot, so that he could compensate for the lack of feel of the pedal, parked his car, and proceeded to walk to our clinic.
“When he took off the sock, the doctor discovered a third-degree burn on his foot. "How did you burn your foot?" This baffled the patient, "I don’t have any burn, doctor, I came here because of a little numbness."
He had walked a little over a mile from the parking structure to our clinic, and in the process developed a severe burn as he dragged the numbed foot on the hard floor and he did not even know it. The incident stunned us: why in the world did we put a diabetic clinic furthest from the medical center entrance? Why couldn’t we foresee what our patients might have to go through?
A humbling experience like this could happen even at best medical facilities, but it can be prevented with good planning and design. Today, the healthcare industry, in America in particular, faces unique challenges: increasing competition, the prospect of healthcare reform, shrinking bottom lines, insurance and regulatory mandates and compliance concerns, etc. This is forcing hospitals to seek out new ways to do business and deliver services.
In the mid-1990s, Princeton Baptist Medical Center (Princeton) was seeking small niches to differentiate itself amid increasing competition from other hospitals. Princeton Foot Clinic (PFC), an offshoot of the outpatient physical therapy services, was such an opportunity. Its goal was to contribute to the Princeton’s bottom line through patient retention, increased market share, improved service efficiency, and high customer satisfaction. QFD was introduced to the new clinic to help them discover and understand the needs of potential customers.
Healthcare is a complex composition of highly competent medical professions. Confident and skilled in their ability, each specialized field and department prefers and expects a great degree of autonomy. This often makes it difficult to get them think and act together toward the changes and new ideas that are needed for an organization to stay competitive.
At PFC, many different specialists had to work together to treat a patient because of the complexities of foot medicine. This included orthopedic surgeons, nurses, podiatrists, physical therapists, as well as referring physicians specializing in non-foot medicine such as diabetes, kinesiology, and geriatric specialties. QFD provided a common framework to better communicate and align their services toward the common goal of the patient’s benefit. In short, QFD enabled them to walk in the shoes of their patients.
Additionally, QFD helped them identify several “unspoken” customer needs during the Voice of the Customer analysis phase. For example, the gemba study revealed that referring physicians, one of PFC’s important customer segments, desired to send patients without a prior work-up (assessment). This indicated several things: that physicians would like the option of sending some patients directly to PFC for assessment and treatment; that physicians may be feeling they are wasting time on certain foot cases when capable therapists can not only treat but also handle initial assessment; and/or that it may relate to continuity of care, in that the assessment and treatment can be done in one location for patient convenience.
“Whatever the case, it was revealing to discover some physicians desired an option under which they would forgo some control and potential revenue in the interest of maximizing their own time and improving the quality of care for their patients,” the PFC project team reported.
With advancements in medical technology, we can expect to see more new concepts emerge in healthcare and that the demand for them will rise, including personalized medicine and multi-discipline healthcare—both of which would require multitudes of specialists to understand both spoken and unspoken needs of the patient and collaborate better than ever to treat the whole person, not just an aliment or symptom.
QFD can provide ready tools for understanding the voice of the patient beyond what is stated, translating them into deliverables and priorities. It can be a surrogate pair of patient shoes for healthcare professionals to walk a mile in, helping them, despite their different interests and functions, to see how their services and processes can be aligned more efficiently on the common goal of patient well being.