Key Lessons in Healthcare Delivery: Equity, Needs Assessment, and Scaling (Full Transcript)

Speaker 1: One is everything that you do as a healthcare delivery system or as a multi-stakeholder coalition for a population should stem from your understanding of the needs and assets of that population. Oftentimes we kind of go out there and say, we want to accomplish how much by when, but it's actually how much by when and for whom. And if you were to see, okay, for the whom, what are actually the needs? And it's not just looking at what the system level data, the population level data says about that population, but it's also about doing client interviews and finding out from the patients or the individuals themselves, tell me about what your day is like. Tell me about what it's like to live with this chronic disease and talking to healthcare providers that serve those clients. Then we can make some leadership and governance decisions about who should be at the table to make decisions for, for, and with that population. Then we can make some decisions about what's the best measures to track. What are the things that we actually want to accomplish? What's a portfolio of projects and investments? What is the improvement capability we need to build and with whom in order to serve that population? The second, and I think some of this comes from our work on the pursuing equity initiative is to make equity a property of the system, not an output of the system. That we're actually going to design a system that creates equity for the population that we serve. And that means it kind of flows into the third lesson of that you're really going to have to partner with those with lived experience in order to get there. What equity really looks like, to ask yourself the question, when I look at the data of this population, who isn't thriving? And then ask the follow up question of, and what would it take to change that? So those kind of two questions start to put equity at the center of the system, knowing that when you design for equity in mind, it benefits all. The fourth, I would say, is that people tend to not have the closest window to the ground in terms of their measures. So a lot of people are relying on measures that come out once per year. Can you imagine if that's the only window you have into your system is once per year? So many health rankings release health status and life expectancy once per year. And that's just not a close enough window into the ground of how things really are going. And so how can you pair the fairly insensitive population health measures, which don't move quickly and don't come out very often, with a set of process measures that can give you the line of sight to say, if we're doing X, Y, Z with a population, it's giving us a high degree of belief that we're going to move that measure when it comes out next year. And so having that dashboard of kind of like a complete picture of different levels that you can see into the system, kind of different glasses you can see into the system. And then finally, I think a big lesson is that people aren't coming at this with a mindset to work at scale. So they'll come at this with a mindset of, I got funding to work on a pilot with 50 moms. And when you ask them, but how many moms are you trying to reach, they're like, well, my pilot is 50. And if we're continuing in that mentality of scale up happens once you hit results on a pilot, and then it's some sort of threshold, then inevitably there's going to be a lot of pressure. Sometimes I've heard people say, well, scale up is for hopefully when somebody else takes my job after me, and I don't have to worry about it. When actually you're going to scale from the first person that you serve. And so one of the questions we've asked teams around, improvement teams around the world is when you start thinking about a population, actually write down the number. Could you do a back of envelope calculation? And so as soon as you have that number, it becomes very real. And then you can start to plan to go to scale from the moment that you start serving people. So those are kind of the big five lessons when I think back of the last 10 years.