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About Us
Based in Ann Arbor, Michigan, Blue Cottage Consulting is an independent, woman-owned healthcare consulting firm specializing in visioning, strategy, operations, and facility planning (programming, design review, transition and activation planning).

Blue Cottage Consulting is different - we have vision, knowledge, experience, and a point of view. Our professionals have held executive and management positions at some of the best medical centers in the country. Most importantly, we seek projects and clients that want to transform healthcare.
 
Cottages are about relationships, respite, and reflection. Blue Cottage Consulting is about creating a space for our clients to think, dream, and truly see the ocean of possibilities that exist for any given project. We coach leaders to embrace the possibilities, balance real versus perceived risk, and articulate a bold strategic vision – in other words, Be Transformational.  We get to know you, we work alongside you, and we create an intimacy in our partnership that fosters honesty, challenge, and innovation. It is an exercise that brings out the best in you and your team so that together, we can discover breakthrough solutions with practical implementation, explore global concepts with local applicability, and clearly articulate what success looks like and how we are going to get there.
 
Our consulting professionals challenge the status quo by applying lean efficiency standards to reduce waste, achieve mind-blowing operational innovations, and create an environment where clinical teams can achieve their full potential. We combine robust analytic tools and performance-driven measurement metrics, with real-world experience and active listening techniques to allow both data and people to guide each project to its highest probability of success. Our capabilities come from graduate training in healthcare management, nursing, planning, and architecture, as well as certification and professional training in special skills such as lean operations, six sigma, and executive coaching.
 
We are Blue Cottage Consulting and we are working to transform healthcare one project at a time.
ABOUT US


Archive for the ‘Process Improvement’ Category

What healthcare can learn from The Walking Dead

Wednesday, December 18th, 2013 by Cecilia Lum

I spend a lot of time on the road talking with individuals across the United States about the future of healthcare. With healthcare reform a prominent topic for discussion, everyone has an opinion about the direction of our nation’s healthcare system, and it has been enriching to hear such different perspectives and ideas.

A few weeks ago, I interviewed stakeholders on their thoughts about the current challenges in healthcare and their desires for the future of their community’s health. One of the last interviews was with a community physician who echoed concerns that health improvement is too broad a mission. He elaborated that health is so deeply entwined with jobs, education, income, food resources, family dynamics and transportation. He continued adding other contributing factors while we recognized that the list he was creating is dynamic, not linear. These elements influenced one another, and healthcare is in the middle of a messy matrix of other sub-performing systems.

The physician questioned the initiative’s ability to improve the community’s health; a skepticism that preceded the project’s initiation. We discussed the expansiveness of our country’s health problem, making this effort—like so many others—vulnerable to a scope creep that can ultimately paralyze the project. Having barely made it to the starting line, I was startled by the timing of this cynicism. But his apprehension was real and familiar. I understood his concern, and believe it’s one that resonates with many in the healthcare field. Our interview ended on that somber note and I left thinking, “How can we fix what seems like a doomed cycle?”

Traveling as much as I do has its pitfalls. For one, I am perpetually behind on my television shows. That night, I watched a marathon of Walking Dead episodes to catch-up to the mid-season hiatus. A cohort of the prison residents had fallen ill and was placed in quarantine to protect the healthy. Several began dying and consequently turned into zombies creating more chaos. Some of the community’s most agile zombie slayers were urgently deployed to apprehend medicines from a nearby veterinary school. Hershel Greene, a farmer and veterinarian, sacrificed his safety by entering the quarantine to care for the ill as they awaited medicine, buying them time. Hershel’s compromise was not surprising. After all, his mantra was “we all have jobs to do.” He recognized that his caretaking skills could help others survive, and so it was his duty to do just that for the greater good of the collective.

Watching the community on the Walking Dead come together, each person playing a role in keeping the group alive and safe from zombies inspired me. “We all have jobs to do” may be the solution to addressing the big challenge of improving the health of our country, recognizing that it’s a collective effort and not any sole entity’s responsibility. Ultimately, the idea that it’s one person, one organization, one profession’s duty to solve the healthcare problem is what creates skepticism and stops us from trying without even starting. In fact, that physician’s fear will become reality if we place the burden of responsibility in any one area. That just isn’t a feasible or sustainable approach.

It’s time we recognize and hold accountable all that contributes to our health. Our healthcare system is responsive to illness, but not necessarily preventive of it. We’ve lightened our attention on all the factors upstream, driving people into our healthcare system. Real, tangible change, however, occurs when we all do the jobs we need to do. That means responsibilities and roles for schools, city planners, restaurants and places to buy foods, social services and individuals. I wrote earlier this year that the players in the healthcare field need to work together to productively pivot the direction of our system. Well, it’s more than those players. Health is rooted in more than just the scope of the healthcare delivery system.

The involvement of so many stakeholders can feel overwhelming.  The difficulty is in the coordination. It is simple to rally everyone around the shared mission of improving health. Recognizing each stakeholder’s role in and impact on individual health is also clear. Coordinating these efforts to remove duplication and ensure alignment with the mission, however, is the challenge. Without coordination and engagement of every stakeholder, the effort will be bottlenecked. One President or policy can only take the mission so far. The job of the Affordable Care Act, for example, is to set parameters for improvement among those healthcare entities within the government’s jurisdiction. There’s so much more though. Hospitals, insurance companies, schools, supermarkets, community and religious organizations, individuals and their social networks also have jobs to do.

We need to rally everyone around a real conversation about improving the health of our nation, and everyone’s job around that mission. And more than that, we need to accept that responsibility and hold ourselves accountable to those jobs. It is the only way to improving our country’s health. If it’s a strategy that has kept Rick Rhine, Hershel Greene and (most of) our Walking Dead cast alive for four seasons of a zombie apocalypse, I’d be hard pressed to believe it won’t work for our healthcare system.

Cecilia S. Lum, MHSA, is a Healthcare Consultant at Blue Cottage Consulting.

Let’s Break Down the Silos without Breaking Down Office Walls

Monday, December 2nd, 2013 by Cecilia Lum

“Breaking down the silos” was a phrase I heard a lot of throughout my Health Management and Policy graduate program. It refers to the absence of communication and collaboration across groups in an organization. Inherently, a counterintuitive habit that may temporarily benefit one group but ultimately stunts the success of the organization. It was my cohort’s neology — we spoke frequently and passionately about ways in which we could “break down the silos” as a means to improving operational efficiencies and quality of care in hospitals.

That was about five years ago. More recently, I found myself engrossed in several sessions at the Healthcare Design Conference in Orlando, Florida, where I heard many presenters and attendees alike chanting the “break down the silos” adage and hailing efforts that aim to do just that. And what we’ve primarily seen in healthcare is an adaptation of the open office trend prevalent in the design and technology industries. These layouts are aimed to promote easy accessibility to colleagues and collaboration, which is a spin-off of the large atrium concept at Pixar that Steve Jobs believed would promote chance encounters among varying disciplines and consequently unplanned collaborations.

However, a recent study “Workspace satisfaction: The privacy-communication trade-off in open-plan offices,” by Jungsoo Kim and Richard de Dear at the University of Sydney, suggests that you can’t break down the silos by forcing people to play in the same sandbox. Kim and de Dear examined privacy-communication trade-off in open-plan offices. The primary problems identified with open offices include the lack of privacy, high noise levels, limitation in space, and temperature control. All of which contribute to worker dissatisfaction and frustration. This is not exactly the state of mind primed for collaboration.

Perhaps we misinterpreted Pixar’s chance encounter methodology. After all, they did create the atrium as the site for collaboration; a neutral space where individuals freely traverse through. The solution may not necessarily be to bring down the silos but provide independent space for the silos to come together naturally. This space needs to be intended for collaboration and communication, as was the atrium at Pixar. What we often see is creation of multidiscipline staff lounges. Not only does it create a space where multiple groups can gather, it creates space efficiencies through economies of scale. However, a staff lounge’s purpose is for reprieve. Inserting an agenda for collaboration to the space intended to allow individuals to “get away” in an industry where breaks are rare can be contentious and detrimental to the culture needed for teamwork.

This dedicated space, then, must be coupled with cultural and operational changes. Individuals must have the time to focus on collaboration with others not immediately in their scope of work. This piece of the solution is the most complex, and perhaps, the reason we’ll probably still be breaking down silos for years to come. But we know that the solution isn’t putting everyone in the same big room, calling it an open, collaboration space, and waiting for the magic to happen. The magic doesn’t just come from breaking down office walls; it comes from giving your team the time, space and freedom to work together.

Cecilia S. Lum, MHSA, is a Healthcare Consultant at Blue Cottage Consulting.

INFOGRAPHIC - Models of Care for Labor and Delivery

Wednesday, June 26th, 2013 by Blue Cottage

Members of the Blue Cottage team recently prepared an infographic that illustrates the models of care for labor and delivery.

Infographic Credits: Caylee RaberImen Alem, MHSA; and Marjorie Serrano, RN, PNP, AIA.

Infographic - Full - LDRP

Visual Reporting for Operational Planning: Photo Journals and Storyboards (Part 2 of 2)

Wednesday, March 6th, 2013 by Caylee Raber

Visual Reporting: Storyboards and Photo Journals

Introduction

This two part blog series focuses on photo journals (Part 1) and storyboards (Part 2), which are tools that are commonly used in a human-centered design process. According to IDEO, a leader in design and innovation consulting, this design approach is called “human-centered” because it begins by examining the needs, dreams, and behaviors of the people who will be affected by the solution. A human-centered design approach is very applicable when designing a new healthcare facility or working to improve hospital operations. Photo journals and storyboards are two of these tools that put users at the forefront and allow us to gain insight into an experience from their perspective. These two powerful, visual reporting tools improve the way we do healthcare consulting work and ultimately optimize the way we deliver care.

Storyboards

Storyboards are a valuable design tool with great applicability to healthcare consulting. A storyboard is typically a comic strip that has been drawn by a user to describe their experience. They usually include thought or speech bubbles to communicate what the user thinks and feels throughout the experience. Like with photo journals, they are a great tool to help better understand the user experience. They provide an emotional and personal portrayal of an experience and can help to identify key gaps and opportunities. A storyboarding activity can be done with all sorts of users, though they are particularly valuable when created by a patient or family member because they capture a very specific, personal experience and the true associated emotions.

When developing the functional program for a new NICU, Blue Cottage held a meeting with several families whose children had been patients in the current NICU. We asked families to draw a storyboard to describe their experience. Families were given 20 to 30 minutes to draw their storyboards and were then encouraged to share their story with the group.

Storyboard: NICU Experience

Storyboard: NICU Experience

This activity encouraged the families to think deeply about their experience and helped them to generate ideas for how to improve the NICU. After some discussion, families were encouraged to go back to their storyboard and for each step, add a sentence or idea about how it could’ve been improved. For example, one parent said that they felt very confused and lost during their first day. They suggested that it would be nice to have a guide to help them on their first day. Another key insight that came out of the activity was the desire for a Wall of Hope within the space. The families agreed that it was very inspiring and helpful to be able to read stories about other children that were born in the NICU and who were now thriving.

Both of these tools have great value in gaining key insights from stakeholders and for inspiring deeper conversations about operational and space needs. Kerry Hart, the Neonatal NICU Manager at Alberta Children’s hospital found these activities to be extremely useful in engaging frontline staff and families.

“I think the staff and families were happy to participate and it was a fun and interactive way of giving their feedback,” Hart said. “The pictures easily provided some self-explanatory rationale so that the individual staff or parent did not have to write a lot to get their point across. I would definitely recommend this to other clients as a fun and interesting way of getting input. Sometimes shaking things up engages people in the process better than just the boring writing out of comments.”

Be sure to check out part one of Visual Reporting for Operational Planning: Photo Journals and Storyboards, which highlights valuable uses of photo journals.

Caylee Raber is an Industrial Designer at Blue Cottage Consulting.

Visual Reporting for Operational Planning: Photo Journals and Storyboards (Part 1 of 2)

Tuesday, March 5th, 2013 by Caylee Raber

Visual Reporting: Photo Journals and Storyboards

Introduction

This two part blog series focuses on photo journals (Part 1) and storyboards (Part 2), which are tools that are commonly used in a human-centered design process. According to IDEO, a leader in design and innovation consulting, this design approach is called “human-centered” because it begins by examining the needs, dreams, and behaviors of the people who will be affected by the solution. A human-centered design approach is very applicable when designing a new healthcare facility or working to improve hospital operations. Photo journals and storyboards are two of these tools that put users at the forefront and allow us to gain insight into an experience from their perspective. These two powerful, visual reporting tools improve the way we do healthcare consulting work and ultimately optimize the way we deliver care.

Photo Journals

Photo journals allow users to give feedback in ‘real time’ while they are experiencing something, and allows us, the healthcare consultant, to engage and gain insight from a greater number of users. They can help to make users more aware of the problems and opportunities around them, and can help to prepare them to think about the future. They act as a great tool for generating further conversation in a meeting. They also help consultants to see the problem or opportunity.

For a typical photo journal activity, users are given cameras and asked to capture photos in response to a question or prompt. For example, in a healthcare setting when engaging frontline staff, we may ask them to take photos of things that work well in their unit and things that need improved. Another approach is to give patients or family members a list of things to take photos of,such as their favorite place to take a break or a space they wish was improved. Once photos have been captured, team members from Blue Cottage will group the photos based on key themes that were identified. We then share the photos in a user group meeting and use them to generate further conversation about operational improvements or the design of a new space.

Photo Journal Instructions and Disposable Camera

Photo Journal Instructions and Disposable Camera

At Blue Cottage, we use photo journals in a variety of ways. We have used photo journals with a client as an activity in order to inform the development of the functional program for their new NICU. Families and staff took the photos. Six cameras were given to the current NICU units. Three cameras instructed staff to take photos of things that worked well on their unit and three cameras instructed staff to take photos of things that they found frustrating, or made their job more challenging. A few families were also given cameras. Their instructions included a list of ten things to photograph. Once developed, these photos were presented at three meetings, one for nursing staff, one for physicians, and one for families. In each meeting the photos sparked extensive conversations that brought to light additional insights into how to design their future space.

For example, many of the photos we received referenced over crowded storage spaces and materials being stored in inappropriate locations. Through our discussions we came to discover that the main problem behind the overcrowded halls and storage spaces wasn’t so much a lack of adequate space, but rather a lack of trust in the supply system which resulted in staff hoarding more supplies in their unit than necessary. The photos helped to spark a conversation about their supply system and identified a key operational opportunity for improvement.

Photo Journal Activity: Current State Challenges for 22 Nursing Units and Support Services Groups

Photo Journal Activity: Current State Challenges for 22 Nursing Units and Support Services Groups

Recently, when tasked with creating a functional program for the redevelopment of a major hospital, we engaged all 22 of their nursing units and their support service groups with a photo journaling activity. The purpose of this activity was to have the staff share the challenges of their current state with us, the other consultants, and most importantly, with each other. This activity created a shared acknowledgement of their current state challenges and led us into discussions about their needs for the future. Key themes that were identified through the photos included: the need for appropriate spaces to support infection control; the need for sufficient storage spaces; the need for single-patient rooms; the need for adequate staff workspaces to support multi-disciplinary teams; and the need for an elderly-friendly approach to design. The photos from the activity helped to visualize some of the key problems and concerns shared by staff and will be a powerful tool in expressing these views in their final business case document to be presented to the Ministry of Health in British Columbia.

Be sure to check out part two of Visual Reporting for Operational Planning: Photo Journals and Storyboards, which highlights valuable uses of storyboards.

Caylee Raber is an Industrial Designer at Blue Cottage Consulting.