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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.
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Archive for the ‘Process Improvement’ Category

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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.

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Posted in Healthcare, Healthcare Consulting, Operational Planning, Operations, Patient Experience, Performance Excellence, Process Improvement | No Comments »

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.

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Posted in Healthcare, Healthcare Consulting, Operational Planning, Operations, Performance Excellence, Process Improvement | No Comments »

Cyclical Nature - Finding (Repeated) Value in the Healthcare Industry

Friday, January 18th, 2013 by Julia Fetzer

If you are in the healthcare industry long enough, you begin to feel like you have “been there, done that.” But instead of finding this frustrating, it can be liberating and challenging and fun! It can provide opportunities to review history, apply new technologies, learnings, and approaches and make it better than it ever has been before. The repetition and cyclical nature of our industry gives us reason to recall, learn, adapt, and pull on what we have learned to keep moving forward. Yet it also provides some familiarity that helps us base our actions on research, metrics and trends.

As you discuss the future of healthcare delivery and the opportunities we have moving forward, you can look to the past for some of the successful ways care was delivered in the past. Some of the human elements that make such a difference – the human touch of caregivers, the comfortable environment and surroundings of homecare – all of these things are components we are now trying to replicate again as we move our healthcare delivery model back to the most common element of the individual and the personal relationship that is developed with a caregiver.

I am struck by how often the discussions move towards the holistic approach to healthcare. How we talk about the basic preventative and primary needs of the individual person that can keep them well and address their health before they are actually patients in our system of acute care visits and tests.  As we approach these “new” models of care, we seem to be taking some of the best pieces of what has been done in the past and replacing some of the “broken” pieces with new technologies, renewed focus on quality and extraordinary efforts to address the challenges with innovation and transformation.

This is why I love healthcare and love the industry that surrounds healthcare. There is a common goal and mission in healthcare that focuses on the improved health of a population. And this is coupled with a focus on using our past to learn and inform our future. Rather than being frustrated with the repetition, use it to renew your passion and desire to improve the health of a population with all the enthusiasm change brings with it.

Julia Ingram Fetzer, MBA, is an Executive Project Manager at Blue Cottage Consulting.

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Posted in Healthcare, Healthcare Innovation, Process Improvement, strategy | No Comments »

Increasing Patient Access by Applying the Team Model to Primary Care Clinics

Monday, July 2nd, 2012 by Meghan Schmansky

During a recent engagement, Blue Cottage examined the operations of a network of primary care clinics. The goal was to identify opportunities to transform the clinic operations to accommodate additional patients, while maintaining the same level of engagement in the existing patient and provider relationships.

The communities served by the primary care clinics (PCC) demanded additional access to the clinics, as was evidenced by the long wait-lists and emergency room utilization. Clinic leadership had implemented a number of innovative process improvements and it was thought they had reached their capacity limit. When developing recommendations, Blue Cottage drew upon the expertise of our team, past experiences, and best practice research. One recommendation focused on the further development of the team model within the clinic.

The team model in a primary care clinic places the management of the patient’s care upon the entire team, typically including a physician, nurse, medical assistant, front desk receptionist, and pharmacist. The skills and strengths of each team member are capitalized upon in the team model, as opposed to the traditional model in which the physician, a primary care provider (PCP) is solely responsible for patient care with limited outside assistance. Within each team there are often smaller “teamlets” consisting of a physician, nurse and/or medical assistant. Teamlets are responsible for management of their specific panel of patients and are supported by the additional team members.

This formula is the foundation of a comprehensive team care structure and process developed by Dr. Thomas Bodenheimer, an adjunct professor in the Department of Family and Community Medicine at the University of California, San Francisco (“Building Teams in Primary Care: Lessons Learned,” California Healthcare Foundation, July 2007).

When empowered to practice to the full extent of their skills, the medical assistant is responsible for managing their panel of patients by following up to ensure patients are up to date on immunizations and any necessary testing (Wagner, E. “The role of patient care teams in chronic disease management.” BMJ 320 (2000): 572-575. Print.). The medical assistant will reach out to the patient if they are overdue for an appointment, testing or immunization.

With medical assistants monitoring and encouraging patient compliance, the nurse has more time to dedicate towards coordinating and managing care for patients with chronic conditions and spend less time triaging urgent issues that often result from non-compliance.

The front desk receptionist coordinates all non-clinical aspects of the clinic, including scheduling, phone messages, patient paperwork, reminder calls, insurance inquiries, etc. The patient ultimately benefits from this coordinated model as their care is the focus of an entire team and not an individual provider and clinics are able to increase access as a result of implementing the team model.

The challenges experienced by the clinic mentioned above are not uncommon. The average PCP panel size is 2,500 patients, which would require 18 hours per day for one PCP without a team (Yarnall, K.S.H., et al. “Primary Care: Is There Enough Time for Prevention?” Am J Public Health, 2003; 93:635-41). Existing PCP capacity constraints and access issues are (and will be) felt in primary care clinics throughout the country, given the existing PCP shortages are likely to be compounded by looming healthcare reforms.

The team model is a promising approach towards increasing patient access, while maintaining existing patient and provider relationships.

Meghan Schmansky, MHSA, is a Healthcare Consultant at Blue Cottage Consulting.

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Posted in Best Practice Benchmarking, Breakthrough Innovation, Clinical Productivity and Alignment, Healthcare, Healthcare Consulting, Healthcare Innovation, Operational Planning, Operations, Patient Experience, Performance Excellence, Process Improvement | No Comments »

Wellness is worth millions but what will it take to actually make the public healthier?

Tuesday, May 22nd, 2012 by Jason De Leon

Wellness

Each hour on LinkedIn Today several trending articles mention “wellness.” It is widely covered not only in healthcare news but also for retail, technology, marketing, and business sections. According to economic adviser and author Paul Zane Pilzer, wellness will be the next trillion dollar industry. An industry that would not be mutually exclusive to  hospital systems and insurance companies but employers, communities, and government as well.

That prediction came about in 2002. What will keep the wellness movement relevant long enough for it to actually make the public healthier? Recent news indicates it may take generations, but one thing is for certain, it will require strategic access to better healthcare. Whether the federal government, fortune 500 companies or community action lead the way to better access, many people stand to profit from the movement.

Recently, the Columbus, Ohio Chapter of the Society for Marketing Professional Services (SMPS) held a program, The Convergence of Retail and Healthcare. At a high-level, panelists discussed the impact of the Affordable Care Act (ACA) and Accountable Care Organizations (ACO) which were defined in promotional materials as a transformation in healthcare from “episodic treatment of critical illness to preventative care and efficient management of chronic conditions.”

The panel was moderated by Dawn Tyler Lee, Executive Director, Partners Achieving Community Transformation (PACT), and included guest speakers Chad Pinnell, MBA, Senior Vice President, Equity Inc.; Adam Troy, CEO, Troy Enterprises; and Dr. Clay Marsh, Associate Vice President, Physician, Professor, and Vice Dean, The Ohio State University Medical Center.

Granted Dr. Marsh’s laundry list of titles, he exceeded the audience’s expectations with many fun-filled facts about wellness and health. For example, did you know that the average human consumes more than 100-pounds of sugar per year (Business Insider, February 19, 2012)? That’s astonishing. What was most interesting was his knowledge and dedication to the “modalities” created by ACO. It will “create a healthcare environment that stays with you and tracks your life to make you healthier,” Dr. Marsh said.

He referenced a Mister Rogers Neighborhood episode about going to see a doctor. The episode was less about how the doctor takes care of you and more about how to prepare for long wait times. “Primary Care is important but needs to be more innovative,” he said. The following points summarize his message:

  1. Healthcare shouldn’t be sick care
  2. It should be consumer-centric as opposed to doctor centric
  3. Customer service in healthcare must be increased

He added that the ability to reframe the paradigm of healthcare toward becoming more preventive will be achieved by marketing healthcare in a more positive way. If people can look beyond the fear that is induced by terminal illnesses and increase the positive aspects of being fit and eating right, people will feel incentivized to lead healthier lives. Most businesses in the U.S. are finding value in this model with 70-percent of the nation’s employers offering wellness benefits (Baseline Magazine, May 17, 2012).

Commercial retailers have their finger on the pulse to bring the same wellness incentives to communities by providing more access to healthcare in places people often frequent. With hospitals creating the visibility of retail department stores and community based retailers, such as groceries evolving with the rise of pharmacies, urgent care, and minute clinics, a strong connection has been created between healthcare and retail. Pinnell, whose employer, Equity Inc. is the nation’s 16th largest healthcare developer, stated that “the reason pharmacies boomed 20 years ago was to drive retail at grocery stores.” Developing family practices, women’s health, pediatrics, and other services on grocery store sites “could quadruple retail traffic,” he added.

Since the health and wellness piece is wide open for retailers, Pinnell stated that many companies are currently investing millions in this model. Wal-Mart and Target have medical doctors on staff. Starbucks created a wellness division to develop healthier foods. “Each retailer will have a stake in this,” he said. However, the general public cannot be easily directed to better wellness because of a good marketing campaign. “You can put a Whole Foods in but if a mother of two is driving past three quick service restaurants, she is likely to stop there first,” Pinnell stated. “We need to strip away the access to unhealthy food and provide better options,” he added.

There is an “art” for developers and retailers to provide more healthcare access, according to Troy, whose company has participated in several urban redevelopment projects in Columbus, Ohio (Troy Enterprises, 2012). In line with the essentials of marketing, retail healthcare access has to “connect people, places, and products,” he said.

Troy referenced a $10 million community redevelopment project in the near east side of Columbus that is being led by PACT. Wellness and nutrition act as key elements to this project. One of many goals is to provide access to better foods and fitness activities for the community where for the most part, there is no actual grocery store located in this area. “It is about getting people engaged,” Troy said.

In a related instance that is among many community wellness projects popping up across the U.S., Blue Cottage is partnered with Moody•Nolan, Inc. and HKI Associates to complete a feasibility study for for establishing central and regional wellness centers for the Columbus City Schools district. By providing clinical and nutritional expertise from registered nurses, and former healthcare system administrators, and a nationally-renowned behavior, motivation and wellness expert, Blue Cottage is playing an essential role to design improved wellness programs for the school district.

So, the communities are involved. The fortune 500 companies are investing. The federal government is on board. Every key player is on the list for sustaining wellness initiatives except for the one facet that could very well be the linchpin of this so-called revolution - social media networks. While internet-based healthcare services like Hello Health are on the rise, social media networks haven’t worked their way into the picture quite yet.

Acting as a true one-stop shop, “Social Media Network X” such as Facebook, LinkedIn or Google + has the client base, the social community, and the product to offer healthcare services. With that being said, commercial retailers need to find a better way to align their wellness investment with online communities. Once one of the top social media networks bridges the gap between personal profile accounts and electronic medical records services, the landscape of access to better healthcare will be forever changed. Social media networks can connect universal medical advancements instantaneously, allowing patients and providers to be connected like never before. According to Moffett Field, California based company Scanadu, social medicine “embraces patient-centric healthcare as a personal information service, in your control – in your hands – amplified by the Cloud,” (Forbes, May 5, 2012).

With the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the development of security and privacy policy by social media networks will obviously be a mountain worth climbing as the ROI would be revolutionary.

Retail may play a part in this process but it will not be the lead. At least, let’s hope not. Didn’t we learn anything during the box retail boom? Placing additional healthcare services like urgent care, pharmacy, and minute clinics in retail centers can be extremely expensive and has proven to be unsustainable. Preventive healthcare is headed a different direction. With the latest advancements in technology and real-time information, preventive healthcare will start at home.

When asked if there was a home health model in place for retail development, Pinnell responded that eventually places like Walgreens, CVS, and grocery stores will need to find ways to sell and deliver their non-direct healthcare products such as trash bags, toilet paper, and razor blades into the home while providing home health services. What’s intriguing is that the one-stop shop/healthcare grocery model may be what is best for large retail companies but it will not be cutting edge enough to define sustainable public wellness as it speeds quickly towards a home health model.  This model will be driven online by a leading social media network that has yet to be named.

Jason L. De Leon is Business Development Manager at Blue Cottage Consulting.

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Posted in Breakthrough Innovation, Client Relations, Fitness, Healthcare, Healthcare Consulting, Healthcare Innovation, Healthcare Reform, Process Improvement, Strategic Planning, Wellbeing | No Comments »

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