Case Study: Patients at Healthy Lives Associates Experience Disruption

Image: An individual using crutches enters a room, shaking hands with a health care worker. Author: Stefan_Schranz. Source:

Image: An individual using crutches enters a room, shaking hands with a health care worker. Author: Stefan_Schranz. Source:

Consider the importance of the operating system as part of aligned Operational Layers. What happens when people, tools, and processes aren’t fully aligned?

In this case we’ll consider a health care clinic, Healthy Lives Associates, founded to provide access to high-quality care in a suburban community. Over time, it built a strong reputation for its internal medicine and pediatric departments and families asked for more specialized services, in the interest of easily accessible high-quality care for a broader range of health needs. The organization expanded slowly and thoughtfully, in line with a comprehensive strategy and operating model, adding a laboratory on-site, radiology, dermatology, and other specialties.

One of the last specialties to be added was orthopedics. Though the orthopedics practice had been present for a few years, it still “felt” a bit separate. For example, patients could skip the regular entrance and registration process for an orthopedics appointment, though the main entrance and registration process was required for all other visits. One patient shared this experience: after an appointment at orthopedics for a hand injury, she was sent to radiology for an x-ray right away after the doctor suspected a fracture. She crossed the four-foot hallway, since the departments faced one another, and told the radiology receptionist she needed an x-ray. Neither the receptionist nor the x-ray technician knew how to help, since apparently the orthopedics department used a different data system than the rest of the clinic, and its data was updated only daily rather than in real-time. The patient was told she could come the next day, because of course the technician wasn’t allowed to take the patient’s word on exactly what needed to be x-rayed. As it turned out, the patient had broken her hand, and waiting another day could have created more damage.

Can you relate to this fairly obvious “glitch”? It took a few seconds to walk across the hallway from one department to the other, yet it took a day for data to bridge the same gap. Of course, this is a problem for patients and treatment. Moreover, it evidences a lack of alignment between the operating system and the clinic’s operating model and strategy, since these were focused on the accessibility of multiple specialties.

These missteps with the operating system may lead to consequences such as:

  • Service delivery problems; in the above example, this was a delay in treatment for a broken hand, but of course the health consequences could be far more serious

  • Staff confusion and burnout, as staffed trained in standardized procedures were left without the tools to do their jobs

Fortunately, we can identify the gaps in the operating system and address them through design, implementation, training, and governance.

Learn more about the concepts and theory behind this case study in the post “Operational Layers: Operating System.”