Value Demand vs Failure Demand in Healthcare

02/23/2022 Compiled by Valmeek Kudesia

Failure Demand

"Extra" work-load (re-work) upon a system that arises because the system did not meet the needs of a person from the system's initial attempt e.g.

  • repeat trips to an emergency department for an infection, because

    • a person was unable to obtain the correctly prescribed antibiotics to treat the infection, because

    • the person did not have reliable transportation to a pharmacy following the first emergency room visit

  • escalation of chronic illness requiring hospitalization, because

    • a person did not receive correctly ordered and authorized home services that would stabilize chronic disease, because

    • the person was unable to navigate scheduling system for home services

Value Demand

Work-load upon a system that within the system's initial attempt:

  • correctly perceives the person's needs

  • meets the person's needs

  • meets the person expectations

Variety vs Complexity

Complexity

Implies unnecessary variation in tasks or objects e.g.

  • Different sizes of the same fabric entering a JIT process that makes gloves for people who are in cold temperatures

  • Adds more cost, time to the process of making and delivering highly sought after item, gloves

Variety

Variation inherent to the reality of needs e.g.

  • people have differently sized hands; however, each person has same size hands day over day

  • people have different subjective perception of cold at a given temperature, which will affect a person's need for gloves; however, each person has mostly same subjective cold perception day over day

  • temperature may change day-to-day and affect many people's need for gloves

Inability to Accommodate Variety ⇨ Failure Demand

Instructive Scenario

Glove Factory

    • Staffed by people dedicated to prevent suffering from cold

    • Standardized (in name of efficiency, quality, scale)

      • Single size of glove

      • Single thickness of glove

    • Discouraged from accommodating inherent variation in people who require gloves

People

Continue to have

  • Variation in hand sizes

  • Variation in perception of cold

  • Variation in ambient temperature

Likely Outcome

Glove Factory

  • Repeat visits from people suffering from cold

  • Tries desperately to match demand for gloves

  • Observes [mismatch supply]-driven failure demand

  • Sometimes injures workers or people who need gloves

  • Often burns-out skilled and dedicated workers

People

  • Who don't "feel cold" won't buy gloves (maybe get frostbite)

  • Who feel cold and have larger/smaller hands

    • Consume many gloves in hopes of better fit ⇨ still feel cold

    • Still feel cold ⇨ more visits to glove factory ⇨ frustration

    • If skill/means ⇨ modify gloves ⇨ do not feel cold

  • Temperature changes ⇨ people to purchase or discard gloves

System cannot meet variety inherent to reality

i.e. people have different sized hands

⇨

System makes attempt:

  1. Delivers mismatch to true need

  2. Stimulates customer return

  3. Original need unmet or increased

⇨

"Failure Demand"

(i.e system and customer vicious cycle)

System Flow

  • Failure Demand and Value Demand from individual patient flow through healthcare system

  • Note "Considerations for Innovation" in system flow

  • Note caution re observed work from data to consumed insight in clinical context because most work that is visible will be Failure Demand