Value Demand vs Failure Demand in Healthcare

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

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

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