Most if not all of Healthcare Delivery is a series of interconnected processes. From diagnosis to treatment, from prescriptions to incisions, from dressings to blessings — every part of the care experience is process driven.

As we know well from other industries, it is variability in outcomes — mistakes and defects — that is costly and in healthcare even dangerous. For decades process standardization has been rolled out in all industries, including the service industry like Hyatt for hospitality or Disney for amusement parks.
 
What standardization allows is the optimization of the experience and the results, systematically reducing mistakes and defects. A repeatable process becomes measurable, and a measurable process becomes improvable, and an improvable process is cost-effective and outcome-efficient.
 
Yet in healthcare we allow many versions of processes and many levels of process performance to take place, resulting in avoidable if not even preventable variation in experience and outcomes.
 
The lack of standardization does not only hurt patient care. It also impacts the experience of clinicians who must deal with the unreliable results of the processes that influence their work – a computer outage; a missed communication, an overlooked medication, an undocumented allergy.
 
To enable the sustainable delivery of extraordinary care, as it is our mission, we must standardize and continually optimize the numerous care delivery processes.
 
And no technique is more effective than “Happy Day Scenario Process Design”.
Sunday, Monday…Happy Days?
In the late 1990s, I moved to the US from Germany and while the German pop culture is heavily intertwined with the US (i.e., I, too, grew up with TV Shows such as Sesame Street, Alf, Bonanza, Dallas and Dynasty (aptly named “Denver” in Germany), one show we did not have was “Happy Days”.
 
Therefore I could not understand why everytime I mentioned the term “Happy Day Scenario” (and I was probably slurring the ‘s’ from ‘scenario’ into “Happy Days Cenario”) people inevitably smiled because of this “theme song” from the 70s US TV Sitcom.
 
But why am I sharing this with you?
Main Success Scenario
Because in 1998, I was fortuitously introduced to a cool technique that was invented (or at least widely popularized) by Alistair Cockburn, a computer scientist: A Use Case template.
 
In software design, or more precisely in the requirements engineering for a software system, a Use Case describes the interaction of a user with the software to achieve a certain goal or outcome. The detailed and systematic description in “natural language” linguistically bridges the gap between the users (who can easily understand and relate to the description) and the software engineers (who need to write code to create that experience for the users).
 
What Alistair did is to templatize and systematize the process of developing a use case, starting with what he called the “Main Success Scenario”.
 
For a reason I cannot remember, for me this turned into the “Happy Day Scenario”. My use of the terminology was probably reinforced by the chuckling and smiling reaction I got from people, every time I used that term. So it stuck.
Happy Day Scenario
So, what is a Happy Day Scenario? Using a common interpretation it would be when things go extremely well, when you get exceedingly lucky, such as winning the lottery or getting a hole in one.
 
But what I mean by a “Happy Day Scenario” is what happens most of the time when things go well. When you walk up to an ATM to withdraw some cash, you get the right amount of cash and you get your card back. When you go to the doctor, they do give you the prescription you need and do not operate on the wrong side.
 
Thus a Happy Day Scenario in a process is what should happen 80, 90% or even 99% of the time – when things go as planned, when there are no mistakes or defects and you accomplish the goal you set out.
 
When using the Happy Day Scenario approach to designing or redesigning a process, there are two phenomenal benefits from spending most of your time initially on defining the Happy Day Scenario – i.e., the steps taken most of the time under normal circumstances.
Stop Making Success so Difficult to Achieve

The first benefit is that most individuals and teams that set out to design or redesign a process inevitably will quickly delve into all the things that can go wrong. It happens even to the most optimistic of us and it is worse for the highly creative.

What this approach yields is a process that is riddled with safeguards and countermeasures for the 1 out of 100 chance that under certain circumstances something could go wrong. In order to prevent an undesirable outcome once, you have to jump through hoops 99 times.

Secondly, most of the creative energy and time is spent focusing on all the things that could go wrong, rather than on designing the ideal experience, the Happy Day Scenario, when everything goes as planned (as it should, typically).

Now, granted, when the consequences of failure are catastrophic, we better safeguard against it (e.g., putting on a seatbelt every time you drive, though you may never need it).

But to require people to perform an extra step all the time is not only frustrating, but also highly inefficient.

Focus on Alternate Scenarios Systematically

So rather than starting with everything that could go wrong, you and your team should first focus your energy and creativity on designing the best possible process, the best possible experience — for clinicians, staff, and patients when it comes to healthcare delivery process design: Design the “Happy Day Scenario”, what should happen 80%, 90% of the time when things go as planned, optimized for the experience and the outcomes.

After you’ve defined and optimized the Happy Day Scenario you can — and this is the second benefit — go through each and every step of that scenario to identify what, under reasonable circumstances, could go wrong in each step.

For each “wrong” you can then systematically define the best “alternate scenario” (that still allows the user to accomplish their goal) or the best “exception scenario” (that prevents further damage and allows the gracious completion of the process).

As I said above — when teams design a process by starting with what could go wrong, they lose sight of the ideal scenario, expend most of their energy on alternate scenarios, and they may still miss something because without a Happy Day Scenario they cannot systematically verify that they thought of each and every step.

Happy Days Are Here Again

Once you see healthcare as an intricate system of dozens and dozens of processes and once you focus on redesigning existing processes and designing new processes (like for telehealth or digital health) using a Happy Day Scenario first approach, I am sure it will put a smile on your face and, most importantly, a smile on the faces of the patients, providers and support staff.

What is your Happy Day Scenario?

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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

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