Healthcare
10 Healthcare Innovations
The Harvard Business Review’s Health Care Innovations Insight Center has listed ten innovations it thinks could eventually improve healthcare (“Health Care of the Future,” Gardiner Morse, March 8, 2010).
Checklists. A checklist at Johns Hopkins Hospital required doctors to confirm, among other things, that they had washed their hands before inserting a central line. The 10-day line-infection rate went from 11% to zero. But getting people to use checklists can be a struggle.
Behavioral Economics. Nudge patients to comply with doctors’ orders, and nudge doctors to improve care.
Patient Portals. Patients could log onto their own secure portal to access and share their medical records, check lab results, renew prescriptions, deal with insurers, and communicate with doctors and nurses.
Payment Innovations. “Any hope of affordable, quality care lies partly in payment reform.”
Evidence-Based Decision Making. Electronic medical records should help doctors make better decisions based on the best evidence.
Accountable Care Organizations. The health reform bill includes plans for a pilot ACO whose job is to keep people healthy and out of the hospital and reward doctors and hospitals when they do.
Virtual Visits. Televisiting, a la Ellen Page talking to her doctor, who is in Denmark, in the Cisco ad.
Regenerative Medicine. “Stem cells…can potentially cure an array of devastating, once intractable conditions.”
Surgical Robots. The jury is still out on whether patients do better when a robot is involved.
Genetic Medicine. Once the technical challenges are overcome, doctors will…
9Mar2010 | Steve George | 1 comment | Continued99% Above Average
Call it the Lake Wobegon effect after Minnesota’s very own Garrison Keillor, that fictional place where “all the women are strong, all the men are good looking, and all the children are above average.”
Only in this case, they’re not children: They are the chairmen of 722 nonprofit hospitals, and 99% of them think their hospitals fare at least as well as a typical hospital on standard quality measures, according to a survey published in Health Affairs. Even worse, 100% of the chairmen of hospitals that perform the worst think they are at least as good as a typical hospital. (“Only 1% of Hospitals Are Below Average,” Jacob Goldstein, WSJ Blogs, November 9, 2009)
It’s hard to know what’s most appalling about this ignorance:
- The chairmen don’t know how their hospitals perform on standard quality measures, information that is available to anyone on the Internet.
- The chairmen don’t know what “typical” performance is—also available on the Internet.
- No one has bothered to share this information with the people who bear some responsibility for their hospitals’ performance or, worse yet—
- The chairmen don’t care.
The Baldrige Criteria ask how you evaluate the performance of your board members. I would add questions about how the board reviews the hospital’s quality performance to that evaluation. The Criteria also ask how you use these performance reviews to develop and improve the board. Based on the survey, one easy way to improve your…
12Feb2010 | Steve George | 0 comments | ContinuedHow Would You Reform Healthcare?
The American Society for Quality (ASQ) recently polled 120 healthcare quality professionals on this question. Their first target? Payment systems such as billing, coding, and insurance claims. Improving these areas would reduce paperwork that causes added expense and reduce patients’ and doctors’ frustration.
Tort reform and limiting liability claims against physicians was identified as a way to decrease the cost of liability insurance, which is generally one of a physician’s greatest costs of operation.
The experts would mandate a universal system of electronic medical records with bar-coding to provide real-time, nationwide access to patient records. Such a system would address the limited information sharing that causes rework and serious errors.
Third, the experts would implement the criteria of both the Baldrige Award and ISO 9001 in all provider organizations. If you’ve read anything on Baldrige.com, you can see the value of this recommendation.
Finally, the experts would create a free market competition for insurance and standardize preventive care/annual medical check-ups by making them affordable and readily available.
Click here to read ASQ’s press release on the poll results.
To learn more about Baldrige and healthcare, click on these articles:
- A Healthcare Role Model
- Baldrige Saves Lives
- Why Baldrige? Saint Luke’s Makes the Case
- 3 Ingredients to Improving Healthcare
A Healthcare Role Model
I don’t know if the Providence Regional Medical Center in Everett, Washington, has thought about applying for the Baldrige Award, but it should. It’s already a role model for high-performing healthcare organizations.
A recent article in BusinessWeek lists its world-class attributes (“Hospitals: Radical Cost Surgery,” Catherine Arnst, January 7, 2010):
- Uses scorecards throughout the hospital to measure quality and efficiency
- Acts on innovative ideas from staff (a nursing team’s idea to check on patients every two hours to see if they need help moving around their rooms reduced falls by 25%)
- Places the day-to-day care of most inpatients in the hands of hospitalists (the program reduced length of stay, infections, and surgical complications)
- Created “single stay” wards where, after heart surgery, cardiac patients remain in one room throughout their recovery (patient satisfaction soared and average length of stay dropped by more than a day)
- Breaks even on Medicare patients while almost 60% of U.S. hospitals lose 20 cents on the dollar
- Offers financial training to 800 independent doctors affiliated with Providence to get them thinking about cost efficiencies
- Established an independent panel to investigate medical mistakes, share its finding with patients, and voluntarily offer a financial reward if warranted (Providence has two malpractice suits pending compared to 12 to 14 on average at other hospitals of similar size)
- Provides $16 million in healthcare each year that goes unpaid
- Wins awards: Top 100 Hospital and Distinguished Hospital for Clinical Excellence three years in…
Great, Not Perfect
SSM Health Care was the first healthcare organization to receive the Baldrige Award when it won in 2002. With 15 acute-care hospitals and two nursing homes in four states and nearly 23,000 employees, SSM has been a beacon for performance excellence, earning a number of quality awards including several state awards for SSM facilities. Sister Mary Jean Ryan, chairman and CEO, described how SSM integrated the Baldrige model in her book, On Becoming Exceptional—SSM Health Care’s Journey to Baldrige and Beyond (ASQ Quality Press, 2007).
By every measure, SSM is a great organization. But it’s not perfect. Earlier this week, the U.S. Department of Labor announced that SSM was ordered to pay $1.7 million in back wages to 4,700 employees for violating Fair Labor Standards Act overtime rules: It automatically deducted nurses’ pay for lunch periods even if the nurses worked during that time. SSM reimbursed the nurses earlier this year.
It’s important to remember that no organization is perfect. Mistakes will be made. SSM quickly rectified the situation and, based on what I know about Baldrige organizations, likely has improved its processes so that this situation does not recur.
It would have been instructive to learn how SSM responded but no mention of the issue or of the Labor Department’s settlement can be found on SSM’s Web site. I can understand why it wouldn’t want to publicize an embarrassing event, but I also…
10Dec2009 | Steve George | 0 comments | ContinuedBaldrige Saves Lives
According to Rulon Stacey, president and CEO of Poudre Valley Health System, there are people alive today because of what PVHS has done with Baldrige. PHVS, which won the Baldrige Award in 2008, will receive the Award from President Obama in a ceremony on December 2.
Located in northern Colorado, PVHS has 4,300 employees, 600 physicians, and 900 volunteers. It started integrating Baldrige in 1999. “It was a big time of change for Poudre Valley Health System,” said Pam Brock, vice president of marketing. “We’d gone through five CEOs in four years and we had a 25% turnover rate. The organization was struggling and this was when Rulon first became CEO. He knew we needed something to take the organization to a different place.” (“PVHS goes to Washington—finally,” Steve Porter, Northern Colorado Business Report, November 20, 2009)
Its results point to a very different place. Modern Healthcare magazine named it one of “America’s 100 Best Places to Work in Healthcare” in 2008. Poudre Valley Hospital was recognized as the nation’s number one hospital for sustained nursing excellence in 2007 and 2008. For five consecutive years, Poudre Valley Hospital has been one of seven U.S. hospitals named a Thomson 100 Top Hospital for superior outcomes, patient safety, and operational and financial performance. According to the Center for Medicare and Medicaid Services, its patient satisfaction scores surpass the national top 10%. And its staff voluntary turnover…
23Nov2009 | Steve George | 0 comments | ContinuedTo Improve Hospital Care, Improve the Board
When Health Affairs surveyed a nationally representative sample of board chairs of 1,000 U.S. not-for-profit hospitals, it found that fewer than half rated quality of care as one of their two top priorities, and only one-third of the boards received formal quality training. Only 63% included quality performance on every board agenda.
The magazine ranked the hospitals by publicly-reported quality measures for acute myocardial infarction, congestive heart failure, and pneumonia. As the abstract for the article describing the survey concluded, “The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals.” You can read the article online here.
The Baldrige Criteria address senior leaders’ responsibilities for improving the quality of care but do not specifically link this to hospitals’ boards. The Criteria ask how you evaluate the performance of board members and how you use those reviews to improve the effectiveness of individual members and of the board as a whole.
Based on the findings of the Health Affairs study, hospitals would benefit from providing formal quality training for their board members, making the hospital’s quality performance a part of every board meeting, and holding boards accountable for performance on key quality of care measures. When that happens, quality of care will become one of the board’s—and, one would expect, the hospital’s—top priorities.
…
11Nov2009 | Steve George | 0 comments | Continued
