Healthcare
Disruptive Innovation and Healthcare
Item 2.1 of the Baldrige Criteria asks how you collect and analyze information about four key factors including “early indications of risks or major shifts in technology, health care markets, health care services,” etc. In other words, how do you anticipate the kinds of changes that could transform healthcare and, in the process, radically change how you are providing it?
Clayton M. Christensen, a Harvard Business School professor, called this “disruptive innovation,” which is “an unexpected new offering that, through price or quality improvement, turns a market on its head.” He is quoted in an article in the New York Times earlier this year that introduces some of the disruptive innovations that are reshaping healthcare. (“Disruptive Innovation, Applied to Health Care,” Janet Rae-Dupree, NYTimes.com, January 31, 2009)
One such innovation is fixed-fee integrated systems offered by such providers as Mayo Clinic and Kaiser Permanente. Customers make monthly payments to these providers in exchange for “cradle-to-grave health care.” Kaiser’s integrated system cost 22% less than competing systems in 2007, in part because it promotes health and discourages overtreating.
The spiraling healthcare costs that have helped inspire healthcare reform will lead to other disruptive innovations. The question is: Do you have processes in place to recognize these innovations early and prepare for or adopt them? Because if you don’t, the ground will shift and your organization will be scrambling to recover rather than leading healthcare into a new era.
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Strategic Challenges for Hospitals
According to an annual survey by the American College of Healthcare Executives (ACHE), 77% of the approximately 1,100 hospital CEOs who responded identified financial challenges as one of the top three issues confronting their hospitals. Patient safety and quality ranked second according to 43% of respondents, while care for the uninsured was third at 41%.
When asked what specific concerns faced their hospitals in the area of patient safety and quality, redesigning care processes and redesigning the work environment to reduce errors both received 66%, compliance with accrediting organizations got 60%, and medication errors was identified by 57% of respondents.
These strategic challenges help explain why healthcare organizations now account for roughly half of all Baldrige applications despite being one of six categories: Financial challenges, which are exacerbated by caring for the uninsured, are forcing hospitals to be as efficient as possible while still providing safe, high-quality patient care. The Baldrige model helps hospitals address all of these challenges by understanding how their management systems work, where their greatest opportunities for improvement are, and how they can make dramatic improvements quickly.
The nine hospitals and medical centers that have received the Baldrige Award demonstrate how to tackle all of these challenges at the same time. To find out how they did it, read their award application summaries, which are available through the Baldrige program.
You can read a summary of the ACHE survey here.
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3 Ingredients to Improving Healthcare
I recently wrote about the Thomson Reuters study that identified the top 100 hospitals based on clinical quality and efficiency. According to Linda Wilson at ModernHealthcare.com, the study identified three ingredients the top 10 hospitals in this list often use “for successful quality improvement: a corporate-level coordinating committee, ample involvement in planning from front-line caregivers, and a systemwide electronic health record.”
Wilson shows how these ingredients are making a difference at one Top 10 hospital—HealthEast Care System in St. Paul, Minnesota. HealthEast’s goal is to help physicians and nurses improve quality. “The bedside caregivers are constantly challenged to be delivering the right care, at the right time—every time,” said Craig Svendsen, CMO for HealthEast, which relies on the three ingredients to align caregivers with best-practice quality of care.
The Modern Healthcare story also quotes Jean Chenoweth, head of the 100 Top Hospitals programs at Thomson Reuters. In an era of public reporting of quality data, she says, system-level board members and executives should ask themselves: “Does the mission of the health system need to change if it doesn’t have quality in its mission?”
18Aug2009 | Steve George | 0 comments | ContinuedDead by Mistake
“Experts estimate that a staggering 98,000 people die from preventable medical errors each year. More Americans die each month of preventable medical injuries than died in the terrorist attacks of Sept. 11, 2001.”
The paragraph leads the home page of a new Web site devoted to what it calls “a critical and neglected health care issue.” Dead by Mistake is a project of Hearst newspapers and television stations that aims to shed light on an issue that plagues healthcare in the U.S. The site includes video, case studies, and photos that put a human face on these tragedies, as well as articles about the lack of progress on the national and state levels and how hospitals have been slow to adopt lifesaving practices.
12Aug2009 | Steve George | 0 comments | ContinuedHospitals Avoid Lean and Six Sigma
Healthcare has been a boon to the Baldrige Award, accounting for roughly half of all applicants over the last few years. To support their drive for performance excellence, hospitals and medical centers are also adapting lean and Six Sigma methodologies to improve quality, cycle time, and productivity.
At least, that was the impression.
In “Get Your Checkup” in the August 2009 edition of Quality Progress (you must be a member of ASQ to read the article), the ASQ Lean Six Sigma Hospital Study Advisory Committee reports on the results of an online questionnaire returned by 77 hospitals. While the small number of participants prevents sweeping conclusions, the study provides early indicators of the deployment of lean and Six Sigma in hospital settings.
According to the survey, 4.2% of hospitals have deployed lean, 8.2% have deployed Six Sigma, and 5.7% have deployed Lean Six Sigma. At the other end of the spectrum, 91.6% have zero to minor deployment of lean, 83.5% zero to minor deployment of Six Sigma, and 90% zero to minor deployment of Lean Six Sigma.
To their credit, the authors manage to build a six-page article filled with impressive tables out the experiences of a handful of hospitals, but even they eventually admit that there’s not much there:
“Based on those findings from a small sample, it would also be easy to question whether lean and Six Sigma have real, broad impact across hospitals nationwide, rather than just in isolated departments, or any ability to close the gap between good and bad metrics.”
Of course,…
10Aug2009 | Steve George | 0 comments | ContinuedMeasuring Quality in Healthcare
The quality of healthcare has always been an issue but now it’s front-page news as part of the healthcare reform debate. In the July 2009 Quality Progress, Janusz J. Godyn, M.D., takes issue with institutions that define healthcare quality by how patients and families perceive it. According to Godyn, “third-party payers should reward hospitals for maximizing quality of care, while patients should reward hospitals for quality of service.” Of the two, he states that “there is no doubt that quality of care is more important and should shape the meaning of quality in healthcare.”
He proposes three models to measure quality of care, none of which is a panacea:
- Measurable results of medical outcome
- Compliance with the best evidence-based practice
- Ethics plus knowledge and skills plus equipment minus poor safety practices
Godyn also takes issue with the Baldrige Criteria for healthcare, arguing that the Award “focuses on human perceptions of quality as drivers of actual quality in healthcare.”
He’s wrong. Item 7.1 specifically asks for the results of healthcare outcomes-the quality of care. Item 7.2 asks for results of patient satisfaction-the quality of service. Item 7.1 is worth 100 points, which is the largest total for any Item in the Criteria. Item 7.2 is worth 70 points.
28Jul2009 | Steve George | 0 comments | Continued
