Healthcare
The Unheralded Quality Side of Healthcare Reform
The May issue of Quality Progress has an interesting article on provisions in the Patient Protection and Affordable Care Act (aka, the healthcare reform bill recently passed by Congress and signed into law) aimed at improving quality of care, the delivery of care, and patient safety. (“Quality Key Ingredient in Healthcare Reform,” Mark Edmund)
Lost in the hubbub generated by partisan attempts to denigrate the act is well-deserved praise for the following provisions:
- Patient-Centered Outcomes Research Institute, an independent body that will conduct research and communicate results on the risks and benefits of marketed drugs, devices, and medical products, including the most effective options.
- Trauma center program will fund research on emergency medicine.
- Workforce advisory committee will determine what steps to take to respond to and avoid doctor and nurse shortages.
- The Center for Quality Improvement and Patient Safety will research and share information about improving the quality and safety of healthcare.
- Wellness programs funded by grants to small businesses that establish them.
- Innovation center within the Centers for Medicare and Medicaid Services will focus on reducing program costs while maintaining or improving quality of care. (And by the way, wouldn’t President Obama’s nominee to lead this organization, Dr. Donald Berwick, be ideally suited for the job?)
- Collaborative Care Network Program aimed at coordinating and integrating healthcare services for uninsured or underinsured people.
- Quality metrics and measures for reporting and reimbursing for federal health programs.
- Bundled payments, to be tested in a pilot program, for providers to promote efficiencies and reduce spending.
- Incentives and penalties for hospitals based on performance.
Let’s hope politics doesn’t squash the potential of these much-needed quality…
17May2010 | Steve George | 0 comments | ContinuedThe First Healthcare Sustainability Scorecard for Suppliers
In “Kaiser Permanent Launches Health Care Industry’s First Sustainability Scorecard,” by Ariel Schwartz (May 4, 2010), Fast Company shows us the scorecard’s SKU-level questions that suppliers must answer:
- NICU product?
- PICU product?
- Latex-free?
- Lead, Mercury, Hexavalent chromium, Polybrominated biphenyls, Polyborminated diphenyl ether, <1,000ppm or Cadmium <100ppm
- Polyvinyl Chloride (PVC)-free?
- Diethylhexyl phthalate (DEHP)-free?
- California Prop 65 Chemical <threshold or warning level
- Product – Contain more than 10% post-consumer recycled content?
- Primary Packaging – Contain more than 5% post-consumer recycled content?
- Secondary packaging – Contain more than 30% post-consumer recycled content?
- Product – Designed for multi-use (i.e., not a single-use device)?
- Manufacturer’s product code for environmentally preferable alternative
The desired answer for questions 3 through 11 is “yes.”
Kaiser Permanente claims that, if all things are equal between competing suppliers, the scorecard will be the deciding factor.
The article provides an example, courtesy of Robert Gotto, executive director in Kaiser’s Procurement & Supply group:
“One contract we went through last year was for a rigid endoscope provider. We evaluated the four major players and found that clinical performance and pricing were comparable, but there were big differences in terms of sustainability performance. One supplier had the foresight to develop a camera that doesn’t need to be sterilized with chemicals. It uses steam instead, and we can cut down chemicals in operating rooms by half.” The supplier was awarded a five-year, $100 million contract.
Kaiser buys a billion dollars of medical equipment and products each year and its supply chain partner, Broadlane, which will adopt the scorecard in September, influences $10 billion in medical purchasing. Chances are good that Kaiser Permanente won’t…
5May2010 | Steve George | 0 comments | ContinuedLeading Change (Hopefully) at Medicare & Medicaid
Donald Berwick appears to be President Obama’s choice to run the Medicare and Medicaid programs. Berwick is president and CEO of the Institute for Healthcare Improvement (IHI) a nonprofit that promotes innovative ways to improve patient care. Thousands of healthcare providers participate in IHI’s work. You can learn more about it by clicking here.
Dr. Berwick is a pediatrician and a clinical professor at the Harvard Medical School. He has served as a leader and advisor on a number of government councils and task forces aimed at improving the quality of healthcare.
And he’s a Baldrige guy. From 1989 through 1991, Berwick served on the Panel of Judges for the Baldrige Award. His Baldrige experience has influenced his vision of what is possible in healthcare. In his book, Escape Fire: Designs for the Future of Health Care, Berwick writes, “When I compare our aims for improvement in health care to those in the world-class companies I saw as a Baldrige judge, nothing impresses me as much as our timidity…World-class organizations don’t shy away. That’s where Motorola’s Six Sigma goals came from. That’s how Roger Milliken decided to take Milliken Corporation to unprecedented cycle times, and how Xerox and Ritz Carlton have committed to 100% customer satisfaction. They understand bold aims; we don’t yet.”
Berwick gets high marks from his peers. In Modern Healthcare (April 12, 2010), Nancy Nielsen, immediate past president of the American Medical Association, wrote, “Dr. Berwick is widely known and well respected for his visionary efforts that focus on optimizing the…
19Apr2010 | Steve George | 0 comments | Continued10 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 be able to replace defective genes with working ones and tailor drug treatment to your specific genetic profile.
To read more…
9Mar2010 | Steve George | 0 comments | 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 board is to tell it how your hospital performs on standard quality measures. While you’re at it, share data on…
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 a row and ranked #1 for cardiac and critical care, stroke, and general surgery
As Providence and Baldrige Award-winning hospitals have…
12Jan2010 | Steve George | 0 comments | Continued
