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The U.S. health care system is renowned for cutting-edge technology and the best rescue care in the world. However, countless shortcomings of our current health care system are well chronicled: We spend twice as much on health care in the United States as do other developed countries, we fail to deliver basic quality of care half the time, we see more than 200,000 patients die annually from safety mishaps, and we waste more than $700 billion per year because of inefficiencies and unnecessary services.
These shortcomings are among some of the reasons for the evolution of the Affordable Care Act. Yet, meaningful transformation of our health care system will not come from legislation. Furthermore, change will not come easily, but will require learning and applying new skills in process improvement to redesign the way we deliver care, and in order to redesign care, those who actually deliver care must lead. The new knowledge and skills of how to redesign care are crucial, or as Henry Ford once stated, "If you always do what you have always done, you will always get what you have always gotten." In last month’s Systemness blog, I introduced process improvement. This month we turn toward gaining a basic understanding of what we mean.
[Read Part 1: What do making airbags and delivering health care have in common? (Continuous Improvement, Part 1)]
Principal No. 1 is that every single thing we do is a process, and process improvement is simply the use of a standard methodology to identify and eliminate waste. Waste can be classified by what author Jay Arthur calls the three D’s: defects, deviation, and delays (Lean Six Sigma for Hospitals, McGraw Hill, 2011.)
But the definition doesn’t stop there. Process improvement must attack waste that impacts the customer, in our case, the patient, the family, and the payer.
When you embark on a process improvement project, you must be able to answer the following questions affirmatively: Will fixing this process improve the access, quality, safety, experience, and/or cost of care? If you start from a position of "how will this help me, the provider?" you could be on the wrong track. We must allow the needs of the customer to drive our improvement.
It’s important to note what’s missing from the definition of process improvement: train and blame, memorization, promises of vigilance, education of patients, and altering patient behavior. These have been basic to patient care for more than a century, and of course they (sometimes to our detriment) have their prominent place in today’s health care delivery. However, process improvement should not depend on them. In the Checklist Manifesto, Atul Gawande makes the case that the complexity of health care delivery has outgrown these; physicians and the systems they operate within can depend on these no longer.
But which methodology is best? The answer to this question is not worth your worry. Three main process improvement methodologies dominate this discussion: lean, six sigma, and plan-do-check-act (PDCA). These methodologies overlap each other in many ways, and the unique aspects complement each other well. At our institution we have incorporated a blended approach using lean management and methodologies adapted to our local culture creating a generic six-phase process improvement framework: project definition, baseline analysis, investigation, improvement design, implementation, monitor. If we had simply adopted six sigma’s methodology (define, measure, analyze, improve, control), we would have been equally successful. Ditto if we had declared ourselves a PDCA institution.
The Bottom Line
For all of our technology, our education, our many bright minds, and for all the money poured into our industry, health care hasn’t met its potential. We have a lot of room to run. America generates $700 billion per year of health care waste. We have a $700 billion opportunity. Payers know this, and they are done overpaying. Reimbursements for physicians and hospitals are at their height. They are falling and will continue to fall.
Financial penalties for preventable errors (is there any other kind?), poor patient satisfaction, and nonstandard care are upon us. Gone are the days of craft-based medicine. The need to understand and apply process improvement is upon us – the golden age of systemness is here.
Dr. Pendleton is chief medical quality officer at University of Utah Health Care in Salt Lake City. He reports having no financial conflicts of interest. Find him on Twitter @MDBobP. Steven Johnson is a value engineer in the Value Engineering program at the University of Utah Health Care. He is a six sigma black belt certified by the American Society for Quality. Steve has been a lean six sigma practitioner for 18 years in aerospace, automotive, chemical, construction, and healthcare. Steve has a mechanical engineering degree, an MBA, and a graduate certificate in predictive analytics.
The U.S. health care system is renowned for cutting-edge technology and the best rescue care in the world. However, countless shortcomings of our current health care system are well chronicled: We spend twice as much on health care in the United States as do other developed countries, we fail to deliver basic quality of care half the time, we see more than 200,000 patients die annually from safety mishaps, and we waste more than $700 billion per year because of inefficiencies and unnecessary services.
These shortcomings are among some of the reasons for the evolution of the Affordable Care Act. Yet, meaningful transformation of our health care system will not come from legislation. Furthermore, change will not come easily, but will require learning and applying new skills in process improvement to redesign the way we deliver care, and in order to redesign care, those who actually deliver care must lead. The new knowledge and skills of how to redesign care are crucial, or as Henry Ford once stated, "If you always do what you have always done, you will always get what you have always gotten." In last month’s Systemness blog, I introduced process improvement. This month we turn toward gaining a basic understanding of what we mean.
[Read Part 1: What do making airbags and delivering health care have in common? (Continuous Improvement, Part 1)]
Principal No. 1 is that every single thing we do is a process, and process improvement is simply the use of a standard methodology to identify and eliminate waste. Waste can be classified by what author Jay Arthur calls the three D’s: defects, deviation, and delays (Lean Six Sigma for Hospitals, McGraw Hill, 2011.)
But the definition doesn’t stop there. Process improvement must attack waste that impacts the customer, in our case, the patient, the family, and the payer.
When you embark on a process improvement project, you must be able to answer the following questions affirmatively: Will fixing this process improve the access, quality, safety, experience, and/or cost of care? If you start from a position of "how will this help me, the provider?" you could be on the wrong track. We must allow the needs of the customer to drive our improvement.
It’s important to note what’s missing from the definition of process improvement: train and blame, memorization, promises of vigilance, education of patients, and altering patient behavior. These have been basic to patient care for more than a century, and of course they (sometimes to our detriment) have their prominent place in today’s health care delivery. However, process improvement should not depend on them. In the Checklist Manifesto, Atul Gawande makes the case that the complexity of health care delivery has outgrown these; physicians and the systems they operate within can depend on these no longer.
But which methodology is best? The answer to this question is not worth your worry. Three main process improvement methodologies dominate this discussion: lean, six sigma, and plan-do-check-act (PDCA). These methodologies overlap each other in many ways, and the unique aspects complement each other well. At our institution we have incorporated a blended approach using lean management and methodologies adapted to our local culture creating a generic six-phase process improvement framework: project definition, baseline analysis, investigation, improvement design, implementation, monitor. If we had simply adopted six sigma’s methodology (define, measure, analyze, improve, control), we would have been equally successful. Ditto if we had declared ourselves a PDCA institution.
The Bottom Line
For all of our technology, our education, our many bright minds, and for all the money poured into our industry, health care hasn’t met its potential. We have a lot of room to run. America generates $700 billion per year of health care waste. We have a $700 billion opportunity. Payers know this, and they are done overpaying. Reimbursements for physicians and hospitals are at their height. They are falling and will continue to fall.
Financial penalties for preventable errors (is there any other kind?), poor patient satisfaction, and nonstandard care are upon us. Gone are the days of craft-based medicine. The need to understand and apply process improvement is upon us – the golden age of systemness is here.
Dr. Pendleton is chief medical quality officer at University of Utah Health Care in Salt Lake City. He reports having no financial conflicts of interest. Find him on Twitter @MDBobP. Steven Johnson is a value engineer in the Value Engineering program at the University of Utah Health Care. He is a six sigma black belt certified by the American Society for Quality. Steve has been a lean six sigma practitioner for 18 years in aerospace, automotive, chemical, construction, and healthcare. Steve has a mechanical engineering degree, an MBA, and a graduate certificate in predictive analytics.
The U.S. health care system is renowned for cutting-edge technology and the best rescue care in the world. However, countless shortcomings of our current health care system are well chronicled: We spend twice as much on health care in the United States as do other developed countries, we fail to deliver basic quality of care half the time, we see more than 200,000 patients die annually from safety mishaps, and we waste more than $700 billion per year because of inefficiencies and unnecessary services.
These shortcomings are among some of the reasons for the evolution of the Affordable Care Act. Yet, meaningful transformation of our health care system will not come from legislation. Furthermore, change will not come easily, but will require learning and applying new skills in process improvement to redesign the way we deliver care, and in order to redesign care, those who actually deliver care must lead. The new knowledge and skills of how to redesign care are crucial, or as Henry Ford once stated, "If you always do what you have always done, you will always get what you have always gotten." In last month’s Systemness blog, I introduced process improvement. This month we turn toward gaining a basic understanding of what we mean.
[Read Part 1: What do making airbags and delivering health care have in common? (Continuous Improvement, Part 1)]
Principal No. 1 is that every single thing we do is a process, and process improvement is simply the use of a standard methodology to identify and eliminate waste. Waste can be classified by what author Jay Arthur calls the three D’s: defects, deviation, and delays (Lean Six Sigma for Hospitals, McGraw Hill, 2011.)
But the definition doesn’t stop there. Process improvement must attack waste that impacts the customer, in our case, the patient, the family, and the payer.
When you embark on a process improvement project, you must be able to answer the following questions affirmatively: Will fixing this process improve the access, quality, safety, experience, and/or cost of care? If you start from a position of "how will this help me, the provider?" you could be on the wrong track. We must allow the needs of the customer to drive our improvement.
It’s important to note what’s missing from the definition of process improvement: train and blame, memorization, promises of vigilance, education of patients, and altering patient behavior. These have been basic to patient care for more than a century, and of course they (sometimes to our detriment) have their prominent place in today’s health care delivery. However, process improvement should not depend on them. In the Checklist Manifesto, Atul Gawande makes the case that the complexity of health care delivery has outgrown these; physicians and the systems they operate within can depend on these no longer.
But which methodology is best? The answer to this question is not worth your worry. Three main process improvement methodologies dominate this discussion: lean, six sigma, and plan-do-check-act (PDCA). These methodologies overlap each other in many ways, and the unique aspects complement each other well. At our institution we have incorporated a blended approach using lean management and methodologies adapted to our local culture creating a generic six-phase process improvement framework: project definition, baseline analysis, investigation, improvement design, implementation, monitor. If we had simply adopted six sigma’s methodology (define, measure, analyze, improve, control), we would have been equally successful. Ditto if we had declared ourselves a PDCA institution.
The Bottom Line
For all of our technology, our education, our many bright minds, and for all the money poured into our industry, health care hasn’t met its potential. We have a lot of room to run. America generates $700 billion per year of health care waste. We have a $700 billion opportunity. Payers know this, and they are done overpaying. Reimbursements for physicians and hospitals are at their height. They are falling and will continue to fall.
Financial penalties for preventable errors (is there any other kind?), poor patient satisfaction, and nonstandard care are upon us. Gone are the days of craft-based medicine. The need to understand and apply process improvement is upon us – the golden age of systemness is here.
Dr. Pendleton is chief medical quality officer at University of Utah Health Care in Salt Lake City. He reports having no financial conflicts of interest. Find him on Twitter @MDBobP. Steven Johnson is a value engineer in the Value Engineering program at the University of Utah Health Care. He is a six sigma black belt certified by the American Society for Quality. Steve has been a lean six sigma practitioner for 18 years in aerospace, automotive, chemical, construction, and healthcare. Steve has a mechanical engineering degree, an MBA, and a graduate certificate in predictive analytics.
