Quality and Economics of Health Care

Brief Summary

The Safe Care Environment in our hospitals have two opposing and complementary tenets – a standardized and an integrated care process that are staffed by a motivated and agile workforce. The Total Quality programs in engineering, manufacturing and other industries can help balance these two forces by fully understanding the constraints of their industry. Similarly, the healthcare industry also needs to find this balance and in this blog, I will outline how a team of quality engineers, business process improvement and clinical staff from a teaching hospital have tackled this challenge and produced remarkable results.

The Safe Care Environment

Last week I had the opportunity to attend a two day course organized by IHI in Boston Massachusetts. The program was mostly attended by department chiefs and chairs from many prestigious teaching hospitals around the globe. As most of us non-medics only see doctors when we are sick and under those circumstances we expect our doctor to be the authority; decisive and with a Captain Kirk like persona. But this setting was different, they were there to learn from each other and I got to observe their dialogue. It was the best two days I have spent in years.

The main theme of the program was that the health care community recognizes that the cost of health care is rising at rates that are not sustainable. In addition, with the aging population, the cost is expected to increase unless significant interventions are injected. In health care, the community recognizes that there is room to improve quality of the care delivery process and simultaneously reduce the cost curve.

A Doctor discussed that the Safe Care Environment has two tenets – a standardized and an integrated care process staffed by a motivated and agile workforce. For the past 27 years, I have worked in hospitality, engineering, manufacturing, finance and insurance industries and I have learned that the same tenets apply in these industries when it comes to providing cost-effective quality service. Due to the fact that each industry has different characteristics and constraints, how the quality and continuous improvement environment is created is different. The discussion in this course, however, was how to create a Safe Care Environment, what obstacles must we overcome and why current efforts are not yielding the expected outcomes. The puzzle for me was considering that the health care industry has the most talented and committed workforce among all the industries I have worked for, why is there this struggle?

I believe the challenge that the Health Care industry has is that it has a unique characteristic: The Patient. The patient is as non-standard as anything can get. Two patients with the exact same diagnoses may require a completely different care plan. That makes the problem to solve complex but it still is a solvable problem as I describe below:

Approach to Building a Safe Care Environment

Study the complete care delivery process; standardize only the aspects of the process that are repeatable. Then automate those processes in an easy to use manner. Those aspects that cannot be standardized require a mechanism to guide staff using their expert knowledge and judgment to consistently complete the task.
Provide real-time feedback to staff to reinforce how the standardized, integrated and guided process is making their life easier and thereby enabling the right clinical outcomes and also provide feedback to indicate that they are making the care process more affordable.
Create a formal and pragmatic process by which the value of standardized and guidance processes can be reviewed and altered as required.
Make it simple to change the improved care delivery process. Failure to do this will create an environment where process will be followed for the sake of following the process.

Application of this Approach

Our team of quality assurance engineers, business performance improvement practitioners and members of clinical staff from leading teaching university applied this approach to the following key care delivery process:

Patient Centric Interprofessional Communication
Patient Hand-off – physician to physician
Nursing Hand-off and Electronic Kardex
Inter-professional collaboration
Emergency Department Consultation
Patient Satisfaction
Build Care Teams in Real-time
Real-Time process effectiveness that was used to improve clinical outcomes
Process to change the care process and study its impact on process effectiveness and clinical outcome

The Results

Noticeable reduction in interruptive Pager/smart phone messages from one clinician to another
A larger number of underlying medical issues resolved within a clinically significant timeframe
Less time taken to know the critical issues with patients under care at the shift change
Increased staff satisfaction – enabling medical staff to do what they were trained to do and took an oath to do – provide superior care for patients

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