U.S. Healthcare System Sorely Needs Quality - How Safe Is Your Hospital?

A recent report from the Institute of Medicine (IOM) said  a leaner, more quality-driven U.S. healthcare system will save money, improve care and produce better results.

The Insttute and it's report grabbed headlines last month for estimating the U.S. healthcare system sqaunders $750 billion each year through unneeded care, elaborate paperwork, fraud and other waste.  Also contributing to this alarming sitiuation is lack of communication, coordiantion, and quality.

An organized system that finds out what went wrong and where, and then allows the health system to correct those mistakes right way could save money and lives, the IOM report recommended.

The IOM report can be accessed at www.iom.edu/reports/2012/best-care-at-lower-cost-the-path-to-continuously-learning-health-care-in-america.aspx.

The IOM report recommended that patients should know patient safety when they go in the hospital.

How safe is your hospital?  Check before you check in!

Grading Hospital Safety - About 180,000 Medicare patients die each year from hospitals accidents, errors, and infection according to the U.S. Department of Health and Human Services.  Another 1.4 million are seriously hurt by their hospital care. 

So how safe is your hospital?  I'm Jim Tripp and you can send me email with jstripp@Comcast.net . We can talk about Quality in the white water with healthcare.

The Biggest Mistake Doctors Make

A patient with abdominal pain dies ... from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab results gets misplaced. A child's fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis.   

Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes - and more likely to harm patients - but they're also the leading cause of malpractice claims, accounting for 35% of nearly $39 billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to John Hopkins.

Misdiagnoses are among the most common, costly and harmful medical errors. But they are also some of the most preventable...

The good news is that diagnostic errors are more likely to be preventable than medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis.

Part of the solution  is automation -- using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results.

"Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar od the patient quality and safety movement," Says Mark Graber, a longtime Veterans Administration physician and a fellow at the nonprofit research group RTI International.

Automation is not a process - Process is  a method of doing something, with all the steps  involved including the patient.

It is important to ask your Doctor These questions:

• Can you review my primary concerns and symptoms?
• How confident are you of the diagnosis?
• What further tests might be helpful to make more confident?
• Will the tests you are proposing change the treatment plan?
• Are there findings or symptoms that don't fit your diagnosis?
• What else could it be?
• Can you facilitate a second opinion by providing me with my medical records?
• When should I expect to see my test results?
• What resources can you recommend for me to learn more about the diagnosis?

I'm Jim Tripp and my email is jstripp@comcast.net .  I worked in healthcare for 40 years. Please send your questions.  You are the patient and it is imperative you ask about the process from the doctors and all other clinical staff members in hospital.

Resources taken from:

"The Journal Report: Health Care"
By Laura Landro
The Wall Street Journal

American Hospital Association Environmental Scan

The 2013 American Hospital Association Environmental Scan provides insight and information about market forces that have a high probability of effecting the health care field.  It is designed to help hospital and health health system leaders better understand the health care landscape and the critical issues emerging trends their organizations likely will face in the foreseeable future.

This is a summary of the Environmental Scan:

Provider Organizations & Physicians

• Relying on the current primary care system is not going to be adequate
• A culture of performance excellence and accountability
• Hospitals and health systems will need to be much leaner in all ways

Quality & Patient Safety

• Medical schools are not doing an adequate job
• Cost savings opportunity in health care lies with supply-sensitive care
• Poor quality metrics could be penalized
• Enhancing care coordination during hospital-to-home transitions
• Concerned that public reports fairly and accurately reflect their performance

Information Technology & E-Health

• Delayed implementation of ICD-10
• Mobile health has been shown to reduce the need for hospital admissions and physician office visits
• This past year alone, health care generated an estimated 150 exabytes of information
• Coordinating care for patients with complex health conditions
• Hospital executives say they are very concerned about the cost and process of fully integrating EHRs

Consumers & Demographics

• Half of Americans will develop a mental illness
• Adult and childhood obesity
• Rise in chronic conditions
• 5 percent of the population accounted for nearly 50 percent of health care expenditures
• Most boomers are going to be working after age 65
• Families are the principal caregivers for our nation's older people

 The Environmental Scan 2013 is available at www.aha.org .  I recommend you to get the full scan on the website.

What Most Stymies Innovation and Creative Thinking?

Over the last 12 months, Healthcare Leaders are saying the word CHANGE!! to physicians and employees.  What is CHANGE in the eyes of leaders, physicians and employees?  Will they keep the Traditional and/or Ideal business model?  It took Mayo Clinic 100 years to become a world-class healthcare institution.  Leaders don't have the 100 years it took the Mayo Clinic to make all the CHANGES to sustain their institution for the next century. 

 Albert Einstein said  "You can't solve a problem with the same kind of thinking that created  it."  Let's look at survey data to find out if Leaders support the CHANGES.

The American Society Quality (ASQ) does a Quick Poll each month at www.qualityprogress.com, where visitors can take an informal survey.  Here are the numbers for all industries from a recent Quick Poll July 2012:

"What most stymies innovation and creative thinking?"

• Lack of Leadership support                     46.1%
• Fear of failure                                            23.0%
• No, dedicated time                                     18.4%
• Inadequate resources                                12.3%

The data tells us that Leadership doesn't want to change the culture and become high-performance learning organizations. 

Franklin Covey Leader Question

As a successful leader, I imagine your team's productivity is constantly on your mind.  Franklin Covey has surveyed over 350,000 employees from nearly all major industries asking them this important question: "How much of your time is spent on important priorities?"  The results are:


                30% - Spent on Important Priorities     70% - Spent on Urgencies & Irrelevancies

What would it be worth if your organization could reverse those figures?  How would it impact operations, customer service, sales output and the bottom line? 

Provider Organizations & Physicians should create a culture of performance excellence and accountability for performance and improvement in all key areas - health care and process outcomes, customer-focused outcomes, workforce focused outcomes, leadership and governance outcomes, and financial and market outcomes.

Hospitals and health systems will need to be much leaner in all ways.  Leadership teams are starting to realize how difficult this task will be using traditional cost management techniques.

Deming's System of Profound Knowledge

If you work in quality and improvement, you know W. Edwards Deming (October 14, 1900 - December 20, 1993).  He was an American statistician, professor, author, lecturer and consultant.  He is perhaps best known for his work in Japan.  There, from 1950 and onward, he taught top management how to improve design and service, product quality, testing, and sales through various methods.  He received the Distinguished Career in Science Award from the National Academy of Sciences in 1988.

In 1993, Dr. Deming published his final book, The New Economics for Industry, Government, and Education, which included the System of Profound Knowledge and the 14 points for management. The key is to practice continual improvement and think of manufacturing, not just bits and pieces.  The prevailing style of management must undergo transformation.  A system cannot understand itself. The transformation requires a view from the outside.  For example, many hospitals in the country will have to transform to meet coordination of health care like the Accountable Care Organization (ACO). It is imperative, as hospitals are required to start following mandates and guidelines set forth by the ACO, that current systems in place, which are broken and not producing results, are viewed from an objective, "outsiders" view, from top to bottom, to truly make an effective transformation. 

Deming advocated that all managers need to have what he called:
The System of Profound Knowledge, consisting of four parts:

1. Appreciation of a system: understanding the overall processes involving suppliers, producers, and customers (or recipients) of goods and services;
2. Knowledge of variation: the range and causes of variation in quality, and use of statistical sampling in measurements;
3. Theory of knowledge: the concepts explaining knowledge and the limits of what can be known;
4. Knowledge of Psychology: concepts of human nature.

Deming explained, "One need not be eminent in any part nor all four parts in order to understand it and apply it. 

An example of an organization that found Deming's System of Profound Knowledge to be highly effective was the North Shore-Long Island Jewish Health System.  By following the parts of The System of Knowledge and completing a true transformation, this health care system was able to become a high-performing learning organization.  What they found through their transformation was that, traditional top down leadership, which encompasses: directing, controlling, change initiating, being project oriented,  decisions being made by one or a few individuals, and a "turf" and "silos" mentality, was NOT producing results for their organization.  By implementing an ideal top down leadership, which met employees half way, a transformation was achieved.  The results of following an ideal top down leadership model were: guiding, leading, communicating vision, developing strategy, being process focused, making decisions as a team, disciplined problem-solving, systematic organizational change, and empowered cross functional teams and individuals.

The biggest asset in an hospital are the employees and stakeholders.  When you make your transformation make sure all employees and stakeholders use The System of Profound Knowledge.  You will harvest knowledge from employees and stakeholders to drive the new system into to the next 10 years and beyond.

Performance Excellence Training System

Now is the time to take action and prepare your health care organizations for sweeping change - through Performance Excellence Training System - PETS.  I will give you the cliffs notes of PETS and how it can help you.

PETS provides a proven system to improve your organizational culture, drive performance excellence and demonstrate the public good you create for your community.  PETS is not just another improvement project - it is a process for system-wide change that produces sustainable results for your health care organization.

PETS process is delivered in four steps designed to analyze, diagnose and treat your organization - much as a physician would be a patient.

Step One:    History and Physical Assessment
First, we work with your senior leader to review your current results, examine your culture and gauge your tolerance for change.  The backbone of the history and physical assessment is the National Quality Health Care Criteria for Performance Excellence.  We incorporate the best practices used by winners in and out of health care.

Step Two:   Diagnosis of Major Systems
In this step, we inspect the vital characteristics of the major systems in your organization.  Major systems include your health care delivery processes, business and support processes.  Using this information, we will create a culture-centric improvement model based on unique features and needs.

Step Three: Customized Treatment Plan
Next, we put the plan into action.  Using proven tools and knowledge including strategy development and deployment, balanced scorecard, process-based management, Six Sigma methodologies and other best practices from nationally recognized health care organizations to generate improvements and engage people across the organization.

Step Four:  Keeping you well and fit for the long term
Finally, we use the Plan-Do-Check-Act- Cycle to assess the outcomes of the treatments and examine the results.  Training is a major focus here, allowing you to take what you have learned and sustain the improvements into the future. 

I hope you like the PETS and  how powerful it is - from the top of the administration and physicians to frontline people PETS will work in process management to drive knowledge and performance excellence.  Let me know your thoughts.

Welcome to "Creating a Sustainable Healthcare System"

Welcome to the Creating a Sustainable Healthcare Blog.  I am happy to have you as a reader!
With twenty plus years as a healthcare consultant, I have seen it ALL!  Administrators who don't know the names of their front line people, nurses who refuse to work with doctors, and conversely physicians who do not respect and work with nurses and other clinical staff.  The majority of the hospitals I have worked in, we couldn't get the leaders to understand a system. The gap between the leaders and the front line healthcare staff is WIDE. 

Here we are in 2012 with the three common barriers preventing resource optimization - 1. Misaligned incentives between hospitals and physicians, 2. Lack of discrete data systems to measure performance, and 3. Real or perceived lack of time and/or resources to implement initiatives.  The culture the leaders have created is brutal for the front line staff - tears, anxiety, and fear because they are being controlled and directed to carryout processes without collaboration and teamwork.

My ideal is to create a High-Performing Learning Organization -which involves: guiding, leading, communicating vision, developing strategy, teaching individuals to become process focused, implementing team decision making, disciplined problem solving, systematic organizational change, and empowered cross functional teams and individuals.
My hope is that this blog will provide interested readers with knowledge regarding healthcare systems and processes, that if implemented, actually provide RESULTS.  Knowledge is POWER and without it, our healthcare system will continue to be in a state of CHAOS.  Here is to the journey that we must embark on for CHANGE!