What You Don’t Know Can Harm You

I am sure that many of you have heard the saying What you don’t know can’t hurt you. From much experience I know that just isn’t true in many cases, especially in healthcare. Consider these cases if you will

Because I am presently involved in alcohol and other drug research, I have the opportunity to hear many stories from recovering alcoholics. One story related directly to care this person was receiving for a persistent cough. The patient’s doctor had prescribed cough syrup with codeine; the patient reported to fellows at an AA meeting that she wanted to drink it all at once. Clearly, the codeine appealed to her addictions. A doctor who had been aware of her past and who knows the problems with narcotic substances for recovering alcoholics would never have made this prescription.

Failure to know what medications a patient is taking account for many of the errors at hospitals. For instance, not knowing a male patient is on aspirin therapy can lead to complications during surgery. That is why JHACO is emphasizing reconciling medications at admission to hospitals.

How Do You Know You Are Getting Better Use Data to Drive Improvement

The best quality improvement initiatives are driven by data! Why How are you
going to know how much you have improved if you don’t measure something

All of you have been exposed to measures in many situations. Most of them were
important. In school, you were graded. Perhaps you own shares of stock; how do
you measure the success of the stock–its increase in value, a measurement. How
do you know if your team wins By its score, a measurement. The fact is that many
daily activities in life have accompanying measures to judge their success.

You might argue that you know if things are getting better; you can just tell. I am
sure that you can. This is not enough, though. In the healthcare field it is
important to measure improvement. One reason to do so is to prove to others that
things are improving. For instance, suppose you are in charge of implementing
electronic health records in a hospital setting. You meet resistance from several
staff members, including a large number of doctors. How can you overcome this
resistance Collect data–lower percentage of wrong prescriptions, for instance–
from a pilot program of willing participants and then demonstrate the positive
benefits with your data. With such results in hand, you will overcome many
doubters.

The Four Key Approaches of Healthcare Lean-Six Sigma

As one begins to understand the theory of constraints and system thinking, an epiphany enlightens. One has to look to improve the system and all interdependent process as whole, by improving systematically a process here and a process there. Improving without a systematic view, just brings little results often shifting the root problem.

Lean-Six Sigma for Healthcare has four interwoven approaches

1. A strategic deployment approach – Senior Executive’s goals are tied to the strategic plan by category of quality, expense reduction, patient safety, physician satisfication, patient satisfaction. This categorization is extended to six sigma project selection. Additionally a system map illustrating the relationships between all major entities and core processes is developed The C-suite champions the Lean Six Sigma deployment across the hospital, medical center, or health system

Good Quality Improvement Programs Produce Better Bottom Lines

W. Edwards Deming once said, In God we trust, all others bring data! That is just what I propose to do in this newsletter. I often speak of how continuous quality improvement programs improve the bottom line at a healthcare site. This idea is throughout my web site. I promote the idea that Quality pays, it does not cost. That is, a good quality improvement program based upon population level data not only is not cost neutral, it improves the income and profit at a site. Many healthcare professionals do not believe this. They point at all the regulatory standards for quality, such as those written by JHACO, and believe that quality is actually costing them quite a bit. I have done some extensive research on this topic recently and believe that I can prove this point convincingly to you.

Fortunately there is good documentation of financial outcomes at healthcare sites which use various quality improvement approaches. I am very familiar with two of these-TransforMed’s National Demonstration Project and the Federal Government’s NIST (National Institute of Standards and Technology) Baldrige Award program. Starting in 2006 TransforMed, a subsidiary of American Academy of Family Physicians, began a program to aid in transforming a sample of primary care practices into models of the Patient-Centered Medical Home (PCMH). One group of sites was actively involved with representatives from TransfoMed to adopt the Patient-Centered model and the other group used materials supplied to them by TransforMed to use in a self-directed approach to adopt the model. TransforMed’s CEO, Dr. Terry McGeeney, wrote an article recently (available on the TransforMed website) summarizing the financial impact of the adoption of the PCMH. The results were very positive. The revenue for the assisted sites rose 10.49% on average and the rise in revenue for the self-directed sites was 2.43%. For physicians at these sites personal income rose nearly 14% at the assisted sites and 13% at the self-directed sites. This was achieved while most of these practices were installing electronic medical records. These results are well documented because of TransforMed’s practice change model incorporates strict tracking of financial data.

Where Do You Begin Begin With the End in Mind!

I know that many of you want to make things better at your site–make things safer,
have your chronically ill patients become much healthier, get home on time from the
office consistently, and much more. So, where do you begin!! I like the answer
given by Stephen Covey in The 7 Habits of Highly Effective People (if you haven’t
read it yet, I highly recommend it). He says to Begin with the End in Mind. What can
this mean He states that all things are created twice–first mentally and then
physically. So, the first step is to have a vision of what you want at your healthcare
site. Do you want to reduce infections 60%-70% if your site is an ICU Studies at
the Institute for Healthcare Improvement show this is possible. If you are a primary
care physician, do you want to increase the income of your practice 10%-20%, leave
the office on time, and also dramatically improve the health of your patients A
recent issue of Family Practice Management demonstrates how. If you have primary
contact with patients, do you want to consistently know all the prescriptions that
they take so as to avoid conflict in medication or other undesirable outcomes
JHACO is requiring hospitals to reconcile medications for all their patients. A May
23, 2006 article in the Wall Street Journal discussed how hospitals are improving in
this area.