posted by admin at 4:38 pm
Today, a public call with HHS Secretary Kathleen Sebelius and CMS Administrator, Dr. Donald Berwick, celebrated 4500+ organizations pledging support for the Partnership for Patients. Over 2000 of the participants are hospitals.
Joe McCannon, Senior Advisor to the Administrator, offered a number of characteristics of healthcare organizations leading the way in making patient care safer, more reliable and less costly. I have paraphrased Mr. McCannon’s observations made as he and the Partnership for Patients team have traveled across the country. These leading organizations:
• set aims & goals for patient safety improvements and state them publicly – what, how much & by when
• put patients and families on the Board and committees
• count the number of tests they run every day because they are as interested in learning every day as they are in results
• devolve ownership of improvement to the frontline
• continually recognize success – incremental and period-end results
• share stories & narratives of patient experiences & use language of creation – to create an ideal health system
• are rabid about finding new ideas – doing site visits, reviewing literature to help them break out of traditional patterns of thinking
• have the “patient & family” in the room, in the discussion – always
Learn more about the Partnership for Patients @ (more…)
posted by admin at 6:01 am
For as long as I can remember advocates of patient safety have both held the–very safe–aviation industry up as a useful analogue to health care.
But this blog entry in the WSJ calls the analogy into question. At least it calls into question the simple (simplistic) imitation of the practices of aviation that are commonly seen as solutions to many patient safety problems in health care.
posted by admin at 5:47 am
Kaiser’s news feed has an interesting article about so-called “Accountable Care Organizations,” (ACOs) which to date remain mysterious.
First, it needs to be said that NO ONE knows what ACOs are or will look like. There has been a pilot, which was quite successful. But CMS was set to clarify regs for ACOs and has missed the deadline. And there’s little indication when the guidelines will emerge.
Second, I’ve heard policy analysts report that the one most important thing for success in ACOs is “culture.” I really didn’t see that coming; yet it makes perfect sense.
Finally, ACOs–to date–are focused on docs and their behavior. The article I link to above argues that patients ought to be included in ACOs. Healthy behaviors can, the authors rightly mention, be part of the ACO calculation.
Nevertheless, I’m not sure how CMS can share gains in this way. It’s an interesting idea. And, in my view, shows promise.
posted by admin at 9:40 am
Last week when John Kenagy and I were having lunch he emphasized that his recent book–that, by the way was named the Book of the Year by the American College of Healthcare Executives (ACHE)–focuses on the role of senior leadership in transforming healthcare.
John continues to speak to groups of Execs and has been working with some systems to prepare them to begin their Adaptive Design transformation.
It’s worth reading.
posted by admin at 4:59 pm
On the IHI’s blog there is a listing for a seminar on “Improvement Skills to Empower Front-Line Nurses.”
This seems well intentioned, but wrong headed. Frontline nurses are constantly in motion. I know, I’ve seen thousands of hours of it.
The good intentions of organizations that seek to empower staff to “solve problems themselves” is misguided. Each nurse can contribute to the process of improvement, but someone else–ideally, the manager or charge–needs to do the work of studying operational and clinical problems. They can then coach and collaborate with frontline nurses in finding solutions.
Many of the things smart, well intentioned leaders teach nurses (read: add to their duties) turn out to be most powerful sources of so-called workarounds. Nurses work around systems because they’re already overloaded. To make matters worse, nurse managers spend most of their time off the unit and are not there to do the “leg work” so that frontline nurses–who are our greatest source of information about what’s happening–can add what they have to offer in understanding problems and improving work processes.
Teaching nurses more about how to do improvements is unlikely to alleviate this. What’s required is improvement in the quality of managerial work on the units.
The processes we use yield exactly the results they were designed to deliver. This is as true for managerial processes as it is for clinical and operational processes. It’s time for a revolution in managerial quality.
posted by admin at 1:27 pm
I was at a conference a couple of weeks ago and heard an attorney who specializes in policy speak about Accountable Care Organizations.
Interestingly, besides saying that we know very little about what ACOs will look like, he continually made the point that the organizations that took place in the pilot felt that a culture of adaptation and openness were the most important success factors.
Culture–to me, anyway–often sounds a bit squishy as a term. But clearly, health care organizations must become adept at adaptation and improvement if they want to meet the challenges to come.
posted by admin at 7:14 am
My last post was on how small improvements lead to big improvements–”moving the big dots”; today’s is about how the inverse is true–how small problems seem to accumulate to moving the “big dots” in the wrong direction. This article article is a perfect example of this. (I know, NYTimes again, but I can only keep up with so much news.)
This article points out how a handful of hassles resulted in sub-optimal care for patients. From the article:
None of these [infection prevention] precautions made it easy to examine or even to visit him. Most of us were loath to go through the process of gearing up more than we had to; and even his wife of 20 years groaned occasionally when she dutifully swathed herself in protective coverings each day. As the weeks wore on, we clinicians found ourselves minimizing our interactions.
Let me be clear here. Everyone had good intentions. It’s just that the small things involved in gowning up–as the doc describes it–were fraught with hassles. As a side note, I’ve observed docs for many days and nurses for >1000 hours. Their workload is mind-boggling. Anything that impedes their work needs–for their sake as well as ours–to be improved. And improved. And improved again and again. Our experience is that the “row harder slaves” approach to improvement either fails to sustain or just plain fails.
Our firm’s experience continues to show that there are ways to design taking appropriate cautions that would make it EASY for clinicians and family members to provide appropriate care for patients.
Remember clinicians are running full-tilt. We cannot leave “fixing it” to them. Instead, managers must take responsibility to facilitate improvement efforts. This also means that their leaders must help to clear the path for them to engage in small but critical efforts to remove the “sand in the gears” of the work life of clinicians.
We have named “Rule 4″ because we operate according to 5 rules. Rule 4 is: every improvement should be made as close to the work as possible, under the guidance of a teacher/coach/manager, using the scientific method. Our frustrated clinicians (and family member) in the article I cite above deserve to have those resources and skills at their disposal. Indeed, the future of healthcare depends on it.
posted by admin at 4:11 pm
In recent conversations with clients, they’ve been reporting to us the cumulative power of many relatively small improvements.
My experience with this is that when people see the results of the work our clients do–although we teach and coach, the results belong to them–they always ask, “What did you do to achieve these results?”
This always takes our clients by surprise, because they haven’t done one thing to achieve their results. They can usually cite a couple of high-impact improvements. But even those improvements don’t equal the sum total of the results they’ve made.
In fact, there are two factors that make the difference:
1. Frontline managers and designated coaches have facilitated many, many small improvements. Sometimes thousands of them. Nothing fancy, mind you. Just day after day making smart bets on what things will move the BIG DOTS.
2. The culture has begun to change in significant ways. To put it in the language of my colleague Anita Tucker, the organization is moving from a “culture of workarounds” to a “culture of improvement.”
This cultural change happens bit-by-bit, day after day. The cumulative effect, then, is that things improve greatly. And best of all, it continues to improve.
posted by admin at 2:45 pm
The state of New York faces a $200B shortfall in its healthcare obligations to retirees. (See this article).
There are essentially two strategies to handle this: renegotiate promised benefits and/or do more with existing capacity. Probably both will be required.
We’ve had the experience a number of times where we’ve been able to help organizations avoid large capital expenditures by helping them to better utilize their current resources–all with a total focus on meeting patient needs exactly.
Frankly, I’m hoping New York can meet their obligations by increasing capacity to care for retirees, without cutting benefits. I don’t know about re-capturing $200B, but I know they can reduce their liabilities through more effective use of their current facilities, technology and (especially) people.
posted by admin at 12:42 pm
Every leader I’ve ever talked to expresses a concern that they feel pulled in a million directions. Ask a frontline worker and they’ll say it’s more like a billion. This is made worse by the fact that there is a constant stream of “breakthrough” ideas. As a friend of mine says, “The greatest fear of a leadership team is that the CEO will read a new book.”
New processes, technologies, and ideas are essential to progress. But I assert that stability is the precondition for success of new things.
I also continually hear that leaders seek standardization. In my view, this is absolutely right. Once we create consistency we can know whether our new processes, technologies, and ideas really improve care for our patients and their loved ones.
And continual progress toward the ideal of the best outcome for every patient every time is founded on stability first.
