18

Jul

Great healthcare graphs and discussion

posted by admin at 1:44 am

I love a good graph. Lane Kenworthy found a new way to express just how inefficient our American healthcare system is compared to other countries. Here’s the link…

08

Jul

Partnership for Patients – Characteristics of Leading Organizations

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…)

28

Jun

How (not) to Produce High Quality Managerial Work

posted by admin at 8:40 am

This blog entry hints at what we’ve developed (and continue to improve) over the last several years.

Let me start with what may be two controversial assumptions:

  1. Managing well, like other skills, is acquired through practice.

  2. The vast majority of success in executing key strategic initiatives lies in the hands of frontline managers and their staff (plus docs). (See the opening to Fred Hassan’s “The Frontline Advantage”

In the same way that we invest in understanding clinical quality, our group has developed a relatively simple program that enables managers to continually develop “managerial quality.” High quality managerial work is characterized by three things.

High quality managers

  1. actively engage staff and docs as they create sustained improvement along the dimensions of quality and cost;

  2. understand how to lead and coach their people–rather than merely “telling” or “implementing”; and
  3. know how to translate key initiatives into the daily work of them and their staff.

This post is getting long, but I can tell you that we’ve been surprised at how even the most “difficult” managers thrive when they get a chance to learn and teach what they’re learning. Managing no longer amounts to doing a staffing matrix, defending a budget, and refereeing fights among staff members. It becomes satisfying, generative work.

22

Jun

Weak Strategies for Lowering Health Care Costs

posted by admin at 7:06 am

The author of this article argues that innovation will be the savior of healthcare. Surely this is true, but it’s too vague to be actionable.

To be fair he cites some examples that organizations could follow. But those he cites are insurers who are voluntarily capping their earnings.

While I find this noble and it sure sounds great, I doubt this will reach a stable equilibrium.

Also, it runs counter to Adam Smith’s fundamental insight that coordinated specialization leads to higher economic output (think: pin factory).

The problem is not that insurance companies can make lots of money, but rather two other problems. First, right now insurers and HCOs are engaged in a zero-sum game. Finding common cause–not capping profits–will more likely lead to decreased costs (and, I buy the shibboleth that it must be tied to better quality.) That is, surely we can create a more healthy game.

One more note: I think that the only stable route to higher quality at ever lower costs is to work hard on effectiveness–some clinical, some operational.

Right now the average cognitive load on a doctor or nurse–most of it spent waiting, hunting, etc.–is appalling. If we have effective systems, we eliminate a lot of the “noise” that occupies the minds of extremely bright, limited-capacity machines. The payoff is that providers can be more present for their patients, leading to the right outcome for every patient every time.

18

May

H&HN Daily Podcast on Avoiding Staff Burnout

posted by admin at 2:14 pm

In the May 6, 2011 H &HN Daily from the American Hospital Association, Rod Dykehouse, VP & CIO of ProHealth Care, talks about the impact of health care changes on IT and hospital staff. With implementing an EMR, meaningful use and ICD-10 changes, it’s easy for staff to be overwhelmed.

Mr. Dykehouse explains how his IT team partners with departments throughout their system. They also manage incoming project requests so that staff handle 2-3 projects instead of having the whole laundry list in front of them.

We applaud this approach and posit that it applies to staff throughout the system. New IT systems change not only the work of IT staff but of all the end users throughout the hospital. Think of your own computer – figuring out what’s changed with a software update or have you ever switched from a PC to a MAC? And how does all this work when you’re pressed to get something done? It’s not necessarily hard, but it’s different and takes practice to accommodate the new technology into your work. Now think of a busy nurse or doctor trying to meet patients needs while adapting to a new EMR. Factoring in the ability for staff to practice in an environment as close to how their work happens eases the adoption of new technology and, importantly helps staff get patients what they need and keep them safe from “go-live” on.

view the podcast

04

May

Adaptive Design @ Iowa Health System on Healthcare Value Leaders’ Network podcast

posted by admin at 11:02 am

Mark Graban interviews Ray Seidelman from the Iowa Health System’s Center for Clinical Transformation about their Adaptive Design learning. Ray highlights how Adaptive Design learning has grown from transforming med/surg care at IHS’ hospitals to a way for improving work throughout the system. Front line engagement has fueled this growth. Listen to the podcast here:

03

May

EHR Meaningful Use vs. Usability

posted by admin at 6:16 am

Meaningful use is one of the criteria for subsidy for EHRs. But up to this point usability has not.

Docs, nurses, and others are constantly complaining about too many clicks, too many screens, too much hunting, multiple sign ins, etc.

A lot of this data entry, therefore, is getting turfed to residents. Which creates a situation where residents become good at treating charts, and not necessarily patients.

Elegant engineering designs are not necessarily useable. The usability movement hit the internet years ago, why has it not yet hit EHRs?

14

Apr

Dr. Kenagy book signing

posted by admin at 5:38 pm

Dr. John Kenagy and Rule 4's Dolly Bellhouse with Michael Covert, CEO Palomar Pomerado Health in background

I had the great pleasure of joining Dr. Kenagy at his “Book of the Year” book signing at the American College of Healthcare Executives Congress in Chicago last month. It was great to connect with executives from across the country leading their organizations to be truly adaptive. It is great preparation for the challenges and changes facing all of us as we guide organization to make care ever more ideal for patients.

31

Mar

High Deductible Health Plans

posted by admin at 5:36 am

According to a study by the RAND Corporation, high-deductible plans do, in fact, lower healthcare spending.

However, these plans also have the effect of reducing preventative care–like immunizations and cancer screenings–which likely has downstream costs. So, it seems, there really is no free lunch.

30

Mar

Are ACO Regs on the Way?

posted by admin at 8:08 pm

This article from Politico suggests that they finally are. Although they’ve been promised many times before, this time it seems like the real thing.

Now the question is: other than lawyers, who (in the near term, at least) stands to gain from their release?

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