Medicine is at a crossroads. Tried-and-true techniques have failed to yield needed improvements, and in some cases, the remedy instigates new woes. Now forward thinkers in healthcare are tapping a new fount of knowledge—industry—and learning best practices from unlikely sources like mattress factories, fast food franchises and evangelists.
It’s no secret that healthcare is in crisis. With the average patient in a hospital intensive care unit contending with 1.7 medical errors each day, the most vocal critics might characterize patient safety as an oxymoron. Performance incentives are perverse; under the current fee-for-service reimbursement model, providers are paid regardless of outcome. And when anything goes amiss, a culture of silence, rather than accountability and learning, pervades. Standardization—which is key to boosting efficiency, reducing errors and controlling costs—is the exception, rather than the rule.
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Despite its critical condition, there are pockets of progress. Johns Hopkins Medicine in Baltimore, has led a crusade against preventable infections and pioneered a five-step checklist to help providers prevent the hospital-acquired bloodstream infections that kill more than 30,000 patients a year and sicken thousands more. The model has been applied in 47 states and around the world and inspired the book “The Checklist Manifesto: How to Get Things Right” by Atul Gawande.
The orthopedic surgery department at Brigham and Women’s Hospital in Boston, standardized knee replacement management, and, in the process, halved the cost of knee implants while also improving recovery to the point at which the average patient is discharged nearly one day earlier than under its previous every-surgeon-for-himself model.
Seattle Children’s Hospital has streamlined its pharmacy ordering process to achieve 90-minute medication turnaround in 95 percent of cases, up from the pre-process improvement mark of 80 percent.
How have these organizations bucked the middling status quo that permeates healthcare? Not by learning from their peers. Former Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD, once famously quipped that hospitals that achieved top laurels amongst their peers were “the cream of the crap.”
Instead, these organizations looked far and wide for new models and processes, tapping some unexpected sources for solutions.
Take, for example, Seattle Children’s Hospital. Fifteen years ago, when the hospital embraced its goal to be the best children’s hospital in the country, it surveyed the local pediatrician community. Physicians agreed that Seattle provided high-quality care, but issued a couple of caveats. “They told us ‘we have trouble getting patients’ appointments, and you never call us back,’” recalls Howard E. Jeffries, MD, MPH, medical director, clinical effectiveness.
The documented access and communications issues, coupled with internal recognition of inappropriate care, spurred the hospital to contract with Joan Wellman, a performance improvement consultant and founder of Joan Wellman and Associates. Her response was both bold and spot-on. “You aren’t going to find what you need to make these changes in healthcare because no one is doing what needs to be done to make these changes.”
The hospital agreed, and embarked on its decade-long performance improvement project. Read on to learn more about how and where these pioneers located springs of knowledge.
From the mattress factory to the OR
One hallmark of Lean performance improvement is study trips. Several years ago, the general surgery team at Seattle Children’s traveled to a mattress factory in Japan to discover what could be learned. The very successful factory made approximately 100 kinds of twin beds, but only 10 of these beds were sold frequently, says Jeffries. Despite the unpredictable nature of its business,