What do Paul O’Neill, James Womack PhD, Francois de Brantes, Alan Gleghorn, Don Shilton, Henry Hawthorne, Alan Aviles, and John Toussaint MD have in common? They were all keynote speakers last week at what attendees have said was the best Lean Healthcare Transformation Summit yet. But that’s not all. They also are CEOs or former CEOs who have focused on bringing operational excellence to their organizations. That means personally learning how to be a lean leader. They inspired hundreds of people with their stories and experiences.
The Lean Healthcare Transformation Summit is an annual event where leaders can network and share their experiences on implementing lean, as well as their struggles and successes with new healthcare payment systems and becoming transparent on cost and quality performance. The networking is considered the best part of the experience. Our job at the Center is to bring important thought leaders to the attendees to stretch their thinking.
Today, The Journal of the American Medical Association (JAMA) published an article by John Toussaint, M.D. and Donald Berwick, M.D. which describes several important changes that must happen legislatively and from a policy standpoint to lower cost and improve quality for Medicare beneficiaries.
The Affordable Care Act (ACA) allowed for fee-for-service Medicare data to be released to Qualified Entites (QEs). Unfortunately, fatal flaws in the wording of the statute 10332 do not allow physicians to have access to the entire data set. This means they can not drill down into the data to understand where performance issues may exist. This, in turn, means there is no chance for physicians to improve the cost and quality of medical care, the whole purpose for which the Medicare data release statute was written into the ACA in the first place.
Behind every successful organization there are principle-based leaders, or individuals who strive for perfection and exhibit the constancy of purpose required to implement meaningful cultural change. According to Steven Spear, organizations that generate more value for the customer with less effort do it by generating and sustaining “broad-based, high-velocity, non-stop improvement and innovation.”
And, we need a critical mass of successful organizations in the healthcare marketplace to tip the balance toward a transformation into an industry that consistently rewards value instead of volume, practices transparency of results, and continuously improves care delivery processes.
WCHQ has been leading the way for more than a decade in physician public reporting. Most of the reporting, however, was done at the entire group level not the individual business unit. Today WCHQ released it’s individual clinic report. It is possible for any patient to see how their doctor team is performing on critical quality indicators such as cancer screening. This exciting new development adds to the already important stature of WCHQ’s national leadership on the issue of public reporting.
Recently in Health Affairs http://www.createvalue.org/blog/post/?bid=305 Dr. Lamb has shown that public reporting of physician performance improves quality. Now that we have even more granular performance information by individual clinic each clinic can now set new targets reaching for the benchmark acheived by the best clinic in the state.
Public reporting continues to push us further toward higher quality and lower cost. Congratulations to WCHQ and the providers who have agreed to publicly report their performance. It’s about time every doctor in the state should be reporting as well. The following link will take you to the report.
Potent Medicine: The Collaborative Cure for Healthcare written by John Toussaint, has been awarded the 2013 Shingo Research and Publication Award. The award is given annually by The Shingo Prize for Operational Excellence, a not-for-profit organization that is part of the Jon M. Huntsman School of Business at Utah State University. It recognizes a book’s contribution to the body of knowledge surrounding operational excellence.
The Shingo Prize is well-respected among lean organizations and leaders,said Dr. Toussaint, CEO of the ThedaCare Center for Healthcare Value. This recognition is the Good Housekeeping seal of approvaland confirms that the book content meets the highest standards for excellence. For Shingo to honor Potent Medicine with this award is both humbling and gratifying.
In January, the ThedaCare Center for Healthcare Value added a team member to start building educational products to help transform healthcare. Steven Bollinger comes to the Center with experience in publishing books and videos designed to share lean knowledge with the manufacturing industry. As part of the introduction to the team, we invited him to be a part of a Gemba walk through ThedaCare. In Steve’s first blog post he shares some of his observations from that tour.
– John Toussaint, MD
CEO, ThedaCare Center for Healthcare Value
Are You on an Island of Excellence Surrounded by a Sea of Mediocrity?
Many, if not all, hospitals are practicing lean thinking in some shape or form. During slow times they may run a kaizen event or develop a value stream map of one of their more disorganized processes. From the readings I have done, this is how most medical facilities start on their lean journey. So, it’s not wrong to begin to document standard work, or take steps to improve the culture within your hospital. It’s just that at some point most groups within their hospital will reach a limit on what they can do with their part of the care stream.
WHIO was created in 2006 to improve the cost and quality of care delivered in Wisconsin. A recent report from AHRQ shows Wisconsin to be second for low cost and high quality in the nation narrowly eclipsed by Minnesota (see attached graph –State comparison). Because providers have complete access to the entire WHIO data set they can drill down into performance and change care practices delivering improving outcomes for patients.We believe this is an important reason Wisconsin performs so well.
One of the big stumbling blocks for WHIO has been lack of access to Medicare data. With the advent of Affordable Care Act it appeared the Medicare data was going to be released to “Qualified Entities”. Unfortunately, the language in the bill has not allowed this to happen at WHIO. First section 10332 of the ACA only allows for the Qualified Entities that receive the Medicare data to publicly report the physician performance. It does not allow for any other use. If a physician group wanted a copy of the data set so as to drill down into group or individual performance it can’t do so. The group could request a drill down and Qualified Entity in this case WHIO could deliver the report but WHIO could not charge for it. Who’s going pay then? The Government isn’t which means these reports won’t happen.
At the Center we have been working on legislation which would correct this serious deficiency in the law. We are garnering bi-partisan support. in fact in the president’s budget the issue is addressed as well. For now, we will have to wait but rest assured many of us are aware of the problem and working on it.
Julie Bartels shares her thoughts on IT’s evolution and its role in the lean journey.
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The days of waiting for the users in clinical and operational areas to ‘define their requirements’ and ‘tell IT what to do’ are long gone.
I cut my teeth in Information Technology in the mid 1980’s. It was referred to as Electronic Data Processing or EDP then. We prided ourselves in being ‘systems’ oriented – uncommonly smart, thorough thinkers able to grasp technology and wield it on behalf of the organization. These were the days of computers as big as city blocks running high volume transactions (millions!) at 90% reliability with sub-second response time – a performance standard that is laughable today. It was the role of EDP to automate the business to increase capacity and standardize quality. Technical staff were routinely located in remote areas of the building – it was generally accepted that we could function just as well and maybe even better in isolation. Basements or converted out buildings with few windows and no connection to our users would suffice. Social skills were a minimal job requirement. If we had one or two people who could navigate communications with the rest of the company that was fine. The career path of an EDP professional followed the implementation of technology from one business sector to another; manufacturing to service to finance to healthcare…okay, maybe not to healthcare. No need to understand the business or the customer to do our jobs. The total value of our work was in automating business processes so that companies could do more, faster. Our primary business was ‘technology’. It was the role of the user to define requirements — we built exactly what they asked for, no more, no less. If they didn’t get it right the first time, well, rework was expected. That’s how it was and we liked it just fine.
This will be our fourth year co-hosting the Lean Healthcare Transformation Summit with the Lean Enterprise Institute to bring together hundreds of healthcare professionals dedicated to care redesign with less waste and fewer errors. Our feedback in the past has confirmed this summit is a perfect way to meet great people, build relationships, and rub shoulders with the industry’s best thinkers and innovators.
Our summit is quite different than others. It is laser focused on three components of the healthcare industry:
These components are emerging in experiments around the country to have the most impact on real health reform. When we see all three components being implemented at once, we see the best cost and quality results. This is our definition of one piece flow for health reform. Our approach is to expose the attendees to the most advanced thinking in these key areas by having leaders present what they have learned from doing real work each day. Many of theHealthcare Value Network members will share lessons learned on these topics. Many of the highest performing organizations in North America will be at the summit this year. We all will be learning from world class presenters.
Dr. Len Berry has studied many organizations in his illustrious career. From airlines to manufacturers to healthcare, he has identified what makes organizations great. His book The Soul of Service is one of the most thoughful books ever written on how to deliver world class service in any industry.
Recently I had the priveledge of co-authoring an article with Dr. Berry entitled “The Promise of Lean in Healthcare”. This article describes the principles of lean healthcare which Dr. Berry learned when he spent a month at Thedacare.
I highly recommend listening to this thoughful conversation between Mark Graban and Professor Berry.
