ealth care costs keep rising sharply while health care quality remains low. It is an unfortunate fact of life experienced by many people in the U.S.. With all our technology, experiential learning and leading edge operations management knowledge you would think health care providers would have their act together. John S. Toussaint and Kathryn Correia reveal the real reasons health care delivery is so expensive and inefficient…
A lot of money has been spent on information technology in health care with little to show for it. When it comes to change, the technology is the easiest part. Most health systems in America have or are implementing the EHR. And the vendor processes for implementation have become very good. The hard part is to get the doctors, nurses, and administrators to agree on what is the best way to deliver the care. Health care technology is only very effective when it is used to support a well-designed care process. A lot of money has been spent on information technology in health care with little to show for it.
In a nutshell, here’s why the system is so cumbersome and inefficient…
It only takes 10 minutes of direct observation of a nurse in a hospital to understand care-delivery processes are not standardized and are dependent on individuals, not systems. This lack of reproducibility leads to errors. Since every caregiver does it his or her own way, it’s difficult to improve anything. Stable systems that are reproducible are required to deliver consistently high quality. Industrial companies figured this out 50 years ago. The writings of manufacturing gurus Imai and Shingo provide insight into how quality is built into processes. A process must first be stabilized then standardized before being improved. Because few standardized processes exist in care delivery there are many possibilities for error. That’s why simply making a poor process electronic by implementing an electronic health record (EHR) doesn’t lead to better quality or cost.
To fix the problem health care providers must standardize care delivery. It sounds tacky but what worked for McDonald’s to standardize preparation of the Big Mac and what worked for Toyota to standardize car manufacturing will work for the health care industry…
Health care technology is very effective when it is used to support a well-designed care process. The design of new standard care processes need to be owned and driven by the people doing the work, not by some outside consulting firm that brings a 100-page playbook as the answer. As the frontline workers create new designs, they need certain systems that can help them deliver the improved care. Examples of these systems include electronic alerts for medication interactions and reminders to ensure all steps in the care process for the pneumonia patient are followed.
There are two types of improvement systems needed to create a well-designed care process. One is a improvement approach that brings members of an existing clinical team members together to improve an existing care process. They use proven improvement methods such as the principles, systems, and tools of the Toyota Production System (TPS). The second is an innovation process aimed at radically redesigning care. It’s associated with TPS and employsdesign thinking.
The bottom line?
Technology now exists to support disruptive innovation in health care. It is an important enabler, but the process must precede the technology. For example, Hospital at Home is an innovation that may well cut the cost of care significantly by reducing the need for inpatient beds. It couldn’t happen without the technology, which allows 24-hour monitoring of patients, real-time electronic communication between providers, and complex equipment to be rapidly set up in the patient home. But it still requires a nurse and a doctor.
For more information and examples of health care providers building better systems and processes that benefit consumers take a look at the full report.
thumbnail courtesy of hbr.org
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