As we discover new medical treatments we are dramatically improving our ability to cure diseases and save lives. On the other hand each new and more powerful drug, each new technology has associated with it increased chance for adverse events. Unfortunately Medical errors have been to easily accepted as the collateral damage for progress in healthcare. Before you feel too depressed, on balance there are still more medical miracles than medical mistakes
Engaging the Leadership Triad in Accelerating Change Using Lean Six Sigma Stephen Mayfield, Dr. H.A., MBA, MBB Senior Vice President American Hospital Association [email_address]
Several Themes from High Performing Organizations
Seeing differently – especially using variation and error as welcome feedback.
Engaging two levels of leadership for collaboration which means:
embracing system thinking which cultivates process excellence in which the human factors tendencies within the system are attended.
Use of tools that facilitate the dialogue between levels of leadership.
Establishing the value proposition, or the Business Case for Quality
Using Lean / Six Sigma as methods to Reduce Waste and Eliminate Defects
Moody’s has a negative outlook for the US not-for-profit hospital sector, as virtually all rated healthcare credits are facing some degree of credit stress due to a combination of impaired access to the capital markets, soaring credit spreads, counterparty downgrades, and a slowdown in the global economy .
Moody’s Investors Service
The New Realities = Margin Non payment adverse events Medicare pressures Non payment readmissions Waste & Inefficiency “ 20% to 50% of all health care efforts are attributable to waste and inefficiency.” Rework, work arounds, defects, errors, unnecessary harm, delays, misuse, overuse, underuse. - COSTS REVENUES
Systems of Care and Simple Metrics At the Operational Level Information -> Clinical Decisions -> Care Processes -> Patient Flow Clinical Information System Financial System Patient Patient Patient Patient Cp 1 + Cp 2 + Cp 3 …. Cp 1 + Cp 2 + Cp 3 …. Cp 1 + Cp 2 + Cp 3 …. Evidenced Based Medicine Clinical Best Practices Outcome Indicators (LOS, Mortality, Infection, Readmits) Patient Flow Process Measures (Waste, SMR, Cycle Time Variances, etc.) Charges CD CD CD
On a Cruise who has the most impact on your safety?
In Short – Performance is affected by Human Tendencies related to cognitive processing attributes and limitations and the effects of system variability and interactions, ESPECIALLY those associated with decisions and communication.
“ American industry has become very accustomed to running their businesses by watching each other. In fact many of them are still focusing on the competition, only this time it is Japan. In a few years it will be Korea, then China, then some other country. If you just try to meet the competition, you will not survive in this new economic age. You must try to meet the customer, not just the competition.
And it is you who must change , not the competition.”
-- William Scherkenbach, 1986 , excerpted from a presentation to General Motors
Healthcare Excellence Requires Collaborative Leadership System Thinking that Supports Process Excellence Context Leaders (executive, trustee, physician leaders) Content Leaders (clinical and non-clinical)
Leadership Creates the Framework for a System that Supports Process Excellence Culture Strategy Structure Process Process Excellence
Performance Improvement is a function of standardizing the methods, stabilizing the performance, reducing variation until the next innovation moves performance to a new level
Iceberg of Ignorance: What % of the Organization’s Problems are known to…. 4 % 9 % 74 % 100% Top Management Middle Managers Supervisors Front-line Employees Problems hidden from management Adopted from Sydney Toshida