From a Keynote at Dubai Arab Health on behalf of American College of Healthcare Executives

1. Diagnosing Healthcare
Systems
A Roadmap to Systemic Solutions
Martin Hedley
Chief Operating Officer
Oriel STAT A MATRIX Middle East - Al Khobar, KSA

2. Surrounded by Problems
• a discussion of the problems faced by healthcare
in mature and emerging economies
• the problems are of a diverse nature in each
country
• each healthcare executive is only responsible for
a part of the patient outcome, yet expected to
deliver full results if patient goes to hospital
• the tendency and necessity to react to ‘hot issues’
is driven more by the media than analysis
we need a method to decide what gets worked on, how it gets worked on and at what priority

3. Quick Assessment
which image most represents the state of affairs in
your organisation??
A B

4. Quick Assessment
which image most represents the level of
control & serenity your people feel at work??
A B

5. Quick Assessment
If you scored two ‘A’s ...

6. Common Solutions Proffered
• single solutions from other healthcare institutes
that have yielded results
• consulting organisations with specialities or
proprietary intellectual property
• our own staff ideas about what needs to be done
• examples: leadership development, six-sigma,
service line management, electronic medical
records, etc
• why these are all good, but limited, and how we
need to approach them
solutions that worked elsewhere will not necessarily translate to our system

7. Relate To Patient Diagnosis
•
first thing we notice are symptoms
•
we look for “obvious facts”
•
we seek supporting evidence to test our first
hypotheses
•
we consider patient lifestyle
•
we ask questions about patient environment
•
we start testing for proofs
•
we find causal linkages
•
we decide on one or more root causes and start a
course of treatment
we need to know the process of organisational system diagnosis

8. Healthcare is a System
• what are the symptoms, why we jump to ‘solve them’
• why do we look for “obvious facts” and not dig deeper
• what attention do we pay to the healthcare institute
environment
• how well do we start testing for proofs
• do we find causal linkages
• if we did, we could decide on one or more root causes
and start an effective course of treatment
• now we ready to pick a ‘tool’ to solve a given problem
we need to think of, and be aware of, a system and what is causing downstream results

9. System of Excellence
Baseline Performance
Regulations Met
Performance Management
People / Leadership
Excellence

10. Critical, Sick or Preventive
• the logical sequence we have discussed ignores a
priority issue
• is our system critical, in need of healing, recovery or
an immune build-up
• the answer will be you have problems in all four
categories and priority will be important, and it will
change frequently
• we need tools to answer all these questions
• we need a framework to give an organisational
context to our improvement efforts
we need a process that maintains focus, but allows for necessary and common changes

11. Systems Overlays - Organisation
Finance&Admin
MedicalSpecialists
Admitting
MedicalStaff
Labs&SupportServices
Cleaning&Maintenance
Patient Outcome
Executive Management

12. Systems Overlays - Project Scope
Finance&Admin
MedicalSpecialists
Admitting
MedicalStaff
Labs&SupportServices
Cleaning&Maintenance
Executive Management
Project A
Project B
Project C
Project D
Project E

13. Systems Overlays - Core Process
Physician Encounter
Pre-Hospital Outreach
Scheduling & Admitting
In-Patient Care
Enabling Services
Surgery
Executive Management
Discharge

14. Strategy of Improvement
• holistic assessments that address the total system
• continual measurement of the most critical drivers of
patient outcome
• cross-functional overlay on the organisation chart
• facilitation discipline to overcome departmental or
functional biases
• communication to explain why one method is picked
over another
• improvement support expertise distributed among
groups
we need to know how to get the entire system working together, despite functional expertise

15. Strategy of Improvement
an interesting thing happens to our people
when we introduce “improvement”
programmes
Everything’s out of control,
I’m way too busy and you
want me to do what?
Don’t you trust me?

16. Strategy of Improvement
Oh ... all ... right, if you say so.
I’ll give it a try ... (again)

17. Strategy of Improvement
This is harder than I thought!
We really need to do
something about this!

18. Strategy of Improvement
Hey, we came up with a
great solution on our own.
Let me show you!

19. Strategy of Improvement
We’re more in control
now, and we can make
changes ourselves.
This is OK!

20. Strategy of Improvement
Which environment do you prefer?

21. Tools of Improvement
• service line focus, business intelligence from our
outcome data
• leadership development
• process improvement (six-sigma, reengineering,
value stream mapping)
• waste reduction (lean, quality circles)
• electronic medical records
• evidence based medicine
• many, many more
we need a way to decide on the best tool, or tools to apply and explain to our people why

22. Case Study
a case study from business intelligence out of
everyday hospital data
you already have most of the key data necessary to start making systemic change

23. you already have most of the key data necessary to start making systemic change

24. Annual Inpatient Discharges
Sample Dashboard

25. Resource UtilisationPatient Throughput
$629,000 potential reduction in bed days (1,500 days) may exist in
pulmonary, general surgery and orthopaedics
$1,400,00 potential economic impact may exist in pulmonary, general
surgery and orthopaedics

26. Total joint replacement n=271

27. Total joint replacement
n=271

28. Total joint replacement
n=271

29. Total joint replacement
n=271

30. Total joint replacement
n=271

31. • Peer-to-peer comparisons of LOS for same surgery
• “Lean” clean up of post-operative area
• Best practice research against similar procedures
elsewhere
• Six-sigma variation reduction in surgical
procedures process
• Problem solving teams in post-op infection control
• Process redesign of patient scheduling and room
assignment process
Systemic Actions Taken

32. Total joint replacement surgeries - results

33. Summary
the more integrated our strategy for
improvement, the sooner we will achieve a
state of sustainable performance
management and excellence
you and your staff can take control of the system and feel empowered, despite emergencies
OR