The Institute for Healthcare Quality, Safety, and Efficiency at the University of Colorado Hospitals

January 14, 2015 at 3:50 PM Leave a comment

I recently attended a graduation of sorts, from something called the Institute for Healthcare Quality, Safety, and Efficiency at the University of Colorado Hospitals. What I saw was dozens of people organized into several teams. Each team was from a different hospital unit, and each team had a project to improve quality, safety, and efficiency for its respective unit. They had used Lean and other methodologies to identify root causes, implement changes, and measuring the effect of those changes. If you’re from another industry, none of this sounds at all unusual. If you are from health care, you recognize that this is terribly unusual. In fact, this was only the second graduating class for the Institute.
Such training is old hat in many other industries, especially manufacturing. A friend who runs a health care systems engineering school tells me that one of the reasons he’d shifted into health care is that traditional industry is saturated with process improvement engineers, and there are no new opportunities for his graduates there. However, the use of industrial engineering methods in health care is relatively recent, particularly on the scale to which IHQSE aspires for its institution.
There are many possible reasons for this slow adoption, but some would argue that one of them is that process improvement hasn’t been profitable in health care under current payment systems. It simply doesn’t fit with the business model. If one is paid for activity, reducing activity through improved efficiency reduces revenue. So why would a very successful business like UCH engage in revenue reduction on any significant scale?
It’s a critically important question. A basic tenet of Clayton Christiansen’s work at Harvard Business School is that only rarely do institutions that succeed under one business model participate in the development of the one that disrupts and replaces that model. The temptation to resist change and perpetuate the last successful revenue model is just too great in most instances. And yet, that’s essentially what a hospital accustomed to being paid fee for service does when it engages in process improvement.
Likely several things are going on. It’s hard to argue with reducing harm the system does to patients. But that’s always been true, and it doesn’t explain why we did so little before, and why programs like IHQSE are now proliferating around the country. The number of financial penalties for system failures is also increasing steadily, like nonpayment for readmissions and obvious errors, like wrong side surgery (e.g., operating on the left leg when it’s the right that needs fixing).
But I hope a larger shift in thinking is happening, and that it’s good for the system and its patients. I think it may finally becoming orthodoxy in American health care that the seemingly endless stream of dollars that financed its expansion over the past couple of decades, is coming to an end. In a restricted top line growth environment, profitability increasingly depends on efficiency. And so I hope what we are watching is health care adapting to an emerging environment where efficiency and efficacy isn’t just the right moral thing to do for patients, it’s the best business model. Payers and purchasers are starting to change from paying for activity to paying for outcomes at a set price and a set quality standard. In that environment, it makes all kinds of business sense to do things effectively and efficiently, because it reduces waste, waste that the seller of the service pays for, not the buyer.
I dearly hope this is true. One of the nice things about this shift, even though it puts financial pressure on providers, is that it creates a financial benefit by improving care for patients. Suddenly making care safer, more satisfying for patients, and less expensive is good business. It was very heartening to see how proud the teams were of making their care safer, better, and more efficient. They were truly excited that they could improve the way they do things, and not simply accept that some error, even some harm, was an acceptable standard. To put it more simply, it seems to feel good to do better for the people they are entrusted to serve and the institution for whom they work, simultaneously.

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