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Performance Imperatives

February 27, 2012
by Mark Hagland
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Healthcare leaders are recognizing the need to use formal methodologies to systematize change efforts

As the leaders of patient care organizations nationwide move forward on a host of pressing mandates, driven by healthcare reform and the meaningful use process, as well as a gradually awakening healthcare consumer world, more and more of them are coming upon a very basic truth: change initiatives must be strongly organized to get healthcare where it needs to go. Indeed, the leaders of pioneering U.S. patient care organizations began more than a decade ago to learn and adopt formal performance improvement methodologies—including Lean Management, Six Sigma, the Toyota Production System (TPS), and others—either individually, or more often, in combination—in order to turbo-charge change.

And, even as the healthcare industry has lagged far behind manufacturing (the industry in which all the main performance improvement methodologies were created and first nurtured), transportation, retailing, financial services, and even the health insurance industry, in adopting such methodologies, things are changing very quickly these days. More and more patient care organization leaders now recognize that deep process change will be required to prepare their organizations for such healthcare reform-related mandates as value-based purchasing, readmissions reduction, and healthcare-acquired conditions reduction, as well as to prepare for the voluntary accountable care organization and bundled payment programs, and the mandatory meaningful use process.

Industry experts like Mark Van Kooy, M.D., director of clinical informatics at the Pittsburgh-based Aspen Advisors, say the time has absolutely arrived to leverage performance improvement methodologies for change. “We’ve been able to get by with a lot of ad hoc problem-solving, and using talented individuals who are charismatic and have a knack for problem-solving, in a non-reproducible way; but I think those days are gone,” says the Sewell, N.J.-based Van Kooy, who worked  most recently as the de facto CMIO at the Marlton, N.J.-based, four-hospital Virtua Health, before joining Aspen in July 2011. “There’s a lot of talk now about meaningful use Stage 2, and about how, if organizations haven’t made changes for meaningful use Stage 1 in a systematic way, they’re really going to struggle going into Stage 2,” he insists.

Taking Cues from Other Industries
“It’s only been recently that people in healthcare have realized that the non-healthcare world actually has some good ideas,” agrees Harry Greenspun, M.D., senior adviser, healthcare transformation and technology, at the Washington, D.C.-based Deloitte Center for Health Solutions. Patient care organizations, Greenspun says, need to recognize the “cultural shift” required to begin to effectively use performance improvement methodologies. “It’s not just using them,” he says, “it’s, can we take the delivery of healthcare and figure out how to systematize it? Can we break things down into repeatable chunks?” That may mean, he says, beginning in individual units such as the cardiac cath lab, pharmacy, or home health program, and expanding outward following initial successes. Most importantly, he says, “What makes these things work is having them be data-driven and getting feedback” from real-time data analysis. “Until recently, you didn’t have that.”

Harry Greenspun, M.D

And though some hospital-based organizations, such as the Virginia Mason Medical Center in Seattle, the first U.S. hospital organization to formally adopt TPS as a guiding methodology for change management, have already become famous for helping to lead the industry forward using formal methodologies, many other patient care organizations nationwide are beginning to catch up now.

For example, at the two-hospital, 226-bed Susquehanna Health, based on Williamsport, Pa., Karen Armstrong, R.N., senior vice president and CIO, has been working with colleagues to lead a variety of Lean Management projects. To date, she says, “We’ve educated about 80 of our management staff in Lean principles,” and have been working forward in numerous areas, including optimizing operations in the health system’s clinical lab, physician waiting room operations, and so on. Armstrong says she’s been fortunate in particular that her assistant CIO is a management engineer by background, and that the organization also has several full-time management engineers leading the various projects.

One area she and her colleagues have been particularly focused on is the perioperative area, one in which Armstrong says the overlap between meaningful use work and systematic performance improvement is especially strong. “I think anybody striving towards meaningful use or making headway in any of these areas is going to be looking to install a perioperative system,” she offers. “But what’s hard is not the installation itself; everyone knows how to install an IS. It’s educating people in advance, and getting their buy-in.” And that inevitably means through pre-implementation process improvement using formal methodologies prior to go-live.

What does this mean for CIOs and CMIOs? Aspen Advisors’ Van Kooy (who strongly advocates the mixing of different methodologies for optimum effect) says the bottom line is simple: “Learn process improvement methodologies, and become fluent in the subject.” And that, he says, means that, as never before, healthcare IT leaders need to understand care delivery processes at a deep level so that they can be the best partners possible in leveraging IT for process change.