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8 years later, Still Pursuing Perfection?

December 30, 2008
by Joe Bormel
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8 years later, Still Pursuing Perfection?Organizational Change Takes Patience; Grant Funding May Be Essential, Too.

8 years later, Still Pursuing Perfection?



Organizational Change Takes Patience; Grant Funding May Be Essential, Too.







This posting started off as a grateful reaction to Gwen Darling’s blog post. But it grew. She was blogging on the

Top Ten Hospital Tech Hazards.








I went to and read the WSJ and ECRI links she provided. In the process, I saw ECRI’s tag line: “The Discipline of Science. The Integrity of Independence.”

Sounds great!




Then I pondered, which of these 10 hazards can be

fixed with HCI technology? Yes, that’s laughably sincere framing of a big problem, but perhaps a reasonable starting point for anyone trained, in part, as a technologist. So, “Misleading displays” jumps out. The focus was medical devices, including medication pumps and vital sign monitors.




Fast forward. Readers of HCI are keenly focused on work needed for the real, system-level fixes, some percentage of which benefit from technology enablement:



- change management



- human-computer interactions



- risk management



- organizational behavior



- workflow redesign



- productivity improvement



- organizational culture



- safety



- quality



- etc.
(see yesterday’s post,

Top Ten Informatics Events; for

AMIA’s Meryl Bloomrosen slide click here)




Not a New Problem – It's

Systems, not individuals, not working harder, and not about blame




Almost a decade ago, I was invited to help healthcare provider organizations pursuing an interesting grant:





Aiming High for Perfection




What if health care delivery in the United States aimed to be perfect? What would it look like? We now have some preliminary answers, thanks to a project known as Pursuing Perfection (PP) — funded by The Robert Wood Johnson Foundation and led by the Institute for Healthcare Improvement (IHI).




The work of Pursuing Perfection, which began in 2001, is anchored by a shared desire to totally transform health care delivery. There are 13 participants in the US and Europe, and their efforts, taken as a whole, offer some of the best evidence yet that fundamental improvement in patient care is possible across and within a wide range of health systems. Most important of all, the Pursuing Perfection sites have learned that the pursuit of perfection, or aiming high, raises the bar on health care performance and leads to clinical and operational results once considered out of reach.




and

this from Hackensack's site :




Pursuing Perfection challenges its grantees to set new, higher standards for the delivery of healthcare services and then to

share their methods for achieving this goal with providers across the country. The grant sponsors call this sharing component “

transparency” since it requires that grantees expose the details of their journey —

the good and the bad — outlining the lessons learned along the way as well as their formulas for success. (emphasis mine)





So what happened with Pursuing Perfection and the Grant Recipients?





Good news: Lots of impressive results in safety, mortality and costs. The primary source, RWJ and IHI,

contact information here.




My favorite resource has been the related

Remaking American Medicine DVD

available through PBS

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Comments

Joe,
This is a solid post, and well worth consideration by senior healthcare execs. I agree with you that the objective progress achieved to date would absolutely not have occurred without grant money, and to go a step further, grant money from a highly credible and respected source.

Pursuing Perfection requires (often deep) cultural change. That takes courage. To be honest and admit there are problems, especially to do so by those who understand and who can effectively articulate them, is an undeniable requirement. After all, that's what transparency is all about.

But let's go deeper for a moment. To articulate problems, we must first really understand them. That means we must listen to those who have been on the receiving end of their negative effects first hand. For instance, clinicians need to listen to what patients and their families have to say. Granted, this can be painful, as in cases where (an extreme example) a medical error results in death. But such is necessity. No excuses.

By being more attentive to the words and emotions of those on the receiving end of our industry's problems, and coupling them with being less passive in terms of objectively presenting them transparently, we foster accountability. Painful, but the only real path to pursuing perfection. A path, in-and-of itself, that has no end.

People, not systems, ultimately make changes. CEOs can help facilitate their coming forward, instead of their feeling stifled by the existing culture of too many healthcare organizations and institutions. Here, technology can play an important role by reducing the intimidation factor. The CEOs need to implement video conferencing, for instance. Video conferencing offers an opportunity to speak more candidly, and being candid (honest) at all levels is also one of those "necessities•bCrLf when it comes to cultural change.

Additionally, I'd like to make a brief comment about your "excerpt amplifying Mark's article.•bCrLf Here, I agree that it is necessary to first set a strategy, then search for a grant that will match it. However, let's not overlook one very important factor. Such a grant is not critical for just its monetary value. In fact, it will also keep those who would "tinker•bCrLf with the strategy in check. If the strategic goal is reasonable, attainable, and beneficial, then leave it alone. The only changes to the plan should then come at the tactical level, where we learn one step at a time by achieving (or failing to achieve) individual objectives along the way.

When I started reading this blog, you were at the top of the list of bloggers. Recently, I've started to read others, and will need to find time to make comments to their posts as well. But let me close with a suggestion.

You link many of your posts to other HCI bloggers, and to your previous posts. I can't speak for anyone else, but I like this approach. However, maybe you can take this a step further . . . down the path so to speak.

I would like to see you, or someone here, develop a series of posts based upon one important topic to promote more participation. A single posting ultimately gets buried by those that follow. But a series or some kind, not necessarily every post by a specific blogger, would keep an idea, a concept, a thought alive to promote greater participation, and may lead to HCI generating feature stories of interest in the magazine, as well as driving more people to this blog site. Cross pollinating, so to speak. Just a thought.

Jack


Joe, and Jack,

Joe, thank you for your excellent blog, and Joe and Jack, thank you for your interaction so far regarding that blog. Joe, thanks also for quoting a piece of the conclusion of my cover story.

What I find fascinating is that, no matter where we begin with an article in Healthcare Informatics, in the end, all the most profound issues, problems and questions end up being largely non-technical. Sure, of course, there are technical obstacles to leap with regard to any IT-related implementation or work but I think most CIOs and other senior IT executives, and many clinician leaders, would agree with me that the hardest elements to fix are the human-oriented ones. Change management sounds a lot easier than it is! And culture, in any kind of organization, whether healthcare or non-healthcare, is incredibly difficult.

This is why "creating a culture of patient safety and care quality," something to which I am fervently committed personally, and a goal that our magazine supports very strongly, is so difficult to achieve. As many healthcare leaders already realize, it's one thing to go live with a CPOE system it's another to realize the vast potential gains in care quality and patient safety that can accrue from that IT innovation.

Most of all, what you just wrote here, above, "Leadership takes a lot of courage," and "leadership takes real listening," is absolutely true. My fervent wish for all leaders of hospital and healthcare organizations in the coming year would be that every single patient care organization could make some key breakthrough in cultural and organizational change that would help facilitate some further quality breakthrough. In the meantime, the energy of people like you will hopefully move us all forward! Great post and comments, Joe and Jack!

Mark Hagland

Thanks for the kind words, Jack. You pointed out a few dimensions that I hadn't considered much:

1> The Value of Getting a Grant:  It's not just the grant money but also the brand of the granting organization.

2> Leadership takes a lot of courage.

3> Leadership takes real listening; it's going to be painful; it's often the only path to understanding.

4> Leadership means behaving accountably; see #2.

5> The role of technology in helping/bringing about culture change (e.g. video conferencing).  Interesting and with precedent.

6> Other values of seeking and attaining a grant:  stabilizing the vision through the grant.

7> HCI blogging:  we  should strive to thread the blogs around themes... keep those themes alive... (let's see what others think)

In the course of researching the blog post, I found this short interview with the folks who make the Pursuing Perfection DVD, here They made some of the same points you did, Jack.

The other thing I found in my research was the HIMSS organization's services to help hospitals identify appropriate grants and help them write those grants.  For people interested in this topic, your not alone!

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Joe Bormel

Healthcare IT Consutant

Joe Bormel

@jbormel

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