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Is Healthcare really the same as other Businesses?

July 14, 2008
by Pete Rivera
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I had a “routine” flight delay and “routine” miscommunication between what the posted airport flight schedule stated and the intended airline’s departure time. Flight delays are so routine that I should know better than to trust the airport departure time. But I guess I am still naive, even with years of traveling and maximizing my frequent flier miles, I still trust the information posted on the screen. I guess it’s because I still believe that someone is doing their job efficiently and striving to improve processes. But in reality it’s the 80-20 rule, they get it right 80% of the time, so why bother striving for perfection. Nobody is perfect, right?

The Lean methodology is founded on the principle of reducing waste while looking at the overall process and making tools available were they should be. Six Sigma focuses on defects and errors. I grew up with Deming and Steven Covey and I learned early on that you don’t chase process deviation spikes. However, you do monitor data and determine if any of your processes are out of norm using statistical analysis (which was early Six Sigma). So what is the proper percentage of defects? The answer of course is zero.

That is the answer that the patient wants to hear before going in for an operation. Zero defects. But some how with all our quality improvement programs we still accept a margin of error. The percent of duplicate medical records, the number of improperly coded procedures, the lack of notifications of abnormal labs, the incorrectly filled prescription, and the list goes on. We react to the incident, we chase the spike in the process which caused the problem, we report on the improved solution for that issue and we move on. We treat the symptom and not the disease.
Why do we keep making the same mistakes? Is it that nursing works separately from labs, and labs from pharmacy? Are we so compartmentalized that we can not look at the big picture? We keep saying that manufacturing is very different from healthcare. But is it really? Why do we continue to struggle to implement quality and succeed in reducing errors? Are we more like the airlines flight schedules than we care to admit?

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Comments

Our QA departments are mainly focused on physician compliance and meeting JCAHO requirements. Organizations that have adopted some form of Lean, or Six Sigma or TQM take on smaller projects with a high probability of success in hopes to tackle more complex projects. But the quality process never addresses cross functional issues because they are not empowered to do so. Collecting data, documenting process flows and creating a gap analysis based on best practices are all time consuming. Unless the Quality initiative is addressed at a VP level and empowered at that level, I don't think most organizations will ever reach the successes seen in other industries.

EMR's can reduce errors and improve patient care...the problem is many times in the system build and implementation. Not too many organizations have actually had a "successful" implementation...meaning that success should be based on end user satisfaction. Go-live is a dirty word in most health organizations. Many, many, many EMR implementations are struggling...and organizations keep dumping more money into projects gone awry. If you really listen to the front line users, top complaints are that the build and design team isn't listening to their needs. If the finance industry messed up our bank accounts as much as organizations mess up their EMR systems...we would all be broke! If the FAA used an EMR there would be daily plane crashes! In both of these organizations there are quality standards that are set both by governing bodies and consumer demands...as transparency and quality service becomes demanded, the healthcare industry will be forced to evaluate their information systems and bring in the right workforce to meet expectations. Right now organizational politics and tight budgets are the driving factor...not quality.

what is the solution Pete? how can we get around that part of human nature which makes people only worry about their own jobs, turfs, and problems. Someone has to be incentivized to look at the whole picture. But getting down into the weeds can be scary, most prefer to just pretend they don't see what's going on just like the people that walked over that woman in NYC who died in the ER recently.

Wow! I would challenge you to research JAMA or other peer reviewed articles on reduction of medical errors. They all clearly show significant reductions in medical errors through the use of automation. Clinicians are being driven to shorten the encounter times and have to digest HPI by skimming through the paper chart in record time. EMR's and Computerized Physician Order Entry systems are tools that can be used to flag patients that don't necessarily fit into the typical treatment regimen. There are too many opportunities for human error within the continuum of care. Nursing documentation, lab, physician orders and pharmacy have failure points and communication issues.
I admire your zeal to hold firm to the purity of the science of medicine. But the reality is that other electronic tools provide diagnostic level information that are just as important as the MRI and improve the overall quality of patient care.

Business rules and tools can give a short term result in health care. But health care is an anti-business model. We use and buy technology and actually increase health care costs. Like a multi-million MRI, big investment, big benefit. EMR big investment, no benefit but to the payers. Business use technology to decrease costs and increase productivity. Lean Sigma is great, and product lines are great too. They help structure the health care management which is quite ignorant of models and practices in the business sectors. Doctors will spend millions to improve health care, but not much in EMR because a good experienced outpatient physician with a pen is just as good. But an MRI or even Stethoscope, BP Cuff, we buy because we need.

Pete Rivera

Director Informatics, Hayes Management Consulting

Pete Rivera

@Gator_Pete

www.Hayesmanagement.com

 

 

 

 

 

 

 

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