Us­ing a sys­tems ap­proach in health­care could elim­i­nate much of what ails the in­dus­try

I can­not re­call a time dur­ing my 35 years in health­care when changes in re­im­burse­ment mod­els, govern­ment reg­u­la­tions, qual­ity mea­sures and cost con­trols were not be­ing de­bated, planned or im­ple­mented.

Modern Healthcare - - COMMENT - By Dr. Gary S. Ka­plan In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­ Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­

Amid this ebb and flow, we must re­main fo­cused on fun­da­men­tals such as ac­cess, ap­pro­pri­ate care, safety, value and trans­parency.

The Af­ford­able Care Act has sur­vived, for now, but the work of Congress and health­care lead­ers is far from fin­ished. We must pledge to work to­gether, re­gard­less of po­lit­i­cal af­fil­i­a­tion or ide­ol­ogy, to make the ACA bet­ter. Ac­cess to af­ford­able health­care is essential to the qual­ity of life for all Amer­i­cans.

I urge Pres­i­dent Don­ald Trump and mem­bers of Congress to launch an ini­tia­tive that will ad­dress the bro­ken pro­cesses that al­low pre­ventable waste and avoid­able cost to shackle the U.S. health­care system. They should in­vite providers, pay­ers, pa­tients and pol­i­cy­mak­ers from across the po­lit­i­cal spectrum to par­tic­i­pate.

Amer­i­can health­care is in a dan­ger zone. Islands of ex­cel­lence ex­ist, but there is too much vari­abil­ity and in­con­sis­tent per­for­mance in qual­ity, safety and pa­tient ex­pe­ri­ence.

By some es­ti­mates, more than 30% of health­care ex­pen­di­tures are un­nec­es­sary or wasted. Yet na­tional health­care spend­ing is pro­jected to rise an av­er­age of 5.6% an­nu­ally through 2025, out­pac­ing growth in the gross do­mes­tic prod­uct by 1.2 per­cent­age points per year.

How can we en­sure we get the high­est value in re­turn for this ever-grow­ing health­care bill? The an­swer is to ap­ply struc­tured sys­tems-engineering ap­proaches to health­care de­liv­ery across the na­tion. Bring­ing a Sys­tems Ap­proach to Health, a dis­cus­sion pa­per pub­lished in 2013 by the In­sti­tute of Medicine and the Na­tional Academy of Engineering and for which I had the honor of serv­ing as a co-au­thor, notes that sys­tems ap­proaches have im­proved ef­fi­ciency, qual­ity and safety in the avi­a­tion and au­to­mo­tive in­dus­tries and “could be sim­i­larly trans­for­ma­tive for health and health­care.”

A sys­tems ap­proach, the pa­per ex­plains, ap­plies sci­en­tific in­sights to un­der­stand the ele­ments that in­flu­ence health out­comes and al­ters pro­cesses to pro­duce bet­ter health at lower cost. Tools in­clude pro­duc­tion system meth­ods and other man­age­ment in­ter­ven­tions that help or­ga­ni­za­tions im­prove op­er­a­tions while bet­ter un­der­stand­ing how hu­mans in­ter­act with tech­nolo­gies and pro­cesses.

A sys­tems ap­proach re­lies on ev­i­dence-based prin­ci­ples to re­duce vari­abil­ity by stan­dard­iz­ing pro­cesses, em­bed­ding best prac­tices and driv­ing con­tin­u­ous im­prove­ment. This ap­proach would make it a pri­or­ity to iden­tify and elim­i­nate waste—any­thing that adds cost but no value—and thereby re­strain costs for con­sumers, providers and in­sur­ers.

For ex­am­ple, the process for de­ter- min­ing whether an MRI is nec­es­sary and ap­pro­pri­ate should be the same in Seat­tle and Ban­gor, Maine, and every­where in be­tween. Stan­dard­iz­ing pro­cesses, where vari­a­tion adds no value, also min­i­mizes the po­ten­tial for hu­man er­ror, in­creas­ing care qual­ity and pa­tient safety.

I know a sys­tems ap­proach ac­cel­er­ates qual­ity, safety and ef­fi­ciency based on our ex­pe­ri­ence at Vir­ginia Ma­son. We adapted engineering prin­ci­ples of the Toy­ota Pro­duc­tion System more than 15 years ago and use them to im­prove how we serve our pa­tients and sup­port our or­ga­ni­za­tion’s cul­ture of in­no­va­tion. Pa­tients of­ten par­tic­i­pate along­side Vir­ginia Ma­son team mem­bers in our con­tin­u­ous-im­prove­ment work­shops. They are our part­ners as we use our sys­tems engineering ap­proach to de­sign pro­cesses based on their ideas and needs. It’s ex­cit­ing to imag­ine where this im­por­tant work will take us.

As a na­tion, we have more knowl­edge than ever about how to pro­vide ap­pro­pri­ate, high-qual­ity care and keep pa­tients safe. There is no le­git­i­mate ex­cuse for hes­i­tat­ing to ap­ply this knowl­edge to make care bet­ter, safer and more af­ford­able. Ac­cept­ing the sta­tus quo will yield more of what we have—a health­care system hob­bled by in­ef­fi­ciency, waste, un­nec­es­sary vari­abil­ity and, all too of­ten, less than op­ti­mal qual­ity and safety.

Dr. Gary S. Ka­plan is a practicing in­ter­nal medicine physi­cian who has served as chair­man and CEO of Vir­ginia Ma­son Health System in Seat­tle since 2000.

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