Man­age­ment guru’s wis­dom more im­por­tant than ever as health­care strives to re­ward value

Modern Healthcare - - COMMENT - By Dr. Robert Weil and Dr. James Re­ichert

To many ob­servers, the en­dur­ing wis­dom of W. Ed­wards Dem­ing, one of the world’s best-known man­age­ment ex­perts, has been ap­plied in some de­gree to al­most ev­ery busi­ness sec­tor—in­clud­ing health­care.

In an in­dus­try made more com­pli­cated than it in­her­ently is through reg­u­la­tion, po­lit­i­cal ma­neu­ver­ing and per­pet­ual change, health­care should em­brace these prin­ci­ples as a mantra for the fu­ture, in­cor­po­rat­ing all of Dem­ings’ 14 prin­ci­ples into a daily reg­i­men.

In fact, we should de­pend more than ever be­fore on two of the key tenets that un­der­lie his phi­los­o­phy and ap­ply most di­rectly to our work: un­der­stand­ing vari­a­tion and break­ing down bar­ri­ers.

While we preach ad­her­ence to these prin­ci­ples, we of­ten don’t prac­tice them ef­fec­tively, at least not in a con­sis­tent way that would move the in­dus­try closer to its elu­sive holy grail: the Triple Aim.

One for­mi­da­ble ob­sta­cle to dra­matic im­prove­ments in the de­liv­ery of su­perla­tive care has al­ways been the ex­is­tence of si­los—bar­ri­ers that im­pede ef­fi­ciency and help fos­ter an “us-against-them” men­tal­ity when team­work and col­lec­tive re­spon­si­bil­ity hold the key to suc­cess.

In health­care, groups such as man­age­ment, op­er­a­tions, fi­nance and clin­i­cal staff tend to form dis­tinct, in­de­pen­dent do­mains, fo­cus­ing more on their own work rather than on how they can sup­port or­ga­ni­za­tional suc­cess.

This has been an his­toric ob­sta­cle for an in­dus­try well-known for a bi­fur­ca­tion be­tween hospi­tal lead­er­ship and the med­i­cal staff. As physi­cians, we are well-aware of this di­vi­sion, which is nar­row­ing as we ac­cept an in­te­grated, team­based ap­proach to pa­tient care, based on value ver­sus vol­ume. Yet, it re­mains more an ex­cep­tion than the rule where physi­cians, nurses and ad­min­is­tra­tors are form­ing func­tional, cross-pur­pose teams to im­prove care and lower costs.

Man­age­ment pro­cesses such as Six Sigma and Lean have been an in­te­gral part of health­care for years. But they rep­re­sent just one step in a journey to­ward quan­tifi­able and mean­ing­ful im­prove­ments in pa­tient out­comes. Imag­ine the en­hance­ment across the board in a sys­tem clearly ded­i­cated to and reliant on the prin­ci­ples Dem­ing es­poused. We be­lieve the re­sult would be bet­ter out­comes, bet­ter qual­ity and bet­ter op­er­a­tions in a safer en­vi­ron­ment.

His prin­ci­ples were first em­braced in Ja­pan, and then repli­cated in the U.S. by an auto in­dus­try seek­ing greater re­li­a­bil­ity through stan­dard­iza­tion. One need not go to Ja­pan to fig­ure out that in­stead of hav­ing a dozen dif­fer­ent but es­sen­tially in­ter­change­able knee re­place­ments avail­able to our ortho­pe­dic sur­geons, we prob­a­bly need to get to one or two.

We in health­care must do the same across the sys­tem, strip­ping need­less or harm­ful vari­a­tion from our pro­cesses to cre­ate a sys­tem that guar­an­tees high re- li­a­bil­ity and high qual­ity.

In re­cent years, many tens of mil­lions of dol­lars, along with count­less other re­sources, have been in­vested in pro­cesses to re­duce vari­a­tion. The hard truth is: We are not get­ting there, and we are not get­ting there quickly enough.

For our or­ga­ni­za­tion—Catholic Health Ini­tia­tives, with 100 hos­pi­tals and other op­er­a­tions in 17 states— scale and scope have pro­vided a tremen­dous ad­van­tage in pro­mot­ing many of Dem­ing’s prin­ci­ples.

Size also has helped the or­ga­ni­za­tion sus­tain the mo­men­tum for change and im­ple­ment a com­pre­hen­sive, sys­temwide an­a­lyt­ics plat­form that uses data to de­crease vari­a­tion and re­duce hospi­tal-ac­quired in­fec­tions, mor­tal­ity and safety is­sues. What’s more, big data is used to iden­tify any weak ar­eas in clin­i­cal care, al­low­ing lead­ers to cre­ate ef­fec­tive plans to ad­dress de­fi­cien­cies.

The goal: Mis­take-free out­comes. It’s an ob­jec­tive shared by ev­ery­one in health­care.

While we’ve high­lighted just two of the 14 “points for man­age­ment” from Dem­ing, each of the other 12 are just as ap­pli­ca­ble in an in­dus­try con­stantly striv­ing to im­prove its per­for­mance.

Adopt­ing a devil’s ad­vo­cate ap­proach to the health­care land­scape, there are still too many ex­ec­u­tives who pay lip ser­vice to these man­age­ment tenets, not giv­ing them the sup­port they need to take hold and thrive in their or­ga­ni­za­tions. In­stead, let’s whole­heart­edly wel­come Dem­ing’s wis­dom, put his prin­ci­ples into prac­tice, and guar­an­tee the high­est-qual­ity care to ev­ery pa­tient, ev­ery time, ev­ery­where.

Dr. Robert Weil, left, is se­nior vice pres­i­dent and chief med­i­cal of­fi­cer for Catholic Health Ini­tia­tives. Dr. James Re­ichert is the or­ga­ni­za­tion’s vice pres­i­dent for clin­i­cal an­a­lyt­ics.

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