ASQ Healthcare Division Newsletter

July 15, 2009 ‐ Patton McGinley

July / August 2010

Message from the Chair
I Can See Clearly Now

I can see clearly now
the rain has gone
I can see all obstacles in my way
Gone are the dark clouds
that had me blind
It’s going to be a bright,
bright sunshiny day¹

The opening words of this song remind me of where we are in healthcare today and the implications for the ASQ’s Healthcare Division in the future.
The healthcare reform legislation and ARRA (Stimulus) legislation and their resulting rules and regulations are becoming more real every day. So are their implications for health providers, payers, purchasers, and patients.

In a nutshell, the message is, “This Ain’t Goin’ to Be Your Father’s Heathcare System”!

Recommendations from a March 2010 slide presentation by Price Waterhouse Coopers’ Health Institute illustrate the forces healthcare providers face today:

Implement more quality initiatives and embrace quality improvements.
Seek creative ways to provide care outside of the traditional settings.
Determine impact of Meicare level payments.
Collaborate and creatively find ways to reduce the cost of care.

Almost every one of their recommendations involves providers finding ways to reduce waste, improve quality, effect change, and “think outside the box.”

Enter ASQ and the HCD. Is there an organization in the United States better and more comprehensively resourced to provide learning resources and best practices to the healthcare providers, payers, patients, and purchasers who will be incented both positively and negatively to adopt process improvement and quality management tools and methodologies over the next few years?

Many of the concepts and changes called for in the legislation/regulations such as “Meaningful Use of Health Information Technology” can be facilitated and more effectively implemented if the resources contained in the ASQ/HCD Healthcare BOK are used and if individuals with training and certifications (such as the one the HCD is currently developing: Healthcare Process and Systems Improvement Professional [HCPSIP]) are engaged in making the necessary changes. The HCD can and should become a force in the effort to provide and continuously improve the skills of the cadre of process improvement professionals that will be needed.

The HCD will need to implement improvements to some infrastructure to meet current and future member needs for information resources, peer communication, education, benchmarks, etc. Targets include the HCD website, an HCD social marketing capability, and coordination of HCD messages.

We must also effectively plan for divisional leadership depth and succession. Finally, we must implement effective ways of recruiting new members and of continually assessing and meeting their needs to provide maximum value.

We have in place committed individuals to lead each one of the Division’s Task Groups and Committees. These leaders will be held accountable to the HCD Leadership Council for developing a vision, mission, goals, and objectives for their Committee/Activity, and a business plan with roles and responsibilities, expected outcomes and deliverables, metrics, timetables, and estimated returns on investment/benefits. We want to keep the number of things we try to do manageable, ensure tangible achievements, and focus on improvement of the Divisional Infrastructure and cost-effectively providing maximum member value.

As Chair, I am now asking all HCD members to step up to the plate this year in one of several ways:

Become a member of an HCD Committee or Activity Task Group. For a list, please email me at jaf@prism1.org or call me at 248/709-6669.
Let me and/or any of the HCD Leadership Council (listed on http://www.asq.org/health/about/leadership-health.htm) know your thoughts and comments on how we can serve you and other members of ASQ and the HCD better.
Attend the 2011 QIHC in Pittsburgh, held in conjunction with the ASQ World Conference

Our goal is to be able to say truthfully that with respect to the dramatic changes under way in healthcare in the United States, “we saw clearly then,” that we saw (and overcame) “all obstacles in our way,” and that it truly was “a bright, bright sunshiny day” for healthcare, for ASQ, and for the HCD. Please join the team!

Joe Fortuna

ASQ Healthcare Division Chair
248/709-6669

jaf@prism1.org

¹ From the song, “I Can See Clearly Now,” by Johnnie Nash, Columbia Europe, ASIN: B00002580D

“A systems perspective includes your senior leaders’ focus on strategic directions and on your patients and stakeholders…that your senior leaders monitor, respond to and manage performance based on your results. A systems perspective also includes using your measures, indicators, core competencies, and organizational knowledge to build your key strategies. It means linking these strategies with your work systems and key processes and aligning your resources to improve your overall performance and your focus on patients and stakeholders. …It means managing your whole organization, as well as its components, to achieve success.”

2009-2010 Baldrige Health Care Criteria for Performance Excellence

Patient-Centered Care
By Glenn Bodinson and Kay Kendall

In so many respects, the concept of patient-centered care seems to be the most obvious way to deliver healthcare — from the perspective of the patients and their families in collaboration with the providers. While there is no one universally accepted definition of “patient-centered care,” common attributes include: improved quality outcomes, increased patient satisfaction, reduced costs, fewer re-admittances, fewer medication errors, and shorter lengths of stay for acute conditions. Where the concept has been implemented well, the attributes also include increased physician satisfaction, increased staff satisfaction, and reduced staff turnover rates. Often debated in the literature and within the medical community, the concept seems no closer to widespread adoption by healthcare systems in the United States than when it emerged in a significant way in the late 1970s.

The failure rate of major change initiatives is often cited at around 70 percent. A recent Google search of “why change initiatives fail” returned 3,830,000 hits in 0.25 seconds. In his book, Leading Change, John P. Kotter identifies the following common reasons:

Allowing too much complacency.
Failing to create a sufficiently powerful guiding coalition.
Underestimating the power of vision.
Under-communicating the vision by a factor of 10 (or 100 or 1,000).
Permitting obstacles to block the new vision.
Failing to create short-term wins.
Declaring victory too soon.
Neglecting to anchor changes firmly in the corporate culture.

In addition to these, we believe that there is another unexplored, underlying root cause to the failure of patient-centered care to fully take hold. And that root cause is a lack of a systems perspective in trying to implement a large-scale change not only in a single organization but in the larger community of medicine, too.

What are attributes of a system? Complex and dynamic in nature, more than a sum of its parts, highly interdependent with interactions between and among the various components. In many organizations that aspire to patient-centered care, the effort is approached as a project, which assumes a linear progression of events — the antithesis of a system.

What does a systems perspective offer that would enhance the adoption of patient-centered care? First, a system doesn’t operate as a “zero sum” game. It doesn’t assume that for us to win, you must lose. “Patient-centered care” does not automatically convey the fact that this offers benefits to the providers of healthcare as well as to the patients. Without the buy-in of physicians, staff, and other providers, healthcare organizations will create the “antibodies” to reject a major change such as patient-centered care.

Second, a systems perspective provides a view to the interactions and interdependencies of its components. Improvement in patient flow requires the removal of waste, reduction in handoffs, and harmonization of interdepartmental activities. Just as we would not try to improve the health and fitness of a patient by first addressing blood pressure, next managing diabetes, then reducing cholesterol, then increasing cardiovascular capability, etc., we’d look at the overall objectives and create an integrated wellness plan with the patient to leverage and accelerate the benefits from each individual action. And what we’ve seen with improved patient flow is the obvious outcome of improved patient satisfaction and also the improved satisfaction of healthcare providers who no longer have to deal with the frustrations of a disconnected system.

Finally, a systems perspective ties patient-centered care into the way leaders lead and the way that the organization is managed, rather than an initiative “on the side.” Is there a model available that could provide a new way to think of patient-centered care? Yes. The Baldrige Framework—in place since 1987 and continuously evaluated and refined to include the leading validated management practices. If we’re serious about patient-centered care, isn’t it time we considered a proven model to promote its implementation?

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