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8th Annual Lean & Six Sigma and Business Improvement in Healthcare Summit
InterContinental New Orleans Luxury Hotel, New Orleans, LA (Workshops: March 17 and 20, 2009. Summit: March, 18 & 19, 2009) |
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| 2008/11/25 |
Hospital Errors and Accountability — The Beginning of a Six Sigma Journey?
For nearly a decade, data has shown that almost 100,000 deaths occur each year due to preventable hospital errors. Accounts of botched medical services pepper news outlets. Even celebrities are reporting ill effects: Dennis Quaid, Glenn Beck.
Today, CBS News reported on what some hospitals and some state and federal government organizations are doing to begin to address the problem.
Providing care and medical services to a person in a hospital is a process—just as much as assembling a product or completing a financial transaction are processes. (The only difference being that a human being is the object that goes through the process.) For those reading who know a bit of Six Sigma, Lean, or BPM—imagine how much opportunity there is within the domain of healthcare to undertake process improvement work! And because healthcare directly affects the wellbeing of people, imagine the direct benefits to individuals and communities. This news story from CBS begs questions like: why haven’t hospitals started improvement efforts sooner? And: what factors in our society (doctor/nurse practices, economic pressures, government regulations, hospital procedures, insurance constraints, education, news media, etc., etc., etc.) allow poor quality to reach such deadly levels in the first place?
At least, in some quarters, healthcare providers are hopefully starting to approach the very basics.
Tags: data, financial accountability, hospital errors, medical errors
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This entry was posted on Monday, March 17th, 2008 at 7:31 pm and is filed under Current Events, Real World Examples. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
One Response to “Hospital Errors and Accountability — The Beginning of a Six Sigma Journey?”
Punit Says:
March 22nd, 2008 at 11:15 am
The article is very sensitive. As you mentioned about numbers, then how about mentioning that by using six sigma, the total defects per million opportunities is 3.4. In this example, instead of 100000 of people losing their lies due to hospital errors, six sigma can help reduce that number to 3.4 from million patients.
I have just started a blog on six sigma as well. You can add this link to your blog or I will appreciate if you can comment on my blog:
http://sixsigmamethodology.blogspot.com/
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| 2008/11/25 |
All Things Considered, August 22, 2007 When Medicare sneezes, hospitals do more than just catch a cold. The federal program pays about 40 percent of the nation's annual hospital bill.
But starting in October 2008, Medicare will stop paying hospitals for infections or injuries that occur in the hospital. Under new rules published Wednesday, Medicare will soon stop payment for at least eight conditions, including common hospital-acquired infections, blatant surgical errors, and injuries that result from a fall.
Medicare's Herb Kuhn says that Medicare specifically chose conditions that hospitals can prevent. He hopes the financial disincentives will force hospitals to change the way they do business. The hospitals are forbidden from passing the additional costs on to patients.
"Over the last few years, I don't think hospitals can assert anymore that they deliver high-quality care. They need to demonstrate it," Kuhn says.
But the hospital industry has doubts about the new rules.
"The concept of a payment policy that supports quality and safety is something that we support," says Nancy Foster, who handles quality and patient safety issues for the American Hospital Association. "Whether this particular policy is the most effective way of altering payment to help induce a higher-quality care is a question that I think we need to ask."
One problem, Foster says, is that hospitals don't know how to prevent certain things — like falls.
"People may wake up in the middle of the night, need to use the restroom, not remember that the nurse instructed them to call for help first — or think they were OK, go to stand up and find out that the surgery they had has weakened them so that they are unable to support their own weight and fall to the floor and be injured," Foster explains. "No one wants that to happen. We just don't have a perfect strategy to prevent it."
Foster also says that it may be hard to implement the rules. For example, starting in October, hospitals will have to check for certain infections in every Medicare patient coming into the hospital. That's the only way to know whether those infections started in the hospital. But Foster says getting that information from a patient being admitted through the emergency room might not be appropriate:
"They're in a great deal of pain, struggling to get their breath. They're scared because it's a life-threatening condition. Is that the right time to focus on determining whether they have a urinary tract infection?"
Lucien Leape of the Harvard School of Public Health, thinks that the changes are long overdue. Leape is one of the top experts in patient safety and an author of the 1999 report from the Institute of Medicine that documented the depth of the medical-error problem.
Back then, Leape says, "We really didn't know much specifically about what we should do. It was, 'Hospitals ought to do something.' But it wasn't quite clear what it was."
Today, he says, dozens of safe practices have been developed to prevent such errors. But he says there hasn't been enough of a push for hospitals to put them into use.
"I think it's fair to say that progress in patient safety up to now has relied on altruism. It's been largely accomplished by good people trying to do the right thing," Leape says. "And what we're saying is that hasn't gotten us far enough, and now we'll go to what really moves things in our society, which is money."
And it's not just Medicare. If the new program proves successful, private insurance companies are also likely to start refusing to pay for medical mistakes.
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| 2008/11/25 |
Breakthrough Quality: What the Board Must Do
By Chip Caldwell, FACHE, Greg Butler and John Grah, FACHE
As in other industries, hospital and health system quality performance may soon be the dominant factor driving consumer choice. Yet health care boards, hospital executives and strategic planners possess far less knowledge of quality system structures than their business counterparts. “The 2005 ‘Building a Better Delivery System’” report from the Institute of Medicine and the National Academy of Engineering shows that the health care sector has been slow to adopt quality and systems engineering tools widely used in other industries,” says Mike Nichols, president of the American Society of Quality, Milwaukee. “With our health care system plagued by cost, quality and access problems, hospital leadership has an obligation to learn from other industries that have achieved those quality and productivity gains that deliver value to knowledgeable customers.”
The good news is that hospitals are beginning to implement quality models like Lean Six Sigma from other industries in order to increase transparency by improving quality and decreasing costs. In fact, quality and price have never been so transparent in health care management.
For example, the large insurer United Health Care, Minneapolis, estimates the cost of a cardiac catheterization in an Orlando hospital at $839, while some comparison shopping suggests the price at a hospital in Chattanooga, Tenn., is $1,002. Recognizing the emerging importance of transparency, Erlanger Health System, Chattanooga, highlights their quality metrics and compares them to national and statewide benchmarks on its corporate Web site.
Additionally, increasing transparency is pressuring boards to rethink their roles with executive management in ensuring community confidence. Rather than a passive advisory role as recipients of quality reports, trustees are beginning to realize the importance of setting the quality strategy and overseeing the effectiveness of quality systems in use within the health system. “The health system board must be educated and fully engaged in its commitment to provider and institutional quality in health care,” says Charles Longer, M.D., Erlanger’s board chair. “The outcome of quality improvement efforts in an organization will be a major determinant of success in delivering care and financial viability.”
Parallel Effort
The importance of quality performance has mushroomed as a result of a parallel effort by Medicare to reimburse for high quality outcomes and refuse payment for conditions associated with poor quality processes such as various types of health care-associated infections, pressure ulcers and other medical errors. Also, the Department of Health & Human Services created the Hospital Compare Web site (www.hospitalcompare.hhs.gov) to empower patients and their families to shop for the highest quality services. For example, a Chicago health care consumer can go the site and compare angioplasty procedures for 53 hospitals in the area on outcome measures, costs and patient experiences. Currently, health care shoppers are only able to compare a small number of services but, if current trends hold true, information and places patients can go to obtain that information will be greatly increased over time.
Hospital executives vary greatly in their knowledge, strategies and success levels in this emerging domain. However, boards of trustees often are ill-equipped to fulfill their obligation to ensure that quality strategies, metrics, infrastructures, professionals and oversight align. For instance, boards are rarely involved in detailed quality discussions, opting to allow the medical director, quality professionals or executive team to propose the final strategy for board approval.
In other industries, the board sets quality policies and goals that guide executive management in achieving the established goals. Assisting executive management in developing more collaborative approaches will be required in this era of quality and price transparency.
Addressing Weaknesses
The challenge of elevating hospital quality systems to the next level must begin by addressing current weaknesses in board quality improvement thinking. Unlike their service and manufacturing industry counterparts, health care boards, executives, and quality professionals do not understand the cost of quality as well as they understand quality metrics themselves. This is likely to lead to excessive quality waste in health care as price transparency takes root.
All too often in health care, boards rely upon external agencies like the Joint Commission and the Institute for Healthcare Improvement to fulfill quality obligations. They will put into place recommend projects or procedures often without the proper structure needed to sustain these changes. This approach lacks an overall strategy and results in suboptimal improvements, conflicting priorities, imprecise measurements and staff that is not held accountable for results.
Hospitals can use a framework for designing a modern quality oversight process suggested by the late Joseph Juran, widely recognized as the father of the modern quality movement, in which the board parallels the same process to improve quality as it does to track financial planning and budgeting to make financial improvements and to exercise financial control. For each design feature in the financial and budget process, the board should follow a similar and parallel path to ensure quality planning, budgeting, improvement and control.
Next Steps
In order to achieve positive momentum over time, it is recommended that the board and executive management undertake the following activities:
Update the board quality committee’s charter to include the above-stated quality principles, particularly the board’s role in establishing the quality agenda and goals, as well as quality oversight and accountability.
Invest adequate time to properly examine and direct the organization’s quality strategies in core services such as the emergency department, surgery and all patient care areas as well as for overall clinical and operations effectiveness.
Strengthen the annual hospital quality infrastructure assessment. During this assessment, the board should examine the overarching quality strategy and the structure put in place to support it. The board should expect executive management to present an action plan. The plan should either create a quality structure or improve on the existing structure. The board, as accountable overseers, should set the expected intent, format and uses of the annual assessment; executive management should commission the quality professionals to conduct the assessment and oversee implementation of the board-approved action plan to improve; and the quality professionals should supervise the outside agency’s review and should implement the board-approved improvement, with monthly progress reports to the board quality committee. This type of approach can mirror financial planning and budget oversight processes models that are currently used by both the board and executive team.
Update the organization’s strategic approach to quality to include annual goals—with quarterly and monthly milestone measures—for every quality task force, committee, project team, and quality professional cost center. These goals should be trended month-to-month in a graphic format showing comparison to goals and inclusion of the cost of quality.
Assign a board member to participate in the organization's quarterly and/or monthly quality report at meetings with medical staff, and quality and patient safety professionals. If a quarterly or monthly review of all quality task forces, committees, and project teams does not exist, insist that one be established.
The heightened national focus on quality and price transparency, from both the private and public sectors, will require a radical rethinking of quality improvement and controls as well as planning and budgeting for quality. This evolution may make some in the organization uncomfortable. But, by laying out a precise plan, along with accountability for achieving redesign milestones, board members can feel confident that they have fulfilled their obligations in ensuring the organization’s performance in the coming century of quality.
—Chip Caldwell, FACHE, is president of Chip Caldwell and Associates, Saint Augustine, Fla., and a faculty member of the American Society for Quality, Milwaukee, and American College of Healthcare Executives, Chicago. He can be reached at chipc@chipcaldwellassoc.com or (904) 687-8160. Greg Butler is executive vice president of Chip Caldwell and Associates. John Grah, FACHE, provides coaching to hospital executive teams in Lean Six Sigma. This article was provided on behalf of the AHA Quality Center, a resource designed to help hospitals accelerate their quality and performance improvement processes. Tools and articles about equity in care are available at http://www.ahaqualitycenter.org/.
This article 1st appeared in the June 2008 issue of Trustee Magazine.
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