Hospitals and physician practices would be wise to learn how to squeeze the waste out daily tasks and improve their processes using tested quality tools that enhance performance in healthcare.
We must promote quality in health care by creating an environment that will embrace process improvement and quality tools to maximize return on spending under the economic stimulus bill to exhibit "meaningful use."
We must focus on the stimulus bill in the areas of Healthcare Information Technology, the healthcare infrastructure, the quality of care. To be able to measure our effectiveness and maximize the return on spending under the economic stimulus bill, organization will have to partner with each other.
The European Framework for Lean Training in Healthcare Operations - EFLTHO is an effort of the European community to make the LEAN change management techniques a core tool in evolving healthcare culture in Europe. We should be looking to do the same thing here in the US. They are looking to to provide a comprehensively researched, successive learning path for those engaged in clinical operations. The US needs to be working in parallel with the Europeans and create a world alliance. Why is this so important?
We must be careful to focus on guiding the US government to fund organizations that will change how they work BEFORE they adopt new work-management software. Typically corporations that "learn how to change" become more productive with the implementation of IT. Getting doctors to change their habits is tricky, as Robert Langreth wrote in the Forbes Magazine article "The Devil Inside Wired Medicine" on May 11, 2009. He said 'digitizing medical data is easy. Using it to improve care will be hard." Langreth writes that electronic records might make medicine safer and cheaper, but it might just digitize the worst flaws of today's system where errors are rampant and basic recommended treatments often fall through the cracks. He quotes a 2009 National Research Council report which warned that many computer records simply mimic existing paper-based forms and that "poor designs .... can increase the chance of error." He refers to Clement McDonald, MD, a pioneer in computerized records who now works at the national library of Medicine when discussing when discussing the complex work flows and the large number of computer systems in hospitals. He compares installing an electronic record to be "like doing a brain transplant, where you have to wire every single nerve." David Brailer, MD says "it is a massive reorganization" of how a hospital works.
The big players are Microsoft and GE Healthcare. They say "the market is poised for explosive growth and we can help more people get better outcomes at lower cost." Sure - GE reaps $2 billion in revenue from medical records and related software. If they make this much money and the costs are less - the savings 'should be' enormous!
At this point only 17% of doctors use electronic medical records in their outpatient practices according to the New England Journal of Medicine. Most of these are bare-bones systems they say. Also a mere 9% of hospitals have electronic medical records. Goal should be to help the current administration to define "a meaningful way" for the planned Medicare bonus payments to providers that use electronic records. Installing a hospital system can take many months and cost between $10 million and $100 million.
Brandon Savage, MD, Chief Medical Officer for GE Health Care Data Processing business is helping to lead a $200 million project in partnership with Intermountain Healthcare in Utah to build a medical records system with all sorts of new bells and whistles to help doctors. Organizations such as the American Society For Quality Healthcare Division (ASQ), the largest quality organization in the world, should get involved with this project and look at its design from a process improvement perspective. Hopsital physician leaders should get involved with ASQ to to listen and learn form its boby of knowledge.
The PSO Services Group is a Patient Safety Organization (PSO #28) listed by the Department of Health and Human Services. It provides resources to other PSOs and hospital systems to build and operate Patient Safety Evaluation Systems (PSES) as required for participation in the program. The heart of the PSES is a Web-based Kaizen Knowledge Builder application, the first of its kind, provided by CRG Medical, Inc. www.crgmedical.com It is different by design. The principle of Kaizen applied to healthcare is to solve problems at the point of the delivery of care. The point of delivery of care is usually at the bedside, but it could be in the pharmacy, kitchen or the parking lot. When every employee is empowered to share what they know, the work around(s) they do, or their best practices with management in close to real time we can achieve continual improvement, reduction in costs, greater efficiencies and effectivenance with safer patient outcomes. Analysis of the record is done the HCW (Health care worker) at the time of entry reducing the load on the quality or risk manager and enabling them to aggregate data and learn what needs to be fixed quickly. KBCore helps CEOs learn to listen to the caregivers and by listening they learn what problems need fixing. KBCore helps hospitals help themselves at really low cost. We must introduce LEAN Processes to complement the Patient Safety Organizations endorsed by the Patient Safety and Quality Improvement Act of 2005.
Any ideas of how to share this knowledge rapidly?
Douglas Dotan
dotan@swbell.net
(713)825.7900
Yesterday, the first telephone conference call of the 35 listed Health and Human Services Patient Safety Organizations - PSOs took place. It was interesting to note that seldom if ever we heard on the call that the purpose of the PSOs was to create a learning organization. Dr. Bill Munier of AHRQ explained in his opening remarks that even though the Act began with 'patient safety' it is also about 'quality improvement'. The formation of the PSO community is an opportunity for creating patient safety knowledge, sharing it and learning from it. Quality is what the customer/patient expects from the care they receive, and what the employees expect from the care they give. There still seems to be that fear in the provider community of doing something wrong, that someone will find out about it, and having to bear the consequences of that action. Responsibility and accountability is the essence of a just culture. This is what builds trust. That is whole concept of transparency. I think that it is a moral obligation and a social responsibility of every organization to participate in the PSO community. I think that we should create, at least at the State level, a recognition seal or emblem stating "We are a Patient Safety Organization". The seal of recognition should be on all uniforms, letterheads, stationary and the front door of every participating hospital. Care givers, adminstrators, allied health and even janitors should wer this badge of honor with pride. We owe this to our patients. If a hospital is not part of a PSO patients should ask 'Why not!" If me or my loved ones have to go to a hospital, I would like to know that everyone there is doing everything possible to "prevent harm and keep patients safe".
What do you think?
Please join us at the first major public forum in Texas on PSOs.
Date/time:
Wednesday, January 28, 2009
Program: 5:00 pm - 6:30 pm
Reception: 6:30 pm - 7:00 pm
Location:
The University of Texas Health Science Center at Houston, School of Nursing Alkek Auditorium,
6901 Bertner Houston, TX 77030
Recommended by the Institute of Medicine and authorized by the Patient Safety and Quality Improvement Act of 2005, the creation and implementation of the Patient Safety Organizations (PSOs) is envisioned by our panel of experts to vastly change the U.S. healthcare system. PSOs are designed to improve the quality and safety of U.S. health care by encouraging clinicians and healthcare organ- izations to voluntarily report and share data on patient safety events without fear of legal discovery. By communicating these events and lessons learned, we begin to build knowledge and identify best management and clinical practices that are fundamental for all healthcare organizations.
Panelists
Douglas B. Dotan
PSO Services Group* (PSO 0028)
William A. Hyman
ACCE Technology Healthcare Foundation* (PSO 0017)
Lindsey Donges
Human Performance Technology Group, Inc.* (PSO 0003)
Steve Montague
LifeWings Partners, LLC
Deborah C. Hiser
Brown McCarroll, LLP
Beryl L. Vallejo
St. Luke’s Episcopal Hospital
Moderator
Elizabeth A. Smith
Community Medical Foundation for Patient Safety* (PSO 0029)
* Indicates official PSO recognized by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.
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