HBR Blogs: Jim radically rethinks healthcare delivery

Jim’s post from the HBR Blog Network

Editor’s note: This post is part of a three-week series examining innovation in health care, published in partnership with the Advanced Leadership Initiative at Harvard University.

When I first suggested to a team of health care clinicians that their work needed to be radically redesigned, I was told that the word “radical” was reserved for only the most serious of medical procedures and I had no license to use the word — after all, I was not even a physician. Today, I believe more than ever that only the radical redesign of health care’s clinical and administrative processes will deliver lower costs and improved safety.

What we describe as a “health care system” is no system at all. It’s a collection of fragmented, non-communicating parts, implicitly dangerous in design. During an average four day hospital stay, a patient sees 24 different clinicians and administrators; when a physician places an order for medications in a hospital, there are seventeen steps between when that order is given and when the medication reaches the patient’s bedside – all opportunities for error. And this complexity happens within a single health care delivery organization. When multiple physicians, clinics, hospitals – and insurance companies – are involved in the care of a patient, the complexity can be overwhelming, both for the patient and clinicians.

Designing a real system of care will require a combination of technology, process, and people. Information technology will be the great enabler of change – connecting multiple care givers, providing a portable health care record, and eventually providing the information required to link treatments to outcomes. But technology alone will not deliver lower costs and safer care. Clinical work must also change, and that involves process. We have seen great advances in the diagnosis and treatment of illness, but many of the processes in care delivery haven’t changed very much in fifty years – the same patient questions get repeatedly asked, delays exist in getting test results back, real patient education is left up to the patient and the Internet. And when information technology has been introduced into the physician’s examining room without process change, the work of physicians has become more difficult, not less. When work does change for the better, it’s also because the behaviors of people have changed – both clinicians and patients.

The challenge may seem daunting, but I have seen some encouraging examples of redesigned delivery processes. They have been as simple as taking down the walls between warring orthopedic surgeons and radiologists in a group practice and requiring their administrative staffs to meet every morning to plan the day’s work. And they have been as ambitious as Novant Health’s Safe Med program.

The staff at Novant, a leading hospital in North Carolina, had noticed that 18% of its emergency room cases involved recently discharged elderly patients with Adverse Drug Events (ADE’s). These patients were not going home and purposely overdosing; they just weren’t paying attention to medication instructions when being discharged. They wanted to get home – where they were at risk of taking both old and new medications.

So Novant instituted a program in which hospital pharmacists telephone elderly patients a couple of days after they have been discharged and ask them to review the medications they are taking. The ADE cases showing up in the emergency room have been reduced from 18% to 4%. But the program required getting attending physicians to accept the new role for pharmacists, finding hospital pharmacists with patient skills (they normally never see a patient), and developing computer systems that keep physicians apprised of what’s going on. Safe Med is an example of how people, process, and technology can come together to improve safety and lower costs – an emergency room is an expensive place to be.

The case for action for radically rethinking health care delivery can easily be made alone on the basis of lowering costs and improving safety. But I also believe that many hospitals and physician practices will soon be at risk of financial collapse if they don’t take action. Federally enacted “health care reform” means that hospitals and clinicians will be paid less for their work as it’s currently performed.

You might think that hospitals will now earn more because they won’t have to provide free care to the previously uninsured. Think twice. Without radical change, the cost of care will continue to rise dramatically, driven in part by advances in science and technology – look at new drugs that can cost a patient or insurer thousands of dollars a month. With these increased costs and Medicare and Medicaid payments being reduced to help pay for “health care reform”, I don’t know the head of a single hospital who doesn’t fear red ink ahead. Most hospitals already operate on the edge of profitability.
It’s time for health care professionals to take on the redesign of their work. No angel of government can or should do it for them.

Jim Champy is a consultant and author. His latest book, co-authored with Dr. Harry Greenspun, isReengineering Health Care: A Manifesto for Radically Rethinking the Delivery of CareHe is currently a 2011 Advanced Leadership Research Fellow at Harvard.

http://blogs.hbr.org/innovations-in-health-care/2011/03/radically-rethinking-health-ca.html

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