Quality: The time is now

"Reform" of the U.S. healthcare system can mean a myriad of things, all of which have been discussed and debated ad nauseum over the past two years – before, during and after passage of the Affordable Care Act.

 

Is structural transformation of the delivery system the solution to the healthcare crisis? Should we reconfigure the way providers are reimbursed? Is self-defeating patient behavior a critical problem that must be addressed?

 

Yes to all of the above. But what I haven't heard a great deal of discussion about, although it is absolutely crucial if U.S. healthcare is to lower costs and improve outcomes in the long-term, is the need for a profound cultural transformation.

 

The kind of transformation I'm imagining is more about process than politics.

 

I recently attended the annual meeting of the ASQ, the organization that administers the Malcolm Baldrige National Quality Program Award. The Baldrige award recognizes excellence in the manufacturing and service industries – and, since 1999, healthcare.

 

Members of the ASQ have promoted quality improvement techniques in manufacturing and other industrial processes since the Second World War. Some of the more renowned strategies, such as Lean and Six Sigma, have become international synonyms for quality control.

 

Healthcare leaders have often rejected comparisons to manufacturing and other industries, but in recent years some of that resistance has disappeared as an increasing number of healthcare facilities have seen the utility of quality improvement techniques.

 

For instance, the Lean quality improvement strategy focuses on the removal of waste and the optimizing of workflows within an organization. Coming out of the Toyota production system, Lean techniques have been implemented successfully in hospitals, particularly in the operating and emergency rooms. Admissions, discharge, purchasing and information systems are other hospital departments that have used Lean techniques to eliminate wasteful, redundant processes.

 

Six Sigma is a very sophisticated process improvement tool made famous by Motorola and GE in the 1980s. The focus of Six Sigma is to reduce variation within a process. For instance, hospitals have used Six Sigma to help reduce patient waiting times in the emergency department.

 

While both approaches have distinct strengths, the newest training programs combine the two methodologies into what's called a "Lean Sigma" approach.

 

Quality improvement methodologies can succeed at the departmental level, but they are most effective when the leadership team at a healthcare organization endorses process improvement and makes it central to the organization's culture.

 

From the perspective of the business office, Kathy Price, director of clinical effectiveness at Sisters of Charity of Leavenworth Health System in Lenexa, Kan., said deployment of quality improvement processes in healthcare is not intended to "get more money" for an organization, but to tighten the revenue leaks – to make sure your organization is not losing money.

 

"We have to move away from the mindset that lower cost implies poor quality," Price said at the recent ASQ conference. "An organizational focus on quality means going beyond notional or potential savings and implementing real cost reduction – taking real money out of budgets."

 

That frightens a lot of people in healthcare, to whom cost savings suggests deficient care. But the promise of core process improvement is that performance excellence and cost reduction can go hand-in-hand. It's not an "overnight achievement," Price says, but can ultimately be self-sustaining if an organization embraces cultural transformation.

 

Given our political system's seeming inability to address the cost-quality conundrum in healthcare, perhaps its time for healthcare organizations themselves to make real investments in process improvement.

 

If not you, who? If not now, when?