Can The 1980s Quality Management Process Transform Healthcare For The Better?

7 tips to follow

The American healthcare industry is a bloated, ineffective mess.
 
Every year, 250,000 Americans die from medical errors. Healthcare is a $3.3 trillion-dollar industry that makes up almost 20 percent of our Gross Domestic Product (GDP).

 

Everyone has their “thing,” and ever since I was younger, mine has been efficiency.

Some people make fun of me about it, but it’s a primary driver behind what I do. I want to make things simpler, so people can live better lives.
 
With that said, you can imagine how much the healthcare system irritates me.
 
I wish I had a magic wand that could wipe away the inefficiencies and billions in wasted dollars, but even if I did, I’m not sure it would work. The healthcare system is just so massive, touching the life of every American at some point either as a patient or a caregiver.

Where would you even start fixing something that broken?
 
While I don’t have all the answers, I do have a 1980s total quality management process that can serve as a blueprint for starting to improve the healthcare industry.
 
I know what you’re thinking – a 1980s management process?! However, let me explain.

When I worked at IBM, there was a knowledge-management consultant named Lawrence Prusak. He said that you could not change a culture, but that you could change a process, and that process change could lead to a cultural change.
 
This process is taken from my notes of when I first learned about Total Quality Management. It’s worked well at several large companies, including McCaw Cellular, which later became AT&T.

Here, we decide which measures to focus on, opportunities for prevention of disease, and how to reduce costs. We listen to customers to find out what they like and don’t like, what works and what doesn’t. Then, we set priorities based on these opportunities.

For example, many patients find it irritating to have to fill out their entire medical history on a clipboard every time they go for care. People also hate to have to wait.

Elite Health is a great example of a company that’s working to fix what’s broken: the doctor enters the room at the same time you do, and your electronic medical records are displayed on a wall in front of you in a private room on a big-screen TV.

All stakeholders—individuals, providers, health plans, governments, and agents—must identify key customers and suppliers. I use “customers” and “suppliers” on purpose.

Stakeholders must ask: who gets my output, and whose input do I need?

Each stakeholder has a role here and can gain efficiency by defining the outputs and the inputs. That’s where new value comes from.

They say good, fast, or cheap—pick any two.

We can make faster and better decisions, for example. In this case, we might be able to do all three because the system is so inefficient.

What do you need from me and how do you need it?

What do I give you and how do you want it?

We must answer these questions. From there we can establish performance measures so that, under certain circumstances, we should be able to perform at a particular level.

For example, if a cancer centre needed to know specific details about the melanoma cancer a patient has, the pathology centre should do so in a level of detail that the cancer centre can select the appropriate course of action without lengthy delays.

The agreed-upon requirement is that it is not enough to say the patient has melanoma. We need to know the exact details so the exact treatment can be prescribed.

On the basis of your data, we identify the gaps between what customers need and what your work process can supply. There are plenty of these to choose from.

There is a need for serious talk about end-of-life issues. There is a gap between how people want to live—and die—in their final days and how the system treats them.

Gaps are everywhere, and we need to continue to identify and fix them.

This step of the process may involve flow charting, looking at bottlenecks, and engaging in root-cause analysis of breakdowns and why they happen.
Does the current process consistently meet customer requirements or not?

Think about a hospital. Each of the departments in the hospital can do a great job of admitting and providing the appropriate services in a timely manner.

Yet, the overall customer wait time was eight hours because the departments operated independently, and the overall efforts were not coordinated.
So, in isolation, the independent departments get high marks, but that does not reflect the overall customer experience. There’s room for improvement here.

When you find that the current process doesn’t work, you fix it so it does work.

If it still doesn’t meet requirements, you may need to develop a new process.

Maybe you also have contingency diagrams and checklists to anticipate problems. Data and analytics are only making it easier and easier to fix problems.

Execution is a challenge, but that challenge means you’re into the solution part of the process, which is good. However, note that if the government or anybody else says, “here’s the problem and here’s the solution,” it means they skipped all those other steps.

At this stage, we identify leading and lagging indicators of success, set benchmarks, create a feedback system, document the results, and make it all transparent so people can shop and know what the results are. Allowing the consumer to shop for value will fundamentally change the way the industry operates today.
 
The government is making strides through publicly available Star Rating Systems, which measure and compare health plans, hospitals, and doctors, based on a standard set of measures. It’s a good start, but we need more systems like this in place.
 
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