Delivering operational excellence

Check out Fixing Healthcare From the Inside, Today in the Harvard Business Review. Author Steven J. Spear documents lessons learned from the Institute for Healthcare Improvement (IHI), which I've written about before. If you don't have time for the whole article, you can read Spear's summary of it (The Health Factory) in the New York Times.The Institute has been applying best practices from industry to health care processes, following in the footsteps of companies like Toyota, Alcoa, Southwest Airlines, and Vanguard. The principles of operational excellence are outlined in a sidebar:

• Work is designed as a series of ongoing experiments that immediately reveal problems
• Problems are addressed immediately through rapid experimentation
• Solutions are disseminated adaptively through collaborative experimentation
• People at all levels of the organization are taught to become experimentalists

Spear provides case studies that show how these principles can be applied to reduce infection rates, reduce medication errors, and improve process flow to increase efficiency and customer service. I posted here on the results of this sort of approach applied to C-sections when my wife was at Beth Israel recently and also noted how far they still have to go on more routine processes.

I'm a big fan of these sorts of initiatives. They are much more promising than the typical pay for performance (P4P) approach, which sets quality and cost targets for providers without the process support needed to help them achieve systemic improvements. P4P is also somewhat insulting to providers, whose commitment to quality is assumed to be manipulable with small injections of cash in a few places. Luckily, P4P is not incompatible with the IHI approach.

I'm encouraged that IHI is making an impact in the real world and that it's becoming better known among the general public.