After reading Joe De Feo’s July 8, 2011, Quality Digest Daily article, “A Positive Prognosis: Transforming Health Care in America,” I took another look at the wonderful book, Escape Fire (Jossey-Bass, 2003), a compendium of Dr. Donald Berwick’s inspiring plenary speeches at the Institute for Healthcare Improvement’s (IHI) 1992–2002 annual forum. Berwick is probably the leading health care-improvement thinker in the world. He is the former CEO of IHI and, as some of you know, a controversial Obama appointee as head of the Centers for Medicare and Medicaid Administration. In my opinion, he is most definitely the person for the job. As if it wasn’t difficult enough to deal only with health care cultures, he now has the thankless job of integrating messy political agendas into the very serious business of health improvement.
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100 Years of Tradition Uninterrupted by Progress
According to Press Ganey, patient turnaround times in Emergency Departments remain at four hours, unchanged for a decade.
The 1999 To Err is Human report called for a 50 percent reduction in medical errors, but in 2009, Dr. David bates said, "With respect to the 50 percent reduction, the truth is that we don't really know, because we don't have good metrics for sorting out how common medical errors are in most institutions.
In Complications, Atul Gawande reported that autopsies turned up major misdiagnoses as the cause of death a shocking 40 percent of the time, and rates have not improved since 1938.
In The Innovator's Prescription, Clayton Christensen describes how healthcare's business model hasn't changed for 100 years. Deans of medical schools come to his summer program thinking that medical programs should be expanded to five years; they leave, having learned Lean principles, thinking they can produce better doctors in three years not five.
There's an estimated trillion dollars to be saved each year by applying Lean Six Sigma to healthcare. This will more than pay for healthcare Reform. Isn't it time for customer (i.e., an impatient) to start demanding fast, affordable, flawless healthcare?
And it doesn't have to take forever or require armies of multi-colored "belts". Much of these gains could be achieved in a couple of years with laser-focused improvement. But this reminds me of the old joke: "How many psychiatrists does it take to change a light bulb?" Answer: "Only one, but the light bulb has to want to change!" Healthcare has to want to change and believe it's possible to achieve great gains quickly will delivering better care.
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