by A. Blanton Godfrey
Quality Health Care
The lessons learned by
apply widely to other organizations.
Until a few years ago, most people in health care, as in many other industries,
were convinced that higher quality meant higher costs. If people wanted
better health care, they would have to be willing to spend more. Better
quality meant new technologies, new medicines and more staff.
In 1987, a rather remarkable experiment was launched: the National Demonstration
Project in Quality Improvement in Health Care. The premise of the NDP was
simple: Twenty-one health-care organizations agreed to participate in an
eight-month study of the applicability of industrial quality-improvement
methods in health care. Twenty-one companies agreed to support these health-care
organizations during their studies. The support included free consulting,
materials, access to training courses and reviews. The companies participating
included many of America's leading quality organizations, such as AT&T,
Corning, Ford, Hewlett-Packard, IBM and Xerox.
Their final meeting held much excitement. Fifteen of the health-care organizations
had made significant progress, and many showed substantial results. The
NDP was extended three more years and evolved into the Institute for Healthcare
Improvement, a not-for-profit organization providing leadership in health-care
quality management throughout the world.
The lessons learned in the NDP and by health-care organizations apply way
beyond the health-care field. Several years ago, when I co-authored an article
on these lessons, this point was quickly made clear to me. One of the first
letters to the editor about the article was from the quality director of
one of the leading U.S. manufacturing companies. He stated that if we just
removed the words "health care," these lessons would apply to
any organization. Since then we have continued to learn many things from
the leading health-care organizations that apply widely to other organizations.
One of the first striking findings for many of the health-care organizations
was the critical importance of looking at care as a process. Health care
traditionally had been very doctor-focused. The physician was responsible
for the clinical outcome. Health-care organizations soon discovered how
complex their processes were; the large number of people involved; the importance
of correct, timely and available information; and the many, unmanaged hand-offs
in each process. If a physician receives the wrong lab report, there is
no way the doctor can make the correct diagnosis. If the pharmacy gives
the wrong medicine to the nurse, even the best diagnosis may not matter.
And if the patient fails to follow directions, the entire care path may
Some of the earlier successes were truly remarkable. The Leicester Royal
Infirmary in the United Kingdom, a winner of Hewlett-Packard's Golden Helix
Award, reduced a 40-day neurological test procedure to one day, with an
associated 40-percent reduction in administrative costs. Other hospitals
have reduced lengths of stay by nearly half for some procedures, reduced
emergency room waiting times by 70 percent and eliminated 67 percent of
the time it takes for physical examinations. One has reduced infections
after surgery by more than half.
The most critical part of process management, of course, is measurement.
In Mentoring Strategic Change in Health Care, Chip Caldwell, formerly president
and CEO of West Paces Medical Center in Atlanta, gives many details on how
to construct and deploy the necessary strategic measures.
A few years ago, the director of nursing in a large West Coast hospital
told me that they were not allowed to call patients "customers."
When I asked why, she explained that "customers have rights."
Unfortunately, many hospitals have acted as if the customers were inanimate
lumps to be pushed around, stuck, tested and acted upon. The change in attitude
in the past few years has been stunning. This customer focus has forced
One leading organization is now building a customer-focused medical record.
Instead of each hospital, clinic, doctor's office and other provider keeping
their own records, there will now be one medical record in their community
for each person. Even the competing hospitals have agreed to use the same
database, and all physician offices and the major health plan will also
share. So each person's records will be complete, accurate, up-to-date and
available to all.
Another simple example is changing the emergency-room admittance process.
Because most emergency rooms never turn anyone away, why do most still require
people to complete numerous forms about insurance and other personal data
before treatment? Some hospitals now focus on the customer's emergency first
and gather the required information later.
About the author
A. Blanton Godfrey, chairman and CEO of Juran Institute Inc., was
a co-founder with Donald M. Berwick, M.D., of the National Demonstration
Project in Quality Improvement in Health Care in 1987. He is also co-author
of Curing Health Care and many articles on health-care quality. Ten Lessons
Learned-How Quality Management Really Works in Health Care is available
at http://www.juran.com. Godfrey welcomes questions by e-mail at firstname.lastname@example.org.