Quality Management

by A. Blanton Godfrey

Quality Health Care

The lessons learned by
health-care organizations
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 collapse.

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 significant changes.

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 godfrey@netaxis.com.