Stop Improving Processes if You Want to Transform Hospital Operations

Imagine air-traffic control using nothing but telephones, pagers and white-boards. Seems like a bad idea, doesn't it?

It might work for a few dozen simultaneous flights but how about a few hundred or the 4,710 commercial flights that are in the air as I write this? In this Flintstones' world, I imagine, flying is unpredictable, expensive and, relative to our world, dangerous.

Stepping into Bedrock, would you suggest that they fix their problems through process improvement initiatives focused on improving taxiing, refueling and flight-planning? Or, would you recommend the use of modern technology and install a state of the art air-traffic control system that ensures all flights fly at their best possible rates with regard to safety and efficiency? I'm betting on the later.

Well, with respect to flowing all patients simultaneously from arrival through discharge we are basically in Bedrock. So, instead of improving sub-processes of patient flow why not tackle the root of the problem by installing an enterprise-wide hospital operating system?

While it’s true that a hospital may have some technology assist – hotel-like software helping manage the "booking" and cleaning of rooms and facilitating transports – most have nothing that approaches a system whose aim is ensuring all patients flow simultaneously at their best possible rates with respect to length of stay, service times, quality, safety and resource consumption.

Just as bad air-traffic control has dire consequences, so does not having this hospital operational control. I believe that there is evidence that its absence leads to tens of billions of waste annually and probably contributes to the 44,000 avoidable deaths due to medical and medication errors.

The truth is that today’s modern hospital is too complex, with too many simultaneous transactions not to have a system that is responsible for patient-flow, yet most often they have none. As a result hospitals tend to operate as a collection of independent departments that compete for limited resources: clinicians, patient beds, wheelchairs, medications, IV pumps and other essential diagnostic and treatment resources. Most attempt to treat this systemic problem by repairing its parts, but the treatments tend to be outside of any global system-aim or "organizational consistency of purpose", as W. Edwards Deming might say. Thus, state of the art process improvement methodologies are applied to one department at a time, but process improvement which rests on the shoulders of siloed operations and technology won't be transformative and is difficult to sustain.

Without an enterprise control-system, process improvement initiatives are unlikely to provide meaningful, sustainable, enterprise impact. If you believe that it is vital to transform hospital operations, start by installing a hospital operating system. And then start improving processes.

In future posts, I will describe the characteristics of a successful hospital operating system, and I will offer a few case studies of their success.

There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says "Morning, boys. How's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes "What the hell is water?"

David Foster Wallace

Is Transforming Healthcare Operations a Moral Imperative?

If one could transform hospital operations, conservatively liberating $42 billion annually and reducing the 44,000 avoidable deaths due to medical and medication errors, doesn't it become a moral imperative to do so?

As I have said in previous posts, The U.S. healthcare system is fundamentally broken in that the forces of market capitalism are disengaged from the delivery of healthcare. And I agree with Rick Jackson, in his comment, that the economic incentives are misaligned resulting in a system that violates the basic laws of economics.

Adequately addressing this issue is going to require true bipartisanship effort, and the political intestinal fortitude to shut down (or at least redefine) the health care benefits industry (Aetna, United, etc.). But, what do we do while we wait for our politicians to do the right thing?

I believe we could dramatically improve the sate of healthcare by transforming hospital operations and in so doing liberate $25 to $50 billion annually. Additionally, and just as importantly, a meaningful operational transformation should greatly reduce the 44,000 to 98,000 deaths and $17 to $29 billion attributable to avoidable medical and pharmaceutical errors (IOM 1999 Consensus Report).

Hospitals can be transformed, and in future posts I will share some thoughts about how that transformation can be achieved and report on a few success stories.

Now I want to be clear, I am not bashing care-delivery organizations or providers. I believe that they are the inheritors, not the cause, of what Bill Franklin  described as an accidental healthcare system that would have made Franz Kafka proud. I guess what I am asking is, if there is a better way -- especially with the stakes as high as they are -- aren't we compelled to pursue it?

So, I ask again

If one could transform hospital operations, conservatively liberating up to $42 billion annually and reducing the 44,000 avoidable deaths due to medical and medication errors, doesn't it become a moral imperative to do so?

If you agree, how do we move the public debate toward answering this question and others that could actually make a difference?

If you don't agree, set me straight.