Fixing Healthcare from the Inside

Fixing Healthcare From the Inside, Today by Steven J. Spear, Harvard Business Review (so online access disappears sometime soon).

To understand how the improvements were achieved, it is necessary to appreciate why such a gap exists between the U.S. health care system's performance and the skills and intentions of the people who work in it.

Best efforts are not the answer, as Deming said.

The changes I've described at West Penn were individually small, but taken together they led to marked improvement in the presurgical unit's performance. That's also characteristic of change at Toyota: People don't typically go in for big, dramatic cure-alls. Instead, they break big problems into smaller, tractable pieces and generate a steady rush of iterative changes that collectively deliver spectacular results.

First, as Shadyside discovered, the solutions from one situation may not apply in another. Second, the most effective changes - —at West Penn, South Side, and elsewhere - —are small ones, generated by rapid experiments. Draw too big a group into the initial deployment, and the experiments become unwieldy, requiring too many people to change too much of their work at the same time.

More good ideas: don't just copy idea, rapid experiments and pilot on a small scale (PDSA). You can't just copy what works in one place (this is one of the risks of benchmarking, if done improperly - as is often the case). The "solutions" are part of a system and therefore the effect of that "solution" in another system might not be the same. Therefore you have to be careful when looking at applying solutions. What is needed is an understanding of the system that the improvement will be made. And then the pilot tests need to be done in the appropriate way.

You also want to apply the improvements as widely as possible (to standardize). New improvements should be piloted on a small scale and then standardized and applied as widely while retaining a balance between adopting improvements widely to gain the greatest benefit and adopting "improvements" too widely - in those places where the system in which those "improvements" would be applied is not appropriate.

The Improvement Guide is an excellent book on improvement (and is written by the management consultants - Associates in Process Improvement) working on the breakthrough series with IHI. The breakthrough series with the Institute for Healthcare Improvement also has some good material on this topic.

More resources on this topic:

• Articles and paper on improving the management of health care
• Online resources for improving the management of health care