Monday, October 10, 2011

Mission: Improvement; a primer to guide healthcare reformers.

In the upcoming weeks, I'll be blogging a series a posts entitled "Mission: Improvement; a primer to guide healthcare reformers".

Lots of books and articles have been written about project management and continuous quality improvement. Why another one? Simple, there is a need for a practical approach to improvement not a theoretical treatise. This will help you understand what to do in the trenches while fighting the battle for improvement.

Over decades of experience in the field, the author has found that most people know what needs to be done. They have read the books, attended numerous lectures and conferences, and even participated in numerous performance improvement projects. The missing link tends to be inadequate application of that knowledge, perhaps not knowing which tools to use at which time, and how all of the pieces fit together.

Similarly, in the author's humble opinion - having worked at a number of different healthcare organizations, most healthcare providers are not "knowledge poor" when it comes to implementing evidence-based medicine - rather what's missing is the knowledge of how to redesign systems in order to ensure the right outcome; what's missing is often the motivation or incentive to change. Unfortunately, the attribution of a knowledge-deficit as the critical missing element often leads most improvement teams to focus on education efforts. However, education does not lead to significant, sustainable change. Change results from redesigning systems to lead to the desired outcome; by making the default option the desired option. Secondly, change results from the collective efforts of cross functional teams; these teams produce insight about the organization's working and capacity that any one individual is not privy to. Thirdly, change results from behavior modification. Physicians and clinicians know what needs to be done; they may not make the action enough of a priority; behavior modification techniques expertly implemented within the context of a performance improvement system can lead to desired outcomes.

The lessons that I will share with you have led in real world settings to what I call "high performance outcomes":
  • Utilization Management:
    • Reduced inpatient length of stay by 25% at two facilities
    • Reduced emergency room length of stay by 90 minutes for patients waiting to be admitted
  • Diabetes
    • Improved patient education from 81% to 100%
    • Improved hemoglobin A1C evaluation from 14% to 57%
    • Improved lipid profile evaluation from 10% to 24%
  • Congestive Heart Failure
    • Improved communication of discharge instructions from 88% to 98%
    • Improved “perfect care” (patients meeting all measures) from 80% to 95%
    • Reduced readmissions from 18% to less than 10%
  • Surgical Care Improvement Project
    • Improved foley catheter removal within 48 hours from 46% to 72%
    • Improved prophylactic antibiotics given within one hour of surgery from 64% to 100%
    • Improved discontinuation of prophylactic antibiotics within 24 hours from 75% to 88%
  • Stroke
    • Improved LDL less than 100 or statin initiated from 50% to 100%
  • Pneumonia
    • Improved ordering of blood cultures before antibiotics from 84% to 100%
  • Ambulatory Care
    • Improved selection of prophylactic antibiotics from 55% to 92%
    • Improved initiation of prophylactic antibiotics from 69% to 100%

Watch this blog in the coming weeks for more discussion about the items above and expert tips on how to get the results many of us seek.

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