By Failing to Prepare, You Are Preparing to Fail:
Laying the Foundation for Success
John L. Haughom, MD
April 2014
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Proprietary and Confidential
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Healthcare: The Way It Should Be
Part One – Forces Driving Transformation
• Chapter One – Forces Defining and Shaping
the Current State of U.S. Healthcare
• Chapter Two – Present and Future
Challenges Facing U.S. Healthcare
Part Two – Laying the Foundation for
Improvement and Sustainable Change
• What will it take to successfully ride the
transformational wave?
Part Three – Looking into the Future
• What will it take to successfully ride the
transformational wave?
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Why do we see this?
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And not this?
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A ‘Field of Dreams’ Mentality…
“Build it, and they will come.”
Geography is destiny:
“Who you see is what you get.”
Health care system
vs.
Supplier-induced
demand
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Evolution of Methods to Manage
Organizational Complexity
•
As organizations
have become more
complex, humans
have adapted by
evolving methods
that help them deal
with increasing
complexity
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Guilds
•
Prior to 1800, commerce was
dominated by guilds
•
An association of artisans,
merchants or others with
common expertise who control
the practice of their craft by
limiting membership with
training requirements and
governmentally granted power
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Scientific Management
•
Developed by Frederick Taylor, ~1911
•
Defined mass production methods –
assembly line, time and motion
studies
•
Based on the idea of processes
Frederick Taylor
•
•
•
One one side: well-educated engineers
who designed the processes
On the other side: uneducated workers
who did as they were told – cogs in the
machine
Taylorism is still in common use
“In the past, the man has been first. In
the future, the system will be first.”
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Lean Production
• Scientific management fails in the face of
increasing complexity
• Lean production…
•
Walther Shewhart
Standardized processes with… …“smart cogs”
that… …adapt to individual needs
• That is, “mass customization”
•
Efficient processes that can deal with complexity
• Healthcare organizations remain heavily
invested in Taylor’s views of organizational
management, and lag behind in more modern
methods of managing complexity.
W. Edwards Deming
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We will win and you will lose…
“We will win and you will lose. You cannot do anything about it because your failure is
an internal disease. Your companies are based on Taylor’s principles. Worse, your
heads are Taylorized, too. You firmly believe that sound management means
executives on one side and workers on the other. On one side, men who think and on
the other side men who can only work. For you, management is the art of smoothly
transferring the executives’ ideas to the workers’ hands.
We have passed the Taylor stage. We are aware that business has become terribly
complex. Survival is uncertain in an environment filled with risk, the unexpected and
competition. Therefore, a company must have the commitment of the minds of its
employees to survive. For us, management is the entire work force’s intellectual
commitment at the service of the company without self-imposed functional or class
barriers.
We have measured – better than you – the new technological and economic
challenges. We know that the intelligence of a few technocrats – even very bright
ones – has become totally inadequate to face these challenges. Only the intellects of
all employees can permit a company to live with the ups and downs and the
requirements of its new environment. Yes, we will win and you will lose. For you are
not able to rid your minds of the obsolete Taylorisms that we never had.”
Konosuke Matsushita, founder of Matsushita Electronic Industrial Co. (ultimately Panasonic)
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The Evolution of Process Management
System of
Production
Deming and others
Scientific
Management
Airline Industry
Frederick Taylor
Healthcare
Industry
“Craftsmanship”
Guild System
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Advances in Aviation
Cockpit, circa 1917
Boeing 787 Dreamliner cockpit, circa 2013
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Process Management Works…
Annual Anesthesia Mortality Rates
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Tesla: Mass Customization at Work
• A highly integrated, highly reliable technology-enabled
work environment
•
160 of the world’s most advanced robots perform standard,
highly repetitive tasks with tremendous reliability
•
3000 skilled workers use
their intellects to manage
complexity and adapt to
customer needs
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It is happening in medicine, too…
Aethon Tug
da Vinci Xi
Healthcare Robotics Nurse Assistant
Espon Veebot
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iRobot RP-VITA
“microbots”
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Lean Production
Standardized care processes managed by…
…“smart cogs” that…
…can adapt to individual needs to maximize value for
patients
In Lean terms, “mass customization”…
…efficient processes that can deal with complexity yet
allow front-line workers to adapt when the customer
requires it…
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Applying Modern Improvement
Methods to Healthcare
A Sound
Improvement
Strategy
Good
Data
Lean
Methods
Sustainable
Value for
Patients and
Competitive
Advantage
Institute of Medicine Innovation Series white paper. Going Lean in Health Care. Cambridge,
MA: Institute for Healthcare Improvement; 2005.
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Brent James, MD, 101…
“Managed care” means
“managing processes of care” ...
…not managing physicians and nurses.
(clinicians are the ones who manage the process of care)
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Deming 101…
…engaging the “smart cogs”
of healthcare…
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The Healing Professions are Changing…
From craft-based practice
•
Individual clinicians working alone… …using handcrafted
customized solutions for each patient… …based on a core
ethical commitment to the patient and… …vast personal
knowledge gained from training and experience
To profession-based practice
•
Groups of peers, treating similar patients in a shared setting…
…plan standard coordinated care delivery processes (e.g.,
using evidence-based standard protocols)… …which individual
clinicians adapt to specific patient needs (e.g., mass
customization)
Growing experience is demonstrating
•
This type of care is less expensive, less complex, and yields
better patient outcomes
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Shared Professional Accountability
I will not tell you how to practice medicine…
•
I will argue the science, but if I cannot convince clinicians “on
the data,” I will not expect them to change how they manage
patients
I will try to create an environment of shared
professional accountability…
• Where groups of clinicians who manage similar
patients in similar settings, discuss best patient care
practices with recourse to the medical literature,
expert opinion and credible data showing their own
performance and outcomes over time
In essence, we are converting care environments to
ongoing learning laboratories (a redefinition of peer review)
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A Framework for Organizing
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Analytic System Components
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Deployment System Components
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Content System Components
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In Summary…
• Over the past century, organization’s have implemented increasingly
sophisticated methods to deal with complexity with impressive results
• These highly successful quality improvement and Lean methods are
beginning to impact healthcare
• Given the increasing focus on value, these techniques will be at the core
of any healthcare organization’s ability to weather the coming changes
• Managing the process of care requires an effective strategy to engage
clinicians, healthcare’s “smart cogs”
• Physicians will need to migrate from a craft-based style of practice to a
profession-based practice focused on shared professional accountability
• Organization’s will have to implement a sound improvement (value)
strategy with the necessary analytical, deployment and knowledge
components
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Thank You
Upcoming Educational Opportunities
The Importance of Data Governance
Date: First Week of May
Presenter: Dale Sanders Senior Vice President, Health Catalyst
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Healthcare Analytics Summit
Join top healthcare professionals for a high-powered analytics summit using analytics to
drive an engaging experience with renowned leaders who are on the cutting edge of
healthcare using data-driven methods to improve care and reduce costs.
Date: September 24th-25th
Location: Salt Lake City, Utah
Save the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014
For Information Contact:
John.Haughom@healthcatalyst.com
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