Presentation on theme: "Linking Quality to Health Cares 2nd Curve From Innovation to Transformation: Delivering and Sustaining Results Institute of Public Administration of Canada."— Presentation transcript:
Linking Quality to Health Cares 2nd Curve From Innovation to Transformation: Delivering and Sustaining Results Institute of Public Administration of Canada Quality Healthcare Network Minto Suites Hotel Ottawa, Ontario 21 January 2011 Martin D. Merry, MD, CM Adjunct Associate Clinical Professor of Health Management and Policy University of New Hampshire Faculty, American College of Physician Executives Faculty, Center for Healthcare Governance, American Hospital Association
2 An Invitation No problem can be solved from the same level of consciousness that created it. We must learn to see the world anew. - Albert Einstein
3 1st 2nd
4 1 st Curve Founders: The Four Doctors Welch Halsted Osler Kelly
5 The most important event in the history of American and Canadian medical education
6 "... for the first time in human history, a random patient with a random disease consulting a doctor chosen at random stands a better than 50/50 chance of benefitting from the encounter." 1912 : The 'Great Divide' Harvard Professor L. Henderson (Harris, Richard. A Sacred Trust. New York, NY: New American Library, 1966)
7 Time Circa Historical Curves of Health Care Innovation (derived from Kuhn, Toffler, Morrison, Merry) (Bifurcation curve: 2011) First Curve/ 4 sigma (Craft-Age Culture) (Craft+Information- Age Culture ) - Future Performance (Second Curve/ 6+ Sigma) Crossing the Chasm Performance
8 1 st Curve Health Cares Performance Problem 1 st Curve Health Care (Craft Culture) 90% OK 100,000 95% OK 50,000 99% OK 10,000 SigmaDefects per million 1690, , ,800 46,
10 1 st Curve Legacy Medical errors as 5 th - 8 th leading cause of death in US 44,000 – 98,000 deaths annually
11 May 25, 2004: We learn that Canada, too, is infected.
12 The 21 st Century/ 2 nd Curve Flexner Report?
14 What we MUST understand: The emergence of 2 nd Curve Health Care represents a Management, not Clinical paradigm shift. This fact has huge implications for leaders at all levels of the organization.
15 How 2 nd Curve Is Happening Evidence-based medicine Clinical protocols Disease-Line Management Rapid cycle PDCA Lean Six Sigma IT:EHR, Telehealth Clinical Microsystem Design Team-based care New models of System- Community relationships Community health innovation Strength based change (e.g., Appreciative Inquiry) Health Cares beginning ascent of its 2 nd Curve: Re-designing care systems around those served – while restoring the joy of practice to caregivers
16 Board of Trustees Credentialing Departmental (Peer) Review Surgical Case Review Blood UR Drug Usage Review Pharmacy and Therapeutics Medical Records Medical Staff Functions (Silo 1) Nursing Ancillary Laboratory Radiology Physiotherapy Risk Management Finance, Planning Regulatory Agencies Etc. Hospital Functions (Silo 2) Chief Executive Officer Medical Staff Executive Committee Our Structural Heritage, Our structural fatal flaw Management: Departments Physicians: Specialties 2011: The Structure Hierarchy, Fragmentation, Communication gaps, Misunderstanding, Power Struggles, etc.
17 Fast Forward: Community Memorial Hospital, Menomonee Falls, Wisconsin
18 Cardiopulmonary Care Obstetrics, Gynecology, Perinatology,Pediatrics, Neonatology Management and Coordination of Care Participation Leadership Patient/ Community Primary Care Internal Medicine, Medical Specialties, Family Practice, Hospitalist, Psychiatry, Emergency Medicine* Women & Children Care Management Design K:\S\wp\7350(953)\misc\janice8.ppt COMMUNITY MEMORIAL HOSPITAL Menomonee Falls, Hospital Administration Hospital Board Medical Executive Committee Collaborative Practice Credentialing Performance Improvement Cardiology, Cardiothoracic Surgery, Pulmonology, Vascular Musculoskeletal Care Orthopedics, Podiatry, Neurosurgery, PM&R, Radiology* General Surgery, Surgical Specialties, Anesthesia* Surgical Care Radiation Oncology, Medical Oncology, Pathology* Cancer Care Performance Improvement Teams / Clinical Microsystems Caregivers * Specialties provide care in all service lines
20 Patients and Families as Part of the Care Team
21 Seek first to understand, then to be understood. - Stephen Covey
23 1 st Curve 2 nd Curve Evolved around medical and hospital practices Disease focus, one patient at a time Hierarchical, physician controlled Performance problems assumed as people-caused Culture of blame Fragmentation of care givers and health care functions, hand-off gaps common Medical records paper, frag- mented, owned by caregiver Complexity frequent errors, harm to patient Quality is compliance-oriented, 2-4 sigma common Reactive to sentinel events Designed around patient/ community, population need Health, prevention focus, patient plus population Team-based systems outperform hierarchy Recognition that performance problems 95% systems-based Just Culture Integration of all system elements, care seamless for patients EHR, smart cards owned by patients Integration of quality sciences minimizes error, harm Quality, value oriented toward 6+ sigma, O preventable harm Pro-active, Resilience-led
25 Senges Five Disciplines Personal Mastery Mental Models Team Learning Shared Vision Systems Thinking (1 st Curve health care, for all of its positives, focused almost solely on Personal Mastery. As many have shared at the meeting, all five disciplines are essential to Learning Organizations., and the 2 nd Curve.)
26 As John Maynard Keynes once noted... The hardest thing is not to get people to accept the new ideas, it is to get them to forget the old ones. Or, as Max Planck, a pioneering 20th Century physicist once remarked, Scientific progress moves forward, one funeral at a time.
27 Command & Control Pyramid (Taylorism, circa 1900) Top Management Obedience Commands Hint: Doesnt Work Anymore
28 The New Leadership: Creating Context Farmers dont grow crops; they create conditions under which crops can grow. - Stephen Covey Question: In my leadership role, am I creating a fertile field for a) the growth of modern quality/safety practice and b) a fundamentally different form of top- down/bottom up collaboration?
29 Stewardship/Servant Leadership (Covey, Block, others) Top Management Resources/ Support Caregivers/Innovation Those We Serve
31 The ThedaCare Breakthrough Realizing that ThedaCare needed change, leaders tried one improvement program after another over the course of many years. Most of the programs offered incrementally better results for a while, until everyone slid back into old habits. Finally.. Leaders started thinking about breaking down the divisions between caregivers specialties, divisions of labor and habits of working to create a unified focus on the patient. Because this would require change in everyone involved, it was clear that hospital units needed a revolution instead of isolated, incremental adjustments.
32 Todays Leader Todays leader is not someone who knows all the answers…or who makes decisions and gives orders in the old military model of leadership. Rather, the new leader is someone who can assess a situation, bring people together, build consensus, and discover solutions, building on the talents of everyone involved. The new leader is a facilitator, a communicator, a team builder. - Diane Dreher, The Tao of Personal Leadership
33 Best of 1 st Curve Aviation 2 nd Curve
34 There are many ways to ascend Mt. Washington – auto road, cog railway, and many hiking trails. My best wishes to you Leaders on Ontario Health Care as you ascend your path toward 6 sigma health care! 6+ sigma! Thank You!