Presentation on theme: "Linking Quality to Health Care’s “2nd Curve”"— Presentation transcript:
1 Linking Quality to Health Care’s “2nd Curve” From Innovation to Transformation: Delivering and Sustaining ResultsInstitute of Public Administration of CanadaQuality Healthcare NetworkMinto Suites HotelOttawa, Ontario21 January 2011Martin D. Merry, MD, CMAdjunct Associate Clinical Professor of Health Management and PolicyUniversity of New HampshireFaculty, American College of Physician ExecutivesFaculty, 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
4 1st Curve Founders: “The Four Doctors” HalstedKellyOslerWelch
5 “The most important event in the history of American and Canadian medical education”
6 1912 : The 'Great Divide'"... 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."Harvard Professor L. Henderson(Harris, Richard. A Sacred Trust. New York, NY: New American Library, 1966)
7 (Craft+Information-Age Culture ) 2 Historical Curves of Health Care Innovation(derived from Kuhn, Toffler, Morrison, Merry)Future Performance(Second Curve/6+ Sigma)First Curve/4 sigma“Crossing the Chasm”(Craft+Information-Age Culture )Circa 1910(Craft-Age Culture)Performance(Bifurcation curve: 2011)Time -
8 1st Curve Health Care’s Performance Problem SigmaDefects per million1690,0002308,000366,80046,210523063.41st Curve Health Care (Craft Culture)90% OK ,00095% OK ,00099% OK ,000
14 What we MUST understand: The emergence of 2nd 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 2nd Curve Is Happening Evidence-based medicineClinical protocols“Disease-Line” ManagementRapid cycle PDCALean Six SigmaIT:EHR, TelehealthClinical Microsystem DesignTeam-based careNew models of System-Community relationshipsCommunity health innovationStrength based change(e.g., Appreciative Inquiry)Health Care’s beginning ascent of its 2nd Curve:Re-designing care systems around those served – while restoring the “joy of practice” to caregivers
16 Our Structural Heritage, 1917-2011 Our structural “fatal flaw” Board of TrusteesMedical Staff Executive CommitteeChief Executive OfficerMedical Staff Functions(“Silo 1”)Hospital Functions(“Silo 2”)CredentialingDepartmental (Peer) ReviewSurgical Case ReviewBlood URDrug Usage ReviewPharmacy and TherapeuticsMedical RecordsNursingAncillaryLaboratoryRadiologyPhysiotherapyRisk ManagementFinance, PlanningRegulatory AgenciesEtc.Physicians:SpecialtiesManagement:Departments2011: The Structure Hierarchy, Fragmentation, Communication gaps, Misunderstanding, Power Struggles, etc.
17 Fast Forward: Community Memorial Hospital, Menomonee Falls, Wisconsin
18 Patient/ Community Hospital Board Women & Children Care Primary Care COMMUNITY MEMORIAL HOSPITAL Menomonee Falls,Hospital BoardWomen & Children CarePrimary CareMedical Executive CommitteeHospitalAdministrationObstetrics, Gynecology,Perinatology,Pediatrics,NeonatologyInternal Medicine, Medical Specialties, Family Practice, Hospitalist, Psychiatry, Emergency Medicine*Management and Coordination of CareParticipationLeadershipCardiopulmonary CarePerformanceImprovement Teams /Cardiology, CardiothoracicSurgery, Pulmonology, VascularRadiology*Neurosurgery, PM&R,Orthopedics, Podiatry,Musculoskeletal CareCollaborativePracticeManagementDesignPatient/CommunityMicrosystemsClinicalCredentialingCaregiversPerformance ImprovementRadiation Oncology, Medical Oncology, Pathology*General Surgery, Surgical Specialties, Anesthesia*Surgical CareCancer Care* Specialties provide care in all service linesK:\S\wp\7350(953)\misc\janice8.ppt
23 1st Curve 2nd Curve Evolved around medical and hospital practices Disease focus, one patient at a timeHierarchical, physician controlledPerformance problems assumed as people-caused“Culture of blame”Fragmentation of care givers and health care functions, “hand-off” gaps commonMedical records paper, frag-mented, “owned” by caregiverComplexity frequent errors, harm to patientQuality is compliance-oriented, 2-4 sigma commonReactive to “sentinel events”Designed around patient/ community, population needHealth, prevention focus, patient plus populationTeam-based systems outperform hierarchyRecognition that performance problems 95% systems-based“Just Culture”Integration of all system elements, care “seamless” for patientsEHR, “smart cards” owned by patientsIntegration of “quality sciences” minimizes error, harmQuality, value oriented toward 6+ sigma, O preventable harmPro-active, Resilience-led
25 Senge’s “Five Disciplines” Personal MasteryMental ModelsTeam LearningShared VisionSystems Thinking(1st 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 2nd 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.”
28 The “New Leadership:” Creating Context “Farmers don’t grow crops; they create conditions under which crops can grow.”- Stephen CoveyQuestion: 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) Those We ServeCaregivers/InnovationResources/SupportTop Management
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 Today’s LeaderToday’s 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
34 6+ sigma!Thank You!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!