I recently received my April issue of Harvard Business Review. This issue has several excellent articles in a Spotlight on Fixing Health Care. My recommendation – go to the local bookstore and buy it or buy reprints from the www.hbr.com website. Note that Harvard Business Review is very picky about making copies of their articles.

Turning Doctors into Leaders

HBR article summary:

• Health care delivery is fragmented and chaotic, principally because of an explosion of knowledge and technological advances. Taming this chaos requires a new breed of leaders at every level.
• Health care’s new leaders must organize doctors into teams; measure their performance not by what they do but by how their patients fare; deftly apply financial and behavioral incentives; and dismantle dysfunctional cultures.
• By organizing care delivery around patient’s needs – an idea more radical than it sounds – the leaders of cutting-edge health care organizations are raising the quality, efficiency, and value of the services they provide.

This article’s headings are closely aligned with the Baldrige Criteria: Articulating Vision and Values (Category 1 – Leadership), Organizing for Performance (Category 5 – Workforce Focus), Developing a Measurement System (Category 4 – Measurement, Analysis, and Knowledge Management), Building Effective Teams (Category 5 – Workforce Focus), Improving Processes (Category 6 – Process Management) – and a great ending – Dismantling Cultural Barriers.

I encourage you to read this article with the Baldrige Core Value of Managing for Innovation in mind. The examples given describe organizations that fundamentally change the way they provide care in a manner that drives improved outcomes. They also are making changes that require the integration of physicians into the change process.

Health Care Needs a New Kind of Hero

An interview with Atul Gawande, whose book The Checklist Manifesto, talks about how the simple “checklist” tool can reduce mistakes and save lives, in addition to driving greater efficiency and teamwork. If it’s intriguing, buy the book. I haven’t read it yet, but it’s on my “must-read” list.

Consider this simple tool as a method to help hardwire practices that will drive outcomes in your Quality pillar. Also consider in this article how physicians are integrated into teams – moving from a culture where “we celebrated cowboys, but what we need is more pit crews.”

Fixing Health Care on the Front Lines

This article basically says that health care delivery is based on an old model, but with greater information available we should be changing the way care is delivered.  Process must be changed to provide this type of care – consider Baldrige 6.1 – Work Systems (How do you design your work systems?) and 6.2 – Work Processes (How do you design, manage, and improve your key organizational work processes?)

HBR article summary:

• Many of the proposals for improving the quality and curbing the rising costs of health care call for radically changing either the players or the rules governing them. The approaches won’t work. Regardless of what happens to reform efforts, the only realistic hope is for existing general hospitals, clinics, and physician practices to redesign themselves.
• No single organizational design will fit all, but there are common design principles. Organizations should configure themselves to excel at three tasks: applying scientifically established best practices for treating well-understood diseases, using trial and error to deal with conditions that are complicated or poorly understood, and capturing and applying learning generated by day-to-day care.

Four design principles are highlighted in the article:

1. Manage the Care – decisions, tasks, and workflows crucial to optimizing patient care must be the organization’s primary focus.
2. Corral Variability – High- and low-variability care must be separated. Consider the use of checklists (above) in the low-variability care – low-variability care is why we have core measures that measure standardization of treatment.
3. Reorganize Resources – When health care delivery organizations redesign clinical processes, they must also redesign the supporting infrastructure and practices.
4. Learn from Everyday Care – structure and processes of hospitals, clinics, and practices must be designed to help organizations learn from daily work.

This article truly strikes at the heart of what Baldrige Category 6 is all about…

These three articles provide multiple examples of organizations that are doing what the articles describe. Many are larger organizations like Intermountain Healthcare, Virginia Mason, and Mayo Clinic. Smaller organizations can learn from these innovators and bring the innovations into their organizations.