Archive for the ‘Quality Improvement in Health Care’ Category
Investing and Healthcare — The Quality and Learning Link
A couple of years ago, my colleague Jim Porto at UNC Chapel Hill asked me to teach a two-day seminar on performance psychology, and I loved it. My students, on the other hand, initially evidenced a normal distribution, with agnosticism as the mean. In other words, a small number loved it, a small number hated it, and most figured it was a necessary block to check before moving on to more productive things. As I continued to teach it and my skills presenting the materials became better, the response improved, and, because the materials were taken from research rather than the self-help section at Borders, the impact has been rewarding (and the student evaluations would make my mother proud).
Well, I no longer teach the seminar (having handed it to others who are every bit as capable), but I’ve retained interest in the topic. Over the winter holidays, I read Malcolm Gladwell’s Outliers and Geoff Colvin’s Talent is Overrated. While both are interesting (Colvin’s is better, despite Gladwell’s higher standing on the New York Times Best Seller list), I decided to apply Jacobi and invert – looking at the causes of failure.
Healthcare Camouflage
Open the New York Times last weekend and there were two articles concerning healthcare quality in the United States. The first recounts the efforts by New York State government to close or consolidate hospitals with high patient-harm rates. The first indication that such closures are exceedingly difficult is the necessity of creating a special, independent commission. When elected representatives lack the spine or the consensus to do that for which they were elected, an independent commission is often the solution of choice.
Clinical Pathways and The Story of O
Newton wrote the Principia (the most influential, non-religious text in human history) in 1684. His three laws of physics and theory of gravitation are contained within it. Almost immediately there was controversy, when Leibnitz published his text creating calculus, and Newton off-handedly claimed he had invented calculus in order to perform his research for the Principia. The issue is not resolved until Newton produced his working papers – with credit ultimately given to both for this monumental advance.
The Google Model of Healthcare Quality and Advertising
The Google model — trading advertising for quality:
http://www.nytimes.com/2008/11/24/business/media/24carr.html?em
The article notes that Google rarely advertises its new functionality, but, having built a better mouse trap, users seek and adopt it — because, by reputation and past exposure, it consistently delivers on three fronts … simplicity, utility, and price … the constituent attributes of its character and persona. With each new addition, a web of use and reliance follows, creating a barrier to exit for the consumer and more strongly establishing customer loyalty.
Tiered Healthcare System?
In my Quality Controls class, a number of students have been debating the merits and detraction of a tiered healthcare system, where the wealthy have the option of buying high-end services and the poor get the quality of services their wallets and government support can afford. Here is my take on the question.
Healthcare Quality Thoughts from Recent Work
(Painting of Magnolias in a Bowl referenced later)
It is during the summer that I take a break from teaching and focus on consulting projects that keep me current in the field of management and prevent me from feeling sequestered from the competitive healthcare market. This posting is devoted to some common healthcare management themes identified during recent consulting projects and conference presentations.
CQI In Complex Industries
The distinction between Total Quality Management and Continuous Quality Improvement is that CQI has been modified for healthcare environments. While earlier postings discuss the success of TQM on the factory floor and in production operations, it may be helpful to contrast that side of industry with something more akin to healthcare, such as information technology (especially, software design and development).
Like a Hamster on a Wheel — Time Management Versus Innovation
Reference: High School’s Worst Year?; For Ambitious Teens, 11th Grade Becomes a Marathon Of Tests, Stress and Sleepless Nights. Jonathan Kaufman. Wall Street Journal. (Eastern edition). New York, N.Y.: May 24, 2008. pg. A.1
I often wonder whether the “Life-Long Learner” is a conceptual myth. It isn’t that we can avoid intellectual growth as we age – it is all but compelled by the speed of change. Nor is it sustaining the love of learning that has me uncertain about whether the life-long learner remains viable. Instead, as the father of a high school junior, a teacher of undergraduates and graduate students, and as a consultant working with physicians, I see the problems from several informing perspectives.
Cavetching On-Line — The WWW.BullHorn for Patient Complaints
Studies indicate that it takes three times as many satisfied customers to overcome the damage to reputation from a single dissatisfied customer. Why? The satisfied customer will tell 21 of their closest friends about the negative experience, while the satisfied customer will tell just seven.
I’ve mentioned this statistic in previous postings, and I have gone so far as to note that it is not the average of three-to-one that is so compelling, but the disproportionate influence of the outlier. A single highly dissatisfied customer, possessing an abundance of motivation and friends, or one that is particularly well regarded in the community, can represent a business’s worst nightmare.
All Hail the Healthcare Simpleton — Easy Interventions Produce Dramatic Improvements
Dr. James Reason, M.D., is credited with creating the heuristics for identifying the causes of error… not in healthcare, but, instead, for the airline industry. He identified and catalogued the causes of human error, and the Federal Aviation Administration took them to heart in an effort that significantly reduced the frequency of airline accidents.
Dr. Reason, however, should not be considered a great catalyst of success in an altogether different industry without taking into account Jay Forrester. Forster, the father of Systems Thinking and Systems Dynamics, identified the causes for why we tend to get precisely the opposite result from those our systems and practices are designed to produce. He recognized that small influences at the start of a process tend to promote significant consequences at the end of the process, and that this works for, both, good and ill.
In “The Tipping Point,” Malcolm Gladwell describes the efforts of the Giuliani administration in New York to combat crime – focusing on arresting turnstile jumpers and whitewashing graffiti artists. While the law and order crowd credits the eventual success in reducing New York City crime to a “zero-tolerance” posture on infractions large and petty, it appears that this relatively low cost focus on turnstile jumpers and graffiti artists achieved precisely what Jay Forrester advocated. Namely, focusing on small and seemingly insignificant leverage points early in the process to achieve dramatic outcome improvements. ["The Tipping Point" book, lecture by Gladwell at the TED on spaghetti sauce and at the 2007 New Yorker Conference on genius.]
