I took the day off from work on Friday, left at 5am to drive to Glenwood Springs for a Colorado Association of Healthcare Executives (CAHE) conference.One of the topics was "Using Lean Principles to Optimize Workflow and Quality in Cardiology Care". The speaker mentioned Deming (same guy that my statistics teacher had us read a book about). Basically, the talk was regarding applying Industrial Engineering concepts to healthcare (without calling them that). I spoke with him afterwards because I am still trying to figure out why the healthcare industry hasn't caught on to the basic concepts that most businesses have been doing for 20 years. I suggested my theory that even though there are plenty of people with their MBAs in the hospital, most of them have medical undergrad degrees or backgrounds. They get their MBAs but never leave healthcare, so they don't see it implemented in the real world and have a hard time doing it themselves. He agreed with me and encouraged me that my educational background and prior work experience could be very valuable if I continue in the field.
I'm just trying to figure out who's really running the show and what leadership position I would need to be in to make a difference. Plenty of hospitals have Process Improvement or Quality teams/departments. Even the hospital I'm at has one. They make departments choose a Performance Improvement project. I even get solicited from RNs that want to use the EMR to help them on a improvement project, so they can get a certification. To me, it is just like Bob Nardelli trying to bring Six Sigma to Home Depot. There is a group dedicated to Six Sigma. They all have their black-belts and guide those working on Six Sigma projects throughout the company; however, from my perspective few of the projects seemed to be completed. I'm guessing perhaps people got a little busy working until 4am on a Sunday preparing for a quarterly earnings call. There is a similarity in these examples, and it's that the leadership perhaps likes the idea and thinks it should be happening, but ultimately it is not a priority.
The speaker made a comment that followed the information in "If Disney Ran your Hospital, 9 1/2 Things You Would Do Differently." The comment was that the culture change has to come from the top and not just mandated, but the top leadership has to really believe in it. Of course, you balance that with every other issue going on (just check out Eileen's blog), and it becomes difficult to manage. Ahh...then it just becomes like politics to me. Everyone has their one area they care the most about and they fight for that one. So the person at the top trying to make everything balanced and fair doesn't really stand a chance. I care about efficiency and processes because it's what I know. The only difference I see is the topic I care about most, if applied, could probably help in all the areas others care about. Streamlining and making processes efficient should save you time or money that you can apply to other areas. It just takes a lot of effort upfront, which what I've learned from trying to implement an EMR, no one has the time to give. I questioned how the speaker was able to make changes in the Cardiology department. He's the administrator and the key was he made changes to staff issues and left the doctors alone. They benefited from the change but didn't have to put in any significant effort to make it happen. Honestly, I wouldn't tell him this but the changes he made could have been done by an Industrial Engineering Senior Design project team.He also mentioned to me that he thought healthcare was about 5 years behind getting traction on these ideas. He made a distinction between "lean" concepts and something like "Six Sigma". He said most companies implementing Six Sigma have already gone through the lean process. They are starting out with somewhat trimmed down, lean processes. The Six Sigma method then improves these. The lean concept focuses on "Plan, Do, Check, Act" (the Deming cycle). He thought most hospitals had problems with the "check" and "act" part of the process. He had to get help from an outside source when trying to implement changes in his own hospital because he didn't have the experience or education to do it himself. I've seen at my current work that people are asked to do things they have no experience in and are given no guidance. Often, there are good ideas but they get lost in poor execution. That's an interesting topic "poor execution". I saw it demonstrated at Home Depot and now the hospital. There is a book on the topic, perhaps my next read.
