A Declaration of Independence Is Only the Beginning

flying cadeuciiOn April 29, Dr. Daniel Croviotto published an editorial in the Wall Street Journal, “A Doctor’s Declaration of Independence,” in which he argued that it is time to “defy healthcare mandates issued by bureaucrats not in the healing profession.”

Dr. Croviotto does a good job of articulating his frustration with the increasingly burdensome bureaucracy and regulations placed on care. Many physicians and nurses share his frustration. I once did, until I saw a way out of the cynicism and frustration – a way that can improve the quality and lower the cost of care for all Americans.

No matter how misguided we think the federal government is in its electronic health record mandate or other requirements, simply defying mandates as Dr. Croviotto proposes is not  likely to accomplish much. Those who signed the Declaration of Independence knew it was only an initial step toward ridding the country of tyranny. They had to create a new vision for a better, more effective government.

Similarly, the medical profession needs to move beyond cynicism to create a vision for a better, more effective healthcare system.

Modern healthcare enjoys one of the most intelligent, educated and committed work forces of any industry in the world. However, they are trying to deliver care using a system that was developed over 100 years ago. While that system has carried us a long way, it is not designed to deal with the complexity that characterizes modern care.

Healthcare is long overdue in implementing a care management system that is better designed to deal with complexity and increase reliability. “Managed care” means managing the processes of care, not managing physicians and nurses.

We need to leverage clinicians’ skills and expertise to implement care processes that are efficient, reliable and waste free.

To get there, though, physicians will need to give up the traditional craft-based approach to medicine. For the last 100 years or so, medicine has consisted of an individual physician putting the healthcare needs of an individual patient before any other end or goal. The physician draws upon his or her clinical knowledge to develop a unique diagnostic and treatment regimen that is customized for each individual patient.

Unfortunately, healthcare has simply become too complex and costly to rely on this craft-based approach to deliver the right care to the right patient at the right time, every time. Doing so only introduces variation and unnecessary costs that contribute to the estimated $700 billion in medical waste each year.

Instead, clinicians must adopt a profession-based style of practice in which groups of peers, treating similar patients in a shared setting, develop standard, coordinated care delivery processes using standard evidence-based protocols. Individual clinicians can then adapt this standards-based style of practice to specific patient needs.

And organizations can use information systems and analytics to track the cost and quality of care against specific procedures, measure their effectiveness, and inform improvements.

What I’m describing is akin to the application of the Lean process improvement methodology that Toyota and hundreds of other businesses have used to eliminate waste and drive value. Just as it did for manufacturing, the Lean approach can help medicine produce less expensive, less complex care with better patient outcomes.

In fact, it already has. Under the visionary leadership of Dr. Brent James and others, Utah’s Intermountain Healthcare has demonstrated two decades of success using Deming’s principles of continuous process improvement to drive quality, patient safety, waste reduction and cost savings. Similar results are being achieved by other leading-edge healthcare organizations.

The Virginia Mason Hospital and Medical Clinic in Seattle began implementing Lean principles in 2002. Since then, Virginia Mason has demonstrated it can save capital, use staff more efficiently, reduce inventories, improve productivity, save space and improve care quality. These improvements have resulted in tens of millions of dollars in savings.

Eventually, all healthcare organizations, regardless of payment models and federal mandates, will need to emulate these improvement pioneers if they want to survive the transformation of healthcare.  We need to leverage the incredible progress of the past century and design a new system that is more effective, more efficient and more capable of creating optimal outcomes for patients and communities.

We need to move beyond skepticism and frustration to an era that will be characterized by hope, excitement and promise.

We have the necessary skills. The only question is whether we have the will.

John Haughom, MD,  former senior vice president of clinical quality, safety and IT for PeaceHealth, is a senior advisor to Health Catalyst and the author of Healthcare: A Better Way: The New Era of Opportunity.