href="http://bpmforreal.files.wordpress.com/2012/04/8513650_s.jpg"> class="alignleft"

src="http://bpmforreal.files.wordpress.com/2012/04/8513650_s.jpg?w=300"

alt="" width="270" height="243" />As shown in

href="http://www.thetibcoblog.com/2012/04/27/the-healthcare-reform-that-cant-be-stopped/">Healthcare

Reform That Can't Be Stopped, the Toyota

Production System has found a home in healthcare. The

Wisconsin-based TPS pioneer, ThedaCare, has been employing

Toyota's industrial efficiency principles in its

hospitals to great effect for more than 10 years. Thedacare is

now seeing great interest from other organizations, as the

healthcare industry moves to reap the rewards of its move to

digitize information. So much interest, in fact, that it has

created the ThedaCare

Center for Healthcare Value to help other organizations

realize the promise of continuous performance improvement. Its

head, former ThedaCare CEO Dr. John Toussaint, doesn't

mince words when he talks about what's bringing all

those organizations to his door - and it's not federal

legislation.

"Healthcare performance

was and still is unreliable," he says flatly.

"Those who are honest about what they're

doing recognize that. Twelve years ago, ThedaCare compared

manufacturing and healthcare quality and found healthcare to be

far worse: 90,000 to 100,000 defects per million opportunities

[versus the three defects per million norm in manufacturing].

That's quite frankly still how U.S. healthcare

performs. A 2010 href="http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf">HHS

Study said we were killing 15,000 Medicare patients per

month with medical errors. The NIH's href="http://www.ncbi.nlm.nih.gov/books/NBK22857/">Crossing

the Quality Chasm in 1999 showed the same thing. When

you peel back the onion, we're doing really lousy;

maybe it has even gotten worse. Those of us who have been in the

business of quality improvement have been trying to understand

why that is and implement processes to change

that."

As

proof of the effectiveness of its data-driven reform efforts, Dr.

Toussaint points out that ThedaCare's Collaborative

Care has reduced medication reconciliation errors - that is,

errors from incorrect or conflicting orders for medications - to

zero and maintained that number for four years. Toussaint also

points out that their published href="http://content.healthaffairs.org/content/30/3/422.extract">thirty-day

readmission rate of under 9% is less than half the

national average.

Whether reform is repealed

or not, Toussaint says, "The reform initiatives in the

private sector have already begun and there's no going

back because there just isn't any money left.

Healthcare delivery organizations are going to learn to live with

less revenue. We have big problems that won't be solved

by throwing more money at them. We can either cut the healthcare

workforce by x percent

while reducing quality or we can use data and a proven

methodology to make it less expensive and maintain quality. This

transcends whatever happens in Washington."

Does the Toyota method work in smaller, specialty

healthcare? Seattle Children's has been focused on the need to

reduce variation in care. Dr. Howard Jeffries is the Medical

Director of Continuous Performance Improvement and a practicing

cardiac intensivist. He believes that regardless of the outcome

in Washington, hospitals will be required to assume risk in the

form of bundled payments models where both government and

commercial insurers will pay a fixed amount for a specific

treatment cycle. "The only way to survive is to predict cost. We

can't negotiate these rates until we know what our costs are, so

our goal is to reduce variation as much as we can."

Jeffries states that Seattle Children's wants the only

variation in process to be around the patient's response to

treatment. "What's unique about us is that other care

providers are trying to standardize as much as they can around

the patient visit in peripheral ways, but we're

standardizing what we're doing when we're

making clinical decisions for seeing a patient. We're

also looking at standardizing all other aspects of care from how

you move through the system to what types of medication

you'll receive, including discharge and follow-up

visits."

Jeffries' data-focused approach has

the goal of standardizing care for 50% of Seattle Children's

patients within five years, up from the current 18%, but far

higher than the 8% they discovered when they started one year

ago, a number very common in the industry. They'll need to tackle

increasingly challenging care paths as the laws of diminishing

returns kick in.

Asked how they create

standards and reduce variation, Dr. Jeffries says, "We

talk about it a lot, about the goals and why doctors practice.

Are you a doctor to do what you want or to provide good care to

your patients? The only way you can know is to measure and to

have a standardized practice. If you don't have a

standard practice, anything you do differently is just

noise."

Dr. Jeffries also expects

the rise of the Accountable Care Organization (ACO) where

healthcare will be paid a fixed amount to manage a population of

patients, including their outpatient needs. "This will require

efficient networks of providers working with tight collaboration

toward a common goal."

Up Next:

Intervention While The Patient Is Still

Healthy

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