The urgent need to shine a bright light on healthcare

A colleague asked me the other day what keeps me awake at night. I told him it's the general lack of urgency in healthcare.

Islands of excellence do exist within the nation’s healthcare system, but there is still too much variability and inconsistent performance in quality, safety and patient satisfaction. As a nation, we should be doing more to improve quality and safety, expand access, control costs and elevate the patient experience. And as leaders, we must be willing to make our defects and opportunities visible to our team members. Only with this level of transparency will we generate the organizational focus and the will to pursue the challenging and necessary work of improvement.

The National Patient Safety Foundation's Lucian Leape Institute, which recently merged with the Institute for Healthcare Improvement, observed in its 2015 report, "Shining a Light: Safer Health Care through Transparency," that harm from medical errors continues at unacceptable levels and the U.S. healthcare system is buckling under the costs of care.

All of us in healthcare should ask ourselves every day: "How can we become better at what we do?"

This is an urgent question given the critical nature of our work and the quickening pace at which information and knowledge are expanding.

Until around 1900, human knowledge doubled approximately every 100 years, according to R. Buckminster Fuller, creator of the Knowledge Doubling Curve. Some forecasters now predict that, by the year 2020, medical knowledge alone could double every 73 days.

This should be a catalyst for deepening our national commitment to improving health and healthcare delivery and, ultimately, making the care experience better for patients and providers. While there are many examples, here are three improvement opportunities worthy of urgent attention.

⦁ Apply a structured, systems-engineering approach to health care delivery. Standardizing processes where variability adds no value improves efficiency and controls costs, while also enhancing quality and safety. I know this evidence-based approach works based on our experience at Virginia Mason in Seattle, where we adapted Toyota Production System principles 15 years ago as the foundation for our management methodology.

⦁ Really listen to what patients tell us when we ask how we can make the healthcare experience better for them. Invite patients and their families to participate with healthcare providers, policymakers and insurers in improvement initiatives. Ask them to work side-by-side with us in developing and designing new facilities and programs. Many people consider clinical quality to be a given — something all hospitals should provide — and rate their care based on how they feel they were treated. We can never lose sight of the importance of quality and safety, but patient experience is critical.

Also, we must make sure individuals are fully informed about their healthcare choices and engaged in shared decision-making with their providers. The Lucian Leape Institute explained in its 2014 report, "Safety Is Personal: Partnering with Patients and Families for the Safest Care," that engagement leads to safer patient care by improving the outcomes of care, improving the experience of care for individual patients and improving the work experience for caregivers.

⦁ Nurture a healthcare culture that advances interdisciplinary collaboration and information-sharing among the broadest possible spectrum of care team members. This will empower experts, working together, to more effectively evaluate patients' needs and develop coordinated plans for appropriate care based on best practices. Silos are barriers to improving quality, safety and the patient experience.
We have more knowledge and evidence than ever before about how to provide high quality care and keep patients safe. What's missing is a national sense of urgency to consistently apply what we already know, and will learn, to improve healthcare delivery and benefit patients everywhere.

What keeps you awake at night?


About the author

Gary S. Kaplan, MD, is a practicing internal medicine physician who has served as chairman and CEO of Virginia Mason Health System in Seattle since 2000. He is also chair of the National Patient Safety Foundation’s Lucian Leape Institute. NPSF and the Institute for Healthcare Improvement merged on May 1, 2017. Dr. Kaplan is the recipient of the 2017 National Healthcare Award from B’nai B’rith International.

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