Tuesday, November 10, 2009

Ideas for a better health care 1

After reading a number of articles on health system improvement, it occurred to me that I should be writing the good ideas down, for my own record and for others to read. Obviously they flow in as I read, so there will continue to be many versions of this post.

What aspects contribute to a high-performing health care system?

1. Uniformity: the importance of uniformity is greatly illustrated by Paul Levy and the pig-drawing exercise. It is also reiterated in the famous NYT article on Intermountain Healthcare. Uniformity is crucial to quality improvement - variations cause deviations from standards of care/best practices, variations allow improvisation which leads to medical errors. More importantly, we can't inspect quality with variations. Think about quality inspection in a factory, say of buttons - to inspect quality effectively, the buttons must be uniform and look like the prototype. Without the prototype (standard of care), you won't be able to tell if the buttons look the way they are supposed to look, and you won't be able to tell if the new models of buttons look better than the last, if the buttons in each batch are all different. Of course, there are parts of healthcare that should be individualized, but the fact that we are all human beings means that parts of most things can be standardized.

2. Data is power: without data collection, many capabilities are lost. Data is everything - it can be used to leverage an institution's capability for research, but more importantly it is crucial for quality control. More and more leading institutions (Kaiser Permanente and Intermountain Healthcare) have been using collected data to monitor how each of their units/physicians/other health staffs are performing compared to hospital average/national average. This is quality control that all reputable businesses do on a daily basis - it is horrifying to think that the industry that deals with human lives can get away with doing none. (However, one must be careful of what the consequences of these measures should be.) On the same note, transparency is a boon. If good advances have been discovered, it's only wise to share this information with everyone in your institution so that they can spread these improvements and apply them to their work. If adverse events happen, it's also wise to spread the details of how they happened, so that others can learn from the mistake and chime in on how to avoid the same mistakes next time around.

3. Align incentives: reward wisely - and not with just money. Quality outcomes should be the goalposts, and not the amount of work done - doing more usually means inefficient use of resources that doesn't translate to better outcomes. There is also value in rewards that aren't money, like self esteem, pride in doing a spectacular job, being part of an impact. These rewards usually get people going farther and longer than money.

That's all I've got for now - more pearls will be added as I run into them!

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