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CEO Co-authors National Report on Methods to Improve Health Care
SEATTLE – (July 10, 2013) — Quality, safety, patient experience, value, efficiency and overall health outcomes would improve significantly if the principles of systems engineering were embraced by the American health system.
This is a key recommendation of a discussion paper titled “Bringing a Systems Approach to Health,” co-authored by Virginia Mason Medical Center Chairman and CEO Gary S. Kaplan, MD, and released today by the Institute of Medicine and the National Academy of Engineering. Read the document online.
“All of us in health care have a moral imperative to make it better, faster and more affordable,” said Dr. Kaplan, commenting on the paper’s theme. “Accepting the status quo will continue to deliver the kind of results we have experienced to date: a national health care system that is unaffordable for our citizens, unrealistic for businesses and unsustainable for our nation’s economy.”
In their report, Dr. Kaplan and his co-authors conclude that a structured, evidence-based systematic approach is necessary to address performance gaps, correct or mitigate inevitable human error, eliminate waste and variability, and encourage a culture of continuous improvement. They describe how a systems engineering approach, such as using lean principles as Virginia Mason does, can promote better health at lower cost by engaging the ways in which people, processes and organizations influence patient care. Routinely, these elements are poorly coordinated, leading to problems with safety and quality, as well as unnecessary duplication and waste. Systems approaches can be useful for all levels of the health system — from the patient and clinician interaction, hospital and organization, community, and nation — and have the capability to ensure health care operations consistently provide high performance.
“It is clear that urgent change is needed to improve the health system, given its safety, quality, cost and complexity challenges,” the report states. “A systems approach has improved quality and value in other industries, and it could be similarly transformative for health and health care.”
To illustrate the high potential of these approaches, the authors outline several case studies in which systems-based interventions have proved successful. In one example, Virginia Mason Medical Center implemented a common management methodology, adapted from the Toyota Production System, across its operations. This has reduced wait times, improved outcomes for patients, eliminated unnecessary clinical procedures and lowered cost. The authors note that Virginia Mason’s experience reveals institutional challenges in adopting systems approaches. Implementing a production system across an organization requires substantial leadership support and organizational culture shifts.
Hospital representatives from around the world now travel to Virginia Mason every year to learn about the Virginia Mason Production System and how to apply its methodologies to improve quality, safety and efficiency, and eliminate waste.
The discussion paper explains quality and safety shortfalls occur even as clinicians expend considerable time and effort caring for their patients. “The problem is not with the individuals working in the health care enterprise, but the design and operation of multiple systems in the health care enterprise,” the authors observe. “As currently designed, these systems depend on the heroism of clinicians to ensure patient safety and promote care quality. At the same time, they add unnecessary burdens to clinical workflows, silo care activities and divert focus from patient needs and goals.”
A systems approach would improve health care delivery by considering the multiple elements involved in caring for patients and influencing health. “By understanding how these elements operate independently, as well as how they depend on one another, a systems approach can help with the design and integration of people, processes, policies and organizations to promote better health at lower cost,” the report states.
The report emphasizes “patient needs and perspectives must be at the center of all process design, technology application and clinician engagement.”
The “Bringing a Systems Approach to Health” discussion paper emerges from the work of individual participants in the Systems Approaches for Health Innovation Collaborative of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care, in partnership with the National Academy of Engineering. It is part of the newest category of IOM publications — “Perspectives” — that offer personal observations and opinions of leading experts on developments in health and health care. “Perspectives” are aimed at informing the discussion on pressing issues before the nation.
About Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a nonprofit regional health care system in Seattle that serves the Pacific Northwest. Virginia Mason employs more than 5,300 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to health care delivery to eliminate waste and improve quality and patient safety.
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