December 15, 2010
I’m attending the National Forum of the Institute of Healthcare Improvement. This is the largest and probably most influential international meeting of people working to improve healthcare. It is inspiring, as always. I am struck by several themes.
One of the faculty said Sunday, “We are excellent at everything, but not excellent everywhere.” It’s simple, but profound. What she is pointing out is that there are examples at this meeting, and in the improvement literature, of fantastic results in all aspects of health care. There are places that have achieved dramatic reductions in mortality, infections, and med errors, and improved the care of chronic disease and pain. However, there are no examples yet of places that have achieved excellence at everything across all disciplines (although some are getting close), and we certainly have not achieved excellence everywhere on the globe.
So that’s two issues: reliability and spread. We deal with them both here at Cooley Dickinson. We have improved CHF readmission, but not pneumonia readmission. We have reduced harm, but not in-hospital end-of-life management (too many folks come to the hospital to die).
Reliability is sustaining the gain: in manufacturing they call it ‘process control.’ In health care, we tend to improve when we are paying attention, but slip back when we move on to pay attention to the next thing. There is a whole science to reliability. Our colleagues in nuclear power, airline safety, and the military have figured this one out much better than we have.
Spread is the science of good ideas spreading — sounds easy — but it is the whole field of how human beings learn and change behavior. It, too, can be learned.
What is so striking to me is that the solutions in health care are out there. The challenge is to adopt them, adopt them all reliably, and spread the learning. That means ‘continuous improvement’ and continuous change.
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