Medical Device Daily Contributing Writer

CHICAGO — The World Health Care Congress (Woburn, Massachusetts) held its 2nd annual Leadership Summit on Process Improvement and Business Excellence in Healthcare here last week, bringing together top leaders from hospitals, suppliers and other key policy makers with the mission of advancing the quality of patient care along with improving efficiencies within the realm of providing that care.

The objective of teaching hospital executives how to improve their hospital's performance using advanced business tools is in many respects no different than running a corporation such as Toyota North America (New York), Hewlett-Packard (Palo Alto, California) or Cardinal Health (Dublin, Ohio) all of whom shared their keys to business success.

The ways that Lean and Six Sigma, leading-edge organizational tools, eliminate errors and increase efficiency in corporations were translated into the hospital setting.

But in some regards, implementing these organizational tools into a hospital is quite different than running other types of business operations, since the mission of the hospital is caring for a patient, which becomes a very complicated matter.

William Hamman, MD, PhD, a captain with United Airlines (Chicago) and director of the Center of Excellence for Simulation Research at Western Michigan University (Kalamazoo, Michigan), said, "One of the key differences in treating a patient versus flying an airplane is that the role of leadership vs. authority is not as clear in a hospital."

Being both a commercial airline pilot and a cardiologist, he clearly understands the differences between operating an enterprise and running a hospital. "When you are flying an aircraft, it is quite clear to everyone that the person in the left seat with the most amount of stripes on his uniform is in charge."

However, Hamman said, "when a trauma patient enters the Emergency Department with multiple different clinical problems, it is unclear as to which specialist should have the final authority over that patient — and this is where systems and processes must take over for the safety of that patient."

He added, "The disorganization that occurs in the absence of systems and processes being in place is what pulls the medical care provider away from the care of the patient."

The shift from total authority to team performance has evolved over the past decade and has become critical in both improving patient care as well as in running a business.

Under the sponsorship of a Michigan Life Science Research Grant, Hamman has been able to collect, for the purpose of teaching, real-time video clips of clinical activities in order to improve the quality of patient care as well as efficiencies of operations.

He shared several video clips with the audience, at first seeming somewhat similar to watching YouTube, but that quickly turned into a poignant demonstration of how mishaps occurred in the delivery of patient care. Key stumbling blocks common to several of the vignettes included poor communication among team members and disorganization or misplacement of needed supplies or equipment.

Using Six Sigma methods, it became obvious as to how miscommunications were made and how much production time was being wasted looking for supplies or going to get equipment that was not conveniently located to its point of use. In every case, when the problem was identified and a process was implemented to solve that problem, the quality of patient care was improved and there was also an associated improvement in cost savings and patient satisfaction.

Although each speaker cited distinct and important elements of Lean and Six Sigma that enabled their improvement in performance, several recurring themes appeared to be most pertinent to delivering safety and quality of patient care (see table).

Another recurring theme was that the ability to practice better patient safety is available but the tools to do so are not widely in place yet: thus the appeal for hospital administrators to implement Six Sigma, Lean, or other organizational processes. According to Joel Ettinger, chairman/CEO of Category One, "We have enormous resources in our hospital communities and we need to capture that talent and accelerate it. We have more talent than any other industry ... well, except maybe NASA."

He added, "It is time to lead our industry into excellence. We should want not only to take care of the patient in bed but also to be a role model and to teach the world on how to do it best."

Ettinger said, "Evidence-based medicine is the same as evidence-based management — that is a proven, validated management practice. When a systems-based perspective pervades an organization, then we see improvement."

Joel Cohen, PhD, director of the Division of Social Economic Research Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality (AHRQ; Rockville, Maryland), echoed these sentiments by noting that the mission of AHRQ is to do just that: to provide expertise and tools for improvement in patient safety.

"The U.S. spends 50% more money on healthcare than any other country and yet Americans are less healthy than most civilized countries, having the highest rate of obesity and chronic diseases," Cohen said. "It does not make sense that the U.S. spends more and has no better outcome than other countries."