Health Systems Health Care Organizations

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Health SystemsHealth Care Organizations

• James D. Bales, Jr., MD, FACP
• Washington State Diabetes Collaborative 5
• February 2006

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Health Care Organization

• In Washington State Collaborative 4
• Private and Solo Practices
• Private Group Practices
• Large Group Practices
• Hospital Owned, Corporate Practices
• Government Local, State, and National
• Affluent and Poor

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System Thinking

• The Chronic Care Model is a Change in the way we
  do Business
• Why Change?
• The Health Care System is Not working.
• In the US - it costs more for care
• In the US the outcomes are worse
• Trying harder will not work
• Changing the System will
• (IOM Quality Chasm Report)

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System Thinking

• System vs WIIFM (Whats in it for me!)
• Senges Five Core Disciplines of the Learning
  Organization
• Personal Mastery
• Mental Models
• Shared Vision
• Team Learning
• Systems Thinking
• Peter M. Senge The Fifth Discipline

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Laws of Organizational ChangeJoiner Associates

• Things are the way they are because they got that
  way
• Unless things change, they will likely remain the
  same
• Change would be easy if it werent for all the
  people
• People dont resist change, they just resist
  being changed

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Organizational SupportTop Down

• Deming refused to go to Ford until the CEO
  invited him, sat and listened, and committed to
  the idea Result was Team Taurus
• You can do some changes and improvements without
  the bosss support or knowledge but it is
  likely to be frustrating, energy draining and
  eventually fail
• Individual, extraordinary, heroic effort is
  rarely sustainable
• Do it anyway

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Organizational SupportBottom Up

• Formal and Informal Power Structure
• Respected Clinical Champion
• Peer Review to Enhance Participation
• Participation Leads to Commitment
• Data, Data, Data
• Registry Accuracy and Utilization Critical
• Data Based Decision Making Compelling
• Change Engine Tools (PDSA) Just In Time

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Barriers

• Finances Diverse and Perverse
• Individual and Corporate Inertia
• Failure to Communicate
• The Blame Game
• Focus on Symptoms instead of Disease
• Focus on Self (WIIFM) instead of Patient
• Failure to Focus on Population

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Overcoming Barriers

• It Helps to have a Committed CEO
• Communicate, Communicate, Communicate
  Administrative and Clinical Use Data Elevator
  Speeches
• Maximize Clinical and Administrative Champions
• Find Financial Incentives
• Increased Productivity (Planned Visits)
• Increased Productivity (Lost Patients)
• Increased Productivity (Ancillaries)
• Make the Tedious Parts Invisible
• You Are Not Alone Use the WSC

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References

• Adams, Scott The Dilbert Principle Dogberts
  Top Secret Management Handbook
• Baldrige National Quality Program 2006 Health
  Care Criteria for Performance Excellence
• Berwick DM, et al Curing Health Care New
  Strategies for Quality Improvement Anything by
  Berwick!
• Collins, Jim Good to Great Built to Last
• Covey, Stephen R. The 7 Habits of Highly
  Effective People Principle Centered Leadership
  First Things First The 8th Habit

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References

• Deming, W. Edwards The New Economics Out of the
  Crisis. Anything by Deming difficult reading!
• Eddy, DM The Challenge. JAMA 1990
  263287-290. Anything by Eddy Most published
  in JAMA.
• George, Stephen The Baldrige Quality System
• Insitute of Medicine Crossing the Quality Chasm
• Roberts, Wess Leadership Secrets of Attila the
  Hun.
• Senge, Peter M. The Fifth Discipline The Fifth
  Discipline Fieldbook
• Walton, Mary The Deming Management Method
  Deming Management at Work