It’s Not About The Box Improving Care at Group Health with People, Process and Technology

January 29, 2010

Visual Displays

Filed under: Quality / Affordability — Matt Handley @ 3:39 pm

Powerful message to relearn again and again, expecially for a semi-geek like myself.  Computers are fabulous for many things – organizing and retrieving information among them.  But they are pretty terrible for making work visible.  I never anticipated that stickies on paper would matter more than the latest spreadsheet technology.  so here are jsut a few examples – the photos are too small to see the details – there is a story behind each board.  and they are the real deal – in use on behalf of patients.


How far we have come

Filed under: Quality / Affordability — Matt Handley @ 3:23 pm

A break from large gorup format at teh Leadership forum – no matter how engaging the speakers are, all of us want to participate more actively, and 850 leaders and managers at GH just finished two hours of walking around looking at the different visual displays that high performing teams have constructed to help improve the work that they do on behalf of our patients.  I remember – not very long ago – all we had at Group health in the way of visual displays we had a few crude  displays here and there, and most places thought that visual displays would have no relevance to local work.   Now it is pretty much the way we do the work.  Work that sits on some simple foundations:

1.  Understanding customer (for us our patients) requirements – what they value, and translating that to a standard for performance

2. Defining standard work to reliably meet that performance

3. Measure defects in our standard work

4.  A standard for checking, using visual systems to make the work visible

5.  Using A3 thinking to develop countermeasures

6.  closing the loop of the PDCA cycle – the work of improvement is never finished.

Our work group’s “take aways” focused on the advantages of visual systems that make visible both demand and capacity, and are used for work leveling.  Challenges that we saw included the way we still largely use organizational standards developed by leaders rather than patient requirements when we set targets for our work – but we saw some great examples of groups taking that step.

Exciting.  In the throes of it things seem to move slowly at times, but on reflection the changes are startling.  The greatest thing is that this is not window dressing – these tools are being used to improve the value of the care we deliver to our patients.

Len Nichols at the GHC Leadership Forum

Filed under: Policy — Matt Handley @ 9:46 am

Len Nichols, a health economist from the New America Foundation is the featured speaker at the Group Health’s leadership forum.  A health economist is a scary person to invite to talk about health policy.  They can do math.  Lets start with the lead – by 2016 the percent of median household income that will be required to purchase health insurance with be between 34% to 45%.  That is all of 5 years from now.  Lets look out longer.  The fraction of GDP that will be devoted to Medicare will move form 3.2 % to 7.3% within 20 years.  Those figures alone make clear that the status quo is not sustainable.

He “gets” Group Health – that we recognize (and organize around) the value of thinking about caring not only for individual patients, but also for populations of patients.

Len made clear that it will not be possible to do cost controls without coverage expansion.  Think of it as a bribe to help us manage the transition to a more affordable system.

To do that we will have to change our obsolete business models:

Move from risk selection to helping all enrollees find value
Move from pay for volume to pay for value

Lots about the challenges of getting the congress to do difficult things.  Len has an ringside seat, and can tell the story n a way that is simultaneously entertaining and sobering.  He can explain the current legislation but recognizes that the cacophony and distortions emanating from Washington has prevented the country from understanding, much less trusting, what is coming out.

Engaging conversation, making clear that inaction is not a viable option.  And a challenge that our current aspirations (from our Quality Dashboard) for performance are too modest – I always love that.  If we can’t do it, who can.

Group Health Leadership Forum

Filed under: Improvement News,Quality / Affordability — Matt Handley @ 8:51 am

Today all of the leaders and managers at Group Health are sittiing down together to help each other take stock of our current situation and accelerate the good work underway.  A day for inspiration, some perspiration and an invitation to stretch and learn new ways of improving our performance.

Group Health has come a long way.  Last year’s meeting started with a telecast of the inauguration.  Hard to follow that act. But in the year that followed and  despite the challenges that Group Health faced – looking at a 25 million dollar budget shortfall and facing a very difficult situation with more than 100,000 people losing employer supported health insurance in Washington state.  Group Health did not cut a job – but doubled down on the strategy of cutting waste and avoiding the cost of poor quality.  And ended the year with a positive margin.  And we grew to care for more patients, despite the difficult market.

Group Health achieved more national attention in this year of reform than we could have imagined.  coverage in the New York Times, Boston Globe, USA today, our local media players, CNN, Bloomberg – even Fox news .  It helped others reconsider what Group Health has accomplished, and what we are capable of.  It helped all of us remember our potenttal to improve the health of our patients.

Today we will work on reinforcing and strengthening the clear connections that are now visible between front line work and the benefit that provides our patients and the organization.  I will likely post a few times throughout the day.

Stay tuned.

January 13, 2010

Checklist Week

Filed under: Uncategorized — Matt Handley @ 5:31 pm

A great week for me, focused on, of all things, checklists.  Atul Gwande, surgeon and essayist for the New Yorker, was at Seattle’s Town Hall Sunday night to promote his new book – “The Checklist Manifesto”.  While the evening had some of the challenges of a book tour promotion (relatively short talk, limited discussion) the content was great.  Maggie Mahar has a great summary of the book on her Health Beat blog – no need to repeat it here.

Then today I was with a team of leaders from our group practice rounding at our Tacoma outpatient surgery center to “go and see” there use of the checklist (and associated processes) implemented to improve safety for our patients there.  This is my fourth trip for safety rounds at Tacoma in about 9 months, and there has been real progress.  The checklist is reliably used, the team participates, and care is safer.  To their great credit they recognize that the benefit from using a checklist is about a lot more than compliance with a list of questions – it is about using a tool to minimize human error, and when teams use it well it helps offer a time for reflection that has many benefits beyond the obvious ones.  Teams operate, not individuals (granted, those with sharp tools need to lead the teams and be accountable for the outcome).  Clarifying the role of team members and working to minimize any impediments to team members participating (calling out breaks in sterile procedure, concerns about a patient, etc) are important benefits from following the protocol reliably.  The teams also had a better way for measuring use of the checklist to minimize the Hawthorne effect.

Now – time to develop a checklist for my bike commuting – I ended up riding home after clinic without one of my key lights the other night – forgot to charge the battery!

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