Time at Huron Medical Center (Chapter 16)
Improving DVT Prophylaxis (Chapter 17)
Medication Error before Initiating CPB (Chapter 18)
Patient Satisfaction with the ED Visit (Chapter 18)
Exercises
A Problem Statement and Project Charter for Your QI project (Chapter 4)
The QI team at Heart Medical Center (Chapter 6)
CTQs for the New Women’s Center (Chapter 8)
Mapping “Ordering Blood from the Blood Bank” (Chapter 10)
Identifying “Waste” in the Pediatric Unit (Chapter 11)
In‐training Examination at Mass General Hospital (Chapter 18)
Case Studies
Improving RTA Time at St. Michaels Hospital (Chapter 14)
Door‐to‐Infusion Time at Huron Medical Center (Chapter 16)
The New Balloon Angioplasty Catheter at UIC (Chapter 17)
Decreasing Unplanned Readmissions after Tonsillectomy (Chapter 20)
About the Companion Website
This book is accompanied by a companion website:
www.wiley.com/go/banchs/quality
The website includes:
Powerpoints of supplementary material of project templates and forms.
Scan this QR code to visit the companion website.
CHAPTER 1 The Problem with Healthcare
SO, WHAT’S THE PROBLEM?
In the last 20 years, science has made a number of transformational changes that have impacted the way we think about healthcare. Targeted cancer therapy, drug‐eluting cardiac stents, 3D printing, and the human genome project are but a few of the advances that have revolutionized medicine. Yet how we deliver care and the healthcare experience have not improved at the same rate. Despite significant efforts, regulatory mandates, and the sacrifice of many in the front line we have not achieved our goals of providing safe, efficient, and cost‐effective care for all. Standards and benchmarks often lag or fail to be followed, best‐practices have been slow to spread, and quality differences have persisted among providers and geographic areas. These accounts, coupled with highly publicized medical malpractice litigation, have eroded patients’ trust in the healthcare system.
The current crisis isn’t new. It has evolved over the last 30 years to the current level of intensity that we now face and can no longer ignore. Reports including the Institute of Medicine’s “To Err Is Human” (Kohn 2000), “Crossing the Quality Chasm” (IOM 2001), and “Transforming Healthcare: A Safety Imperative” (Leape 2009) have highlighted the inability of the healthcare system to reliably provide safe, high quality, cost‐effective patient care. The crisis has deepened by rising expectations of patients who are accustomed to a retail setting, where services are customer‐driven, efficient, and accessible 24/7 through mobile connectivity, and are demanding the same from healthcare. A true “patient‐to‐consumer revolution” (Wyman 2014) is demanding increased access, service, personalization, and speed from a healthcare system that is slow, inconvenient, confusing and difficult to navigate. Competition among healthcare organizations is no longer based solely on reputation, but on service, value, and price.
In this environment, healthcare organizations face a significant pressure to provide high‐quality, state‐of‐the‐art patient care while lowering costs and improving patients’ care experiences. These demands exist in the context of heightened accreditation requirements, uncertain governmental mandates, decreasing reimbursement, and overwhelmed clinicians and administrators. The negative results are experienced by both patients and healthcare professionals.
HOW DID WE GET HERE?
Many factors have contributed to the current state of affairs and the inability of healthcare to reliably deliver safe, high‐quality, cost‐effective patient care. Worth mentioning is an out‐of‐date business model, healthcare’s organizations’ inefficient organizational structure, the traditional quality paradigm, and an ineffective physician compensation model.
The business model. Healthcare organizations have been anchored in a business model that may have been successful in the past but has outlasted the circumstances that created the need for it. Despite the needs of the current marketplace, healthcare organizations have continued to focus on providing a full spectrum of healthcare services, that is, all services to all patients. Clayton Christensen in his book The Innovator’s Prescription (Christensen 2009) describes two types of business models that any organization can follow: a solution shop, where a healthcare organization focuses on diagnostic activities, and a value‐adding process where the focus is on the efficient delivery of care and specific treatments. Christensen argues that these two models are different, and they require different resources, processes, organizational structures, and profit models. With the current technological and scientific progress, healthcare challenges, and diversity of needs, trying to provide all services to all patients is the wrong value proposition. The combination of these two models under one roof creates a system that requires an enormous amount of resources, and results in inefficiencies, waste, and duplication of efforts. It creates a system that functions, as Michael Porter describes, as a “confederation of stand‐alone units that replicate services” (Porter 2016). For every dollar spent, a reported 30 cents are wasted in steps that do not add value, the result of excessive bureaucracy, defensive medicine, and duplication of services.
Organizational structure. Healthcare organizations have customarily been organized according to clinical specialties. While this originally arose from the need to maintain the competency of clinicians to deliver high‐quality
