Examples of Quality Through Strategy

There are three great examples of hospitals and clinics that have differentiated themselves on the quality of their services.

The Johns Hopkins Hospital
The Cleveland Clinic
The Mayo Clinic

If you read the mission statements of each of these hospitals, the common theme of all of them is patient care comes first. By focusing on the quality of the patient experience, these hospitals will never have to worry about having patients in their hospital. Patients will seek them out and the bottom line of the institution will be better for it.

Strategy to Quality

The next installment of this series will address the strategic aspects of achieving quality. Strategy can be defined as the path an organization takes from how they are today to how they would like to be in the future. Some call that future the vision of the organization. In this case the vision of the future has to be to run a hospital that cures everyone of their sickness and never makes a mistake. Sounds easy enough...

As an organization we can conceptually see where we want to be. We want to be free of errors that can be prevented. But before we can attempt to devise a strategy to get there we must do two things. We must do an analysis of the external environment that may be contributing to quality problems, but we must also to an internal environment analysis to see where we currently are.

You may have heard the phrase, "what you can measure, you can manage." Focusing internally on the organization would be the first step I would take. Start to find ways to improve the detection and reporting errors. Begin to establish a culture that sees errors as a way to improve and not a fear of reprimand. When you begin to understand the situation you are in, then we can begin to devise a strategy to remedy it.

Quality and Leadership

As we explore the concept of quality at your hospitals we will further dissect the role of leadership in improving quality.

In order to instill quality at our hospitals there are four ways of thinking that we must change to.

1. Quality is not a mistake, it can be measured and it can be managed - In medicine, many people say that outcomes are too unpredictable and therefore there is no way that one can manage and improve it. This is not a mentality of quality leadership. While there may not be a way of measuring something presently, a quality organization will find a to start measuring something and continually tweak it until it is a good measurement.

2. We ultimately serve our patients - Hospitals get very confused as to who their customers are as a business. Are the customers the physicians, the patients, or the community? The patients are the reason for a hospital to be. Improve the quality by focusing on the patient experience and the physicians and community will fall in line.

3. Go long - In order to improve quality in your organization, you have to take a long term approach. If quality is thought in a short term, it will not be accepted by your stakeholders. Changes in quality are expensive and inconvient. Thinking long term puts this in perspective.

4. Tap your inner creativity - Health care workers are not especially known for their creativity, but they may be the most creative and abstract thinkers in the world. Use that creativity to try solutions that you may not think will work. Give your employees the ability to try things and fail. Failure and learning from the failure is what give the world some of its greatest innovations.

Life Without Medicare - Patients

Despite all the consequences of losing Medicare on hospitals and physicians, the most dramatic impact would be on the patients. Medicare was put into place because the over 65 population was a group of people that nobody wanted to pay to care for. Lawmakers then believed that the healthy population could pay for the elderly population in a cost shifting principle.

The only way Medicare could go away is for people to save for the medical care much like they do for their retirement. The common belief is that everyone can put their money in a tax-deffered account and then use it when they turn 65. This idea is ok, but the problem then becomes how do you save money for people who have none. Then, what do you do with the people who did not save their entire lives and then cannot afford care.

None of this will work.

The only idea that I would have is to begin to take the human element out of health care and reduce the marginal cost of care. This includes greater use of computers, machinery, and robotics that can outperform humans. While this may sound like science-fiction, the government needs to defer money from some of their Medicare programs and incentive research in these areas.

What's Your Best Quality?

Hospitals and the public often think about quality in hospitals in the context of safety. This is absolutely a very important aspect of quality, but I want to delve deeper into quality. When was the last time your hospital looked at total organizational quality?

Many hospitals have heard of the Malcolm Baldrige award for quality. In fact, last year two health care organizations won this award.

Mercy Health System
Sharp Healthcare

There are six criteria that Baldrige award nominies are judged on including:

1. Leadership`
2. Strategic Planning
3. Customer & Market Focus
4. Measurement & Analysis
5. Workforce Focus
6. Process Management

We will explore each of these criteria in the coming weeks hoping to find something that you can institute at your hospital to improve your organizational quality. Please leave comments about anything that you may do at your hospital to address these criteria.

Finding Direction: The New Mission

As many of you know this is a very "green" blog that I started about six months ago. Up until this time, we have been drifting along without a direction.

That now all changes...At the Prognosis we have the goal of becoming the publication that every health care management professional reads to help them improve their hospital.

We want you to come here when you are looking for ideas to improve your facility. We want you to come here and share new and innovative ideas that you have discovered at your facility that we can share with the community. We want you to come here when you are looking for mental stimulation and keep you energized in your career.

We hope you enjoy this publication and we welcome any and all feedback.

Life Without Medicare - Physicians

Physicians much like hospitals would be greatly effected by any dissolving of the Medicare system. I could be wrong, but I believe that physicians were a major driver of the implementation of Medicare in the first place.

I believe getting rid of Medicare would put physicians at the mercy of for-profit insurance companies and consumers. Each would have a different effect on how physicians practice medicine. For-profit insurers are getting less tolerant of the autonomy of physicians. There would be less creativity in the practice of medicine and more "by the book" medicine.

Consumers would also have an effect on the way physicians practice. Consumers can be very loyal to physicians that they have had for many years, but that exists mainly for primary care physicians. Specialists however would have a more difficult time because they are less likely to have great customer service. Without the guarantee of payments from Medicare, physicians would find themselves in a less competitive position.

The prospect of the loss of Medicare would have a very dramatic effect on the way that physicians practice medicine and changing the way physicians practice medicine would ripple throughout the health care system.