Even

with ObamaCare Upheld, Much Hard Work Remains to Protect Patients and Make Care Affordable. By Mark Graban, www.MarkGraban.com Even with this weeks Supreme Court ruling that upheld most provisions of the 2010 law, hospitals and health systems around the country will have to continue, if not accelerate, their improvement efforts that started well before the passage of the Patient Protection and Affordable Care Act. These practical changes, driven by proven systems engineering and management principles, often referred to as Lean thinking, will continue making care safer and less expensive, regardless of what happens in our nations capital. For example, Denver Health, the citys public safety net hospital, has used the Lean methodology, based on the famed Toyota Production System, to reduce costs by more than $135 million since 2006. By getting staff members involved in process improvement projects, quality has improved, as Denver Health ranks first in patient survival rates among academic medical centers. Outside of hospitals, Group Health Cooperative, a Washington-based health insurer and care provider, will continue its patient centered medical home (PCMH) efforts that are reducing costs while improving the quality of care. Better coordination and communication, along with increased preventive care, has led to a 29% reduction in emergency room visits and 6% fewer hospitalizations for these patients. Group Health reports that the quality of care is higher, patients have better experiences, and fewer clinicians are burned out. With Group Healths efficiency improvements, the average patient visit is actually longer with PCMH, going from 20 to 30 minutes. Using Lean methods to reduce waste in the clinicians day means they can dedicate more time to patient care instead of searching for missing information, equipment, and supplies. ThedaCare, a five-hospital health system in Wisconsin, has radically redesigned many of its emergency care and inpatient processes, for the benefit of patients and payers. For patients with chest pain, the door to balloon time (from arrival at the emergency room to the clearing of a heart blockage) fell from 90 minutes to just 37 minutes, meaning less heart damage and faster, less-expensive recoveries. For patients who are admitted, satisfaction increased from 68% to 90% with ThedaCares new collaborative care hospital methodology, where physicians, nurses, and pharmacists work as a team with a single integrated plan for a patients care. The health system has achieved impressive improvements for cardiac bypass surgery patients reducing post-operative mortality and length of stay, which leads to about 30% lower costs.

ThedaCare has also reduced the average neonatal intensive care unit stay from 30 day to just 16, through better pre-natal care and the more careful scheduling of cesarean births. These improvements clearly benefit mothers and babies and costs for the healthcare system, broadly defined, are reduced greatly. However, due to the current structure of our healthcare payment system, the savings generated by the hard work of ThedaCares employees and leaders are captured by the payers - both private and public. Organizations like Group Health are somewhat unique in that they benefit financially by keeping patients healthy and out of the hospital. They are both the payer and provider of care, so savings in one part of the organization benefits the other. Leading healthcare providers, like ThedaCare, often find their revenue is lower as the result of shorter hospital stays and improved patient care. Even non- profits, like all three organizations cited here, need to have a positive financial return to be able to invest in their futures. Hospitals and health systems are highly motivated by their mission and their patients needs. Future reform efforts need to go beyond ensuring coverage. They must focus on ensuring health systems can be rewarded financially, or at least not be harmed, for doing the right thing including keeping patients healthy and reducing errors and infections.
ABOUT MARK GRABAN Mark Graban is the author of the Shingo Award-winning book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement and the new book Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. He is also the founder of LeanBlog.org and Chief Improvement Officer of KaiNexus, a software startup. With a background in engineering and manufacturing, Graban has worked exclusively in healthcare since 2005 where he applies "lean" and Toyota Production System principles to improve quality of care and patient safety, to improve the customer/patient experience, to help the development of medical professionals and employees, and to help build strong organizations for the long term. For more information, please visit www.MarkGraban.com.