Better health through better healthcare delivery

Matius, a reader in the US, commented on the importance of improving healthcare delivery, and I couldn't agree more.
Medicine is learning from total-quality concepts pioneered by industry, such as the Toyota method. These practices move beyond meeting minimum quality standards to constantly improve the quality of products, and the systems and processes that produce them.

A central theme is espoused by a former professor of mine at The Dartmouth Institute, Dr. Paul Batalden: Quality improvement in healthcare is the constant improvement of patient health outcomes, system performance, and professional development. This triad ensures better outcomes not only for current patients, but all those that follow. Process-knowledge informs ongoing improvement. Professional development builds joy and purpose with one's work, and endows everyone in the "factory of healthcare" with the sense of responsibility and tools to improve what they do. And I mean everybody: Schedulers making appointments, techs toiling in labs, administrators who never see patients, nurses and doctors who heal and comfort, and the patient. Always at the center of the care-providing team, the patient is not a passive recipient of care, but an active, central team member. This combination of players is the "clinical microsystem." This concept acknowledges that healthcare is not a one-on-one, doctor and patient relationship, but rather a team affair involving many people at many levels, doing many things, all with the same goal of better health outcomes.

Applying constant quality-improvement to clinical microsystemscanleverage large improvements in health outcomes from seemingly simple changes. Communication is an often missing link: Bygathering all the teams working with a patient from pre-hospital admission to post-discharge and discussingwhat is done when and why, redundancies and opportunities for improvement can be identified. Addressing them improves outcomes, streamlines processes, and let's everyone know they matter. In a similar way, surgery can often be improved through the simple act of pretending you are a patient and following all the usual steps from admission to discharge.

Icon Jack Welch said "we measure what matters," and central to improvement is measurement. We all think we're doing great work, but can't really know without measurement. What do we measure, and to what benchmarks do we compare? That depends on what is being improved. But even the pondering of those questions is meaningful: Identifying what matters (what we are ultimately striving to accomplish), and reminding us that benchmarks are not fixed, but ever-rising with each improvement towards "flawless."

The President of Dartmouth College, James Kim, M.D.,has said that the science of healthcare delivery should be a mandatory part of medical-school education. We aren't there yet. But try and apply some basic improvement principles to your life and work. Identify exactly why your work is important, how you would measure the good you produce, how you would improve it, and what "better" would look like. Then do it. Improve. In Batalden's class the first assignment is to make a personal improvement, which canalso be a first step onthe journey towardssustainable joy.