Eric
Just is vice president of technology at Salt Lake City-based Health
Catalyst, a data warehousing and analytics company.
Great
variation exists in our healthcare system
January
29, 2015
To
consider how to improve population health outcomes, let’s
start in an unlikely place—an airplane. If you’ve ever flown on
an airliner, chances are good that you’ve browsed through the
inflight magazine. If so, you’ve likely seen one of the ads for New
York Magazine's
"Best Doctors in New York."
These
ads—a staple of inflight magazines—speak volumes. They implicitly
acknowledge that great variation exists in our healthcare system.
When a loved one goes in for cancer treatment or surgery, we ask
questions like, “Who’s your doctor? Where did she train and with
whom?” We ask these questions because we want to know that our
loved one is getting the best treatment possible in a healthcare
market full of variation. We want to know that the individual
physician caring for our loved one has the best credentials possible.
In
that same vein, when we go to the doctor’s office, we don’t see
ads that look like this.
Why
don’t we see advertisements touting individual pilots as the “best”
of this or that? After all, you trusted the pilot when you climbed
aboard that airplane and read the inflight magazine. However, I doubt
you asked, “Who is my pilot? Where did she get her training? How
many flight hours has she logged?”
The
reason for the existence of ads for individual doctors and the lack
of ads for individual pilots is simple—the airline industry
operates a system of standardized production. This means that the
airlines have built a system standardized by protocols, flight
checklists, and routine maintenance schedules in order to create a
consistently safe experience for the public. These protocols ensure
that all pilots operate according to the same best practices. There
is not a lot of room for individual variation among pilots.
This
system of production represents one end of a spectrum of consistency
and standardization. The other end of the spectrum is a craftsmanship
mentality, in which a handful of masters train apprentices. The
masters share their experiences with their apprentices, and the
apprentices that train under the best masters eventually become the
best masters.
Today’s
healthcare industry is operating much closer to a system of
craftsmanship than a system of production. Unfortunately, this system
propagates variation and inconsistent processes in healthcare. The
industry is making a lot of progress toward standardization of
best practices, but we’re not there yet. We have to ask those
questions about whom a doctor trained with or where she
trained—because it matters!
Improving
Population Health Outcomes Systematically
It
is largely because of our system of craftsmanship that population
health outcomes are not consistent across the nation. One of our
favorite quotes here at Health Catalyst comes from Dr.
Paul Batalden:
“Every system is perfectly designed to get the results it gets.”
Currently,
most healthcare systems are perfectly designed to deliver variable
results. To have consistent, high-quality outcomes, we need to
transform the industry into a system of production.
Sounds
too good to be true? It’s not. Consistent, high-quality outcomes is
a fully attainable goal if the following three critical areas—the
content system, deployment system and analytics
system—are implemented and working together by healthcare systems.
The
Content System
Healthcare
organizations that want to standardize care to best practices must
implement a content system. Putting a content system in place means
determining what the standard of care should be. It means defining
your care processes (for example, cardiac rehab, or sepsis) and
determining what best practices should be followed for that care
process. It means applying knowledge assets, like best-practice order
sets, to important decision points along the care process.
In
the example of sepsis, a very important factor is early
identification of the condition. So we might start by defining those
things that we need to measure consistently to identify sepsis
quickly—things like temperature, heart rate, respiratory rate, and
so forth. As we move forward, we’ll want to tackle sepsis treatment
itself and determine the best-practice protocol for the condition,
such as the appropriate antibiotics to use. Another category we would
consider for sepsis is stratifying groups of sepsis patients. How
would we define or categorize patients who exhibit the beginning
stages of sepsis? How would we define a patient with severe sepsis?
What is the appropriate protocol for each of these groups?
The
Deployment System
Healthcare
organizations must also establish a deployment system to work
hand-in-hand with the content system. The content system establishes
what the standard of care should be; the deployment system
complements that by setting up the organizational structures that
will successfully push the standard of care across the organization
to reduce variation. It ensures that the standard process is used
consistently across the enterprise.
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