"A different and hopeful way of thinking about" healthcare


    Below is a guest post from fellow author and Lean Healthcare practitioner, Naida Grunden.

    Her book, The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota Based Methods, is an outstanding collection of principles and case examples from the Pittsburgh Regional Health Initiative.


    It was, as columnist David Broder reported, “a gathering of lions, a meeting any health care lobbyist would have paid big money to crash.” The date was May 31, 2001, and the place was Pittsburgh.

    At the invitation of PRHI co-founder, Paul O'Neill, then Secretary of the Treasury under President Bush, and JHF President Karen Feinstein, the “lions” assembled. They included Secretary of Health and Human Services, Tommy Thompson; White House aide Mark McClellan; Senator William Frist of Tennessee; and Senator Edward M. Kennedy of Massachusetts. The group attended meetings at Mercy Hospital, UPMC Presbyterian, and the VA Pittsburgh.

    The gathering was intended to interject some new thinking into the health care debate. Rather than focusing on payments and benefits—the quantity of health care—the day's discussion centered around how to deliver health care more efficiently and transparently—the quality of health care. The then-radical notion that an industrial model such as the Toyota Production System could transform the way health care is provided in this country, and dramatically reduce costs, found an eager audience with the policy makers.

    While the current healthcare debate has slid back onto the timeworn notions of cost and quantity, and the false choice between them, it is instructive to review the remarkable agenda from that day in 2001. The topics included an urgent call to eliminate hospital-acquired infections, and institute electronic medical records and non-punitive reporting to spur improvement across whole communities.

    From that day to this, PRHI's vision and core beliefs have never wavered: Quality, safety and efficiency, led by a focus on the patient, will lead to a transformation in American health care.
    All of us who attended that day remember in particular Senator Kennedy's humility, graciousness and genuine interest in health care reform and quality improvement. Although he asked penetrating and sometimes challenging questions, it was clear that Senator Kennedy came to Pittsburgh in the humble role of learner.

    Encouraged by the events of that day, PRHI and the region redoubled its efforts with nationally significant results. Using Toyota methods, the VA Pittsburgh Healthcare System sustained a dramatic reduction in antibiotic-resistant infections, and the techniques learned here have become standard in VA hospitals across the country. Led by the work at Allegheny General Hospital, central line associated bloodstream infections have moved from inevitability to rarity. The region now hosts a national effort to accelerate the use of electronic medical records.

    Quality and safety as the center of health care?

    “It is a different and hopeful way of thinking about one of the major challenges this nation faces,” said David Broder in 2001.

    It still is.

    – Naida Grunden

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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