I've been reading a preview copy of the upcoming book (due out in April) by Dr. Bob Wachter, The Digital Doctor. It's fantastic and provides a real-world, even-handed take on healthcare IT, including EMR/EHR systems. What's the promise, what works, what potential is unmet, and what fails miserably? It's a great read.
I'll be interviewing Dr. Wachter soon for my podcast series, on patient safety, Lean, and his book. If you have questions for him, let me know.
There's one section that references one of my MIT professors, Erik Brynjolfsson.
He wrote about what's called the “productivity paradox.” With new information technologies, adopters (and observing economists) would expect to see a “sharp uptick in productivity,” but that often doesn't occur. Productivity appears to be stagnant.
Sometimes, the healthcare IT initiatives and the billions of dollars that have been spent… seem to be repeating a similar pattern. EMR/EHR systems aren't necessarily leading to the huge cost savings that were promised. But, would we consider NOT continuing to move forward, working to make these systems better over time rather than giving up?
Brynjolfsson identified two factors that might explain this:
- The productivity measurement systems aren't “up to the task”
- Productivity comes from not just the technology, but from also changing the way you work
So, it could be that IT systems fail to deliver their promise OR we're just not measuring and describing the benefits properly. A cynic would say, “stop defending that failed system” and an IT enthusiast might say, “don't be so closed minded about how you define success.”
“A shortfall of evidence is not evidence of a shortfall.”
The Kaizen Paradox?
This got me wondering if there's a “Kaizen Paradox” (or maybe more broadly a “Lean Paradox”). If these approaches are adopted, we'd expect to see big advances in safety, quality, waiting times, cost, etc. (and a better workplace).
Sometimes, an organization can't really point to any benefits of Lean, even after a few years. Is that a measurement problem, an execution problem, or a matter of focusing on the wrong things? Doing lots of training and 5S-ing the nurses stations might not provide any benefit… at least in the short term. Some might say, “we're building new capabilities and developing new ways of thinking.” That's not easily measurable either. But, it has to eventually impact the organization and its measures, right?
But, we often do see great results. Most organizations, including in healthcare, are oriented around measuring cost savings and ROI. Even if you have those results (Franciscan St. Francis has saved millions with Kaizen and our KaiNexus customers have documented almost $50m in savings now), cost savings or bottom-line impact is an incomplete view of the benefits of Kaizen.
Improved patient satisfaction might have some direct reimbursement impact (due to HCAHPS scores and incentives), but it might be hard to measure. What's the “cost savings” from preventing errors, reducing E.D. waiting times, and reducing discharge delays? About half of the improvements documented by our KaiNexus customers affect quality and/or safety, but the definitive results are often hard to measure and they're especially to hard to translate into dollars.
How do we strike the balance between “doing the right things” (engaging staff and improving patient care) with the need to measure and demonstrate results?
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