Notes From My Second Day at #IHI 2011

Following up my notes from Day 1, I'm sharing my notes from the second full day I attended on Wednesday, December 8 2010.

Here, in the last day of the IHI National Forum on Quality Improvement in Healthcare, I saw many speakers, including:

• Corey Booker, Mayor of Newark NJ
• Helen Zak, President and COO of the Healthcare Value Leaders Network (an effort I'm involved in)
• Elliott S. Fisher, MD, MPH & Atul Gawande, MD
• T.R. Reid, author of the book The Healing of America

Notes to follow, along with my reflections of some thoughts generated by what I heard.

Corey Booker:

I usually come into speeches by politicians (sitting office holders) at conferences with pretty low expectations. You might hear some bland platitudes, but I was really impressed by Mayor Booker's speech and his captivating story telling ability – stories of leadership and pushing yourself and others to high levels of achievement.

He told a story about visiting a Newark police station (ala “going to the gemba?”) and seeing officers typing reports using typewriters. In 2006. He saw an officer finish typing and then take the ribbon out of the machine to carry with him — an example of “hoarding” as we might see in hospitals because somebody else would come take the ribbon because they needed it. So they had old technology and, on top of that, they didn't have the proper supplies available readily (again, nurses might relate to that).

Mayor Booker spoke about his goal of reducing murders in Newark by 50% (I think that was the number) in his first year. The “experts” told him that wasn't possible, that he could only aim for 5 or 10% improvement. This idea should sound familiar to those working with Lean. Instead of incremental improvement, we're often aiming for dramatic improvements through system and process redesign – Lean's not just about small incremental improvements. Booker said:

“We're being damned by low expectations!!”

Booker claimed that murders were down 40% in Newark that first year he was in office.

ThedaCare, for example, aims to improve core measures by 50% as a result of their week-long Rapid Improvement Events (as described in the book On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry). Aiming high forces you to get creative, even if you don't hit that target. ThedaCare does set a quota where you get in trouble for not hitting that 50% goal – they celebrate the improvement, but they find they get more improvement by aiming high.

Back to Mayor Booker's talk, he also talked about the need to get to root causes of crime, not just dealing with the symptoms. Booker told a version of this African parable about going to finding the root cause of an ongoing problem. He's helped create pro-bono law programs to help people who were released from prison, to help keep them from committing new crimes. Mayor Booker also emphasized the need to have sustained continued efforts – sort of like Lean is not just a one-time improvement event, saying:

“Life is not about the one-time action. It is about the consistent, indefatigable love and connection.”

My question – do your improvement efforts have consistent, indefatigable action over time?

Healthcare Value Leaders Network:

Many of you know that I have worked since June 2009 as part of the team that's been growing the Healthcare Value Leaders Network, a collaboration network of hospitals and healthcare providers from across North America.

Helen Zak, the President and COO of the Network, hosted a session for IHI attendees to learn about our efforts. After her overview presentation, we had two presenters from our Network member organizations: Barb Bouche from Seattle Children's Hospital and Dr. Bruce Roe from St. Boniface General Hospital in Winnipeg (see this earlier blog post about visiting his hospital: “Learning and Sharing Lean Healthcare in Winnipeg“).

Bruce talked about how St. Boniface is trying to accelerate its results by shifting from tools to principles and then to behaviors. St. Boniface has clear improvement trends (showing charts, not just before-and-afters) in staff engagement, patient satisfaction, and length of stay using Lean management.

Barb emphasized how they have shifted from trying to reduce direct labor and now, instead, focus on attacking waste, complexity, and variation. Part of their Lean management behaviors include their reaction to people who didn't follow processes. Instead of just punishing people, as is often done, they look to how the existing system didn't support people in being able to do their work in the most effective way. They've shifted from “optimizing subsystems to focusing on the whole system.”

You'll be able to read more about Seattle Children's in the new book Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value. Look for a future here on this blog… and if you're interested in learning more about joining our Network, click, here.

Drs. Fisher and Gawande:

I've written a lot about Dr. Gawande and his books (including The Checklist Manifesto: How to Get Things Right)  and I really enjoyed hearing him give a talk in Cambridge last January. Dr. Elliott Fisher is a professor at Dartmouth and is well-known for the Dartmouth Atlas program that compares healthcare costs and quality across the country.

Much of Dr. Gawande's talk was based on the stories about the parallels between U.S. agriculture of 100 years ago and healthcare of today, as he wrote about in this article: “Testing, Testing” back in 2009. Read that article and you'll get a gist of his talk – and his ideas about how healthcare will NOT be solved in a top-down way from Washington D.C.

T.R. Reid:

The final keynote speaker was T.R. Reid, the author of the outstanding book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and the PBS series FRONTLINE: Sick Around America – you can watch online here.

Reid's book (and his talk) emphasized that everything outside of the U.S. isn't something you can simplistically called “socialized medicine.” Reid says you can cover everyone with private docs, private hospitals, and private insurers – as many European countries do. Not everyone is the U.K.'s NHS or the Canadian single-payer system. You can have a system that covers everyone with having to be single-payer and that a fee-for-service approach can even work fine (as it does in Holland, Germany, Japan, and other countries).

Reid emphasized that he didn't find a perfect system anywhere in his search around the world.

As it was last year, the IHI event was intellectually stimulating and motivating. I'm glad I was able to meet some blog readers who introduced themselves – lots of great networking at this event. Thanks to IHI for what they do.

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