The Toyota of healthcare? Deming would be proud.

What a privilege to spend three days in Utah with Intermountain Healthcare at their Mindshare 2012 Conference. I was invited by the CFO Bert Zimmerli and CIO Marc Probst when we met last week at HIMSS 2012 in Las Vegas. I was very interested, but what truly closed the deal was attending a session with CEO’s of some of the most forward-looking healthcare organizations in the world that included Dr. Charles Sorensen of Intermountain Healthcare. I wrote about it and made my plans to travel to Salt Lake City.

I had a great incentive to go. I’ve been trying to understand why healthcare covers such a remarkable spectrum of those who say we’re destroying a good system to those who are clearly saying that it must achieve better results for less. Who has the right perspective?

Dr. Brent James

This morning’s keynote was Dr. Brent James. His message: Healthcare will be fundamentally changed by evidence-based, validated-by-data, best practice protocols. This isn’t out-of-the blue prediction. Intermountain Healthcare has significantly benefited from Dr. James’ thought leadership on the ground, every day in a sizable healthcare organization. To understand more, there’s a 2009 NY Times Magazine article that lays out the difference between theory and Dr. James’ reality.

Many erect barriers to new approaches but are usually heavily invested in the status quo or very concerned about the threat to their livelihood. They have arguments, but James has evidence-based answers to their challenges:

  • While no treatment protocol perfectly fits any individual patient, shared baseline “bundles” of patient data allow mass development of standardized approaches to care which tolerate individual customization as appropriate
  • There are serious limitations to protocol development (treatment plans), but a Learning System that embeds variance and outcomes tracking allows continuous protocol review and tested, safe improvement to happen
  • Reliance on human memory produces an estimated 55% accuracy in medicine. But smart tools embed protocols in workflows that can be followed regardless of human memory.

Not surprisingly, Dr. James makes it clear that this approach requires coordinated teams with reliable data systems. Some things can’t be seen through paper records and conversations. There are things that only become clear when observed in populations, using evidence instead of hunch, and with good understanding of the variations within treatment that effect the outcome.

Data focus

This is Dr. Deming, famous for his work with Japanese auto manufacturing, in a nutshell. It was no surprise that the two worked together a few decades ago and it had a lasting impact. Dr. James understands that the proven methods for manufacturing absolutely apply to Healthcare. The diagram above is a generic administrative example, not one used by James but an example of using statistical analysis and activity-based costing in healthcare.

Nothing is convincing without hard data. Dr. James’ talk covered the same case outlined in the NY Times article: Treatment of Acute Respiratory Distress Syndrome (ARDS). Using an evidenced-based, process-focused approach caused the success rates for patients to rise from 9.5% to 44% while costs fell by ~25% (from $160K to $120K) and physician time fell by ~50%. Better results, delivered far more often, using fewer resources and at a lower cost.

This plays very well into what CFO Bert Zimmerli said in his remarks at dinner last night, “The key to making healthcare more accessible is to make it more affordable.”  At Intermountain Healthcare, this is more than saving patients, it is about saving the country by improving the industry that puts great strain on our economy; no small task.


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Categories: Continuous Improvement, Data Analytics / Big Data, Disciplines, Healthcare

Author:Chris Taylor

Reimagining the way work is done through big data, analytics, and event processing. There's no end to what we can change and improve. I wear myself out...

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5 Comments on “The Toyota of healthcare? Deming would be proud.”

  1. February 28, 2012 at 1:13 pm #

    Inspiring. Is there anything about methodology and tools that led to this improvement or is it just a determined application of Quality Improvement?

    By the way, what is the standard followed for the Medical Process Map–?Cover Outstanding ….? It is delightful to find that all arrows are labeled and NOT to find any Branches / Merges or Forks and Joins. This choice also indicates that what they do is sensible.

  2. March 11, 2012 at 5:49 pm #

    What I see:
    1. Statistics on U.S. share of GDP devoted to healthcare and increasing is unsustainable, and when compared to other countries we spend a lot more and get worse outcomes. It’s broken.
    2. There are many, many hospitals and many are doing many good things — positive deviants like Intermountain. Many are adopting Lean and manufacturing methods.
    3. Historically, healthcare has been a craft industry, and they resist moves toward operational excellence, though it’s clearly needed. The change is cultural. Data helps. Celebrating positive deviants helps.


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