Medical Innovation in the Changing Healthcare Marketplace Conference Summary (2002) / Chapter Skim
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Appendix D: Keynote Speech: Bridging the Quality Chasm, David Lawrence, Kaiser Permanente
Appendix D: Keynote Speech: Bridging the Quality Chasm, David Lawrence, Kaiser Permanente
Pages 65-80
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From page 65... ...
We continue to struggle with what happens when we try to deliver highly sophisticated and increasingly complex science and technology through a system that is not up to the task. THE IOM QUALITY OF HEALTH CARE INITIATIVE Thinking about the subject of the IOM reports really began in about 1995 here at the IOM when we had a roundtable on quality of care, cochaired by Bob Galvin from Motorola and Mark Chassin, the then Commissioner of Health in New York, and now at Mount Sinai Hospital, New York.
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From page 66... ...
In so doing, I will touch briefly on some of the policy levers, because there are significant policy barriers or opportunities among the various tools that we have available for intervening. Wide variations in quality practice were documented back as far as 1975 in the small area variation analysis by John Wennberg, MD, and in a variety of studies across the country over the last 30 years.
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From page 67... ...
and others have had in more tightly managed and highly organized manufacturing systems. When one seeks to understand what the costs of poor quality are, it is not unusual to find substantial opportunities for improvements in the cost performance of the system, by applying the tools of quality improvement.
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From page 68... ...
Increasing numbers of people involved, increasing categories of people involved, increasing expectations about what has to be done to treat people well, and increasing science and technology to manage in the process. Largely as a result of science and technology advances the medical care system is far more complex in terms of the number of institutions and
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From page 69... ...
It is not patient-centerecl. LACK OF ATTENTION TO PRODUCTION DESIGN What would happen in sectors where the complexity of the system haci significantly increased You would create a highly sophisticated procluction design or manufacturing design process to handle the complexity.
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From page 70... ...
The licensing system is designed to protect the interests of particular professional groups within medicine, not to enhance the creation of integrated delivery capabilities. Another example is the staffing requirements built into law.
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From page 71... ...
The Crossing the Quality Chasm report called for experimentation in a variety of reimbursement approaches to find those that would stimulate the creation of integrated delivery capabilities. It may be prepayment or capitation.
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From page 72... ...
We are talking about monitoring, diagnosis, and treatment technologies that enable the patient to self-manage or at least communicate on a regular ongoing basis with the health care system. It does not make sense to continue to invest heavily in the bricks and mortar of the classic delivery systems when there are other vehicles for taking care of patients in a far more responsive, patient-centric way.
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From page 73... ...
Creating Larger Health Care Delivery Units The third area of innovation involves organizational design or scaling. It has proven extremely difficult to figure out how to create sufficient scale on the delivery system side so that you can get the capital needed and the systems and the training capabilities and the other things that larger organizations can provide, applied to the delivery of care.
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From page 74... ...
It is aggravated by the shifting demographics of the country and the shifting disease burden of the country to an increasingly chronic disease burden. The complexity that both bring to the task of taking care of patients has not been matched by an equivalent sophistication on the delivery system side.
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From page 75... ...
David Lawrence: What I observe as I talk to physicians outside of Kaiser Permanente is that the impetus for innovation is largely coming from an interesting group of physicians, the cohort of physicians in their midthirties to mid-forties who have always driven innovation in medical care delivery. There is some very exciting innovation going on around the country that gives some hope that the transformation may occur from these isolated, fragmented groups of less than ten and may turn into something that looks like a virtual production capability.
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From page 76... ...
I would also like to see the federal government take the lead in dealing with the regulatory morass that we are facing in health care. I would also like to see the federal government experiment with different reimbursement approaches to see whether or not we can create integrated approaches for delivering care at the micro level.
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From page 77... ...
The key question is, how do you link these devices back into the delivery system, so that the patient's information is available and used? Agilent and other organizations have spent some time investigating what share of laboratory information on patients that actually gets into the patient's medical record of the health care institution.
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From page 78... ...
David Lawrence: Let me take your points in reverse order. Ed Wagner and Don Berwick are doing some very interesting work, trying to bring together the experiences of integrated delivery for specific diseases, primarily chronic illnesses, documenting the impact that the integrated delivery capability has on the outcomes and also the cost.
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From page 79... ...
David Lawrence: A wonderful question. One of the issues that we have been wrestling with is the analogies that can we draw from other industries, where fractured, fragmented, entrepreneurial activity somehow coalesced into a set of standards and approaches that then was reflected in a rational national policy.
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From page 80... ...
Stephen Merrill, NRC: When one thinks of federal investments in IT infrastructure, one thinks of one fantastically successful recent jumpstart, namely the Internet and several highly troubled internal systems like those of the Social Security Administration, Internal Revenue Service, and the Federal Aviation Administration. Do you have any mode!
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